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Digitized  by  the  Internet  Archive 

in  2009  with  funding  from 

NCSU  Libraries 


http://www.archive.org/details/specialpathologyOOhuty 


SPECIAL  PATHOLOGY  AND 
THERAPEUTICS 

OF  THE 

DISEASES  OE  DOMESTIC  ANIMALS 


BY 

DR.   FRANZ  HUTYRA 

Professor  of  Infectious  Diseases, 

AND 

DR.   JOSEF   MAREK 

Professor  of  Special  Pathology  and  Therapy;  both  of  the 
Royal  Veterinary  College  at  Biuiapest 


Authorized  American  Edition 

From  the  Third   Revised  and  Enlarged  Cierinan  Edition 


JOHN  R.   MOHLER,   V.  M.  D. 

Chief  of  Pathological  Division,  U.  S.  Bureau  of  Animal  Industry, 

AND 

ADOLPH  EICHHORN,   D.  V.  S. 

Senior  Bacteriologist,  Pathological  Division,  U.  S.  Bureau  of  Animal 
Industry,  Washington,   D.   C. 

EDITORS. 


VOLUME    I. 


Infectious  Diseases;    Diseases  of  the   Blood  and   of  the  Hematopoietic 

Organs;  Diseases  of  Metabolism,  of  the  Spleen,  Urinary 

and  Circulatory  Organs. 


With  198  illustrations  in  the  text  and  10  plates. 


CHICAGO,    U.   S.  A. 

ALEXANDER   EGER,    Publisher 

1912. 


Copyrighted  at  Washington,  D.  C. 


ALEXANDER  EGER 

1012 


HAMMOND   PRES"? 

W.  B.  CONKEY   COMHANV 

CHICAGO 


TRANSLATORS   OF   THE  FIRST   VOLUME 


JOHN   R.   MOHLER,    V.  i\l.  D. 

(-'hief  of  the  Pathological  Division.  U.  S,  Bureau  of  Animal  Industry 
Washingfon,  D.   C. 

ADOLPH   EICHHORN,   D.  V.  S. 

Senior  Bacteriologist,  Pathological  Division,  U.  S.  Bureau  of  Animal  Industry 

AVashington,  D.  C. 

DR.   PAUL   FISCHER 

State  Veterinarian,  Columbus,  Ohio 

DR.   H.   J.   ACHARD 

of  the  Editorial  Staff,  American  Journal  of  Clinical   Medicine 
Chicago,  Illinois 


Authors'   Preface  to  the  Third 
German  Edition 


Hardly  two  years  have  passed  since  the  publication  of  the 
second  edition  of  this  work,  which  was  accorded  a  very  favor- 
able reception  by  veterinarians.  While  the  arrangement  of  the 
earlier  editions  as  well  as  the  former  division  of  labor  (Infec- 
tious diseases  written  by  Hutyra,  Organic  diseases  by  Marek, 
each  working-  independently)  is  maintained  it  again  became 
necessary  in  this  latest  edition  to  add  a  few  new  chapters,  to 
supplement  the  text  and  even  to  rewrite  it  in  some  portions, 
in  order  to  do  proper  justice  to  the  results  of  the  most  recent 
investigations  in  the  field  of  internal  veterinary  medicine  and 
of  comparative  pathology.  1 

The  continued  and  active  investigations  in  immunology  pro- 
duce always  new  scientific  facts  and  views  which  are  of  great 
importance  to  the  practitioner.  This  is  particularly  true  of  the 
allergic  reactions,  of  the  sero-diagnostic  methods,  and  of  the 
development  of  methods  for  protective  immunization  as  well  as 
their  practical  valuation  and  application;  all  these  subjects  have 
been  considered  more  especially  in  the  chapters  on  tuberculosis, 
glanders,  infectious  abortion,  and  swine  plague. 

The  section  on  protozoal  diseases  was  carefully  rewritten. 
Aside  from  their  great  economic  importance  for  tropical  coun- 
tries, these  diseases  may  claim  a  general  interest,  owing  to  the 
splendid  results  of  chemotherapy,  because  they  permit  a  very 
promising  outlook  for  the  future  treatment  of  other  diseases 
as  well,  and  lead  our  therapeutic  endeavor  into  new  paths. 

Aside  from  a  few  diseases  of  minor  importance  (Malta 
fever.  Three  Days'  Disease,  etc.)  some  more  important  diseases 
were  included,  viz.,  Leukemia  of  chickens,  Dochmiasis  and  Oeso- 
phagostomiasis,  Enzootic  Cretinism  in  animals,  Serum  diseases 
and  Necrobacillosis;  the  chapters  on  Hemorrhagic  Septicemia 


Preface. 

of  sheep,  Diplitheria  and  Contagious  Epitlielioma  of  fowls, 
Scurvy,  Coccidial  Dysentery  of  cattle.  Enzootic  Parah^sis  of  the 
spinal  cord  in  horses.  Paralysis  of  the  bladder  and  the  Psy- 
choses have  been  rewritten  entirely.  Finally  essential  changes 
will  be  found  in  the  chapters  on  Specific  Paratuberculous  Enter- 
itis of  cattle,  the  parasitic  diseases  and  the  skin  diseases;  also 
in  the  therapeutic  portions  of  most  chapters. 

Great  care  has  again  been  taken  with  the  illustrations. 
Some  less  good  illustrations  in  the  earlier  editions  were  replaced 
])y  new  ones,  and  the  number  of  illustrations  in  the  text  (some 
of  them  in  colors)  has  been  increased  from  319  to  361,  that 
of  the  plates  (which  are  mostly  in  colors)  from  6  to  15.  We 
wish  to  express  our  acknowledgments  to  Messrs.  Ladislaus 
Tatz  and  Leopold  Kalmar  for  the  colored  designs,  and  to  Messrs. 
Eugen  Raitsits  and  Eugen  Schwanner  for  the  photographs  and 
drawings. 

In  order  not  to  enlarge  the  already  considerable  size  of  the 
work,  the  text  was  condensed  wherever  possible  and  small  type 
was  made  use  of  more  freely.  In  consequence  this  edition  con- 
tains only  five  signatures  more  than  the  second,  in  spite  of  the 
many  additions  and  alterations.  We  have  persisted  in  our 
aim  to  produce  a  work  which  should  reflect  the  present  state 
of  veterinary  medicine  as  faithfully  as  possible  and  should  also 
satisfy  the  requirements,  both  of  veterinary  practitioners  and 
of  investigators  and  human  practitioners  who  desire  information 
on  the  problems  of  comparative  pathology.  The  favorable  re- 
ception accorded  to  the  second  edition  permits  us  to  hope  that 
the  present  one  will  be  received  with  like  favor. 

The  book  has  recently  been  published  in  the  Italian  language 
and  a  Russian  edition  is  being  j^repared. 

While  this  edition  was  in  press,  the  publishers  suffered 
the  loss  of  the  founder  of  the  house,  a  loss  which  we  deeply 
regret.  We  are  indebted  to  the  publishers  for  their  courtesy 
in  meeting  our  wishes  in  the  preparation  of  the  Avork. 

HUTYRA,   MAREK. 


Editors'  Preface 


Hutyra  &  Marek's  Spezielle  Pathologie  und  Therapie  der 
Eausfiere  is  generally  recognized  as  the  most  comprehensive 
and  authoritative  treatise  on  the  theory  and  practice  of  veter- 
inary medicine  in  Germany,  Austria  and  Hungary,  and  has  been 
adopted  as  a  textbook  by  all  the  veterinary  colleges  in  these 
countries,  as  well  as  in  Switzerland. 

The  favorable  reception  of  previous  editions  in  foreign  lan- 
guages has  convinced  us  that  the  work  has  found  favor  with  the 
jprofessions  abroad',  and  the  present  edition,  which  has  been 
prepared  in  response  to  a  frequently  expressed  desire  for  such 
a  translation,  should  prove  equally  valuable  to  the  English- 
speaking  veterinarian.  The  chapter  on  infectious  diseases  will 
also  appeal  to  physicians  and  sanitarians  who  have  to  deal  with 
the  diseases  communicable  from  animals  to  man,  and  it  may 
reasonably  be  anticipated  that  the  work  as  a  whole  will  serve 
as  an  authoritative  guide,  and  also  as  an  admirable  textbook 
and  a  standard  of  reference  for  students  and  practitioners, 
especially  those  who  graduated  before  modern  science  had 
thrown  its  light  upon  the  etiology  of  disease. 

We  wish  to  express  sincere  thanks  to  our  eminent  collabora- 
tors for  their  able  assistance  in  translating  portions  of  this 
work,  and  to  Drs.  Henry  J.  Washburn  and  Jacob  Traum,  of 
AVashington,  D.  C,  for  their  aid  in  proofreading  and  in  the 
preparation  of  the  index.  Acknowledgment  is  also  due  the  pub- 
lisher, Mr.  Alexander  Eger,  for  his  uniform  courtesy  and  assist- 
ance in  many  ways. 
Washington,  D.  C,  Aug.  16,  1912. 

MOHLER  &  EICHHORN. 


Table  of  Contents 

Infectious   Diseases. 

GROUP  I. 
Acute  General  Infectious  Diseases. 

PAGE 

•1 .    Anthrax   •. 1 

Ajithrax  in  Man 31 

2 .  Malignant  Edema   32 

3 .  Blackleg' 39 

Bradsot  of  Sheep 57 

Reindeex*  Pest  60 

4.  Swine  Erysipelas  60 

The  Disease  in  Man 77 

5 .  Hemorrhagic  Septicemia   77 

(a)  Fowl  Cholera   87 

Other  Diseases  of  Fowl  of  a  Septicemic  Character 97 

Septicemic  and  Pyemic  Affections  of  Rabbits 101 

(b)  Hemorrhagic  Septicemia  of  Cattle 103 

Septic  Pleuro-pneumonia  of  Calves Ill 

Enteque   112 

(c)  Buffalo  Disease    113 

(d)  Hemorrhagic  Septicemia  of  Sheep 118 

Infectious  Pneumonia  of  Goats 124 

Takosis  of  Angora  Goats 125 

(e)  Swine  PlagTie  125 

Enzootic  Pneumonia  of  Pigs 138 

Pyobacillosis  of  Hogs 141 

6 .  Septicemic  Affections  of  Newborn  Animals  145 

(a)  White   Scours  of  Sucklings 145 

Various  Colonbacilloses  of  Cattle 157 

(b)  Pyo-septicemia  of   Sucklings 158 

7.  Influenza  of  Horses 170 

Influenza  in   Man 195 

Dengue  Fever 196 

Three-days'  Sickness  196 

Malta  Fever  196 

IX 


X  Contents. 

PAGE 

8 .  Distemper  of  Dogs 197 

Distemper  of  Cats 210 

Typhus  of  Dogs 211 

9 ,  Purpura  Hemorrhagica    216 

Purpura  Hemorrhagica  of  Cattle 232 

Purpura  Hemorrhagica  of  Dogs 233 

Purpura  Hemorrhagica  of  Mau 233 

Scarlatinoid  of  Horses 233 

Scarlatinoid  of  Cattle 234 

10.  Rinderpest 234 

Rindei'pest  of  Sheep  and  Goats 256 

Heartwater    257 

11.  Hog  Cholera 257 

12 .  African  Horse-Sickness   285 

13.  Fowl  Pest 290 


GROUP  II. 
Acute  Exanthematous  Infectious  Diseases. 

1.  Pox.     Variola    295 

(a)  Sheep  Pox 302 

(b)  Cow  Pox  318 

(c)  Horse  Pox   324 

(d)  Swine  Pox    325 

(e)  Goat  Pox    327 

2.  Foot-and-Mouth  Disease 328 

Foot-and-Mouth  Disease   in   Horses,    Carnivorous  Animals   and  in 

Fowls 354 

Foot-and-Mouth  Disease  in  Man 355 

3.  Coital  Exanthema   356 

Infectious  Sexual  Disease  in  Rabbits  and  Hares 360 

4.  Infectious  Pustular  Stomatitis  of  Horses 360 


GROUP  III. 
Acute  Infectious  Diseases  with  Localization  in  Certain  Organs. 

1 .  Strangles   366 

Strangles  of  Cattle 388 

Strangles  of  Swine 388 

Strangles  of  Dogs 388 

2.  Contagious  Pleuro-pneumonia  of  Cattle 389 

Infectious  Pleuro-pneumonia  of  Goats 406 

(^hi'onie  Pneumonia  of  Shee}} 407 

3.  Malignant  Catarrh  of  Cattle 408 

Croup   of   Cattle 417 

Catarrhal  Fever  of  Sheeji 418 

4.  Diphtheria  of  Calves 419 

Diphtheria  of  Other  Mammalia 423 

5.  Avian  Diphtheria  and  Chicken  Pox 424 

Diphtheritic  Intlammation  of  the  F.yes  in  Ducks 436 

Diphtheria    in    Man 4.37 


Contents.  XI 

GROUP  IV. 
Infectious  Diseases  with  Special  Involvement  of  the  Nervous  System. 

PAGE 

I.  Tetanus      ^gg 

-•    Rabies .'.'.'.'..'.  463 

Rabies  in  Man 494 

Infectious   Bulbar   Paralysis 495 

Epizootic  of  Cats  with  Nervous  Mauifestations 497 

GROUP  V. 

Chronic  Infectious  Diseases. 

1 .  Tuberculosis    493 

(a)  Tuberculosis  in   Mammals 493 

Tuberculosis  in  Man fiOfi 

(b)  Tuberculosis  in   Fowls f^OS 

Tuberculosis  of  Parrots 615 

(c)  Etiological  Relation  between  Human  and  Animal  Tuberculosis  616 

Tuberculosis  of  Cold-BIooded  Animals 630 

2 .  Pseudotuberculosis f)3Q 

(a )  Pseudotuberculosis  of  Sheep 633 

Mai  Rouge  of  Sheep 537 

(b)  Pseudotuberculosis  of  Calves 638 

3.  Specific  Paratuberculosis  of  Cattle 639 

4.  Actinomycosis  642 

Actmomycosis  of  Man 660 

Actiiiobacillosis    665 

5.  Streptothricosis    667 

(a)  Farcy  of  Cattle 667 

Other  Streptothricoses  of  Ruminants  and  Horses 669 

(b)  Streptothricosis  of  Doers 670 

6 .  Botrj'omyeosis    672 

7 .  Glanders    678 

Glanders  in  Caraivora 73O 

Glanders  in  Sheep  and  Goats 73O 

Glanders  in  Man 73^ 

8 .  Ulcerative  Lymphangitis  of  Horses   73I 

Pseudofarcy    734 

9 .  Epizootic  Ljnnphangitis  734 

Malignant  Fungus  Disease  of  Horses 739 

10 .   Infectious  Abortion 749 

II .  Infectious  Vaginal  Catanh  of  Cattle 750 


GROUP  VI. 

Infectious  Diseases  Produced  by  Protozoa. 

1 .  Piroplasmoses    760 

(a)  Piroplasmosis  of  Cattle 764 

(b)  East  African  Coast  Fever 773 

Tropical   Piroplasmosis  of   Cattle 782 

Pseudo-Coast    Fevei-    782 

Gall  Sickness    783 


XII  Contents. 

PAGE 

(c)  Piioplasmosis  of  Horses •  •  •  •  7^4 

(d)  Piroplasmosis   of   Sheep ^89 

(e)  Piroplasmosis  of  Dogs 'J^^ 

Piroplasma  in  Man ^9" 

Malaria  of  Man ''^' 

2.   Ti-ypanosome  Diseases   '  •  '^; 

(a)  Nagana    «i? 

(b)  Surra ^^t. 

( e )   Dourine    ^}^^ 

(d)   Mal-de-Caderas    -  •  ^p 

.Other  Tiypanosome  Diseases o^J ' 

Other  Trypanosonies  ^3'*^ 

Trypanosorae  Att'ections  in   Man f^3!> 

:i.    Spii-oehaetosis  of  Birds ^-^^ 

S])ir«)('haetes  in  Mammals    -^f-l 

Spirochaetosis  of  Man   °"^"^ 


Diseases  of  the  Blood  and  Blood-Producing  Organs. 

1 .  Anemia    '^y' 

2 .  Infectious  Anemia  of  Horses 851 

3.  Progressive  Pernicious  Anemia 86;5 

Progressive  Pernicious  Anemia  in  Cattle 80S 

Anemia  of  Sheep  and  Goats  in  Punjab 86S 

4 .  Leukemia   8C)i> 

(a)  Leukemia  of   Mammals : 809 

(b)  Leukemia  of  Chickens 877 

5 .  Pseudoleukemia 881 

0 .   Hemoglobmemia  884 

7.  Paralytic  Hemoglobmemia 8S(i 

Pai'alvtic  Hemoglobinemia  of  Cattle flOO 

8.  Hemophilia ^^^ 

9 .  Animal  Parasites  in  the  Blood 902 

(a)  Filaria  Immitis    .  . 902 

Filaria  Sanguinis  equi 90.) 

(b)  Other  Animal  Parasites  in  the  Blood 90(i 


Diseases  of  the  Spleen. 

Diseases  of  the  Spleen 909 

Diseases  of  Metabolism. 

1.  Obesity    !>1''^ 

2 .  Diabetes  Insipidus .' 918 

3.  Diabetes  Mellitus  922 

4.  Diseases  of  Metabolism  Wliicli  Particiilarlv  Atfect  the  Osseous  Svstem  .  930 

(a)  Rachitis   '. 930 

(b)  Barlow's  Disease    949 

5.  Pica    963 

6.  Wool  Eatine 90() 

7.  Gout  968 

8.  Scorbutus     973 


Contents.  X  1 1 1 

Diseases  of  the  Urinary  Organs. 

SECTION  T. 

Diseases  of  the  Kidneys. 

PAGE 

1 .  Albuminuria 977 

2 .  Hematuria    979 

Haematuria   Vesiealis   981 

3.  I'remia   982 

4.  Hyperemia  of  the  Kidneys 984 

Hemorrhagic  Infarct  of  the  Kidneys 986 

5.  Amyloid   Kidney    987 

6 .  Acute  Nephritis   988 

7.  Chronic  Xon -indurative  Nephritis 996 

White  Spotted  Kidney  1000 

S,    Chronic  Indurative  Nephritis 1001 

9 .   Purulent   Nephritis    1007 

0.  Bacterial  Pyelonephritis 1010 

1 .  I'yelitis     .  ." 1019 

2.  Xeplirt)lithiasis    '. 1021 

3 .  Hydronephrosis    1025 

4.  Kenal  Tumors 1028 

0.  Animal  Parasites  in  the  Kidneys 1028 

(a)  Eustrontiylus  Gisras  ..." 1028 

(b)  ,Otlier  Parasites  of  the  Kidneys 1029 

SECTION  II. 
Diseases  of  the  Bladder. 

1 .  Catarrh  of  the  Bladder 1031 

Twisting'  of  the  Bladder 1035 

2 .  Paralysis   of  the   Bladder 1036 

Spasm  of  the  Bladder 1038 

Diseases  of  the   Circulatory  Organs. 

SECTION  I. 

Diseases  of  the  Pericardium. 

1 .  Pericarditis   1039 

Compression  of  the  Heart 1051 

2 .  Hydropericardium   1052 

Hemopericardium     1053 

3 .  Pueumopericardium     1053 

SECTION   IT. 
Diseases  of  the  Heart. 

1 .  Palpitatio  Cordis  1055 

2 .  Bradycardia 1056 

3.  Intennittent  Action  of  the  Heart 1057 

4.  Hypertrophv  of  the  Heart 1061 

5 .  Dilatation  of  the  Heart 1063 

6 .  :\Iyocarditis   1069 


XIV  Coiiteiits. 

PAGE 

(a)  Acute  1069 

(b)  Chronic  1073 

Ossification  of  the  Heart  Muscle 1075 

7.  Fatty  Heart   1075 

8.  Rupture  of  the  Heart 1076 

9.  New- formation  in  the  Heart 1077 

10.  Animal  Parasites  in  the  Heart 1078 

11.  Acute  Endocarditis  1078 

12.  Valvular  Diseases   1085 

(a)  Insufficiency  of  the  Aortic  Valves 1088 

(b)  Stenosis  of  the  Aortic  Opening 1091 

(c)  Insufficiency  of  the  Bicuspid   or  Miti'al  Valve 1092 

(d)  Stenosis  of  the  Left  Auriculo- Ventricular  Opening 1093 

(e)  Insufficiency  of  the  Pulmonary  Valves 1093 

(f )  Stenosis  of  the  Opening  of  the  Pulmonary  Artery 1094 

(g)  Insufficiency  of  the  Tricuspid  Valve 1094 

(h)   Stenosis  of  the  Right  Auriculo-Ventricular  Opening 1095 

( i )   Congenital  Heart  Lesions 1096 

(k)   Combined  Valvular  Lesions 1096 


SECTION  ITT. 
Diseases  of  the  Blood  Vessels. 

1.  Chronic  Inflammation  of  the  Arterial  Wall 1104 

2.  Dilatation  of  the  Aorta 1106 

Aneurysms  of  Other  Blood  A^'essels .' 1109 

General  Diminution  in  the  Tonus    of  the  Small  Artei-ies 1110 

3 .  Obstruction  of  the  Larger  Arteries 1111 

Thrombosis  of  the  Pulmonary  Artery 1115 

4.  Obstruction    of  the  Large  Venous  Trunks 1116 

5 .  Rupture  of  the  Large  Blood  Vessels 1117 


APPENDIX. 
Lymphorrhagia    1119 


Explanation  to  the  Abbreviations  in  the 
References  to  Literature. 


A.  L.  =  Allatoi'vosi  Lapok  (Budapest). 

Amer.  V.  Rev,  =  American  Veterinary  Eeview   (XewYork). 

An.   (Anim.)  Ind.   =  Annual  Report  of  the  Bureau  of  Animal  Industry  (Washington). 

Ann.  ■=  Annales  de  medecine  veterinaire    (Bruxelles). 

A.  P.  =  Annales  de  I'Institut  Pasteur  (Paris). 

Arb.  d.  G;  A.  =  Arbeiten  aus  dem  Kaiserliehen  Gesundheits-Amte   (Berlin). 

A,  d'Alf.  =  Archives  veterinaires  d'Alfort. 

Arch.  f.  exp.  Path. 

u.  Phmk.=  Archiv fiir  experiment.  Pathologie  und  Pharmakologie  (Leipzig). 
A.  f.  Tk.  =  Archiv    fiir    wissenschaftliche    und    praktische    Tierheilkunde 

(Berlin). 
Arch,  f,  Vet.-Wiss.=  Archiv   fiir  Veterinarwissenschaften    (St.   Petersburg). 

A.  vet.  =  Arhiva  veterinara  (Bucarest). 

Beitr.  z.  path.  An.=  Beitrage  zur  pathol.  Anatomie  u.  allgem.  Pathologie  (Jena). 

B.  kl.  W.  =  Berliner  klinische  Wochenschrift. 
B.  t.  W.                     =  Berliner  tierarztliche  Wochenschrift. 

B.  Mt.  =  Badische  tierarztliche  Mitteilungen  (Karlsruhe). 

Bull.  =  Bulletin  de  la  Societe  centr.  de  medecine  veterinaire    (Paris). 

Cbl.   f.  B.    (Bakt.)=  Centralblatt  fiir  Bakteriologie,  Parasitenkunde  und  Infektions- 

krankheiten.     Originale  (Berlin). 
Cbl.   f.  med.  Wiss.  =  Centralblatt  fiir  medizinische  Wissenschaften  (Berlin). 

C.  R.  =  Comptes  rendus  des  seances  de  I'Academie  des  Sciences  (Paris). 
Comp.  Path.  =  The    Journal    of    comparative    Pathology    and    Therapeutics 

(London). 
Diet.  =  Dictionnaire  pratique  de  medecine  et  de  chirurgie  veterinaire 

(Paris). 

D.  A.   f.  kl.  M.        =  Deutsches  Archiv  fiir  klinische  Medizin  (Leipzig). 
D.  m.  W,  =  Deutsche  medizinische  Wochenschrift    (Berlin). 
D.  t.  W.                     =  Deutsche  tierarztliche  Wochenschrift  (Hannover). 

D.  Z.  f.  Tm.  =  Deutsche  Zeitschrift  fiir  Tiermedizin  und  vergleichende  Patho- 

logie (Leipzig). 

Diss.  (Inaug. -Diss.)  =  Inaugural-Dissertation. 

Dresdn.  B.  =  Jahresbericht  der  tierarztliehen  Hochschule  in  Dresden. 

Ergebn.  d.  Path.  =  Ergebnisse  der  allgemeinen  Pathologie  und  pathol.  Anatomie 
(Wiesbaden). 

F.  d.  M.  =  Fortschritte  der  Medizin  (Berlin). 

F.  d.  Vhyg.  =  Fortschritte  der  Veteriniirhygiene  (Berlin). 

Hb.   d.  p.  M.  =  Handbuch    der    pathogenen    Mikroorganismen;     redigiert    von 

KoLLE  &  Wassermann  (Jena). 

H.   (Hann.)  Jhb.     :=  Jahresbericht  der  Kon.     Tierarzneischule  zu  Hannover. 

Holl.  Z.  =  Tijdsehrift  voor  Veeartsenijkunde. 

Hyg.  de  viande       =  L 'hygiene  de  la  viande  et  du  lait  (Paris). 

J.  du  Midi  =  Journal  des  veterinaires  du  Midi. 

J.  of  comp.  Path.=  The  Journal  of  comparative  Pathology  and  Therapeutics 
;'  (London). 

J.  vet.  =  Journal  de  medecine  veterinaire  et  de  zooteehnie  (Lyon). 

Kongr.  =  Internationaler   tierarztlicher    Kongress    (Bern,    Baden-Baden, 

Budapest,  Haag). 

Kozl.  =  Kozlemenyek  az  osszehasonlito  6Iet-§s  kortan  korebol  (Budapest). 

Leipz.  B.  =  Bericht  des  Veterinar-Institutes  zu  Leipzig. 

Maanedsskr.  =  Maanedsskrift  for  Dyrlaeger  (K0benhavn). 

Mag.  :=  Magaziu  fiir  die  gesamte  Tierheilkunde  (Berlin). 

M.  Orv.  Arch.  =  Magyar  Orvosi  Archivum  (Budapest). 

Med.  vet.  =  II  medico  veterinario  (Torino). 

Mitt.   d.  G.-A.  =  Mitteilungen  des  Kaiserliehen  Gesundheitsamtes  (Berlin). 

M.  (Miinch.)  Jhb.  =  Miinchener  Jahresbericht  (Jahresbericht  der  konigl.  Zentral- 
tierarzneischule  in  Miinchen). 


XVI     Ex])laiiiiii(Mi   to  tli«  Abbreviations  in  the  Befereuees  to  Literatme. 


M.  m.  W. 

M.  t.  W. 

Mod.  Zooiatio 

Monh. 

Neur.  Cbl. 

N.  Ere. 

Orv.  H. 

O.  M, 

O.  E. 

O.  Vj. 

O.  Z.  f.  Vk. 

Pr.  Mt. 
Pr.  Mil.  Vb. 
Pr.  Vb. 


Pr.  vet. 
Eec. 
Kep. 
Eevista 
Eev.  f.  Tk. 
Rev.  gen. 
Eev.  v6t. 
Schw.  A. 
Schw.  A.  f. 
S.  B. 


Tz.        = 


Soc.  biol. 
The  Vet. 
Tidsskr. 
Tm.  E. 

T.  E. 
T.  Z. 

Trop.  Vet. 
Ung.  Vb. 
Vet. 
V.  A. 

V.  J.   {\.  Journ.) 
Vet.  Jhb. 

Vet.  Eec. 

V.  f.  T.   (Vortr.  f. 
Tzte.), 

W.  f.  Tk. 
Z.  f.  Biol. 
Z.  f.  Flhvg. 
Z.  f.  Hyg. 
Z.  f.  Imni. 
Z.  ±.  Infkr. 

Z.  f.  kl.   Med. 
Z.  f.  "Vet.-Wiss. 

Z.  f.  Tm. 


Z.  f.  Vk. 
Z.  f.  Phys. 
Zool.  med. 


Miiuchener  medizinisehe  Wochenschrift. 

Miinchener  tierarztliche  Wochenschrift. 

II  moderno  Zooiatro  (Torino) 

Monatshefte  fiir  praktische  Tierheilkunde  (Stuttgart). 

Neurologisches  Centralblatt  (Leipzig), 

II  nuovo  Ercolani  (Pisa). 

Orvoei  Hetilap  (Budapest). 

Osterreichisehe  Monatsschrift  fiir  Tierheilkunde   (Wien). 

Eevue  fiir  Tierheilkunde  und  Tierzucht   (Wien). 

Osterreichisehe  Vierteljahrssehrift  fiir  Veterinarkunde  (Wien). 

Osterreichisehe  Zeitschrift  fiir  wissenschaftliehe  Veterinarkunde 

(Wien). 
Mitteilungen    aus    der    tieriirztlichen    Praxis    im    preussischen 

Staate  (Berlin). 
Statistischer  \  eterinarsanitatsberieht  iiber  die  preussische  Armee 

(Berlin). 
Veroffentlichungen    aus    den   Jahresveterinarberichten   der   be- 

amteten  Tierarzte  Preussens  (Berlin). 
Le  progr^s  veterinaire  (Alfort). 
Eecueil  de  medecine  veterinaire  (Alfort). 
Eepertorium  der  Tierheilkunde  (Stuttgart). 
Eevista  di  medecina  veterinaria  (Bucarest). 
Eevue  fiir  Tierheilkunde  und  Tierzucht   (Wien). 
Eevue  generale  de  medecine  veterinaire  (Toulouse). 
Eevue  veterinaire  (Toulouse). 
Schweizer  Archiv  fiir  Tierheilkunde  (Ziirich). 
Schweizer  Archiv  fiir  Tierheilkunde  und  Tierzucht  (Bern). 
Sachsischer    Bericht     (Bericht    ilber    das    Veteriniirwesen    im 

Konigreich  Sachsen ) . 
Comptes  rendus  de  la  Societe  de  biologie  (Paris). 
The  Veterinarian  (London). 
Tidsskrift  for  Veterenaerer   (K^benhavn). 
Tiermedizinische  Eundschau,  mit  besonderer  Beriicksiehtigung 

der  vergleiehenden  Pathologic  (Halle). 
Tierarztliche  Eundschau  (Friedenau-Berlin). 
Tierarztliches  Zentralblatt  (Wien). 

The  Journal  of  Tropical  Veterinary  Science   (Calcutta). 
Jahresbericht  iiber  das  Veterinarwesen  in  Ungarn  (Budapest). 
Veterinarius  (Budapest). 
ViRCHOw's  Archiv  fiir   pathol.   Anatomie   n.   Physiologie   und 

fiir  klin.  Medizin  (Berlin). 
The  Veterinary  Journal   (London). 
Jahresbericht  iiber  die  Leistungen  auf  dem  Gebiete  der  Veteri- 

narmedizin  (Berlin). 
The  Veterinary  Eecord   (London). 

Vortrage  fiir  Tierarzte    (Leipzig). 

Wochenschrift  fur  Tierheilkunde  und  Viehzucht   (Miinchen). 

Zeitschrift  fiir  Biologie  (Miinchen). 

Zeitschrift  fiir  fleisch-  und  Milchhygiene  (Berlin). 

Zeitschrift  fiir  Hygiene  und  Infektionskrankheiten  (Leipzig). 

Zeitschrift  f.  Immunitatsforschung  und  exper.  Therapie  (Jena). 

Zeitschrift  fiir  Infektionskrankheiten,  parasitare  Krankheiten 
und  Hygiene  der  Haustiere   (Berlin). 

Zeitschrift  fiir  klinisehe  Medizin   (Berlin). 

Zeitschrift  fiir  praktische  Veterinar-Wissenschaften  von  PiJTZ 
(Bern). 

Zeitschrift  fiir  Tiennedizin.  Neue  Polge  der  Deutschen  Zeit- 
schrift fiir  Tiermedizin  und  der  Osterreichischen  Zeitschrift 
fiir  wissenschaftliehe  Veterinarkunde  (Jena). 

Zeitschrift  fiir  Veterinarkunde   (Berlin). 

Zentralblatt  fiir  Physiologie  (Leipzig  u.  Wien). 

Traits  de  zoologie  medicale  et  agricole  (Paris). 


Infectious  Diseases 


I.  Group 

ACUTE  GENERAL  INFECTIOUS  DISEASES 

1.  Anthrax.    Febris  carbunculosa 

(Splenic  Fever;  Milzhrandfieher,  Milzfieher,  Karhunkelkrank- 

lieit  [German];  Fievre  charbonnense,  Charhon  hacteridien 

[French];  Antrace,  Fehhre  carhonchiosa    [It(dian].) 

Anthrax  is  an  acute,  febrile,  infectious  disease  of  domestic 
animals,  particularly  of  ruminants  and  horses,  caused  by  the 
bacillus  anthracis,  and  characterized  anatomically  by  an  acute 
swelling  of  the  spleen  and  by  serous  hemorrhagic  infiltrations  of 
the  subcutaneous  and  subserous  connective  tissue. 

History.  The  disease  was  known  by  its  present  name  in  the  oldest 
times  (civ^Qa^ -=cor\,  on  account  of  the  black  color  of  the  blood),  but  it 
was  confused  with  other  diseases  disclosing  similar  symptoms  until  the 
middle  of  the  last  century.  Its  contagiousness  was  first  established  by 
Eilert  in  1836  by  successful  inoculations  as  well  as  by  the  feeding  of 
anthrax  blood,  and  by  Gerlach  in  a  similar  manner  a  few  years  later 
(1845).  In  the  year  1850  Davaine,  and  Rayer,  in  1855  Pollender  and 
soon  after  Brauell  found  in  the  blood  of  animals  which  died  of  anthrax 
peculiar  rod-shaped  bodies,  which  Brauell  also  demonstrated  in  the  blood 
of  living  animals,  attributing  a  diagnostic  value  to  his  findings.  After 
Delafond  (1860)  had  already  recognized  the  vegetable  nature  of  these 
bodies  and  named  them  bacteria,  Davaine  (1865)  established  their  etio- 
logical importance,  as  in  his  experiments  blood  containing  these  bodies 
produced  the  disease  even  in  high  dilutions,  while  inoculations' with  blood 
without  such  rods  gave  negative  results. 

The  fungous  nature  of  anthrax  bacilli  was  definitely  established  In- 
Cohn.  However,  they  were  first  artificially  cultivated  by  R.  Koch  (1876) 
and  by  Pasteur  (1877),  whose  fundamental  investigations  opened  a  new 
path  for  the  theory  of  the  infectious  diseases  in  general  through  the  study 
of  the  biological  characteristics  of  the  anthrax  virus,  as  well  as  the 
etiology  of  the  disease.  At  the  same  time  Pasteur's  classical  experiments 
in  attenuation  and  protective  inoculation  esta])lished  the  foundation  for 
the  modern  theory  of  immunity,  the  development  of  which  has  already 


2  Anthrax. 

produced  highly  important  and  valuable  results,  and  for  which  the  an- 
thrax bacterium  furnishes  very  satisfactory  material. 

Occurrence.  As  a  disease  of  the  soil  prevalent  in  progres- 
sive agricultural  countries,  anthrax  is  usually  confined  to  certain 
localities  (so-called  anthrax  districts)  where  the  moist,  marshy 
or  periodically  inundated  soil  is  suitable  for  the  growth  of  the 
infective  agent.  In  such  localities  the  disease  appears  enzo- 
otically  almost  annually  with  a  variable  virulence,  principally 
among  animals  at  pasture  in  the  summer  time.  On  the  other 
hand,  and  particularly  in  stable-fed  animals,  it  is  observed  more 
rarely  and  mostly  sporadically. 

In  Germany  anthrax  formerly  existed  very  extensively,  and  the  losses  in  Prussia 
alone  amounted  in  the  jears  from  1878  to  1883  to  over  one  and  a  half  million 
marks  ($375,000).  During  the  period  from  1886  to  1905  the  number  of  cases 
occurring  quarterly  rose  from  0.22  to  0.62  for  10,000  cattle,  in  which  the  highest 
nundiers  occurred  mostly  in  the  second  quarter  of  the  vear.  In  the  period  of  10 
years  (1899-1908)  the  average  cases  were  172  horses,  4^489  cattle,  3,194  sheep,  10 
goats  and  100  hogs;  and  in  the  year  1908  the  disease  occurred  on  4,536  farms  of 
3,832  townships,  affecting  125  horses,  4,865  cattle,  369  sheep,  13  goats  and  216  hogs, 
that  is  of  each  10,000  animals,  0.29  horses,  2.36  cattle,  0.48  sheep,  0.04  goats,  0.10 
hogs;  in  all  9.5  per  cent  less  than  in  the  previous  year.  In  the  last  year  the  disease 
showed  the  largest  extension  in  the  government  districts — iSchleswig,  Posen,  Breslau 
and  Liegnitz;  in  86  per  cent  of  the  infected  farms  only  one  animal  each  was  found 
to  be  affected. 

In  France  the  disease  at  one  time  existed  to  such  an  extent  that  Delafond 
estimated  in  1842  the  annual  loss  at  seven  million  francs  ($1,400,000);  in  1908 
the  number  of  infected  stables  fluctuated  between  23  and  47  monthly,  and  the 
largest  extension  occurred  in  the  northern  districts. 

In  Great  Britain  the  annual  average  during  the  period  of  1899-1908  showed 
835  outbreaks,  that  is  43  cases  in  horses,  893  in  cattle,  58  in  sheep  and  223  in 
hogs.     In  the  year  1908,  80  counties  were  infected. 

In  Austria  the  average  annual  loss  from  anthrax  during  the  years  1891-1900 
amounted  to  195  horses,  1,334  cattle,  128  sheep,  40  goats  and  60  hogs;  in  the  last 
years  the  affection  existed  per  10,000  animals  in  1.3  horses,  1.7  cattle,  0.3  sheep, 
0.06  goats,  0.05  hogs.  In  1908  the  number  of  affected  townships  fluctuated  during 
the  summer  months  between  6  and  27,  and  of  farms  between  6  and   123. 

In  Hungary  there  were  affected  during  the  years  1899-1908  an  average  of 
273  horses,  2,542  cattle,  1,008  sheep  and  about  28  hogs,  which  involved  from  821 
townships  in  1899  to  2,491  in  1908;  the  number  of  affected  animals  in  1899  were 
2,962,  and  7,540  in  1908.  In  1908  the  disease  occurred  in  2,491  townships,  that  is 
on  5,090  farms,  with  358  cases  in  horses,  6,411  in  cattle,  729  in  sheep  and  42 
in  hogs.  The  greatest  number  of  cases  occurred  in  the  low,  flat  lands  of  southern 
Hungary  along  the  Tisza  and  Maros  rivers,  as  well  as  along  the  lower  Danulie. 

In  Russia  the  disease  formerly  existed  to  such  an  extent  that  in  some  periods 
(1864-1866)  numerous  persons  fell  victims,  and  in  the  District  of  Novgorod  alone, 
during  the  years  1867  to  1870,  56,000  horses,  cattle  and  sheep  as  well  as  526  human 
beings  succumbed  to  the  infection.  At  the  present  time  the  disease  is  still  exten- 
sively prevalent,  particularly  in  southern  Eussia,  where  the  official  reports  for  1908 
show   8,555   infected   townships   with   34,650   cases. 

In  Switzerland  the  disease  appeared  in  1908  in  160  townships,  affecting  9 
horses  and  192  cattle. 

Anthrax  also  exists  in  the  other  European  countries  in  the  north  but  not  as 
frequently  as  in  the  south.  Thus,  in  1908,  there  were  3,853  cases  in  Italy,  466  in 
Holland,  395  in  Norway,  878  in  Eoumania,  while  in  Denmark  143',  and  in  Sweden 
214  premises  showed  new  outbreaks. 

The  disease  is  prevalent  in  all  parts  of  Asia;  in  Asiatic  Eussia,  the  "Siberian 
pest"  (there  known  as  Jaswa)  which  is  identical  with  anthrax,  causes  great  losses 
annually,  95,316  cases  being  reported  in  1899.  The  disease  has  likewise  been  well 
known  from  the  earliest  times  in  Africa  and  America.  (In  Brazil  it  is  known  as 
"gorrotilho"  of  cattle  and  sheep.)  In  Australia  it  was  not  supposed  to  have 
been  introduced  until  the  year  1847,  but  at  present  it  causes  an  annual  loss  of 
300,000  sheep. 


Etiologj'.  o 

Etiology.  The  bacillus  antliracis  is  1.5  to  4.0-"  long,  and 
1.0  to  l.j^  broad.  It  is  a  nonniotilo  bacterium  which  nuiRiplies 
by  fission  and  spore  formation,  and  forms  in  the  body  fluids, 
and  still  more  on  artificial  media,  long  chains. 

Staining.  The  bacilli  stain  well,  whik^  living,  with  diluted 
aijueous  fuchsiu  or  iiiethyk-ue  bhie  sohition;  on  dried  cover  glass  sHdes 
with  the  usual  solutions  of  aniline  stains,  as  well  as  bv  Gram's  and 
Weigert's  methods.  Bacilli  just  stained  with  fuchsin  disclose  in  their 
bodies  one  or  more  intensely  stained  granules  adherent  to  the  wall 
(Fig.  1).  In  stained  dry  specimens  the  ends  of  the  bacilli  appear 
sharply  cut.  sometimes  even  slightly  thicker  (resembling  the  form  of 
I)  :  in  the  chains  they  are  separated  by  straight  lined  or  double  convex 
light  spaces  (bamboo-rod  forms).  The  light  parts  are  formed  by  the 
mucin  capsule   (Serafini,  Johne)   which  surrounds  the  plasma  of  each 


Fig.  1.    Bacillus  anthracis.    Fresli  sheep 

blood  stained  with  diluted 

fuchsiu  solution. 


Fig.  2.  Bacillus  anthracis.  irifh  capsule 

Spleen  juice  from  a  horse. 

Oram-eosin  staining. 


individual  bacillus  and  holds  them  together  in  chains  (Fig.  2).  The 
capsule  is  well  developed  in  fully  virulent  bacilli  taken  from  the  blood 
of  annuals,  particularly  of  ruminants,  as  well  as  in  those  cultivated  in 
fluid  blood  serum,  while  on  other  media  the  capsule  formation  is  incom- 
plete (see  also  page  11). 

Cultivation.  Anthrax  bacilli  grow  on  alkaline  media  in  the 
presence  of  oxygen  at  body  as  Avell  as  room  temperatures.  The  highest 
limit  which  is  suitable  for  their  growth  is  4:3° C,  while  the  lowest  tem- 
perature is  12-15°  C.  In  gelatin  of  not  too  strong  concentration  a 
white  streak  develops  after  1  to  2  days  along  the  stab  from  which  hori- 
zontal radiations  branch  off  in  all  directions  (test-tube  brush  forms. 
Fig.  3).  After  3  to  4  days  the  gelatin  commences  to  liquefv  under  the 
influence  of  a  peptonizing  ferment  (Fermi)  along  the  streak  from  the 
surface  do\ni wards,  Avhile  the  bacterial  masses  later  form  a  layer  of 
flaky  sediment  on  the  bottom  of  the  stocking-shaped  li(iuefied"  part. 
The  liquefied  gelatin  above  this,  however,  remains  entirelv  clear.  On 
gelatin  or  agar  plates  the  surface  growth  appears  in  the  form  of  white 
points  which  consist  of  braid-like  interwoven  chains.  The  streak  cul- 
ture on  agar  and  on  potato  forms  a  grayish  white,  reticulated,  viscous 


Anthrax. 


growth  of  dull  luster,  with  wavy  borders,  while  in  bouillon  it  forms  a 

flaky,    slimy    sediment    over    which    the    liquid   remains    clear    or    only 

slightly   cloudy.      The   bacilli    may   also   multiply    and   form   spores   in 

greatly   diluted  aibiiminous   solutions  and  in  ordinary 

M'ater. 

In  the  animal  body  anthrax  l)acilli  multiply  ex- 
clusively by  direct  division,  and  in  this  way  short  chains 
of  3,  4  or  8  links  result  in  the  tissue  fluids  (Fig.  2). 
On  artificial  media  very  long  chains  develop  by  similar 
division,  and  the  bacilli,  which  on  these  media  are 
usually  more  slender,  grow  even  to  form  long,  homog- 
enous threads,  which  subse(iuently  become  divided  by 
cross  sections  into  chains  of  bacilli  (Figs.  5  and  6). 

In  the  presence  of  a  sufficient  quantity  of  oxygen 
and  at  a  temperature  of  43° C.  maximum  or  12  C.  mini- 
mum spores  develoi:*  in  the  bacilli  (Figs.  5  and  6).  One 
pole  of  the  bacillus  separates  by  a  cross  section  from  its 
body  and  incloses  one  or  a  half  of  a  chromatin  granule ; 
after  the  disappearance  of  the  granule  the  fertile  pole 
segment  separates  from  the  wall  whereupon  its  central 
part  forms  the  body,  and  the  peripheral  part  forms  the 
covering  of  the  spore  (Preisz).  Under  favorable  condi- 
tions the  oval  spore  swells,  its  covering  becomes  extended 
and  soon  forms  one  of  the  poles.  The  young  germ  then 
makes  its  appearance  and  grows,  developing  into  a 
])acillus,  which  later  again  propagates  either  by  fission 
or  spore  formation.  (Spores  never  develop  in  the  tissue 
fluids  of  the  living  animal,  in  the  unopened  carcass,  or 
inside  of  the  meat  of  slaughtered  animals.) 

According  to  Brotzu  bacilli  produce  spores  in  the  intestinal 
tract  of  the  ciog  which  is  only  slightly  susceptible  to  anthrax. 
According  to  Oppermann  spores  forni  in  the  caecum  of  the  rabbit 
and  according  to  Piana  in  the  intestinal  tract  of  birds. 

At  42-43 °C.,  as  well  as  on  media  containing  substances 
which  retard  their  growth  (for  instance,  0.1%  carl)olic  aeid),  and 
by  limiting  the  air  supply,  anthi'ax  bacilli  may  temporarily,  or 
forever,  lose  the  faculty  of  spore  formation,  (so-called  asporo- 
genic  modification  [Behring,  Eoux.  Pfersdorf]).  On  artificial 
media  various  irregular  forms  develop  occasionally  after  2  to  .3 
days  (club-,  pear-,  an<l  screw-forms),  although  the  culture  may 
retain  its  original  virulence   (Lignieres  &  Durrien). 

Tenacity.  There  is  a  marked  difference  in  the  tenacity  of 
the  bacilli  and  spores.  AVliile  the  bacilli  are  less  resistant,  the 
sjjores  are  only  destroyed  by  substances  which  have  a  very  ener- 
getic action. 

The  bacilli  are  destroyed  by  drying  in  thin  layers  in  the  sunlight  in  from  6V2 
to  1.5  hours,  in  thick  layers  and  in  the  dark  in  from  2  to  3  weeks,  and  by  heating 
to  55-58°G.  in  10-15  minutes.  In  dried  blood,  however,  they  may  remain  virulent 
for  one  month  or  longer,  and  may  then  form  spores  on  addition  of  water  and 
under  proper  temperature  conditions  (Bongert).  They  are  only  destroj-ed  in  dried 
blood  when  heated  to  92°C  for  2^0  hours  (Momont).  On  the  other  hand,  they 
die  in  putrid  blood,  particularly  in  anaerobic  putrefaction  inside  the  unopened 
carcass,  in  warm  weather  in  2  to  3  days.  The  bacilli  manifet-t  a  great  resistance 
against  low  temperatures,  as  for  instance,  at  10°C.  they  are  destroyed  in  24,  and  at 
24°C.  in  15  days  (Klep7of).  In  the  gastric  juice  they  die  in  15-20  minutes;  in 
pure  or  putrid  water  in  1  to  2  days.  Ichor  destroys  them  if  mixed  with  anthrax 
blood  in  2-4  hours  (Schipp).  The  ordinary'  disinfectants  destroy  the  bacilli  even 
in  high  dilutions   (Koch). 

Simple  drying  does  not  destroy  the  spores  at  all,  so  that  in  such  condition, 
for   instance,   when    dried    on   silk    threads,    they   may   remain    gei'iiiinative    for    18i/^ 


it 


Fig.  3.  Six-day 
old  gelatin  cul- 
ture of  the  an- 
thrax   bacillus. 


Tenacit  V.      I'at  lioiieii  icil  v. 


0 


hours  (Siekely).  They  also  reinaiii  vinilont  for  a  \ou<f  time  in  pure  or  putrid 
water,  in  putrid  blood  and  in  the  jjround  (aecordinjf  to  tSirena  &  8fagliosi,  they 
live  in  the  jrround  for  3  years,  in  water  for  17  and  in  ichor  for  LI  months).  Tiiey 
resist  the  ilirect  sunlight  for  KKI  hours  (Moniont).  Dry  heat  (12(»-14()'C.)  destroys 
them  in  .'?  hours,  while  Idowinjr  steam  of  lOO^C.  kills  them  in  ")  minutes  (Koidi). 
They  may  still  germinate  after  5  minutes  boiling  (C!epi)ert).  On  the  other  hand, 
the  action  of  a  falling  temperature  from  7(5.5  to  72°L'.,  inside  of  a  manure  pile  is 
sufficient  to  destroy  the  spores  (Pfeiler). 

Of  the  disinfectants,  corrosive  sublimate  is  the  most  effective,  since  a  solu- 
tion of  1:1000  <lestroys  the  spores  in  20  minutes  (the  addition  of  O.o%  hydro- 
chloric aciil  or  2%  carbolic  acid  increases  the  action  of  the  solution).  The  follow- 
ing are  also  effective:  fresh  chlorine  and  iodine  water  (2%),  formaldehyde  ('/^%), 
permanganate  of  ])Otash  (-■)%),  lysol  (')%),  carbolic  acid  (-■>%),  fresh  chlorate  of 
lime  {^^7c),  chlorine  gas  (5%),  fluorhydrogen  (0.19c),  and  the  vapors  of  formalde- 
hyde, which  will   positively  disinfect   hair  containing   spores  in   4s   hours    (Gruber). 

Pickling  destroys  the  bacilli  in  meat  after  lU  months  (I'euch),  but  it  does 
not  affect  the  spores  (Abel).  The  drying  and  salting  of  hides  does  not  destroy 
the  attached  spores  which  7nay  remain  virulent  for  125  days  on  hides  that  have  been 


^\ 


'^    V^r    v'^»-     1^-.' 


Fig.  4.      (a)  deep,  (b)  superficial  colonies  of  the  anthrax  ba?illus  on 
gelatin  plates.     Enlarged  80.      I  After  Fliigge. ) 


treated  with  fresh  milk  of  lime  (Griglio).  In  sunlight  hides  containing  the  bacilli 
are  sterilized  in  6L^  to  7  hours,  while  those  containing  spores  are  not  sterili/.etl  even 
after  exposure  for  13  hours  (Esmarch).  Quick  lime  solution  and  lime  kill  the  spores 
in  the  tanning  process  in  12-17  days.  Infusion  of  quel>racho  Viark  does  not  afl'ect 
them  in  12  days  (Keszler),  the  lime  pits  (0.5-0.8%  lime  contents)  are  not  effective 
against  the  spores   (Gartner  &  Dammann.     See  also  p.  23). 

Pathogenicity.  Eabbits,  guinea  pigs  and  mice  are  nsnally 
killed  by  siibentaneous  or  intravenous  injections  of  anthrax 
blood  or  cnltnres,  in  1  to  3  days,  while  infection  is  less  certain 
when  the  spores  are  fed.  By  the  first  method  horses  and  sheep 
may  easily  be  infected,  while  in  cattle  a  local  infection  only  re- 
sults sometimes,  even  after  the  injection  of  larger  quantities  of 
virus.  The  infection  of  herliivora  is  also  quite  easily  accom- 
plished l)y  feeding  spores,  even  when  the  mucous  membrane  of 
the  digestive  organs  is  in  a  healthy  condition.     Although  hogs 


6 


Anthrax. 


may  sometimes  be  infected  by  subcutaneous  injections  and  by 
feeding  (Perroncito,  Crooksliank,  Garth),  yet  in  most  instances 
they  resist  artificial  infection  (Ratz,  Tschernogoroff).  Dogs  oc- 
casionally become  ill  from  intravenous  injections  with  pure  cul- 
tures (Bardach,  Martel),  and  exceptionally  from  the  feeding  of 
anthrax  meat.  However,  as  a  rule  they  manifest  considera])le 
resistance  to  artificial  infections.  Young  pigeons  and  small 
birds  in  general  may  be  quite  easil}^  infected  artificially,  while 
in  large  birds  as  well  as  in  chickens  infection  is  difificult. 

The  high  virulence  of  the  blood  of  animals  dead  of  anthrax 
has  been  established  by  experiments,  according  to  which  a  mil- 
lionth part  of  a  drop  of  blood  injected  subcutaneously  kills  a 
guinea  pig  in  23-24  hours  (Davaine).  By  repeated  passage 
of  the  virus  through  the  body  of  susceptible  animals  (mice, 
guinea  pigs)   as  well  as  through  resistant  animals   (chickens, 


Fig.    5.     i<porc    formation    in    anthrax 

bacilli.      Eif(lit-liours     old     agar 

culture  stained  with  diluted 

fuchsin  solution. 


rig.    6.     Anthrax    threads  irith   spores. 

Cover   glass  preparation  from  an 

,  eight-hours  old  agar  culture. 

Fuchsin  staining. 


dogs)  its  virulence  is  increased,  and  in  this  manner  a  virus 
wliicli  is  fatal  in  24-30  hours  may  be  obtained  (Martel).  On 
the  other  hand,  influences  which  check  the  development  (high 
temperature,  disinfectants  as  well  as  the  continuous  action 
of  the  oxygen  of  the  air),  have  attenuating  effects  on  both  the 
bacilli  and  the  spores.    (See  protective  immunization.) 

In  the  presence  of  certain  other  bacteria  the  multiplication  of  the 
anthrax  bacillus  is  hindered  or  entirely  checked.  As  such  antagonists 
the  following  are  known :  Bac.  pyocyaneus,  prodigiosus,  fluorescens, 
phosphorescens,  Gartner's  baciUns,  Friedlander's  pneumococcus, 
streptococci  and  staphylococci,  and  the  anaerobic  putrefactive  bacteria. 
The  antagonism  manifests  itself  in  such  a  way  that  virulent  anthrax 
bacilH  when  mixed  with  such  antagonists  have  little  or  no  pathogenic 
action. 


The  natural  infection  in  lierl)ivorous  animals  occurs  usually 
through  the  ingestion  of  food  and  water  wliicli  contain  anthrax 


Naluial  Infcetiuii.  7 

spores.  When  taken  into  the  digestive  tract  with  the  food  or 
water  some  survive  the  action  of  the  gastric  juice  and  jjass 
through  the  stomach  unimpaired,  germinating  in  the  alkaline 
contents  of  the  intestines  where  they  multiply  by  fission.  The 
bacilli  enter  the  lymph  spaces  of  the  intestines  and  finally  reach 
the  blood  through  the  lymph  stream. 

The  contamination  of  the  food  with  bacilli  and  spores 
usually  takes  ])lace  from  the  infected  soil  on  which  it  was  grown. 
Anthrax  bacilli  which  in  some  way,  especially  by  means  of 
blood  or  intestinal  contents  of  affected  aninuils,  are  deposited 
in  the  superficial  layers  of  the  soil  may  there  remain  alive  for 
some  time,  and  under  favorable  moisture  and  temperatures 
multiply  or  form  spores.  The  spores  are  for  a  long  time  capa- 
ble of  propagation,  resisting  dryness  and  moisture,  cold  and 
heat,  as  well  as  putrefaction,  until  favorable  germinating  con- 
ditions arise,  whereupon  the  bacilli  continue  to  multiply  and 
produce  new  spores.  Under  unfavoral)le  conditions,  such  as 
excessive  dryness  or  cold,  the  bacilli  are  destroyed,  Imt  the 
spores  resist  such  influences.  In  this  manner  tlie  soil  of  a 
certain  locality  which  has  once  becon]e  infected  may  remain  a 
source  of  infection  for  a  very  long  time. 

The  elevation  as  well  as  the  moisture  and  temperature  of 
the  soil  are  naturally  of  great  importance.  The  infective  agent 
thrives  best  in  moist  soil  rich  in  organic  matter,  generally  in 
swampy,  marshy  soil,  or  in  localities  subject  to  periodical  inun- 
dations. In  such  places  anthrax  usually  appears  when  by  a 
rapid  recession  of  the  ground-water  the  superficial  layers  of 
the  soil  become  exposed,  and  then,  in  the  presence  of  proper 
moisture  and  temperature,  germination  of  the  spores  and  mul- 
tiplication of  the  bacilli  results.  Consequently  the  disease  is 
observed  most  frequently  during  the  summer  time,  particularly 
in  warm  days  following  a  period  of  rainy  weather. 

Forage  plants  are  very  apt  to  transmit  the  disease  since 
the  animals  always  ingest  with  their  food  a  certain  quantity  of 
dirt  which  adheres  to  the  dried  and  stored  feed.  Further,  in 
the  infected  localities  the  water  contained  in  pools  as  well  as 
that  from  springs  may  become  contaminated.  As  a  matter  of 
fact  various  outbreaks  in  pastures  may  be  due  to  the  use  of 
certain  springs,  particularly  if  they  are  shallow. 

The  infectious  material  contaminates  the  soil  in  many  ways. 
The  running  surface  water  may  carry  along  the  spores  and 
deposit  them  elsewhere.  Likewise,  the  wind  may  carry  them 
to  previously  uninfected  localities  from  places  where  the  water 
has  receded  and  the  surface  layer  of  the  soil  has  become  dried. 
Most  frequently,  however,  the  soil  becomes  infected  by  carcasses 
or  parts  of  carcasses  as  well  as  by  the  excrements  of  affected 
animals.  "While  the  bacilli  do  not  produce  spores  in  the  carcass, 
yet  they  pass  to  the  outside,  either  through  the  body  orifices 
or   through    decomposition    of   the    carcass,    when    they   form 


8  Anthrax. 

spores;  from  previously  opened  carcasses  spore-containing 
material  may  be  disseminated  at  once.  When  carcasses  are 
not  buried  sufficiently  deep  or  are  left  unburied  tlie  soil  be- 
comes heavily  infected;  even  burying  opened  carcasses  rather 
deeply  does  not  offer  a  sufficient  protection  in  this  respect. 
The  spores  retain  their  germinating  power  for  a  very  long 
time  even  in  the  deeper  layers  of  the  soil,  and  from  here  they 
may  be  conveyed  to  the  superficial  layers  by  the  rising  ground- 
water. They  may  also  be  brought  to  the  surface  by  earth- 
worms and  deposited  in  their  excrement  (Pasteur,  Bollinger). 
According  to  Karlinski  the  contagium  may  also  be  spread 
through  certain  snails  (Arion  subfuscus).  Investigations  of 
local  outbreaks  have  frequently  proved  shallow  burying  of  an 
anthrax  carcass  on  a  pasture  or  meadow  to  be  the  cause;  be- 
sides this,  the  disease  frequently  occurs  in  pastures  in  the  im- 
mediate vicinity  of  a  decomposing  anthrax  carcass. 

Wholesome  food  grown  on  uninfected  soil  is  sometimes 
subsequently  infected  by  the  excrements  or  the  blood  of  af- 
fected animals  wliich  have  been  bled.  The  bacilli  wliich  con- 
taminate tlie  food  may  continue  to  multiply  and  form  spores 
if  the  conditions  of  moisture  and  temperature  are  favorable, 
and  in  this  way  they  may  cause  stable  infections. 

The  intestinal  contents  of  affected  animals  is  particularly  danger- 
ous as  it  may  not  only  contain  bacilli  but  also  spores.  Horse  or  cattle 
manure  or  its  mixture  with  dirt  represents  an  excellent  medium  for 
the  propagation  of  the  virus,  and  particularly  for  sporulation  (accord- 
ing to  Oppermann,  spores  which  are  formed  on  such  soil  are  particu- 
larly resistant). 

In  anthrax  districts  the  intestinal  contents  of  healthy  animals  may 
not  infrequently  also  contain  spores  which  have  been  ingested  along 
with  the  food  or  drinking  water  and  passed  out  through  the  intestinal 
canal  without  molesting  the  host.  It  is  therefore  possible  for  such 
spore-carriers  to  spread  the  contagion  into  uninfected  territories  with- 
out becoming  affected  themselves. 

According  to  Marclioux  &  Salimbeni  the  disease  is  spread  in  Brazil  by  the 
Urubus,  a  species  of  vulture,  as  they  consume  the  anthrax  carcass  and  then  pass 
masses  of  spores  from  the  intestinal  tract  with  their  feces. 

The  food  may  also  occasionally  become  infected  by  the 
hides  of  animals  dead  of  anthrax.  Hides  are  frequently  dried 
in  the  hay-loft  where  the  blood  drops  on  the  hay  or  other  food 
stored  there,  or  with  the  accumulated  dust,  into  the  mangers 
below.  Sheep  stables  are  particularly  liable  to  become  infected 
in  this  manner,  as  it  is  a  frequent  practice  secretly  to  skin 
carcasses  wdiich  died  of  anthrax  and  to  dry  the  pelts  in  the 
stable.  It  has  also  been  demonstrated  that"  hides  which  have 
been  thoroughly  dried  or  even  salted  or  treated  with  milk  of 
lime  (Griglio)  may  contain  virulent  spores.  They  may  also  be 
present  in  bone  meal  made  from  anthrax  carcasses  duo  to 
incomplete  decalcification  and  the  consequent  retention  of  more 


Natural  Infection.  9 

or  less  fat  in  the  prepared  product  (Lelinert).  Lastly,  the  soil, 
as  well  as  the  food  and  drinking  water  may  occasionally  become 
infected  by  drainage  water  and  waste  from  tanneries,  wool- 
works and  horse-hair  mills  (Grebe,  Uhlich;  (Jiirtner  &  Dam- 
mann  fonnd  that  while  keeping  the  skins  in  the  lime  pit  during 
the  process  of  tanning  the  anthrax  spores  are  not  destroyed). 

The  introduction  of  a  large  quantity  of  spores  is  necessary  for  an 
active  infection,  and  accordingly  anthrax  infections  usually  appear 
only  after  the  ingestion  of  a  considerable  quantity  of  infected  food  or 
drinking  water.  The  necessary  (luantity  of  spores  varies  with  the  indi- 
vidual susceptibility  or  resistance  which  may  be  influenced  by  internal 
and  external  conditions.  Animals  which  are  affected  with  the  so-called 
"latent  infection"  (or  the  above  mentioned  "spore  carriers")  not 
infrequently  develop  the  disease  as  a  result  of  external  weakening  influ- 
ences through  colds,  physical  exertion,  starvation,  etc.  Furthermore, 
by  repeated  though  slight  intercurrent  attacks  the  resistance  of  the 
animals  is  reduced,  and  under  such  conditions  the  anthrax  bacilli 
begin  to  nuiltiply,  and  thus  produce  the  specific  affection.  (According 
to  Oppernuuni  healthy  slieep  may  be  infected  b}^  the  feeding  of  200,000 
spores,  while  sheep  which  were  previously  starved  were  infected  by 
feeding  51,000  spores).  A  reduction  in  the  natural  resistance  is  also 
claimed  to  be  caused  by  protective  inoculation,  according  to  Leclainche 
&  Yallee,  and  some  of  the  losses  from  inoculation  may  be  explainable 
in  this  way. 

Carnivorous  animals  usually  become  infected  after  ingest- 
ing meat  or  blood  of  anthrax  animals.  If  the  meat  is  fresh  it 
.contains  only  bacilli  which  are  usually  destroyed  in  the  stomach. 
On  the  other  hand,  if  the  meat  has  stood  for  a  snfificient  length 
of  time  for  the  spores  to  develop  on  its  surface  and  a  large 
amount  is  ingested  at  one  time  the  spores  may  pass  through 
the  stomach  and  germinate  in  the  intestinal  tract.  In  some 
instances,  indeed,  it  may  be  assumed  that  even  fresh  anthrax 
meat  may  cause  infection,  provided  the  animals  have  eaten  at 
one  time  such  a  large  quantity  as  to  cause  a  portion  of  it  to 
leave  the  stomach  undigested.  In  all  cases  there  exists  the 
possibility  of  the  infection  occurring  through  the  mucous  mem- 
brane of  the  month  and  phar^^lx,  particularly  in  the  presence 
of  bone  splinters ;  from  the  clinical  appearance  of  the  affection 
in  hogs  which  is  usually  manifested  as  a  pharyngitis  and  ulcer- 
ative stomatitis,  it  seems  evident  that  the  entrance  of  anthrax 
bacteria  into  the  tissues  occurs  through  the  pharynx. 

The  milk  of  affected  animals  does  not  transmit  the  infec- 
tion as  the  bacilli  do  not  pass  into  the  milk  from  the  blood 
unless  during  the  last  hours  of  life.  Moreover,  the  milk  secre- 
tion ceases  almost  completely  very  early  in  the  disease. 

Anthrax  very  rarely  develops  through  skin  abrasions,  and 
only  in  those  instances  in  which  the  injury  to  the  skin  extends 
through  the  epithelial  layer.  In  this  way  bacilli  as  well  as 
spores  may  enter  the  tissue  fluids,  and  in  such  cases  the  in- 
fection is  transmitted  through  the  blood,  the  excretions  and 


10  Anthrax. 

secretions  of  the  affected  or  dead  animals.  The  disease  may 
also  be  transmitted  through  infected  food,  straw,  stable  utensils, 
surgical  instruments,  har^^^ess,  hands  and  cloths  of  attendants, 
the  stable  floors  and  water.  The  injuries  may  be  of  the  most 
varied  origin  (bites,  phlebotomy,  shearing  of  sheep,  surgical 
wounds,  spinous  plants,  wounds  caused  by  sharp  pointed  ob- 
jects, etc.),  whereas  the  transmission  by  flies  and  insects  is 
considered  doubtful  according  to  recent  investigations  (Nuttal, 
Miihling). 

According  to  Dalri/mple  the  earbiineular  form  of  anthrax  predominates  in 
Louisiana,  the  infection  being  transmitted  to  healthy  animals  by  horse  flies  known 
there  as  charbon  flies. 

Inasmuch  as  an  artificial  infection  through  inhalation  of 
air  containing  spores  is  possible  even  when  the  respiratory 
mucous  membrane  is  uninjured  (Feser,  Buchner,  Enderlen) 
such  infection  may  occur  under  natural  conditions  when 
the  animals  are  fed  very  dirty  infected  feed.  However,  in- 
halation anthrax  has  never  yet  been  positively  established  in 
domestic  animals  (in  man  a  primary  affection  of  the  lungs 
does  actually  occur.     See  page  31). 

Anthrax  is  not  frequently  transmitted  directly  from  animal 
to  animal.  This  kind  of  infection  occurs  only  when  the  blood 
or  infectious  excrement  of  affected  animals  comes  in  direct 
contact  with  injuries  on  the  skin  or  mucous  membrane.  Never- 
theless the  diseased  animal  is  a  source  of  danger  for  its 
neighbors  as  its  excrement  contaminates  the  straw,  food  and 
the  ground  by  contact  with  whicli  other  animals  are  indirectly 
infected  in  the  manner  above  mentioned. 

Susceptibility.  Of  the  domestic  animals  the  herbivorous 
mammals  are  the  most  susceptiljle,  among  which  may  be  first 
mentioned  sheep,  horses  and  cattle,  and  the  goat  to  a  less 
extent.  Considerably  less  susceptible  are  hogs,  dogs,  cats,  and 
carnivorous  mammals  in  general.  Buffalo  appear  to  become 
affected  but  rarely.  Wild  ruminants  may  be  classed  with  the 
domestic  ruminants  as  regards  their  susceptibility  to  anthrax. 
Domestic  fowls  are  very  resistant  to  artificial  infection  with 
the  exception  of  the  somewhat  more  susceptible  pigeon  (the 
occurrence  of  anthrax  in  fowls  through  natural  infection  has 
not  yet  been  established  with  certainty). 

The  susceptibility  is  probably  influenced  to  some  extent 
by  the  breed,  since  certain  breeds  are  more  susceptible  than 
others.  Thus,  according  to  the  experiments  of  Chauveau, 
Algerian  sheep  manifest  a  remarkal)le  resistance  to  artificial 
infection  which  was  only  overcome  l^y  large  doses  of  the  virus. 
Age  has  an  influence,  inasmuch  as  young  animals  are  more 
susceptible  than  older  ones.  Fatigue,  starvation  and  chilling 
increases  the  susceptibility;  it  also  appears  that  well  nourished 
and  carefully  stabled  animals  are  more  easily  affected  than 


Susceptibility.     Patliogenesis.  H 

those  which  are  more  used  to  liarilship.  Shedding  of  teeth 
as  well  as  pre-existiiii;*  catarrh  and  dii;estive  disturbances 
render  the  animal  particularly  susceptible  to  anthrax. 

Susceptible  animals  acquire  a  long  lasting  immunity  against 
later  infections  after  a  recovery  from  the  disease  (see  immuniza- 
tion ) . 

Pathogenesis.  The  spores  taken  into  the  digestive  tract 
germinate  there  and  grow  into  bacilli.  They  then  pass  through 
the  mucous  glands  and  lymph  follicles  into  the  lymph  spaces 
of  the  nnicous  membrane  and  submucosa,  while  s})ores  which 
directly  enter  the  connective  tissue  through  injuries  in  the 
skin  or  nnicous  membrane  germinate  at  the  point  of  entrance. 
In  the  hinpli  spaces  of  the  tissues  the  Ijacilli  multiply  by  lission, 
although  they  are  more  or  less  inhibited  and  even  partly  de- 
stroyed by  the  hostile  anthracocide  substances  which  are  pres- 
ent in  the  tissue  fluids.  The  final  result  of  the  infection  de- 
pends then  on  the  one  hand  upon  the  resisting  power  of  the 
infected  organism,  and  on  the  other  hand,  upon  the  virulence 
of  the  anthrax  bacilli.  This  again  depends  principally  upon 
their  capability  of  forming  capsules.  According  to  the  investi- 
gations of  Preisz,  which  correspond  with  the  results  obtained 
by  Gruber  &  Futaki  and  also  by  Weil,  the  virulence  of  the 
anthrax  bacilli  depends  tirst  of  all  upon  the  character  of  their 
capsules,  that  is,  the  virulence  of  the  different  strains  of  bacilli 
is  more  or  less  dependent  upon  the  density  and  solubility  of 
the  capsules,  inasmuch  as  dense  capsules  protect  the  bacilli 
against  the  destructive  action  of  the  dissolved  hostile  substances 
and  the  engulfing  action  of  the  phagocytes. 

In  immune  animals  even  bacilli  capal)le  of  producing  dense 
capsules  are  quickly  destroyed  by  the  numerous  anthrax  de- 
stropng  substances  which  are  present  in  the  tissue  fluids,  be- 
fore they  have  time  to  form  protecting  capsules.  Consequently 
an  infection  in  such  animals  remains  inelfective.  On  the  other 
hand,  in  susceptible  animals  which  possess  a  smaller  quantity 
of  anthrax  destroying  substances  a  greater  or  lesser  number 
of  the  bacilli  remain  active,  form  capsules  and  become  more 
resistant,  producing  also  capsuled  progeny.  In  this  manner 
the  capsule  forming  bacilli  multiply  at  the  point  of  infection, 
but  in  the  meantime  their  destruction  is  also  in  progress,  part 
of  them  being  taken  up  and  digested  by  the  migrated  leucocytes. 
A  part  of  the  destroyed  extracellular  bacilli  are  dissolved,  and 
in  this  way  the  capsule  substance,  which  has  been  named 
anthracomucin  by  Preisz,  on  account  of  its  muciu-like  action 
against  reagents,  reaches  the  circulation  of  the  body  fluids. 
Hereby  the  anthracocide  substances  are  gradually  weakened. 
They  are  further  affected  by  the  capsule  substance  which  results 
from  the  bacilli  entering  the  blood  circulation  in  the  earliest 
stages  there  to  be  destroyed  and  dissolved.  Finally,  the  an- 
thrax destroyed  substances  of  the  body  fluids  are  completely 


12  Anthrax. 

or  almost  completely  iieutralizod,  and  therefore  the  bacilli  gain- 
ing entrance  into  the  blood  circulation  multiply  therein  very 
rapidly  with  little  or  no  hindrance.  The  blood  becomes  heavily 
charged  with  the  bacilli  and  in  a  short  time  the  animal  dies, 
showing  manifestations  of  a  severe  disease — frequently  in  a  few 
hours  or  even  less. 

At  points  where  large  numbers  of  bacilli  accumulate  as  at 
the  point  of  infection,  the  great  amount  of  capsule  substance 
which  is  present  swells  from  the  gradual  absorption  of  fluid. 
These  body  fluids  are  absorbed  by  the  capsule  substance  which 
becomes  gelatinous,  and  consequently  the  fluids  are  prevented 
from  re-entering  the  circulation,  causing  in  these  parts  edema- 
tous swellings.  The  bacilli  also  accumulate  in  great  masses  in  the 
capillaries,  and  because  of  the  resulting  interference  with  the 
blood  circulation,  principally  on  account  of  the  injury  to  the 
walls  of  the  vessels,  more  or  less  extensive  hemorrhages  de- 
velop. These  occur  very  frequently  in  the  center  of  the 
edematous  swellings  as  well  as  in  the  organs  with  slow  circula- 
tion (spleen,  liver,  brain). 

The  importance  of  the  capsules  as  a  protection  against  injurious 
action  of  the  phagocytes  and  bactericidal  substances  in  the  body  fluids 
is  recognized  by  the  majority  of  authors,  among  them  being  Babes, 
Metschnikoff,  Gruber  &  Futaki,  Preisz  and  others.  There  are  others,  how- 
ever, such  as  Bail,  Fischoeder,  Toyosumi  and  Menokawa,  who  are  even 
at  the  present  time  inclined  to  consider  the  capsule  formation  as  an 
abnormal  swelling. 

Regarding  the  origin  of  the  bactericidal  substances  in  the  body 
fluids,  Preisz  accepts  the  opinion  of  Metschnikoff  that  they  originate 
from  leucocytes.  Gruber  and  Futaki  also  attribute  a  certain  amount 
of  importance  to  the  leucanthraeocidin  which  is  given  up  by  the 
leucocytes  on  certain  stimulation,  ])ut  they  believe  that  the  destruction 
of  the  extracellular  anthrax  bacilli  is  due  to  the  action  of  the 
placqanthracocidin  which  is  secreted  by  the  blood  plates  into  the  blood 
plasma  under  the  stimulation  of  the  anthrax  substances,  and  M^hich 
also  confers  upon  the  serum  its  germicidal  action  after  the  coagulation 
of  the  extravascular  blood. 

Some  of  the  symptoms  of  the  disease  (fever,  severe  general  dis- 
turbances) as  well  as  analogy  to  other  diseases  point  to  the  fact  that 
anthrax  bacilli  produce  toxic  substances  similar  to  those  of  other  path- 
ogenic Ijacteria.  When  these  are  absor])ed  into  the  circulation  their 
action,  on  the  one  hand,  is  injurious  to  the  central  nervous  system, 
particularly  the  respiratory  center,  and  on  the  other  hand,  at  the 
places  where  great  numl)ers  of  bacteria  are  accumulated,  on  the  blood 
vessels.  However,  the  filtrates  of  the  cultures  are  not  toxic,  and  as  a 
matter  of  fact,  the  existence  of  an  anthrax  toxin  has  not  been  satis- 
factorily proved  (Conradi,  Levy  &  Beckmann).  Nevertheless,  through 
the  process  of  autolysis  a  rennet  ferment,  a  fatty  acid  splitting  and  a 
peptonizing  ferment,  may  be  extracted  fi-om  the  bacilli  (Pfersdorff), 
while  Boidin  produced  from  them  fatty  sulistances  which,  when  inocu- 
lated subcutaneously,  caused  inflammatory  edema  and  progressive 
emaciation.  Lastly,  the  observations  of  Johne  show  a  production  of 
hemolysins  whereby  in  a  hanging  drop  of  blood  charged  with  anthrax 


Aiiatniiiicnl  Chaiifios.  13 

bac-illi  the  red  l)lood  corpuscles  dissolve  in  a  few  lioiirs.  Tliis  explains 
the  destruction  of  ervtiirocytes,  the  pronounced  dysi)noea  in  the  later 
stages  of  the  disease  and  the  hiked  condition  of  anthi-ax  ])lood.  Rec^'utly 
Casagrandi,  Wunschheini,  Ileyrovsky  &  Landiieinier,  as  well  as  Krogh 
proved  the  presence  of  hemolysins  also  in  cultures. 

Anatomical  changes.     The  carcasses  of  animals  dead  of 
anthrax  decompose  rapidly  on  account  of  the  l)lood  remaining 
in  a  liquid  condition,  and  therefore  they  become,  as  a  rule, 
irreatly  bloated.     Rigor  mortis  is  also  incomplete.     Dark  red 
blood  escapes  from  the  body  openings,  the  visible  mucous  mem- 
branes are  cyanotic  and  frequently  hemorrhagic,  especially  on 
the  prolapse'd  rectum.     The  autopsy  shows,  in  addition  to  the 
general  manifestations   of  asphyxiation,   extensive   serous  in- 
filtrations and  blood  extravasations  in  the  connective  tissue  at 
different  parts  of  the  l)odv.     The  sul)cntaneous  and  intermus- 
cular connective  tissue  is  infiltrated  in  places,  having  a  jelly-like 
consistency,  and  being  permeated  with  small  circumscril)ed  or 
large  flat,^  dark  red  hemorrhages.     Similar  changes   such  as 
gelatinous  infiltrations  and  hemorrhages  also  occur  in  the  loose 
subserous  connective  tissue,  principally  in  the  mediastinum  of 
the  pleura,  mesenterv  and  that  surrounding  the  kidneys;  also 
under  the  mucous  membrane  of  the  pharynx,  in  the  epiglottis 
and  tissue  surrounding  the  f  renum  of  the  tongue.    Hemorrhages 
may  be  present  in  places  without  serous  infiltrations,  principally 
under  the  serous  membranes,  in  the  catarrhal  mucous  mem- 
-  branes,  under  the  endocardium,  and  in  the  subcutaneous  con- 
nective tissue.     In  rare  cases  a  circumscribed  swelhng  consist- 
ing of  fixed,  infiltrated  cordaceous  tissue  may  be  present  m 
anv  part,  over  which  the  dirty  brown  skin  may  be  broken,  form- 
ing a  deep  sinuous  ulcer  covered  with  necrotic  shreds  of  tissue. 
The  superficial  Ivmph  glands  appear  greatly  swollen,  partic- 
ularlv  near  areas  of  gelatinous  infiltration.    The  cut  surface  is 
reddened,  moist  and  frequently  studded  with  small  hemorrhages. 
The  spleen  with  rare  exceptions  shows  the  characteristic 
picture  of  an  acute  swelling.     Tn  most  cases  the  entire  organ 
is  o-reatlv  swollen,  the  capsule  distended,  the  pulp  blackish  red, 
softened  and  even  fluid,  and  the  swelling  may  be  so  large  as 
to  burst  the  spleen  capsule.    In  rare  cases  the  knobbed  surface 
of  the  spleen  shows  only  a  few  blackish  red,  softened  areas  ot 
various  sizes,  and  fresh  hemorrhages. 

The  parenchymatous  organs,  principally  the  liver  and 
kidnevs,  are  also  congested,  swollen,  and  as  a  result  ot 
parenclnonatous  degeneration  they  are  brittle  and  soft.  P  re- 
quentlv  the  muscles  and  heart  muscle  have  a  grayish-red,  flabby 
appearance.  The  mucous  membrane  and  submucosa  of  the  in- 
testinal canal,  especiallv  in  the  duodenum  and  small  intestine, 
but  rarelv  in  tlie  stomach  and  large  intestine,  are  uniformly 
swollen  in  considerable  portions,  intensely  red,  and  permeated 
with  small  blackish-red  hemorrhages.     The  swellings  may  be 


24  Anthrax. 

very  marked  and  confined  to  smaller  areas,  particularly  tliose 
corresponding  to  the  Peyer's  patches  and  solitary  follicles,  thus 
causing  the  mucous  membrane  to  project  into  the  lumen  of  the 
intestine  in  the  form  of  spherical  protuberances  (carbuncles), 
or  as  elongated,  thick  pads.  On  the  protuberances  or  pads  the 
mucous  membrane  appears  necrotic,  which  sometimes  affects 
only  the  superficial  layers,  although  its  entire  thickness  may  be 
involved,  giving  it  the  appearance  of  a  pale  yellow  pulpy  de- 
posit. The  inner  surface  of  the  abdominal  wall  may  also  show 
various  sized  ulcers  with  greatly  swollen  blackish-red  borders, 
their  bases  being  covered  with  necrotic  tissue  shreds.  Around 
the  nodules  and  ulcers  the  mucous  membrane  and  subserous 
connective  tissue  usually  manifests  a  marked  gelatinous  infiltra- 
tion and  permeation  with  hemorrhages. 

The  lungs  are  highly  congested,  and  edematously  infiltrated. 
The  respiratorv  mucous  membrane  is  hyperemic,  catarrhal  and 
swollen,  particularly  at  the  opening  of  the  larynx,  and  contains 
numerous  ecchymoses.  The  brain  and  meninges  are  also 
hyperemic,  and  between  the  latter  sometimes  extensive  flat 
blood  coagula  are  present  (apoplexia  intermeningialis). 
Hemorrhages  may  also  occur  exceptionally  in  the  brain  sub- 
stance. The  body  cavities  of  the  carcass  frequently,  especially 
in  warm  weather,  contain  a  reddish  fluid.  The  internal  lymph 
glands  show  a  condition  similar  to  that  seen  in  the  external 
glands  except  that  the  condition  is  more  marked,  particularly 
in  the  mesenteric  glands. 

The  blood  is  dark  to  blackish-red  in  color,  contains  only 
a  few  loose  fibrin  coagula,  and  clears  up  only  slowly  in  the  air. 
On  microscopic  examination  the  leucocytes  appear  greatly  in- 
creased (hyperleucocytosis). 

Anthrax  bacilli  are  usually  present  in  great  numbers  m 
the  blood,  spleen,  hmiph  glands  and  parenchymatous  organs. 
Occasionally,  however,  but  few  are  present,  especially  in  the 
rapid,  apoplectic  form  of  the  disease. 

The  pathological  changes  described  are  the  more  distinctly  developed,  the 
more  slowly  the  disease  had  progressed.  Their  distribution  depends  in  the  first 
place  upon  the  nature  of  the  infection  as  the  edema  and  hemorrhages  are  most 
pronounced  at  the  point  of  infection.  However,  superficial  edemas  may  also  develop 
after  infections  through  the  intestines,  whereas  the  describeil  intensive  changes  in 
the  intestinal  mucous  membrane  develop  almost  exclusively  in  this  mode  of  infec- 
tion, although  they  are  not  invariably  present  in  such  a  conspicuous  form  in  all 
cases. 

The  manifestations  of  the  changes  in  hogs  differ  inasmuch 
as  in  most  cases  the  lesions  are  principally  confined  to  the 
pharyngeal  region.  In  addition  to  a  marked  gelatinous-hemor- 
rhagic  infiltration  of  the  pharyngeal  connective  tissue  and  the 
retropharyngeal  lymph  glands,  the  tonsils  are  covered  by 
strongly  adherent  "pale-yellow,  pseudomembranes,  and  are  sur- 
rounded by  the  greatly  swollen  mucous  membrane.  The  tissue 
of  the  tonsils  under  the  pseudomembranes  appears  yellowish- 
gray,  lusterless  and  several  millimeters  in  thickness.     The  in- 


Anatomical  Changes.     Symptoms. 


15 


flammatory  swelling  extends  also  to  the  perilaryngeal  connec- 
tive tissue  and  sujierior  cervical  lymph  glands. 

Intestinal  anthrax  occurs  more  rarely  in  hogs.  When  pres- 
ent the  mucous  membrane  of  the  small  intestine  shows  severe 
inflannnatory  changes  and  developing  ulceration  in  patches  or 
over  more  extended  areas  (Carl). 

The  spleen  usually  presents  a  normal  appearance,  but  may 
at  times  be  greatly  swollen  and  softened.  Zimmerman,  Carl 
and  Bongert  describe  as  rare  occurrence  sharply  circumscribed 
nodules  in  the  moderately  swollen  pulp,  from  a  hemp  to  a  millet- 
seed  in  size,  in  which  the  cut  surface  appears  brownish-red  to 
grayish-red  in  color,  dry  and  lusterless. 

In  one  case  of  Wyssmann  the  lesions  corresponded  to  a  serofibrinous 
pneumonia  (inhalation  anthrax?). 

Anthrax  bacilli  are  found  in  great  numbers  in  the  gelatinous-hemorrhagic  con- 
nective ti^^sue  a^  well  as  in  the  swollen  lymph  glan.ls.  On  the  other  hand,  they  are 
only  sparingly  present  in  the  blood,  and  in  the  spleen  nodules  mentioned  they  are 
mostly  found  in  a  degenerated  form. 

Symptoms.     The  time  of  incubation  of  anthrax  after  arti- 
ficial infection  varies  from  1  to  14  days,  depending  to  a  great 
extent  on  the  place  and  intensity  of  the  infection.    After  sub- 
cutaneous or  intravenous 
inoculation  the  manifesta- 
tions  of   the   disease   ap- 
pear  in   24  to   48   hours. 
Sheep  usually  succumb  in 
•2  to  3  days  to  the  feeding 
of     large     quantities     of 
spores.       However,     the 
time  of  incubation  under 
natural   conditions,  when 
the  animals  take  up  a  con- 
sicleral)ly    smaller    quan- 
tity of  spores,  is  undoubt- 
edly longer.     Thus  in  the 
experiments    of    Pasteur, 
R  o  u  x     &     Chamberland 
sheep,  which  were  infected 
with   food   grown   on   in- 
fected    pastures,     devel- 
oped   the    disease    only 
after  10  days.    In  horses 
and  cattle  the  time  of  in- 
cubation seems  to  be  hard- 
ly less  than  3  days. 

In  horses,  cattle  and 
sheep    anthrax   when   de- 
veloping as  a  result  of  an 
intestinal  infection  usually 
general,    acute    infectious 


Fig.  7.    Fever  curve  in  anthrax  of  a  horse. 


manifests 
disease 


m 


itself  in 
which 


the 
the 


form  of  a 
individual 


25  Anthrax. 

symptoms    are    only    rarely    characteristic     of    the     specific 
alfectioii. 

In  the  peracute  cases  the  course  of  the  disease  simulates 
cerebral  apoplexy  (anthrax  acutissimus  s.  apoplecticus).  Well 
nourished  and  apparently  healthy  animals,  which,  however,  were 
probably  feverish,  suddenly  go  down  in  the  stable  or  in  the 
pasture  and  remain  lying  on  the  ground  in  convulsions;  the 
respiration  is  rattling;  bloody  foam  oozes  from  the  mouth  and 
nose,  the  mucous  membrane  of  w^hich  shows  a  dark  bluish-red 
discoloration,  and  from  the  anus  pure  blood  even  may  escape, 
until  finally  in  a  few  minutes,  or  at  most  within  an  hour,  the 
animal  dies.  This  form  of  anthrax  is  observed  most  frequently 
at  the  beginning  of  an  outbreak,  and  particularly  among  sheep. 

In  the  acute  and  subacute  cases  which  represent  by  far 
the  largest  percentage  of  cases  the  disease  commences  with  a 
quick  rise  in  the  temperature  to  40-42 °C.,  at  which  height  it 
remains  for  a  time,  dropping  quickly  just  before  death. 
(Fig.  7.)  Some  animals,  especially  cattle,  manifest  quite  a, 
lively  disposition  at  the  onset  of  the  disease  and  take  their 
food  in  the  usual  manner. 

In  some  cases  the  disease  commences  with  restlessness  and 
excitement  which  soon  pass  into  depression.  In  most  cases, 
however,  the  malady  is  preceded  by  symptoms  of  general  de- 
pression, the  animal  refusing  to  eat  and  standing  in  one  place 
with  head  hanging,  staring  look  and  dilated  pupils.  In  the 
pasture  the  affected  animals  trail  behind  the  others,  remain 
for  a  long  time  in  one  place  or  lie  down ;  when  urged  to  move 
they  stagger  and  sway.  At  the  same  time  they  have  chills  and 
their  temperature  is  unevenly  distributed  over  the  surface  of 
the  body.  The  pulse  is  accelerated  and  small  while  the  heart 
beats  are  metallic  in  sound. 

The  respiration  is  very  labored  and  accelerated,  and  the 
dark  bluish-red  cyanotic  mucous  membranes,  which  are  fre- 
quently studded  with  petechial  hemorrhages,  are  indicative  of 
insufficient  oxidation  of  the  blood.  A  mechanical  cause  for  the 
difficult  respiration  cannot  be  established  except  in  those  cases 
in  which  edema  of  the  glottis  is  suspected,  because  of  pharyn- 
gitis, swelling  of  the  neck  and  whistling  inspiration.  Examina- 
tion of  the  lungs  reveals  nothing  abnormal  except  a  harsh 
vesicular  breathing. 

Very  frequently  disturbances  in  the  digestion  are  observed. 
Apart  from  affected  appetite  horses  manifest  severe  colicky 
pains  but  without  any  indication  of  meteorism  or  bloating. 
Ruminants  are  less  restless  and  frequently  show  moderate 
bloating  (in  one  case,  a  cow  observed  by  Schmidt,  the  course 
of  the  "disease  manifested  the  symptoms  of  an  acute  paralysis 
of  the  rumen  with  left-sided  pleurisy).  At  first  there  is  con- 
stipation, but  diarrhea  soon  sets  in,  during  which  the  feces, 
particularly  in  cattle,  are  fluid  and  frequently  intermixed  with 


Syniptonis.  ^y 

blood,  or  occasionally  large  masses  of  Itlood  may  be  passed 
by  the  affected  animals.  In  horses  it  is  sometimes  possible 
to  demonstrate  a  marked  enlargement  of  the  spleen  by  rectal 
exploration  or  by  percnssion.  The  nrine  is  dark  red  and  some- 
times even  bloody.  (This  is  a  particnlarly  frequent  symptom 
in  sheep,  in  which  animals  the  compression  of  the  nasal  openings 
causes  immediate  urination.) 

The  milk  secretion  usually  ceases  shortly  after  the  onset 
of  the  disease ;  if  there  is  a  slight  secretion  of  milk  it  is  yellowish 
or  bloody  in  a])i)earance,  slimy,  and  possil)ly  l)itter.  Pregnant 
animals  fre(piently  abort.  After  the  difficulty  in  respiration 
has  reached  a  high  degree,  death  finally  results  with  signs  of 
asphyxiation. 

Besides  these  sjnnptoms,  which  clearly  indicate  the  pres- 
ence of  an  acute  infectious  disease,  in  some  cases,  particularly 
in  horses,  more  rarely  in  cattle  and  very  exceptionally  in  sheejj, 
acute  edematous  swellings  develop  on  the  surface  of  the  body, 
which  make  a  more  accurate  orientation  of  the  nature  of  the 
affection  possible.  In  any  region  of  the  body,  but  especially 
on  the  neck,  breast,  flanks,  or  lumbar  region,  a  more  or  less 
extensive,  rapidly  growing  swelling  develops.  The  swellings 
are  hot,  and  of  a  doughy  or  dense  consistence,  but  the  skin 
covering  them  usually  shows  no  changes.  Exceptionally  on  a 
circumscribed  area  of  the  skin  proper  a  warm,  painful  and  dense 
swelling  develops  surrounding  which  the  sul)Cutaneous  tissue 
also  appears  greatly  swollen  as  a  result  of  the  inflammatory 
edema.  With  the  swelling  of  the  neck  there  is  usually  associated 
a  severe  pharyngitis  or  edema  of  the  glottis  which  considerably 
increases  the  pre-existing  dyspnoea.  On  the  rectal  mucous 
membrane  carbuncular  growths  develop  occasionally  as  a  result 
of  infection  introduced  by  a  rectal  examination  or  by  manual 
removal  of  the  feces.  In  such  cases  the  feces  are  usually 
evacuated  under  severe  straining,  and  contain  dark,  tar-colored 
blood  or  exfoliated  tissue  shreds.  The  rectum  is  prolapsed; 
the  perineal  region  is  edematously  swollen,  while  the  hand  in- 
troduced into  the  rectum  may  detect  flat  or  nodular  swellings 
in  the  hot  mucous  membrane. 

A  primary  affection  of  the  skin  only  rarely  occurs  in 
animals,  and  consists  in  the  appearance  of  circumscribed,  warm, 
painful  and  hard  swellings  which  later  become  gangrenous, 
commencing  in  the  center,  and  change  into  ulcers  (carbuncles) 
which  have  ragged  liorders  and  are  covered  with  necrotic  tissue. 

According  to  some  authors  anthrax  may  occur  in  sheep  in  the 
form  of  an  erysipelas-like  dermatitis  accompanied  by  a  subcutaneous 
edema  which  starts  at  one  extremity  and  soon  extends  to  the  body, 
whereby  the  patients  show  high  fever  and  die  inside  of  I'o  to  2  days. 
The  anthrax  nature  of  the  affection  has  not  yet  been  positively  estab- 
lished. 

The  occurrence  of  the  so-called  gloss  anthrax  is  also  doubtful,  as 
most  cases  in  cattle  designated  luider  this  name  belong  to  hemorrhagic 

2 


X8  Anthrax. 

septicemia.  Tlie  presence  of  gloss  anthrax  can  only  be  accepted  as  prob- 
able when  the  tongue  is  greatly  swollen,  cyanotically  discolored,  or 
when  the  buccal  mucous  membrane  contains  hard  nodules  and  cysts 
filled  with  bloody  fluid. 

In  hogs  anthrax  usually  runs  its  course  with  manifestations 
of  febrile  pharyngitis  with  marked  swelling  of  the  subparotidal 
and  laryngeal  regions.  The  swelling  may  extend  from  the  neck 
to  the  head  and  cause  considerable  difficulty  in  deglutition  and 
respiration.  At  the  same  time  the  mucous  membranes  are 
cyanotic,  bluish-red  spots  develop  on  the  skin,  diarrhea  sets 
in,  and  the  difficulty  in  respiration  and  swallowing  reach  such 
a  state  that  the  animals  finally  die  from  asphyxiation.  In 
experimental  cases  cysts  filled  with  bloody  fluid  develop  on  the 
mucous  membrane  of  the  tongue,  cheeks  and  lips. 

In  those  cases  where  there  is  no  swelling  of  the  neck  the 
symptoms  observed  are  only  debility,  suppressed  appetite  and 
hiding  under  the  straw. 

In  dogs  and  in  other  carnivorous  animals  the  disease  is 
of  rare  occurrence  and  is  usually  manifested  by  severe  gastro- 
enteritis as  well  as  pharyngitis.  Sometimes  after  eating  an- 
thrax blood  an  inflammation  develops  on  the  lips  and  tongue, 
or  general  infection  may  follow  the  development  of  a  car- 
bunculous  ulcer  upon  the  toe  pads. 

Course.  The  development  of  the  disease  and  the  succes- 
sively appearing  symptoms  as  well  as  the  general  picture  of 
the  affection  show  great  variations  from  case  to  case.  While 
sometimes  only  half  an  hour  passes  from  the  onset  of  the  dis- 
ease until  death,  in  other  cases  the  duration  extends  to  two 
and  more,  exceptionally  to  7  days.  In  slow  cases  the  intensity 
of  the  syiuptoms  may  decrease  temporarily  so  that  the  patients 
are  somewhat  brighter,  and  take  some  food,  but  the  improve- 
ment is  followed  after  a  shorter  or  longer  period  by  new  at- 
tacks, and  the  disease  may  even  assume  an  intermittent  charac- 
ter (anthrax  intermittens)  in  which  the  animal  becomes  greatly 
emaciated  under  periodical  febrile  symptoms. 

The  species  of  the  animal  affected,  influences  considerably 
the  manifestation  of  the  clinical  picture.  Anthrax  in  horses 
is  usually  marked  by  symptoms  of  a  severe  spasmodic  colic 
in  which  quite  frequently  edematous  swellings  develop  on  the 
neck  and  chest.  In  cattle  only  symptoms  of  a  general  febrile 
affection  are  usually  observed,  but  hemorrhages  from  the  in- 
testines as  well  as  edematous  swellings  are  not  very  rare. 
Anthrax  in  sheep  usually  runs  a  rapid  course  without  localiza- 
tion to  certain  regions,  acting  like  a  pnre  septicemia,  and  the 
apoplectic  fonn  occurs  most  frequently  in  these  animals.  An- 
thrax in  goats  is  less  acute.  Hogs  usually  die  in  1  to  2  days 
with  symptoms  of  asphyxiation  due  to  the  extension  of  pharyn- 
gitis. 


Diagnosis.  19 

Diagnosis.  It  is  hardly  ])ossil)le  to  diaft-iiose  with  cortainty 
the  perac'iite  case  of  anthrax  on  the  living-  animal,  as  acute 
hyperemia  and  acute  edema  of  the  lungs  as  well  as  edema  of 
the  glottis,  further  congestion  of  the  brain  (sunstroke)  and 
hemorrhages  into  the  brain  su))stance  resulting  from  otlier 
causes  may  kill  the  animal  under  very  similar  nuinifestations. 
In  the  less  acute  cases  anthrax  is  indicated  principally  by  the 
appearance  of  the  rapidly  extending  edematous  swellings  as 
well  as  by  the  bloody  feces  and  urine,  but  even  in  this  respect 
hemorrhagic  septicemia  very  closely  resembles  anthrax  (on 
post  mortem  the  acute  swelling  of  the  spleen  is  always  absent 
in  the  former). 

Likewise  anthrax  may  be  also  suspected  in  severe  gastro- 
intestinal inflammations,  especially  when  associated  with  in- 
testinal hemorrhages,  while  in  horses,  on  account  of  the  severe 
abdominal  pain,  colicky  affections,  invagination  and  volvulus 
of  the  intestine,  may  be  chiefly  confounded  with  it,  and  particu- 
larly so  when,  as  sometimes  happens,  there  are  no  characteristic 
s^^nptoms  present  other  than  those  of  colic.  In  cattle  blackleg 
and  malignant  edema  are  differentiated  by  the  cold  and  crepitat- 
ing consistence  of  the  swelling  in  the  latter  diseases,  as  well  as 
by  the  peculiar  sour,  disagreeable  odor  of  the  fluid  which  is 
contained  in  the  swellings  of  anthrax  edemas.  In  hogs, 
especially  when  suffering  with  pharyngitis  as  a  result  of  an 
infection  with  the  virus  of  buffalo  disease,  the  resemblance 
to  anthrax  is  so  pronounced  that  a  differentiation  is  only  pos- 
sible by  additional  circumstances  (prior  cases  in  buif aloes). 
Finally,  poisonings  occasionally  come  into  consideration,  in 
which,"  however,  a  rise  in  the  body  temperature  occurs  only  in 
the  later  stages. 

The  diagnosis  is  certainly  established  by  the  demonstration 
of  bacilli  in  the  blood  of  the  living  animal  which  in  size  and 
form  resemble  anthrax  bacilli,  as  there  is  no  other  disease 
known  in  which  bacteria  in  any  way  resembling  these  would 
circulate  in  the  blood ;  unfortunately,  they  can  be  demonstrated 
in  the  blood  only  a  short  time — not  earlier  than  16  to  18  hours 
— before  death. 

Characteristic  indications  on  post  mortem  are  the  dark-red 
color  of  the  uncoagulated  blood,  the  acute  swelling  of  the  spleen 
and  the  lymph  glands,  bloody  edema  in  the  subserous  and  sub- 
cutaneous connective  tissue  and  also  hemorrhagic  enteritis. 
These  findings  retain  their  importance  even  in  case  of  negative 
bacteriological  examination.  However,  in  exceptional  cases  the 
enumerated  changes  and  also  swelling  of  the  spleen  may  be 
absent.  In  such  cases  the  bacteriological  examination  alone 
will  give  enlightenment.  If  the  carcass  is  fresh,  not  older 
than  24  hours,  then  the  presence  of  large,  non-motile  rods  and 
short  chains  in  the  blood  which  has  l)een  taken  from  vessels 
distantlv  located  from  the  intestines,  such  as  a  superficial  vein, 


20  Anthrax. 

is  certain  proof  of  anthrax,  particularly  when  by  staining  the 
presence  of  a  capsule  can  be  demonstrated.  If,  however,  a 
longer  time  has  elapsed  after  death,  especially  in  summer  time, 
other  bacilli,  first  in  importance  bacilli  of  malignant  edema, 
may  have  migrated  from  the  intestines  into  the  blood,  and 
these  in  many  instances  can  only  be  differentiated  from  anthrax 
bacilli  by  cultural  methods  and  animal  inoculations. 

Bacteriological  diagnosis.  Relative  to  distinguishing  anthrax 
bacilli  from  other  bacteria  more  or  less  closely  resembling  them  the 
following  is  to  be  noted: 

1.  Anthrax  bacilli  are  present  in  the  blood  of  fresh  carcasses; 
they  are  thick,  rounded  at  the  ends  or  squarely  cut.  They  usually  have 
a  distinctly  recognizable  capsule  and  form  chains  of  2  to  4,  rarelj' 
more,  segments,  in  which  the  individual  segments  are  separated  from 
one  another  by  light  cross  lines ;  they  are  aerobic  and  never  produce 
spores  inside  the  animal  tissues  and  body  fluids.  Su])cutaneous  or 
intravenous  injections  kill  mice,  guinea  pigs  and  rabbits,  in  which 
after  death  the  blood  usually  contains  the  bacilli  in  great  num])ers. 

2.  The  bacilli  of  malignant  edema  are  more  slender,  motile,  rounded 
at  the  ends,  and  besides,  the  edematous  swelling,  fluid  of  the  abdominal 
cavity  and  blood  of  the  portal  vein  contain  curved  thread-like  forms 
of  various  lengths,  some  homogenous,  others  beaded.  In  older  car- 
casses many  of  the  bacilli  contain  in  the  center  one  oval  spore  each; 
they  are  strictly  anagrobic,  li(iuefy  gelatin,  and  form  gases  even  in 
coagulated  blood  serum.  Intravenous  inoculations  are  harmless ;  suli- 
cutaneous  inoculations  into  test  animals  produce  a  rapidly  extending 
edematous  inflammation  with  gas  formation. 

3.  Blackleg  bacilli  are  present  only  in  the  serous  fluid  of  the 
crepitating  swelling  in  a  fresh  carcass ;  they  are  comparatively  short 
and  thick,  motile,  never  grow  in  form  of  threads,  and  produce  in  the 
animal  body  shortly  after  death,  oval  spores  located  either  at  the  end 
or  in  the  center  of  the  bacillus.  They  may  be  grown  anaerobically  but 
also  aerobically ;  liquefy  gelatin  slightly  ;  and  in  coagulated  blood  serum 
they  do  not  produce  gas.  Intravenous  inoculations  are  harmless;  sub- 
cutaneous or  intramuscular  inoculations  kill  the  guinea  pig  and  mouse, 
but  rabl)its  only  as  an  exception. 

In  the  examination  of  material  which  is  no  longer  fresh,  various 
putrefactive  bacilli  (Bac.  subtilis,  Bac.  termo)  come  into  consideration, 
particularly  those  resembling  saprophytes,  the  Bac.  pseudoanthracis 
described  by  Burri  &  Baas,  as  well  as  the  Bac.  anthracoides  found  by 
Hueppe  &  Wood.  They  are  found  frequently  in  blood  or  parts  of 
organs  that  have  been  stored,  and  they  have  some  characteristics  in 
common  with  the  anthrax  bacillus,  but  may  be  distinguished  by  the 
absence  of  other  characteristics  of  the  true  anthrax  bacillus  (Hoppe). 
Further,  they  coagulate  milk  after  a  short  time  and  do  not  form  cap- 
sules in  inactivated  horse  blood  serum. 

The  anthrax  haeillus  may  be  demonstratefl  in  most  instances  in  sufficiently 
fresh  material  by  a  microscopical  examination  for  which  the  various  capsule  stain- 
ing methods  are  especially  adapted  (according  to  Johne,  staining  with  heated  2% 
gentian  violet  solution  followed  by  a  quick  discoloration  with  2%  acetic  acid; 
according  to  Olt  with  3%  safranin  solution  also  with  heating;  according  to  Raebiger 
staining  of  the  air-dried  smears  with  formolgentian  violet  (100-150:10-15); 
further,  Gram's  stain  with  subsequent  eosin  treatment).  The  material  for  exam- 
ination should  be   taken   from   the   blood   or   spleen  of   very   fresh   carcasses;    later 


Bacterioloj^ical   Diaj^niosis.     Prognosis.  21 

from  a  peripheral  vein  (ear  or  jugular)  as  putrefaction  sets  in  later  in  these  parts 
than  in  the  internal  organs.  As  a  result  of  putrefaction  the  bacilli  change  their 
form  after  a  time;  they  become  more  slender;  their  plasma  does  not  stain  well,  and 
later  not  at  all;  at  the  same  time  other  bacteria  and  especially  anaerobic  putre 
f active  bacteria  multiply  very  rapidly.  The  capsule  of  the  anthrax  bacillus  is 
preserved  somewhat  longer  so  that  after  a  time  only  empty  capsules  or  the  remains 
of  i)lasma  envelopes  can  be  seen  (See  fig.  2  on  page  i).  They  finally  become 
unrecogni>able  (according  to  Olt,  in  the  sununer  time  in  about  4.S  hours).  Its 
diagnostic  importance,  however,  should  not  be  overestimated  as  a  capsule  may  occa- 
sionally occur  on  some  putrefactive  bacteria  resendding  the  anthrax  bacillus 
(Noetzl),  and  on  the  other  hand  sometimes  they  cannot  be  demonstrated  even  on 
true  anthrax  bacilli,  especially  in  the  blood  of  horses  and  carnivorous  animals. 

According  to  Cinca  &  Fenca  the  feces  of  affected  animals  (sheep  and  hogs) 
invariably  contain  anthrax  spores  which  can  be  isolateil  through  cultural  methods 
by  a  previous  heating  to  65°C.  This  is  possible  even  in  cases  in  which  the  carcass 
is  alreatly  putrid  and  the  examination  of  the  blood  gives  negative  results. 

In  the  examination  of  stale  blood  or  material  from  organs  good  results  may 
sometimes  be  obtained  by  the  mucin  reaction  which  was  first  describe<l  by  Weichsel- 
baum  (l.si)J),  later  by  Heim  and  recently  recommended  by  MacFadyean.  This 
reaction  is  manifested  in  smears  stained  with  1%  methylene  blue  solution  by  the 
appearance  of  violet  or  purplish-red  granules  which  are  seen  near  the  bacilli  and 
originate  from  their  capsules. 

Positive  results  are  obtained  in  doubtful  cases  by  the  isolation  of  the  anthrax 
bacillus  by  the  plating  method.  According  to  Bongert  the  bacilli  remain  active  in 
dried  blood  for  3G  to  50  days,  in  putrefied  dried  blood  or  tissue  fluids  for  a  shorter 
period.  However,  they  retain  their  virulence  on  an  average  of  from  8  to  20  days. 
In  carcasses  which  have  lain  unopened  the  results  frotu  the  examination  of  smear 
preparations  are  uncertain  even  after  24  hours,  while  by  the  plating  method  they 
may  be  demonstrated  for  2  or  3  days  after  death. 

Finally,  the  diagnosis  may  be  proved  liy  animal  inoculations,  for  which  the 
usual  laboratory  animals,  with  the  exception  of  the  rat,  may  be  utilised  (to  prevent 
an  intoxication  only  small  quantities  of  the  material  should  be  used  for  inocula- 
tions; the  scarified  shaven  skin  is  best  adapted  for  the  inoculation  of  putrid 
material). 

Suspicious  material  forwarded  for  an  accurate  bacteriological  examination  is 
best  prepared  by  si>reading  the  softened  pulp  of  the  spleen  from  3  to  4  mm.  thick 
on"  a  slide,  across  each  end  of  the  slide  a  strip  of  thick  cardboard  is  placed,  and 
another  slide  is  then  placed  on  these  jdeces  of  cardboard.  They  are  then  securely 
tied  and  forwarded  in  a  box  for  examination  (Kitt,  Bongert).  Another  method 
consists  in  breaking  a  boiled  potato  in  two;  the  blood  or  spleen  tissue  having  been 
smeared  on  one  of  the  broken  surfaces,  the  pieces  are  placed  together  again  and 
the  whole  forwarded  to  its  destination  (Olt).  Further,  the  blood  or  spleen  pulp 
may  be  dried  on  the  inner  surface  of  a  test  tube,  or  on  woolen  threads  or  cotton 
pads  (Heim,  Mazzini). 

Jakobsthal  &  Pfersdorff,  as  well  as  Marxer  and  Eberle,  recommend  for  the 
above  purpose  quailrangular  i)ieces  of  gypsum  rods  saturated  in  Loeffler 's  bouillon 
and  placeil  in  strong  test  tubes.  Before  use  they  are  dipped  in  pure  water,  then 
covered  with  a  thin  layer  of  blood  or  splenic  pulp,  placed  in  the  tube,  which  is 
packed  in  a  wooden  case  and  forwarded  to  the  laboratory.  Inasmuch  as  the  bacilli 
form  spores  on  the  rods  in  a  proper  temperature  the  diagnosis  is  possible  even  after 
14  months.  Instead  of  gypsum  rods  small  pieces  of  burned  bricks  are  also  adapted 
(Eeinecke),  or  even  better  filterpaper  rolls  about  the  thickness  of  the  small  finger 
and  moistened  in  water   (Schiiller,  Grabert). 

Prognosis.  Obvioi-isly  anthrax  terminates  not  infrequently 
in  recovery,  altliongli  it  is  hardly  possible  to  estimate  the  per- 
centage of  recoveries  with  any  degree  of  certainty.  In  the 
course  of  various  outbreaks  it  is  a  quite  frequent  occurrence 
that  some  of  the  animals  which  were  exposed  to  the  infection 
show  an  indisposition  and  fever,  but  recover  completely  in  1 
to  2  days.  Such  passing  affections  are  probably  the  result 
of  an  anthrax  infection,  which,  however,  is  overcome  by  the 
energetic  resistance  of  the  animal.  Toward  the  end  of  some 
epizootics  the  disease  often  assumes  a  subacute  form  and  then 


22  Anthrax. 

cases  of  recovery  are  more  frequent.  The  prognosis  is  most 
unfavorable  in  the  peracute  cases,  and  most  favorable  in  the 
primary  local  skin  affections  as  long  as  there  are  no  intensive 
general  disturbances  to  indicate  the  entrance  of  the  bacteria 
into  the  blood  circulation.  The  development  of  edematous 
swellings  in  the  course  of  the  febrile  affection  is  almost  in- 
variably of  unfavorable  significance,  while  the  appearance  of 
bacilli  in  the  blood  is  indicative  of  approaching  death. 

Treatment.  In  primary  local  affection  of  the  skin,  sub- 
cutaneous tissue  or  the  visible  mucous  membranes,  surgical 
treatment  is  first  indicated.  This  consists  in  deep  incisions  of 
the  swellings,  and  after  thorough  squeezing  and  scraping,  the 
wound  is  repeatedly  washed  and  cauterized.  Cross  incisions 
are  advisable,  while  large  swellings  may  be  incised  in  several 
places.  As  disinfectants  the  following  are  recommended: 
Corrosive  sublimate  (1-1000),  carbolic  acid  (3%),  creolin  (5%), 
etc.  Good  results  are  also  obtained  from  subcutaneous  injec- 
tions at  various  places  in  the  periphery  of  the  swelling  with 
2-3%  carbolic  acid  or  5%  creolin  solution,  and  covering  with  a 
carbolic  dressing. 

In  cases  of  generalized  disease  which  are  not  yet  far  ad- 
vanced the  treatment  with  immune  serum  (see  page  28)  gives 
remarkably  good  results.  After  the  intravenous  injection  of 
40-80  g.  of  sufficiently  active  serum  the  temperature  falls 
rapidly,  frequently  within  as  short  a  period  as  6  hours,  and  this 
is  followed  by  a  complete  recovery  after  12  hours  (Jaeger, 
Detre,  Raeluger,  G{\\  and  others).  In  cases  in  which  no  im- 
provement is  observed  after  a  few  hours,  or  in  wdiicli  the  tem- 
perature rises,  it  is  advisable  to  repeat  the  serum  injection. 
Serum  of  high  potency  proves  effective  even  in  small  doses  and 
in  subcutaneous  applications. 

Sometimes  favorable  results  may  be  obtained  from  symp- 
tomatic treatment,  viz.,  repeated  bathing  with  cold  water,  rub- 
bing with  camphor,  turpentine  or  pure  alcohol.  Internally 
wine,  alcohol  or  camphor  may  be  given;  also  sul)cutaneous  in- 
jections of  ether  or  camphor,  etc.  In  the  presence  of  an  in- 
testinal infection  the  administration  of  disinfectants  in  large 
doses  is  indicated,  such  as  creolin  or  lysol  (larger  animals 
20-50  gm.,  smaller  animals  5-10  gm.  or  even  larger  doses) ;  creo- 
sote (5-10  and  1-2  gm.,  respectively),  carbolic  acid  (according 
to  Hess  40-50  cc.  of  a  i/)|%  solution  daily),  calomel  in  small 
and  frequent  doses  (for  horses,  with  y^  gm.  opium)  and  oil  of 
turpentine  (for  larger  animals  200-300  gm.  mixed  with  sweet 
oil).  Enemas  with  disinfecting  fluids  may  also  be  tried,  es- 
pecially in  cases  in  which  the  s^miptoms  indicate  a  severe  af- 
fection of  the  rectum.  Intravenous  injections  of  collargol  (1 
gm.  dissolved  in  50-100  gm.  of  water)  are  also  recommended. 

The  sick  animals  should  be  provided  with  well-ventilated, 
shady  and  cool  quarters.     They  should  receive  an  abundant 


Trcatiin'iit.      Pi'c'vt'utioii.  90 

supply    of    fresh    water,    preferably    water    wliieh    has    been 
slightly  acidilied  with  hydrochloric  acid. 

Bloe.iinj;  which  is  still  pra.-tico.l,  prod.u-cs  only  teniporarv  beneficial  action  in 
the  |.rosoiicc  ot  pulnionary  con^restion,  l.ut  slioul.l  he  perforn.e.l  cautiously  on  account 
or  the  danger  ot  spreading  the  infection. 

Prevention.  In  order  to  pi-otect  healthy  animals  from  in- 
fection care  should  be  taken  that  the  food,  drinking  water, 
utensils,  etc.,  which  are  accessible  to  them,  and  also  the  ground] 
should  not  become  contaminated  by  the  excrement,  blood,  etc., 
of  animals  affected  with  anthrax.  In  cases,  however,  where  this 
has  occurred  the  infectious  substances  should  be  destroyed  or 
at  least  propagation  of  the  infection  should  be  prevented. 

This  can  be  accomplished  by  the  destruction  of,  or  by 
rendering  harmless  all  products  and  excretions  of  the  affected 
animals  and  carcasses.  The  safest  method  for  the  destruction 
of  the  infectious  material  is  by  burning  or  rendering  (steaming 
the  carcasses  under  high  atmospheric  pressure  should  be  eni^ 
ployed  to  the  greatest  extent  possible  owing  to  the  advantages 
afforded  by  this  method).  When  this  is  impossible  the  carcasses 
should  be  buried  at  least  2  meters  deep  in  out-of-the-way, 
fenced-off  places.  They  should  also  be  covered  with  disin- 
fectants, preferably  powdered  unslaked  lime.  The  stalls  oc- 
cupied by  the  affected  animals  should  be  thoroughly  disinfected. 
All  food  and  straw  that  has  come  in  contact  with 'affected  ani- 
mals or  their  carcasses,  or  which  has  been  contaminated  by 
their  excrement  or  blood  should  also  be  burned. 

In  common  practice  the  best  disinfectants  are  boiling  water  and  steam  0  1% 
corrosive  su1)Iimate,  5%  carbolic  acid,  creolin  or  lysol  solutions;  also  formalin 
vapors.  However,  it  is  necessary  for  these  substances  to  remain  in  i.rolon.'od  con- 
tact with  the  material  to  be  disinfected  owing  to  the  great  and  variable  teiiacitv  of 
the  anthrax  spores. 

According  to  Grossenthaler  peat  possesses  disinfecting  qualities  on  account  of 
the  ulnic  acid  it  contains,  and  this  action  may  be  increased  bv  the  addition  of  3% 
sulphuric  acid.  Hi<les  may  be  disinfected  with  5%  creolin  or  lysol,  but  this 
method  is  only  absolutely  successful  when  emploved  within  two  hours  after  the 
death  of  the  animal  (Lignieres  &  Zabala),  otherwise  it  frequentlv  fails.  As  a 
niatter  of  fact  at  the  present  time  there  is  no  method  known  for  an  effective  dis- 
infection of  hides  without  injuring  them  for  their  technical  utilisation  (Xylander). 
Brekle  believes  that  the  question  may  be  solved  bv  subjecting  the  spore-containing 
hi.les  in  a  moist  condition  to  a  temperature  of  43-44°C.',  bv  which  all  spores  would 
germinate  and  the  hides  accordingly  would  contain  onlv  sporeless  bacilli  which 
could  be  destroyed  with  milk  of  lime.  Horse  hair  is  effectively  disinfected  bv  dry 
heat  at  110°C.  followe<l  by  steam  at  100°(;.   (deRossi;  see  also  page  5). 

^The  officially  required  disinfection  of  railroad  stock  cars  in  Germany  with 
59^  "Kresulfol"  (cresol-sulfonic  acid)  was  found  bv  Schuiirer  to  be  absolutely 
ineffective  against  anthrax  spores,  and  he  recommended  instead  the  disinfection 
with  ^%  formaldehyde  solution. 

When  the  disease  appears  careful  search  should  ])e  made 
for  the  source  of  the  infection  (origin  of  food,  drying  of  hides 
in  the  hay  loft,  or  in  the  stable,  etc.).  If  suspicion  is  directed 
to  the  forage  from  certain  fields  or  meadows  this  supply  should 
not  be  fed,  at  least  not  while  the  animals  are  suscepti])le  to 
the  disease.    Should  the  disease  occur  in  a  pasture  the  healthy 


24  Anthrax. 

animals  should  be  removed  to  another  hig-her  and  dryer  place. 
When  necessary  they  should  be  stabled.  Not  infrequently  a 
careful  investigation  of  the  pasture  will  disclose  dangerous 
places  from  which  the  animals  should  be  kept.  In  other  cases 
it  is  possible  to  suppress  an  outbreak  by  the  exclusion  of  pol- 
luted, muddy  watering  places.  In  suspected  places  the  danger- 
ous character  of  the  soil  may  be  eliminated  by  draining  and 
cultivation. 

If  under  existing  circumstances  the  danger  of  infection 
cannot  be  excluded,  and  the  presence  of  a  threatening  infec- 
tion exists,  it  is  advisable  to  reduce  the  natural  susceptibility 
of  the  animals  by  protective  inoculations  thereby  protecting 
them  from  the  danger  of  infection. 

Immunization.  Domestic  animals  may  be  immunized  in 
practice  by  attenuated  living  cultures  of  the  bacilli,  by  spore- 
containing  cultures,  by  immune  serum,  and  finally  by  immune 
serum  and  living  cultures. 

I.  Immunization  with  attenuated  cultures  (Pasteur's 
method).  In  1881  Pasteur  established  by  conclusive  experi- 
ments that  anthrax  bacilli,  when  subjected  to  a  temperature 
of  42-43 °C.,  will  continue  for  a  time  to  multiply  actively  and 
no  longer  form  spores.  He  further  found  that  in  such  cultures 
the  bacilli  die  in  about  a  month,  but  that  in  the  meantime  their 
virulence  decreases  gradually,  and  finally  he  proved  that  the 
bacilli,  when  attenuated  to  a  certain  degree,  will  retain  this 
degree  of  virulence  if  their  cultivation  is  continued  at  body 
or  room  temperature.  On  this  experimental  observation  is 
based  the  practical  method  of  protective  inoculation  worked  out 
by  Pasteur  with  the  co-operation  of  Roux  and  Chamberland. 

The  vaccine  is  prepared  by  growing  the  anthrax  bacilli  in  bouillon 
at  a  temperature  of  42.5 °C.  The  cultures  which  are  at  first  fatal  for 
rabbits,  guinea  pigs  and  mice  are,  after  12  days'  growth  at  the  above 
temperature,  attenuated  to  such  degree  that  they  are  only  exception- 
ally fatal  to  ral)bits.  After  an  additional  12  days  the  culture  kills 
only  young  guinea  pigs  and  mice.  After  the  virulence  of  the  culture 
has  been  attenuated  to  these  degrees  their  cultivation  is  continued  at 
35-37 °C.  With  such  stock  cultures  fresh  bouillon  cultures  are  inocu- 
lated, and  in  this  manner  the  vaccine  is  prepared  in  any  desired  quantity. 

The  more  attenuated  culture  represents  Pasteur's  first, 
the  weaker  vaccine,  while  the  less  attenuated  is  the  second  or 
stronger  vaccine  (premier  et  deuxieme  vaccin).  The  protective 
inoculation  is  carried  out  by  first  injecting  subcutaneously  the 
weaker,  followed  in  10  to  12  days  by  an  injection  of  the  stronger 
vaccine.  The  immunization  is  based  on  the  principle  that  the 
first  inoculation  reduces  the  natural  susceptibility  of  the  animal 
to  such  an  extent,  without  endangering  life,  that  it  withstands 


Iiiuiiuiiizatiiiii.      I'astcui's  ^lelliud.  25 

witlioiit  injury  tlic  socoiid  inociilatioii  witli  the  sli-oii2^or  vaccine, 
AVitliout  tlie  lirst  injection  tiic  second  inoculation  would  prob- 
ably prove  fatal,  while  the  two  inoculations  confer  the  neces- 
sary innnnnity  ni)on  the  animals. 

The  results  of  the  vaccination  are  in  general  satisfactory 
in  view  of  the  experience  ol)tained  from  a  large  number  of 
cases.  Some  of  the  imnnmized  animals  do  not  resist  an  artificial 
infection  by  feeding  repeated  large  quantities  of  spores  (in 
Koch's  exi)erinients  2  out  of  10  slice})  died  after  feeding  them 
for  days  with  virulent  spores  in  quantities  of  the  size  of  a 
hazelnut).  These  are  exceptions  which  have  no  influence  on 
the  practical  value  of  vaccination,  inasmuch  as  under  natural 
conditions  the  intensity  of  the  infection  is  far  below  the  amount 
given  in  these  artificial  infections.  AVhere  vaccination  is  prac- 
ticed in  large  herds  the  losses  from  anthrax  in  the  year  follow- 
ing are  in  general  greatly  reduced  compared  with  periods  in 
which  the  animals  were  not  vaccinated.  In  numerous  localities 
where  the  disease  raged  regularly  year  after  j-ear  it  has  almost 
entirely  vanished  as  a  result  of  vaccination  of  the  animals. 
Not  infrequently  vaccination  immediately  checks  the  spread  of 
the  disease  in  a  herd. 

The  immunity  reaches  the  necessary  degree  in  about  10 
to  12  days  after  the  second  inoculation,  and  lasts  about  one 
year.  (In  the  experiments  of  Azary  vaccinated  sheep  resisted 
the  artificial  infection  even  after  8  months.)  A  longer  duration 
of  the  artificially  produced  immunity  is  doubtful,  and  there- 
fore a  repetition  of  the  vaccination  is  indicated  annually  in 
pronounced  anthrax  districts.  The  breed,  age  and  sex  of  the 
animals  do  not  appear  to  influence  the  results  of  the  vaccination, 
and  young  animals  which  were  only  shortly  weaned  may  also 
be  vaccinated  without  danger  and  with  promising  results. 

Pasteur's  protective  vaccination  is  therefore  indicated  in 
all  places  where  the  annual  losses  from  anthrax  exceed  the 
cost  of  the  vaccination. 

The  effectiveness  of  the  vaccination  has  been  proved  by  Pasteur 
beyond  a  doul)t  through  control  experiments  which  he  carried  out  be- 
fore a  commission  appointed  for  this  purpose  in  1881  at  Ponilly-le- 
Fort.  Of  50  sheep  25  were  regularly  vaccinated  with  his  two  vaccines 
and  14  days  after  the  second  vaccination  they  were  inoculated  with 
anthrax  material,  together  with  the  25  control  animals.  The  results 
showed  that  inside  of  2  days  all  of  the  25  control  animals  died  of  anthrax, 
while  all  of  the  25  vaccinated  sheep  remained  alive. 

Up  to  the  end  of  the  year  ISOO,  70S,0S0  cattle  and  4,971,404  sheep  had  been 
var-einated  successfully  in  France,  as  a  result  of  which  the  entire  annual  loss  over  a 
period  of  12  years  dropped  to  an  average  of  0.34%  in  cattle  and  to  0.94%  in  sheep. 

In  Hungjary  the  first  vaccinations  were  carried  out  in  1881  on  Ayary's  initia- 
tive. Thuillier,  Pasteur's  assistant,  applied  them  first  at  the  Veterinary  Institute 
at  Budapest  with  very  favorable  results,  while  the  later  ones  in  Kapuvar  were  less 
favoralile.  As  vaccination  gave  very  f^ood  results  in  practice,  this  jirotective  treat- 
ment was  soon  taken  up  very  extensively.  During  the  period  of  15  years  between 
1886  and  1900,  53,843  horses,  1,015,700  cattle  and  2,279,221  sheep  were  vaccinated. 


26  Anthrax. 

The  official  report  contains  tlie  results  on  39,506  horses,  718,266  cattle  and  1,247,331 

sheep,  and   according  to  its  statements  the  percentage  of  vaccinated  animals  given 
below  died  of  anthrax : 

Horses.  Cattle.  Sheep. 

After   the   first   vaccination 0.10%  0.02%  0.26% 

In  the  course  of  following  years 0.09%  0.02%  0.33% 


Total .      0.19%  0.04%,  0.59% 

In  Germany  the  results  were  at  first  less  favorable  (in  Tackish  during  the 
period  1882  to  1888  the  entire  loss  of  vaccinated  cattle  amounted  to  3.1%  and  of 
vaccinated  sheep  2.8%).  Later,  particularly  in  Wiirttemberg  and  Alsace-Lorraine, 
the  results  were  more  satisfactory.  Since  1900  in  the  vicinity  of  Magdeburg  over 
2,000  cattle,  mostly  draft  oxen,  have  been  vaccinated  annually  with  uniforndy  good 
results,  and  since  that  time  the  previously  frequent  intestinal  catarrhs  (slight  anthrax 
infections?)  are  no  longer  observed   (Jungklaus). 

In  Austria  vaccination  was  carried  out  on  9,456  fattening  cattle  with  complete 
success  during  the  period  between  1894  and  1898.  It  was  observed,  however,  that 
the  vaccination  of  such  animals  during  the  summer  months  caused  a  severe  reaction. 

In  Eussia  vaccination  has  also  been  followed  by  uniforndy  good  results,  with 
the  exception  of  the  fatal  vaccination  in  the  Crimea  (1888),  which  was  supposed  to 
be  due  to  an  error  in  the  vaccines,  in  which  instance  4,564  sheep  were  vaccinated 
and  3,478  died  in  the  course  of  a  few  days.  The  total  loss  in  the  district  of  Cherson, 
in  which  20,000  sheep  were  vaccinated  during  the  years  1885-1888,  amounted  to 
0.87%  compared  with  previous  losses  of  10%  to  33%  in  former  years  (Wysokowicz). 

Similar  good  results  followed  vaccinations  in  Holland  (Wirtz),  in  Switzer- 
land  (Hess),  as  well  as  in  America  (Dalrymple),  and  Australia. 

Direct  results  from  the  vaccination.  In  the  vaccinated  animals  a  slight 
elevation  of  temperature  is  observed  as  a  rule  in  2  to  5  days,  which,  however,  is 
rarely  accompanied  by  perceptible  disturbances  in  the  general  health.  Not  infre- 
quently in  cattle  an  extensive  subcutaneous  edema  develops  in  the  vicinity  of  tlie 
point  of  inoculation,  which,  however,  disappears  in  1  to  3  days,  especially  if  cold 
applications  are  made.  Exceptionally,  pregnant  animals  abort  or  give  premature 
birth.  In  milk  cows  a  diminished  quantity  of  milk  may  be  observed.  Anthrax 
bacilli,  however,  do  not  pass  into  the  milk  as  a  result  of  the  Vaccination  (Nekljudow). 

Fatal  results  may  sometimes  follow  even  when  the  vaccination  is  carried  out 
correctly,  with  faultless  vaccine,  prol  ably  as  a  res-ult  of  the  low  individual  resist- 
ance of  the  animal.  In  several  instances  of  this  kind  numerous  losses  were  observed. 
Thus,  excepting  the  case  mentioned  in  the  Crimea  after  the  first  vaccination  in  1889 
of  1,383  sheep  in  the  Hungarian  township  of  Lukacs,  77  sheep  and  44  lambs  died 
of  anthrax,  and  in  Guta  in  1893  out  of  1,564  vaccinated  horses  72  died  within  2 
weeks  after  the  first  vaccination.  The  autopsies  in  this  case  revealed  a  septicemic 
complication  in  the  form  of  a  suppurative  inflammation  of  the  serous  membranes, 
and  a  necrosis  of  the  muscles  at  the  ])olnt  of  inoculation,  which  was  caused  by  a 
rod-shaped  bacterium  (Preisz).  In  Fokto,  of  680  horses  38  died  in  1896  of  anthrax 
in  two  weeks  following  vaccination.  In  this  case  the  i>ost  mortem  revealed  a  severe 
intoxication  and  anthrax  bacili  in  association  with  other  bacilli  were  found  exclu- 
sively in  the  edematous  swellings  at  the  point  of  inoculation  (Preisz).  In  the 
vicinity  of  Debreczen,  of  30  horses  vaccinated  in  1902  with  vaccine  prepared  for 
cattle,  9  became  severely  affected,  6  of  which  died  of  anthrax.  In  Austria,  316 
cattle  were  vaccinated  in  the  township  of  Storozynetz  (Bukowina)  in  1893,  and 
among  these  265  were  fattening  cattle.  On  the  day  following  all  animals  mani- 
fested fever,  dyspnea,  bloody,  foamy  discharge  from  the  nose  and  rectum,  and  24 
died  inside  of  a  few  hours  from  peracute  anthrax. 

In  cases  in  which  the  vaccine  acted  too  severely  the  indication  appears  inside 
of  a  week  following  the  first,  or  more  frequently  the  second  vaccination  in  which 
a  marked  edema  develops  from  the  point  of  inoculation  followed  by  a  general  infec- 
tion and  the  usual  post  mortem  lesions  of  anthrax.  In  some  cases  the  animals  do 
not  become  visibly  affected  until  after  three  weeks  of  incubation,  in  the  meantime 
manifesting  a  disturbed  appetite,  finally  succumbing  to  cachexia,  which  points  to  a 
chronic  intoxication.  After  the  vaccination  of  already  infected  herds  the  occur- 
rence of  deaths  may  be  the  result  of  latent  infection  (see  page  8)  as  in  these 
bacilli  carriers  the  resistance  may  possibly  be  reduced  by  the  vaccination. 

The  attenuated  bacilli  contained  in  the  vaccine  retain  their  cultural  charac- 
teristics in  the  body  of  the  vaccinated  animal   (according  to  Preisz  they  form  soft, 


liiiiiiiui  i/.;it  ioii    with    Sjunc-cdiitiiiii  iiii;    \  jicciiics.  27 

rapidly  liqiiefj'iiifi;  capsulos)  as  well  as  their  rcdiieetl  virulence,  which  rannot  reailily 
be  increased  even  it'  passed  through  guinea  pigs  (Ascoli). 

Technic  of  vaccination.  The  vaccine  prepared  by  the  ' '  Institut  Pasteur ' '  or 
by  the  "  Laboratoires  I'asteurChanibcrland "  which  are  established  in  the  various 
countries,  is  marketed  in  small  bottles  closed  with  rubber  stoppers.  The  vaccine  is 
drawn  up  into  a  steriiiyed  syringe  of  about  1  cc.  capacity,  the  plunger  of  which  is 
graduate*!  into  8  parts,  and  sheep,  calves  and  foals  arc  injected  subcutaneously  with 
Yn  of  the  contained  vaccine,  while  mature  cattle  and  horses  receive  Vi  (about  0.12 
and  0.2,5  cc).  The  injections  are  made  in  sheep  on  the  inner  surface  of  the  thigh; 
in  cattle  posteriorly  to  the  shoulder;  in  horses  on  the  side  of  the  neck.  Prior  to 
the  injection  the  site  should  lie  cliji])ed  and  carefully  disinfected.  Twelve  <lays  fol- 
lowing the  first  vaccination  the  second  injection  is  made  at  the  corresponding  place 
on  the  opposite  side  of  the  body. 

The  vaccine  retains  its  jiotency  for  several  days  when  kept  in  a  dark  and 
moderately  cool  place.  Its  eftVctiveness,  however,  is  change<l  in  time,  it  should 
therefore  be  fresh,  and  the  contents  of  an  opened  tul  e  should  be  used  up  by  all 
means  on  the  same  day.  Good  vaccine  when  shaken  is  oidy  very  slightly  cloudy, 
rather  ojialescent ;  more  pronounced  cloudiness  is  an  indication  of  deterioration 
(contamination  with  foreign  bacteria),  and  such  vaccine  should  not  be  used  under 
any  circumstances.  The  vaccine  is  prepared  in  a  somewhat  different  way  for  the 
various  sjiecies  of  animals,  and  therefore  vaccine  for  a  specified  species  should  be 
used.  This  is  particularly  applicable  in  the  vaccination  of  horses  (in  horses,  a  mix- 
ture of  the  first  and  sei'oud  vaccine  of  cattle  is  used  for  the  second  vaccine,  and  is 
therefore  less  severe  than  the  second  vaccine  for  cattle  auil  shee])).  The  best  time 
for  vaccination  is  the  spring,  as  anthrax  usually  occurs  during  tlio  summer  months, 
and  an  attempt  should  therefore  be  made  to  establish  an  immunity  of  the  susceptible 
animals  shortly  before  the  period  of  danger. 

Results  obtained  from  the  use  of  contaminated  and  ineffective  vaccines  pre- 
pared by  the  various  laboratories  indicate  that  ollicial  control  is  urgently  desirable. 

Bad  results  from  vaccination  cannot  be  excluded  with  certainty.  On  the  one 
hand  they  may  be  due  to  the  uncertainty  of  the  degree  of  virulence  and  purity  of 
the  vaccine,  while  on  the  other  hand  the  variance  in  the  individual  resistance  and 
susceptibility  of  the  animals  must  be  taken  into  consideration;  and  the  veterinarian 
making  the  vaccinations  is  unable  to  judge  these  factors.  Therefore  owners  of 
animals  should  be  informed  beforehand  of  the  possible  dangers.  Errors  com- 
mitted during  vaccination,  esi)ecially  neglect  in  the  required  cleanliness,  may  nat- 
urally endanger  the  results,  as  in  such  procedures  other  pathogenic  bacteria  may 
enter  the  body  and  produce  a  passing  or  fatal  disease.  During  the  days  immedi- 
ately following  vaccination  the  animals  should  be  fed  regularly  and  should  not  le 
exposed  to  cold  or  heat,  or  overtaxed  by  hard  work.  As  they  are  particularly  sus- 
ceptible to  the  infection  during  this  time  (negative  phase)  they  should  be  kept 
from  suspected  pastures. 

II.  Immunization  with  Spore-containing-  Vaccines.  Cien- 
kowsky  (1S84)  in  Cliarkow  produced  two  vaeeiiies  by  atteiina- 
tion  of  living  cultures  at  higher  temperatures,  the  weaker  of 
wliich  kills  the  mouse  and  the  earless  marmot,  but  not  the  ral)bit 
and  sheep,  while  the  stronger  kills  30  to  50%  of  rabl)its,  and 
10  to  20%  of  sheep.  The  cultivation  of  the  attenuated  cultures 
is  then  continued  in  bouillon  at  body  temperatures  until  an 
abundance  of  spores  are  formed,  when  it  is  mixed  with  two 
parts  of  glycerin  and  placed  in  stock.  Before  the  vaccination 
fresh  cultures  are  made  from  the  spore-containing  fluid,  and 
with  these  the  animals  are  injected  (Gordzialkowsky)  or  the 
spore-containing  fluid  itself  is  employed  for  the  vaccination. 

According  to  Rajewsky  the  fluid  containing  the  bacilli  and  spores  remains 
effective  for  a  longer  time  in  a  cool,  dark  ])lace.  Otherwise  both  in  the  technique 
as  well  as  the  valuation  of  this  form  of  vaccination  the  same  rules  are  followed  as  in 
Pasteur's  method.  The  dose  of  the  vaccine  consists  of  0.1  cc.  for  sheej),  and  0.2  cc. 
for  larger  animals.  The  animals  usually  stand  the  vaccination  well,  but  disagree- 
able accidents  are  not  totally  excluded.     Thus,   100  cattle  were  vaccinated  in   1902 


28  Anthrax. 

in  one  estate  and  in  three  weeks '  time  -44  became  affected  with  anthrax,  35  dying 
of  the  disease. 

Satisfactory  results  are  obtained  in  many  places  with  spore-eoutaiuing  vaccine. 
This  method  was  also  employed  several  years  ago  in  Hungary  (according  to  Detre, 
with  vaccines  which  he  prepared  by  washing  old  agar  cultures  with  a  salt-glycerin- 
water  mixture).  In  1901  to  1902  the  losses  amounted,  according  to  Detre 's  esti- 
mate, to  0.26%  in  horses,  0.03%  in  cattle  and  0.12%  in  sheep. 

According  to  a  report  of  the  Veterinary  Institute  at  Charkow,  Eussia,  5,584 
horses,  19,572  cattle  and  174,172  sheep  were  vaccinated  in  1897  in  the  southwestern 
part  of  Eussia  with  losses  of  0.25,  0.09  and  0.35%  respectively.  In  Eussia  a  method 
of  vaccination  originated  by  Lange  is  also  used.  The  preparation  of  this  vaccine, 
however,  is  unknown. 

According  to  Beinarowitsch  the  direct  loss  in  reindeer  from  vaccination 
amounts  to  1%. 

III.  Immunization  with  Immune  Serum.  If  animals  sus- 
ceptible to  anthrax  are  injected  with  increasing  doses  first  of 
attenuated  and  later  of  fully  virulent  anthrax  cultures,  they 
will  after  a  certain  time  produce  a  serum,  which,  while  possess- 
ing no  direct  bactericidal  action,  protects  rabbits,  guinea  pigs 
and  sheep  against  a  fatal  infection.  If  injected  shortly  after 
the  infection  such  serum  even  prevents  the  development  of 
the  disease.  Such  immune  serum  also  renders  good  service  in 
practice,  especially  in  cases  in  which  infection  threatens,  or 
where  anthrax  has  already  appeared  in  a  herd.  The  action  of 
the  injected  serum  becomes  effective  in  the  course  of  a  few 
hours.  However,  the  established  passive  immunity  is  only  of  a 
short  duration,  lasting  only  from  1  to  2  weeks.  It  is  therefore 
advisable  in  cases  of  continued  danger  of  infection  to  render 
the  animals  actively  immune.  This  may  be  accomplished  by 
a  subsequent  regular  vaccination  with  attenuated  cultures  by 
one  of  the  above  described  methods. 

Potent  anthrax  serum  was  first  prepared  from  sheep  by  Marchoux,  and  als-o 
by  Sclavo  almost  at  the  same  time,  in  1S95.  Later  Sobernheim,  Memlez,  Detre, 
Carini  and  Ascoli  carried  on  investigations  along  this  line,  but  they  employed  large 
animals,  especially  horses,  for  this  purpose.  This  method  was  also  followed  by 
Sclavo.  The  horses  withstand  after  a  certain  time  an  intravenous  injection  of 
500  cc,  and  even  more  of  a  virulent  culture;  and  they  produce  a  very  potent  serum. 
Of  Sclavo 's  serum  0.5  cc.  protects  a  rabbit  and  from  5  to  10  cc.  protect  a  sheep 
against  a  fatal  infection.  Detre 's  serum  has  a  similar  etfect  on  rabbits,  while  from 
3  to  5  cc.  will  protect  a  guinea  pig  against  an  intraperitoneal  infection,  which  is 
ordinarily  fatal  in  from  1  to  l^/^  days.  Iti  the  experiments  of  Sobernheim,  of  whose 
serum  2  cc.  protects  rabbits  against  1/1000  of  a  loopful  of  a  virulent  culture,  the 
serum  proved  a  protective  agent  even  against  the  feeding  of  anthrax  spores.  San- 
felice  prepared  a  serum  by  immunizing  dogs,  and  3.5  cc.  of  this  serum  per  kilo 
weight  had  a  protective  effect,  while  7  cc.  had  a  curative  effect  on  rabbits  even  when 
administered  40  hours  after  the  infection. 

In  practice  the  dose  for  large  animals  consists  of  10  to  20  cc,  while  for  small 
animals  it  is  5  cc.  Soliernheim  uses  a  mixed  serum  which  is  olitained  from  cattle, 
horses  and  sheep ;  Sclavo  obtained  it  from  asses.  Even  when  exposed  to  the  harm- 
ful influences  of  light  and  air  the  serum  retains  its  potency  for  2i^  years  (Sobern- 
heim). 

In  already  infected  herds  the  spread  of  the  outbreak  may  be  checked  by  treat- 
ing only  those  animals  with  serum  in  which  a  rise  in  temperature  is  observed;  the 
temperature  of  all  animals  being  taken  twice  daily  (Keleti).  Of  course,  if  fever 
is  present  the  serum  should  be  used  in  correspomlingly  higher  doses,  and  the  injec- 
tions should  be  repeated  until  a  drop  in  the  temperature  is  noticed. 

In  some  cases  after  the  administration  of  the  serum,  anaphylactic  symptoTus 
appear.     These  occur  in  from   5  to  20   minutes,  and  are  manifested  by  edematous 


Iniimuiizatioii   willi   liiujiuiie  Seruiii.  29 

swellings  of  the  head,  at  the  point  of  inoculation  and  other  parts  of  the  body. 
Nodular  eruptions  resoiuhlinjj  urticaria,  frothy  diseharf^e  from  the  mouth,  snorting, 
roddening  and  swelling  of  the  mucous  memhraiies,  uneasiness,  and  in  cattle  Moat- 
ing, may  also  lie  oliserved.  Kovarzik  observed  these  symptoms  in  two  herds  in  about 
-0%  of  the  inoculated  cattle,  among  which  the  two  showing  the  strongest  reactions 
ilied  from  asphyxiation.  Inasmuch  as  the  reaction  appears  well  y)ronounced  in 
animals  that  were  especially  exposed  to  the  danger  of  infection,  Kovarzik  and  also 
Zimmer,  from  his  experience  in  horses,  are  inclined  to  believe  that  such  an  alleetion 
is  a  reaction,  imlicating  an  already  existing  latent  infection  (anaphylaxis  due  to 
proteids  of  the  bacilli  which  circulate  in  the  blooil  of  the  latent  infecte<l  animals, 
against  the  analagous  jjroteid  contained  in  the  immune  serum). 

IV.     Immunization   with   Immune    Serum   and   Cultures 

(Sol)eriilieiiii's  Jiietliod).  Soheniheiiii  (1902)  roeoinineiRls  for 
a  lasting,  combined,  passive  and  active  immunization  of  do- 
mestic animals  a  simultaneous  vaccination  witli  serum  and 
antlirax  cultures  (cattle  and  horses  are  injected  on  one  side 
of  the  body  with  5.0  cc, ;  calves  with  3.0  to  5.0  cc,  and  sheep 
with  4.0  cc.  of  an  immune  serum;  and  five  minutes  later,  tiiey 
are  injected  on  the  opposite  side  with  0.5  or  0.25  cc.  of  an 
attenuated  culture,  washed  in  salt  solution,  the  deo-ree  of  viru- 
lence of  which  corresponds  with  Pasteur's  second  vaccine). 
This  method  has  the  great  advantage  of  requiring  only  a  single 
treatment  of  the  animals,  and  the  results  obtained  from  it  are, 
with  the  exception  of  a  few  failures,  quite  satisfactory.  Svarde 
(1906)  however,  claims  that  the  superiority  of  this  method 
over  Pasteur's  has  not  been  established. 

After  vaccination  there  is  usually  a  moderate  elevation  in  tem- 
perature of  0.5  to  1.0°C.,  slightly  diminished  appetite  and  milk  secre- 
tion. A  swelling  often  occurs  at  the  place  of  inoculation.  The  nasal 
mucous  membrane  may  be  swollen,  and  an  exanthema  resembling  urti- 
caria may  be  observed.  Occasionally  the  vaccination  results  in  the  death 
of  the  animal  (most  often  observed  in  work  oxen). 

In  Argentine  and  Uruguay  this  method  of  vaccination  was  employed  from  the 
spring  of  1904  to  September,  1905,  on  140,000  cattle,  30,000  sheep  and  "2,000  horses. 
According  to  Sobernheim  no  fatalities  resulted  from  the  vaccination,  and  almost 
everywhere  a  complete  eradication,  or  at  least  a  marked  restriction  of  anthrax 
was  noted. 

In  Germany,  according  to  Sobernheim 's  statistics,  up  to  the  year  of  1900  about 
4,500  cattle  and  sheep  were  successfully  vaccinated.  Raebiger  &  Johnk  reported 
very  satisfactory  results,  although  some  failures  were  also  observed  by  them.  Accord- 
ing to  other  reports,  however,  the  results  appeared  unfavorable.  Thus,  according 
to  Bnrow,  of  5,000  cattle  vaccinated  by  this  method  in  Ponunern,  8  (0.15%)  died 
as  a  result  of  the  vaccination;  besides,  from  4  to  7  weeks  later  8  (0.08%)  additional 
deaths  resulted  from  anthrax.  In  one  instance,  of  39  vaccinated  cattle,  3  died;  in 
another  case,  of  137  cattle,  37  showed  indications  of  anthrax  inside  of  5  days  of 
which  8  died  (Heine).  Unsatisfactory  results  are  further  reported  by  Hummel 
(losses  from  vaccination,  139  sheep)  and  Lothes  (of  78  cattle,  2  deaths,'  17  severe 
atfections,  marked  diminution  in  nnlk  secretion  in  cows). 

V.  Other  Methods  of  Vaccination.  Previous  to  the  experi- 
ments of  Pasteur,  Toussaint  (1880)  vaccinated  Avith  anthrax  ])lood 
heated  for  10  minutes  at  5r)°C.,  or  mixed  with  1%  carl)olic  acid. 

Chauveau  (1883)  prepared  a  vaccine  by  heating  ]>ouillon  cultures 
Mhich  were  grown  at  42.5  to  47°C.,  then  kept  at  'MC.  until  spore- 
formation,  and  finally  heated  to  80-84° C.     Other  vaccines  were  made 


30  Anthrax. 

by  subjecting  the  spores  to  a  pressure  of  approximately  8  atmospheres, 
also  by  growing  the  virus  in  pure  oxygen  and  under  pressure  of  21/2 
atmospheres. 

According  to  Sobernheini,  Chauveau 's  method  of  ininniiiization  is  used  in 
Chile,  where  80,001)  to  85,000  animals  are  vaccinated  annually  by  that  method;  the 
results  are  indicated  as  being  favorable  in  cattle,  but  only  fairly  good  among  sheep. 

According  to  Chamberland  &  Roux,  the  action  of  a  mild  solution 
of  carbolic  acid  (1:600)  on  anthrax  bacilli  for  24  days  will  attenuate 
them  to  such  an  extent  that  they  represent  protective  vaccines.  The 
same  result  is  obtained  by  the  action  of  bichromate  of  potassium 
(1 :2000-5000)  for  10  days,  and  according  to  Gibier  by  cooling  to  -45° C, 
whereas  Murillo  prepares  a  vaccine  which  is  also  supposed  to  be  satis- 
factory in  practice  by  growing  the  culture  alternately  in  diphtheria 
toxin  and  in  bouillon. 

Arloing,  and  also  Hankins  succeeded  in  immunizing  test  animals 
wdtli  bacteria-free  filtrates  of  culture.  Similar  results  were  obtained 
by  Ogata  &  Jasuhara  with  a  ferment  from  the  blood  serum  of  anthrax 
animals.  Aujeszky  also  succeeded  with  a  mixture  of  anthrax  bacilli 
and  spleen  tissue,  and  also  with  the  spleen  pulp  alone.  According  to 
Emmerich,  Pawlowsky,  Bouchard,  Gilruth  and  others,  an  immuniza- 
tion is  possible  by  the  treatment  with  organisms  w'hich  are  antagonistic 
to  the  anthrax  bacillus  (  see  page  6). 

Finally,  Bail  (1904)  used  for  the  immunization  the  sterilized 
edema  fluid  of  anthrax  animals.  He  presumed  that  the  aggressins 
(lysins  in  the  sense  of  Kruse)  of  the  anthrax  baillus,  which  are  present 
in  the  edematous  fluid,  favor  the  development  of  the  pathogenicity  of 
the  bacillus,  and  if  injected  into  an  animal  they  would  stimulate  the 
production  of  antiaggressins  which  would  protect  the  animal  against 
a  bacillary  infection.  Sheep  which  received  2.5-10  cc.  of  such  edema 
fluid  su])cutaneously  developed  an  immunity  even  against  severe  sub- 
cutaneous infection  with  bacilli  in  from  8  to  10  days.  If,  however,  a 
certain  quantity  of  the  edema  fluid  is  exceeded  the  body  is  unable  to 
use  it  up,  and  because  of  the  increased  aggressins  present  a  hypersensi- 
tiveness  to  infection  develops.  This  method  has  not  yet  been  tried  in 
practice. 

Veterinary  Police.  The  veterinary  police  regulations  refer 
in  the  first  place  to  the  harmless  disposition  and  destruction 
of  all  excrements  of  anthrax  animals,  and  to  the  cremation, 
rendering-  or  deep  burying  of  tlieir  carcasses.  Diseased  animals 
should  be  kept  separated  from  healthy  ones,  and  tlieir  stalls 
should  1)6  disinfected.  The  food  and  straw  which  liave  come 
in  direct  contact  with  affected  animals  should  be  rendered 
harmless;  meat,  milk  and  raw  products  in  general  (also  hides) 
of  affected  animals  should  not  be  permitted  to  enter  the  trade. 
On  the  otlier  hand,  quarantine  restrictions  for  healthy  animals 
with  the  exception  of  severe  outbreaks  do  not  appear  justified 
as  the  disease  is  not  directly  contagious. 

Literature.  Gerlaeh,  Mag.,  1845,  XT,  113;  1846,  XII,  321.— Heusino-er,  D.  Milz- 
brandkrkh.  d.  Tiere  u.  d.  Menschen,  Erlangen,  1850  (Old  Lit.).^ — Pollender,  Viertel- 
jsehr.  f.  ger.  Med.,  1855,  102.— Brauell,  V.  A.,  1857,  XI,  131.  Davaine,  G.  E.,  1863, 
LVII,  320;   1864,  LIX,  393.— Bollinger,  Beitr.  2.  vergl.  Path.,  1872,   122;   D.  Z.  f. 


Anthrax    in    Man.  3X 

Till.,  1885,  XT,  100.— Koch,  Beitr.  7.  Biol.  <1.  Pflaiizcn,  lS7fi;  TT;  Mitt.  d.  G.-A.,  1881, 
1,  49.— Pasieur,  C  K.,  li<77,  LXXXIV  \i.  LXXXV.— Pasteur,  ChamherlaiKl  &  Koux, 
C.  K.,  ISM),  XL'  u.  XCI;  1881,  XCl  I.— Oeiiiior,  A.  f.  Tk.,  ISOd,  VI,  401.— Kodi.  Mitt, 
d.  G.-A.  ISSl,  I,  i;?4;  1884,  II,  Kil.— Liilller,  lliid.,  p.  4!).— Koux  &  Ciiaiiiherian.l, 
A.  P.  1887,  I,  51.S;  1888,  IT,  405.— Kitt,  Moiih.,  1S!)4,  V,  215  (Keview  on  diatiiiosis). 
— Selavo,  (Jbl.  f.  B.,  1895,  XVIII,  744.— Sobernlieim,  Z.  f.  Hyg.,  1897,  XXIV,  3U1; 
Hl>.  f.  p.  M.,  1904,  III;  1904,  IV,  793  (Lit.  on  etiol.  and  vaccination).— ("onradi, 
Z.  f.  Hvg.,  1899,  XXXI,  323  (Lit.  on  toxins).— Bonyert,  Cbl.  f.  B.,  1903,  XXXIV, 
497.— Pieisz,  Cbl.  f.  B.,  1904,  XXXV,  280;  1907,  XLIV,  209;  1909,  XLIX,  341.— 
Ernst,  Monh.,  1905,  XVI  I,  172  (Lit.  on  diag.  niotii.).— OppiMiiianii,  A.  f.  Tk.,  1905, 
XXXII,  41  (Lit.).— Gruber  &  Futaki,  M.  m.  W.,  19o7,  249;  I),  in.  W.,  1907,  1558.— 
Wvssniann,  Schw.  A.,  1907,  XLIX,  2S7  (I.,it.  on  anthrax  in  liojis). — Xvlander,  Arb. 
d.  G.-A.,  1907,  XXV,  457.— Fischoeder,  Cbl.  f.  B.,  1909,  LI,  320  (Lit.  on  capsule 
formation). — Hoppe,  Diss.,  Leipsic,  1909   (Lit.  on  pseudo-anthrax  bacilli). 


Anthrax  in  Man.  Anthrax  in  man  usually  occurs  as  a  local 
affection  of  the  skin  and  subcutaneous  tissue  (carbuncle,  pustula 
maligna,  carbunculus  malignus)  as  a  result  of  skin  infections.  There- 
fore it  is  chiefly  persons  who  come  in  contact  Avitli  diseased  or  dead 
animals  Avho  become  affected.  The  persons  who  most  commonly  receive 
accidental  infections  are  veterinarians,  herders,  butchers  and  laliorers 
who  work  on  hides,  haii-,  liristles  and  wool.  In  these  forms  of  employ- 
ment there  is  also  a  possi])ility  of  infection  through  the  inhalation  of 
spores,  and  it  appears  that  the  so-called  "rag  disease"  or  "avooI- 
sorters'  disease"  in  many  cases  develops  in  this  manner.  Infection 
takes  place  very  rarely  through  the  intestinal  canal,  as  the  meat  of 
anthrax  animals  as  a  rule  only  contains  bacilli  and  not  spores,  and  they 
are  digested  by  the  gastric  juice;  furthermore  the  virus  is  usually 
destroyed  in  the  cooking  of  the  meat.  Therefore  this  method  of  infec- 
tion only  occurs  after  the  ingestion  of  putrefactive  and  improperly 
kept  meat,  or  from  sausage  prepared  from  infected  meat  which  was  not 
fresh.     It  is  also  possible  that  infection  is  transmitted  by  flies. 

The  development  of  the  carbuncle  usually  commences  with  a 
lancinating  pain  at  the  point  of  infection  and  is  soon  followed  by  the 
appearance  of  a  bright  red  nodule,  from  which  a  blackish-red  vesicle 
forms,  containing  a  reddish  serous  fluid.  After  the  rupture  of  the 
vesicle  the  lireaking  down  of  the  tissue  commences,  whereupon  in  the 
surrounding  parts  new  nodules  and  vesicles  form  and  the  affected  area 
shows  marked  edematous  infiltration.  The  subcutaneous  connective 
tissue,  and  the  skin  appear  reddened  as  in  erysipelas.  In  the  mean- 
while general  febrile  manifestations  develop  until  the  infection  becomes 
general  and  the  patient  succumbs  from  septicemia.  The  intestinal  infec- 
tion manifests  itself  in  a  severe  (frecjuently  hemorrhagic)  inflamma- 
tion of  the  intestines  which  is  accompanied  by  severe  abdominal  pain, 
vomiting  and  chills,  until  collapse  and  symptoms  of  asphyxiation  ter- 
minate the  disease.  Both  forms  may  occur  condiined,  and  especially 
may  an  intestinal  infection  be  followed  by  the  appearance  of  edematous 
swellings  in  various  parts  of  the  body.  Inhalation  anthrax  is  mani- 
fested by  an  acute  pleuritis  or  broncho-pneumonia. 

The  carbuncle  developing  after  a  local  infection  can  be  cured  by 
early  surgical  treatment;  and  freijuently  in  such  cases,  as  well  as  in 
intestinal  infections,  the  administration  of  inunune  serum  is  followed 
by  good  residts. 

Literature..     S.  Koranyi.  Xothnagel's  Handbnch,  1909,  V,  Bd.,  1.  T. 


i* 


32 


Malit>iiaiit  Edema. 


Fig.  8.     Edema   bacilli   with  flagella 
Agar  culture  ;  llagella  staining. 


2.    Malignant  Edema.    Oedema  malignum 

{Septicaemia,  gangraenosa,  Septicemie  gangrcneuse   [French]; 
Malignes  Odem  [German];  Setticemia  gangrenosa  [Italian].) 

Malignant   edema   is   an   acute,   febrile,   infectious  wound 

disease  of  domestic  animals, 
whicli  is  characterized  princi- 
pally by  edematous,  later  crepi- 
tating swellings  at  the  place  of 
infection.  Its  cause  is  the  anae- 
robic bacillus  oedematis  maligni. 

History.  The  development  of  crep- 
itating swellings  following  injuries, 
seatons,  castrations,  etc.,  has  been 
known  since  earliest  times,  and  Girard 
(1880)  proved  that  crepitating  sweU- 
ings  in  sheep  may  be  produced  by 
putrid  animal  substances.  Chauveau 
(1873)  showed  by  experiments  carried 
out  on  male  goats  that  the  living  or- 
ganisms contained  in  injected  putiid 
blood  were  closely  associated  with  the 
development  of  the  disease.  Pasteur 
(1877)  studied  more  closely  the  bac- 
terium, named  by  him  as  "Vibrion 
septique, ' '  and  also  succeeded  in  grow- 
ing it  in  pure  culture.  Later  Koch 
&  Gaifky  (1881)  extensively  investi- 
gated the  disease  produced  by  the  in- 
oculation of  dirt,  and  which  they 
termed  malignant  edema.  Since  that 
time  Kitt,  Jensen  &  Sand,  and  Le- 
clainche,  have  contributed  to  the  bac- 
teriology, while  new  observations  re- 
garding its  occurrence  in  domestic 
animals  have  been  published  by  Jen- 
sen &  Sand,  Ratz,  Frohner,  Carl  and 
others. 

Occurrence.  Malignant  edema 
occurs  everywhere  since  its  caus- 
ative agent  is  ever  present  in  the 
superficial  layers  of  the  soil. 
Nevertheless  it  is  not  a  very  fre- 
quent disease,  but  may  occur  in 
horses  and  cattle,  in  cows  partic- 
ularly after  parturition.  Occa- 
sionally in  sheep  it  causes  great 
losses,    and   may   in   veterinary 

Fig.  10.     Bacillus  of  malignant  edema.       hospitals    amOUg    llOrSCS    aSSUmC 
Peritoneal  exudate  from   guinea  ^U  eUZOOtic  character  aS  a  SCQUel 

pig;   dried  cover  glass  prep-  ^  x-  /x       a      -mt      -n    .n 

aration;  fuchsin  staining.  ot  Operations  (L.  A.  Mcrillat). 


Fig.  9.     Bacillus  of  malignant  edema 

Spore   formation    tiiree-day   old 

agar   culture,   stained    with 

diluted  fuchsin  solution. 


— -^"4 


Et  ioloji  V.      PatlniiiCMi  icil  v. 


33 


Etiology.  The  l)ac'illns  oedeinalis  iiiali,i;ni,  Koch,  ( V^il)rion 
septiqiie,  l*asteur)  is  an  anaerobic  bacterium  resembling  the 
anthrax  l)acilhis,  but  appearing  somewhat  more  slender,  rod- 
sliai)ed,  peritrically  llageHaled,  motile  and  multiplying  by  lission 
and  spore  formation.  (Figs.  8  to  10.)  Scxcral  rods  unite  to 
form  longer  chains  in  which  the  ends  in  contact  with  each  otiier, 
as  well  as  the  free  ends,  appear  rounded.  In  artificial  media, 
as  well  as  inside  the  animal  body  after  death,  the  bacilli  grow 
to  long,  curved  nnseginented  threads.  In  the  bacilli,  oval  spores 
develop  either  in  the  juiddle  or  ends  (exceptionally  even  the 
edematous  fluid  taken  from  the  living  animal  contains  H[)()re- 
bearing  bacilli  [Jensen  &  Sand]). 

Staining,     With  aqueous  aniline  dyes  the  ])a('illi  slain  readily,  and 
they  also  take  the  Grain  stain  after  being  carefully 
treated  with  alcohol. 

Cultivation.  The  cultivation  of  this  organism  is 
only  possible  under  oxygen-free  conditions.  Stab 
cultures  in  agar  or  gelatin  show  along  the  stab  cloudy 
or  lentil-shaped  colonies  which  usually  develop  at  the 
Itottoin  of  the  medium  and  close  to  which  the  gelatin 
is  later  li(iuefied.  In  coagulated  1)lood  serum  and  also 
in  dextrose  bouillon  (not  in  saccharose  and  lactose, 
Suiith)  gas  having  a  characteristic  sweetish  putrid 
odor  is  formed,  which  later  causes  disruption  of  the 
media.  (Fig.  11.)  Kerry  found  in  the  gases  hydro- 
gen, hydrogen  sulphide,  carbon  dioxide  and  methane. 
]\Iil-k  is  changed  in  a  few  days  into  a  watery  fluid  with 
gas  formation  and  the  collection  of  a  layer  of  fat  on 
the  surface  (Smith).  In  bouillon  cultures  the  bac- 
teria produce  toxins  in  small  quantities  (Roux  and 
Chamberland). 

The  spores  show  great  vitality.  Dry  muscle  substance 
and  spore-containiny  edema  fluid  enclosed  in  glass  tulies  prove 
virulent  even  after  years.  In  fluid  media  spores  are  destroyed 
after  lieating  to  10()°CI.  for  fifteen  minutes  (Sanfeliee),  while 
in  the  dry  state  they  are  killed  in  ten  minutes  at  120°C 
(Arloing).  Direct  sunlight  kills  them  only  slowly.  Disin- 
fectants are  only  effective  in  strong  solutions  and  after  pro- 
longed contact.  Sporeless  bacilli  are  quickly  destroyed  in  the 
presence  of  air  and  sunlight  as  well  as  by  putrefaction. 

Pathogenicity.  After  the  inoculation  of  a  ri?;-  n.-  ■'^tab  cui- 
pure  culture  in  the  depth  of  the  connective  tis-  ciiius°  in  dextrose 
sue,  a  rapidly  extending  swelling  develops  at  agar, 

the  point  of  injection.  It  becomes  crepitating  as 
a  result  of  gas  formation  within,  and  the  animal  soon  dies  of  a 
form  of  septicemia.  Guinea  pigs  and  nnce  succumb  in  from 
24  to  28  hours.  Cattle  can  be  infected  only  with  great  difficulty, 
and  feeding  of  spore-containing  material  will  not  yjroduce  the 
disease  even  in  susceptible  animals.  Edema  bacilli  injected 
into  the  blood  produce  the  disease  only  when  they  find  a  suita- 
ble soil  for  their  development  somewhere  in  necrotic  tissue  (for 
instance,  in  previously  ligated  testicles  [Chauveau]). 


34  Malignant  Edema. 

Probably  there  are  also  other  bacteria  capable  of  producing  a  dis- 
ease resembling  malignant  edema.  Thus,  Novy  observed  the  appear- 
ance of  a  similar  disease  in  guinea  pigs  following  subcutaneous  injec- 
tions of  milk  nuclein,  and  he  proved  that  an  organism  closely  resembling 
the  above-described  bacillus  was  the  cause.  However,  it  was  somewhat 
more  slender  and  provided  with  strikingly  long  and  thick  flagella.  It 
is  also  an  anaerobic  but  sporeless  bacillus  (Bac.  ced.  maligni  II). 
Klein  isolated  from  garden  soil  (Bac.  oed.  sporogenes)  and  Sanfelice 
from  guinea  pigs  inoculated  with  dirt  containing  putrid  organic  sub- 
stances, a  similar,  although  only  facultative  anaerobic,  bacillus  (Bac,  csd, 
ffirogenes).  According  to  Fraenkel  the  Bac.  phlegmones  emphysema- 
tosaj  produces  in  man  a  similar  disease  (gangrene  foudroyante).  On 
the  other  hand,  according  to  Kirsten  the  edema  bacilli,  like  most  of  the 
species  of  bacteria,  form  groups  of  varieties  which  nvdy  be  distinguished 
from  each  other  by  their  morphological  and  biological  characteristics. 
However,  in  their  clinical  relation  the  most  important  characteristic  is 
the  absence  of  pathogenicity  in  most  of  the  varieties. 

For  natural  infection  of  domestic  animals  solipeds  are 
most  susceptible,  while  cattle,  sheep  and  goats  are  less  sus- 
ceptible.   Hogs,  dogs  and  cats  are  rarely  affected. 

The  infection  results  in  most  instances  from  the  entrance 
of  the  edema  bacillus  into  the  deeper  parts  of  the  subcutaneous 
or  subnuTcous  tissue  through  breaks  in  the  continuity  of  the 
skin  or  the  mucous  membrane  of  the  mouth  and  esophagus. 
There  are  many  opportunities  for  such  infections  as  the  bacilli 
are  widely  disseminated  in  the  dirt,  especially  in  dust  of  hay, 
in  garden  or  field  soil,  in  street  dust,  in  household  drainage, 
in  putrid  organic  material,  and  in  excrement  of  healthy  animals. 
These  substances  are  very  prone  to  come  in  contact  with  w^ounds 
on  the  body,  and  yet  the  rare  occurrence  of  the  disease  can  be 
explained  by  the  fact  that  successful  infection  occurs  only  when 
large  masses  of  bacilli  enter  the  Ijanph  spaces  of  the  connective 
tissue  wdiich  contain  but  little  oxygen.  On  the  other  hand,  where 
the  infectious  material  enters  superficial  wounds  on  the  skin, 
granulating  ulcerations,  or  even  directly  into  the  blood  stream, 
the  bacilli  cannot  propagate  on  account  of  the  presence  of 
oxygen.  Hence  the  infection  occurs  either  through  contused  or 
lacerated  w^ounds  or  during  parturition  l^y  means  of  contami- 
nated hands  or  instruments.  In  other  cases  the  infection  may 
also  follow  vaccination,  castration,  shearing,  bleeding,  intro- 
duction of  seatons,  subcutaneous  injections  with  unsterilized 
medicines  (eserine,  morphine,  creolin,  arecoline),  unclean 
syringes,  bites,  penetration  of  straw^s  into  the  canthus  of  the 
eye,  etc.  The  disease  has  also  developed  in  association  with 
necrotic  processes. 

Lembeken  observed  50  ont  of  600  and  Gilruth  300  out  of  4,000  sheep  dying 
from  malignant  edema  during  or  after  shearing. 

Infection  may  also  occur  through  injuries  or  necrotic  ulcer- 
ations on  the  mucous  membrane,  whereas  the  healthy  mucous 


Patliojionesis.      Aiiatuiiiical   ("liuiiLics.  35 

iiienibraiie  alTords  an  effectual  })rotec'tioii.  Feeding  and  in- 
halation have  failed  to  successfully  transmit  the  infection  to 
experiment  animals. 

Pathogenesis.  .Vfter  the  germination  of  the  spores  in  the 
lymph  spaces  the  bacilli  continue  to  multiply  by  fission  at  the 
point  of  infection  until  hirge  bacterial  colonies  develop.  In  the 
meantime  gases  are  formed  by  the  dissociation  of  the  tissue 
fhiids,  and  toxins  are  produced  under  the  inlluence  of  \vhicli  the 
blood  vessels  are  dilated,  allowing  the  blood  plasma  to  transude 
into  the  connective  tissue  spaces  through  the  relaxed  walls  of  the 
vessels.  With  the  penetration  of  the  bacilli  the  swelling  en- 
hirges,  and  in  case  the  point  of  infection  is  near  the  al)dominal 
cavity,  the  ])acilli  multiply  rapidly  on  the  surface  of  the 
peritoneum  where  they  grow  into  long  threads.  At  the  same 
time  the  al)sorbed  toxins  act  also  on  the  central  nervous  system, 
])arti(ndarly  on  the  respiratory  and  boat  centers,  as  a  result  of 
which  respiration  becomes  difficult  and  the  temperature  elevated. 

The  edema  bacilli  are  capable  of  multiplying  in  the  tissues 
oldy  under  special  conditions.  The  spores  will  germinate  only 
in  the  presence  of  toxins  (from  older  cultures)  in  the  tissues, 
because  otherwise  they  would  soon  be  taken  up  by  the  X)hago- 
cytes  and  rendered  harmless.  Their  propagation  is  also  facili- 
tated by  the  simultaneous  entrance  into  the  tissues  of  other 
micro-organisms  (Bac.  prodigiosus,  staphlycocci,  diplococcus 
pyogenes  and  others).  In  addition  propagation  is  aided  by 
the  presence  of  particles  of  dirt  or  sand  which  protect  the 
spores  mechanically  against  the  phagocytes,  wdiile  toxins  and 
substances  like  lactic  acid,  keep  away  the  cells  through  negative 
chemotaxis  (Besson,  Leclainche  &  Vallee).  At  the  same  time 
the  presence  of  other  bacteria  has  an  influence  on  the  develop- 
ment of  the  pathological  changes  and  gives  rise  to  numerous 
cases  of  mixed  infection. 

Anatomical  changes.  During  the  formation  of  a  swelling 
in  any  i)art  of  the  body  the  connective  tissue  becomes  distended 
and  infiltrated  with  a  yellow  or  reddish  fluid  which  contains 
gas  bubl)les  and  liberates  a  peculiar  disagreeable  odor.  The 
gelatinous  infiltration  of  the  connective  tissue  may  also  extend 
between  the  deeper  layers  of  the  muscles,  while  the  muscle 
substance  proper  turns  pale  yellow  or  dark  red  in  color,  be- 
comes brittle  and  tears  readily.  The  connective  tissue  appears 
in  places  permeated  with  smaller  or  larger  hemorrhages.  The 
abdominal  cavity  contains  a  small  quantity  of  reddish  serous 
fluid;  the  peritoneum  is  markedly  injected,  lustreless,  but  is  not 
covered  with  an  exudate. 

If  the  malignant  edema  has  developed  after  parturition,  the 
uterus  is  found  insufficiently  contracted,  and  the  subsei'ous  con- 
nective tissue  of  the  small  pelvis  shows  edematous  infiltration. 
The  wall  of  the  uterus  is  also  edematous,  the  mucous  membrane 


36  Malignant  Edema. 

swollen  and  covered  with  a  dirty,  pasty,  ill  smelling  mass  which 
also  covers  the  cotyledons  that  are  in  the  process  of  breaking 
down  (Carl). 

The  spleen  as  a  rule  appears  normal  in  size  or  slightly 
swollen.  Exceptionally,  however,  an  acute  swelling  of  this 
organ  with  gas  formation  in  the  pulp  has  been  observed 
(Frolmer).  The  liver  shows  cloudy  swelling  and  the  intestinal 
mucous  membrane  shows  indications  of  an  acute  catarrh.  The 
lymph  glands  are  acutely  swollen,  while  the  lungs  manifest  well 
marked  active  hyperemia  and  also  edema  (which,  according  to 
Kitt,  are  occasionally  the  only  lesions  found  in  sheep) ;  the  heart 
muscle  usually  shows  marked  parenchymatous  degeneration. 
The  blood  is  slightly  coagulated,  and  the  carcass  decomposes 
rapidly. 

In  the  fluid  squeezed  out  from  the  crepitating  swellings  or 
taken  from  the  cut  surface,  or  frequently  in  the  abdominal 
fluid,  edema  bacilli  may  be  found  in  large  numbers  even  in  the 
unstained  miscroscopical  preparations.  The  bacilli,  which  not 
infrequently  contain  spores,  occur  singly,  in  chains  or  as  curved 
threads,  and  are  often  found  in  association  with  other  bacteria. 
Several  hours  after  death  the  bacilli  are  found  in  the  blood, 
particularly  the  blood  of  the  lungs  where  they  often  occur  in 
long  threads  similar  to  those  seen  on  the  peritoneum. 

The  presence  of  the  bacilli  of  malignant  edema  is  not  in  itself 
proof  that  the  particular  animal  died  from  this  disease.  These  bacilli 
occur  frequently  in  association  with  other  bacilli  in  the  intestinal  con- 
tents of  herbivorous  animals,  and  from  there  they  may  spread  after  the 
death  of  the  animal  throughout  the  body  even  to  its  most  distant  parts. 
This  is  particularly  the  case  when  the  blood  remains  fluid,  as  for  in- 
stance, in  a  suddenly  appearing  asphyxiation,  and  thus  promotes  their 
multiplication  and  dissemination.  From  the  intestines  the  organisms 
first  enter  the  peritoneum,  next  the  blood  vessels  of  the  intestines  and 
mesenteries,  and  then  the  portal  vein  from  whence  they  may  be  dis- 
seminated throughout  the  blood. 

Symptoms.  After  infection  an  edematous  swelling,  which 
is  not  sharply  circumscribed,  may  develop  in  12  to  24  hours  in 
any  part  of  the  body.  The  swelling  is  at  first  tense,  warm, 
very  painful,  later  cooler,  soft,  doughy  and  less  sensitive,  and 
may  even  become  entirely  insensitive  in  the  center,  so  that 
the  animal  does  not  manifest  pain  when  incisions  are  made 
into  the  swelling  (at  the  borders,  however,  it  shows  the  charac- 
teristics mentioned).  At  the  same  time  the  swelling  reveals 
crepitation  on  palpation.  The  swelling  usually  develops  at 
places  where  considerable  loose  connective  tissue  occurs  under 
the  skin;  by  spreading  over  the  surface  it  may  occasionally 
involve  the  entire  side  of  the  body,  anteriorly  to  the  neck, 
posteriorly  to  the  upper  parts  of  the  extremities,  resulting  in 
difficult  and  painful  movements  of  the  body.  Upon  incision  a 
reddish-yellow,   reddish-brown,   or   a  colorless   serous   fluid   is 


Symptoms.  37 

discharged  which  contains  gas  bubbles.  In  some  cases  the  skin 
over  the  swelling  acquires  a  dark  color,  and  may  finally  become 
extensively  necrotic. 

In  cases  where  the  swelling  develops  in  association  with 
an  evident  injurv  the  wound  takes  on  a  bright  color  and  a 
peculiar  lustre,  and  a  dirty  red,  fetid,  serous  fluid  oozes  from 
its  surface.    Later  the  margins  of  the  wound  become  necrotic 

in  portions.  . 

If  the  infection  occurs  through  the  genital  passage  during 
or  shortlv  after  parturition  the  first  manifestation  of  the  disease 
appears 'after  2  to  5  days.  The  vulva  swells  in  the  form  of 
a  cushion,  and  a  dirty,  brownish-red,  very  fetid,  thick  secretion 
is  discharged  from  the  vagina.  Soon  a  crepitating  swelling  de- 
velops in  the  surrounding  parts  of  the  external  genitals  which 
is  at  first  warm  and  painful  but  later  cool  and  painless,  and 
gradually  extends  over  the  perineal  region  and  the  lower  abdo- 
men.   Besides  high  fever,  bloating  and  diarrhea  are  observed. 

Malignant  edema  developing  in  association  with  parturition  in  cat- 
tle is  fre(iuently  mistaken  for  blackleg.  Recently  Alrert  &  Carl  estab- 
lished with  a  certain  degree  of  probability  that  the  cases  described  as 
parturition  blackleg  are  actually  malignant  edema,  and  that  blackleg 
never  develops  in  this  form. 

Following  castration  the  first  symptoms  appear  after  a 
few  days  or  sometimes  after  several  weeks;  aside  from  high 
fever,  an  extensive  edema  develops  under  the  skin  of  the  abdo- 
men, emanating  from  the  castration  wound,  and  later  shows 
crepitation  on  "palpation.  In  addition  the  animal  manifests 
colicky  pains,  sensitiveness  over  the  abdominal  wall  and  bloat- 
ing; in  other  words,  there  are  indications  of  peritonitis,  and 
finally  signs  of  a  general  infection  and  exhaustion. 

Of  the  other  s\miptoms  of  the  disease  the  markedly  diffi- 
cult respiration,  the"  cyanotic  mucous  membranes,  the  accelerated 
and  weak  heart  action,  and  the  corresponding  small,  wavy  pulse 
are  conspicuous.  The  body  temperature  reaches  a  high  degree 
even  at  the  onset  of  the  disease,  remains  at  a  uniform  height, 
but  as  death  approaches  it  drops  to  normal  or  subnormal.  In 
later  stages  of  the  disease  diarrhea  is  very  frequently  ol)served 
in  which  fetid  and  watery  feces  are  discharged. 

The  s^miptoms  follow  each  other  rapidly;  the  crepitating 
swelling  increases  in  size  from  hour  to  hour,  and  death  usually 
occurs  in  twelve  hours  to  three  days  after  the  appearance  of 
the  first  s^^nptom.  In  some  of  the  cases,  however,  the  disease 
terminates  in  recovery,  especially  after  appropriate  treatment. 

Livesey  observed  the  disease  in  a  dog.  On  the  left  side  of  the  head 
an  emphvsematous  swelling  developed  and  progressed  to  the  neck  and 
shoulders.  At  the  same  time  the  lips  and  cheeks  became  necrotic. 
Pankul  demonstrated  the  disease  in  hogs;  a  crepitating  swelling  devel- 
oped in  this  instance  from  a  wound  in  the  skin. 


38  Malignant  Edema. 

Diagnosis.  In  cattle  malignant  edema  may  be  mistaken  for 
blackleg.  Malignant  edema  is  indicated  by  the  appearance  of 
the  disease  in  localities  where  blackleg  is  not  prevalent,  fnrther 
by  the  advanced  age  of  the  patient,  the  occasional  localization 
of  the  swelling  in  parts  which  are  poor  in  muscle  tissue,  and  by 
the  relatively  severe  affection  of  the  connective  tissue  com- 
pared wdth  the  slight  involvement  of  the  muscles.  Parturient 
apoplexy  is  differentiated  from  malignant  edema  by  the  absence 
of  the  crepitating  swelling,  and  the  different  bacteriological 
findings. 

In  horses  and  sheep  the  development  of  a  crepitating  swell- 
ing under  febrile  manifestations  indicates  malignant  edema. 
The  crepitation  distinguishes  the  disease  from  edema,  which 
often  resembles  it  very  closely,  as  well  as  from  the  inflammatory 
edema  which  is  caused  frequently  by  a  streptococcus  infection 
follo^^^ng  injuries ;  whereas  in  the  simple  subcutaneous  emphy- 
sema there  is  in  addition  to  the  pre-existing  skin  or  lung  injury 
an  entire  absence  of  febrile  symptoms.  On  post  mortem  care 
should  be  taken  not  to  mistake  the  emphysema  caused  by  putre- 
faction with  the  crepitating  swelling  which  develops  during 
life.    (For  differential  diagnosis  regarding  the  bacilli,  see  p.  20.) 

Treatment.  The  only  possible  method  of  treating  the 
patients  consists  in  incising  the  swellings  as  they  are  forming 
in  one  or  several  places.  This  is  to  be  followed  by  squeezing 
out  the  serous  fluid  and  by  thorough  disinfection  of  the  wounds ; 
at  the  same  time  it  is  advisable  to  inject  disinfecting  substances 
subcutaneously  into  the  tissue  immediately  surrounding  the 
swelling. 

While  the  disinfectant  treatment  is  practically  without 
effect  upon  the  spores  of  the  edema  bacilli,  it  indirectly  prevents 
the  germination  of  the  spores  by  destroying  the  foreign  liacteria 
which  entered  the  wound  and  also  prevents  the  multiplication 
of  the  bacilli. 

Prevention.  In  order  to  prevent  the  occurrence  of  the 
disease,  wounds  of  the  skin  and  mucous  membranes  should  be 
guarded  against  contamination  with  dirt.  Those  wounds  which 
have  already  become  contaminated  should  be  disinfected, 
w^hereas,  after  difficult  parturitions  in  which  the  genital  pas- 
sages have  been  injured  a  thorough  irrigation  of  the  vagina 
and  uterus  will  prevent  the  disease. 

Immunization.  Experimental  animals  may  he  immunized  against 
virulent  infections  by  injections  of  spore-containing  tissue  fluids  which 
have  been  heated  for  7  hours  to  92° C.  (Leclainche  &  Vallee)  ;  by  bouil- 
lon cultures  heated  for  10  minutes  to  105-110  "C,  also  by  filtrates  of 
the  edematous  fluid,  or  through  the  toxins  contained  therein  (Roux  & 
Chamberland)  ;  further  by  blood  serum  of  immunized  animals  which 
have  received  repeated  injections  of  virulent  material  (Duenschmann, 
Leclainche  &  Morel).    These  inoculations  protect  only  against  malignant 


Malignant   Kdciiia.      Bla.klefr.  39 

edema  hut  not  against  anthrax  also,  as  was  proven  l)y  l.cchiincho  & 
\'allee,  ami  whicli  is  contrary  to  tlio  former  views  of  Konx  i:  Duciisch- 
mann. 

Literature.  Chauveau,  Rec,  1S73,  2r)3.— Pasteur  &  Joubert,  C.  R.,  1877,  LXXX  V, 
101.— Koch,  Mitt.  (1.  G.-A.,  1881,  1,  49.— Affkv,  Ibi.l.,  S.  S.S.- Chauveau  &  Arloing, 
Acad,  tie  Med.,  1884,  XIII,  604.— Kitt,  Miinehn.  Jhb.,  1S8.3-84  u.  1884-8.') ;  Monh., 
1897,  Till,  206  (Review);  1900,  XI,  49.— Jensen  &  8and,  D.  Z.  f.  Tni.,  1887,  XIII, 
31.— Roux  &  Chainberland,  A.  P.,  1887,  T,  561.— Leclainche  &  Vallee,  Ibid.,  1900, 
XIV,  590.— Frohner.  Monh.,  1901  to  190.'?,  XII-XIV;  Allg.  Chir.,  Wien,  1905  (Lit.).— 
Carl,  A.  f.  Tk.,  19o:?,  XXIX,  225.— Jensen,  lib.  f.  p.  M.,  1903,  II,  619  (Lit.).— 
Livesev,  Vet.  Rec,  1906,  356.— Hohuekcr,  B.  t.  W.,  1907,  267, 


3.    Blackleg.    Gangraena  emphysematosa. 

{Black  Quarter,  Quarter  III   [Eiiglisli];  Rausclihraud,  Kalter 

Brand,   HauscJiender   Milzhrand    [German];   Ewpiiijsema 

gang raenoi) urn,  Sarkophgsema  liaemorrhagicum;  Char- 

hon  sgmptomaticjiie,  Charhon  bacterien,  Mai  de 

cuisse,  Mai  de  montagne   [French];  Car- 

honchio  enfisematosa  o  sintomat'ico, 

Acetone,  Quarto  nero  [Italian].) 

Blackleg  is  an  acute,  infectious,  but  not  contagions, 
epizootic  disease  of  cattle,  and  exceptionally  of  other  nnninants 
and  of  swine,  in  the  course  of  which  crepitant  swellings  develo]) 
in  the  musculature  of  certain  regions  of  the  body,  accompanied 
by  febrile  sjTnptoms.  It  is  caused  by  the  anaerobe,  bacillus 
gangraenae  emphysematosae. 

Historical.  Until  the  seventies  of  the  last  century,  the  disease  M-as 
considered  as  identical  with  anthrax  or  as  a  particular  form  of  that  dis- 
ease. As  early  as  1782,  Chabert  had  differentiated  the  disease  from 
anthrax  under  the  name  of  charbon  symptomatique,  while  Bollinger 
(1875)  and  Feser  (1876)  showed  that  blackleg  was  to  be  separated  from 
anthrax  from  an  etiological  point  of  view.  Both  investigators  observed 
the  bacilli  contained  in  the  crepitant  swellings,  and  produced  the  dis- 
ease in  ruminants  through  injection  of  the  serous  fluid ;  Bollinger  also 
caused  it  by  introducing  sul)cutaneously  mud  from  places  in  which 
blackleg  was  fretiuent.  Later  the  etiology  of  the  disease  and  properties 
of  the  bacteria  Avere  investigated  thoroughly  by  Arloing,  Cornevin  & 
Thomas  (1879-1884),  and  through  these  studies  not  only  the  etiology 
of  the  disease  was  determined  upon,  but  they  also  introduced  a  prac- 
tical method  of  protective  vaccination.  The  bacteria  which  the  French 
call  bacterium  Chauveaui  were  developed  in  cultures  by  Roux  (1887) 
and  later  by  Kitasato  (1889),  while  still  later  Kitt,  Leclainche  &  Vallee, 
as  well  as  Grassberger  and  Schattenfroh,  completed  our  knowledge  in 
that  direction. 

Occurrence.  Blackleg  appears  mostly  in  mountain  regions 
and  in  valleys  with  swampy  ])astures,  but  is  also  observed  on 
low  lands  exposed  to  inundation.  In  such  regions  it  appears 
chiefly  during  the  hot  season  and  causes  nearly  every  year  con- 


40  Blackleg. 

siderable  losses  among  the  young  cattle,  while  older  animals 
are  attacked  only  exceptionally.  During  the  winter,  and  when 
the  cattle  are  fed  in  the  stable,  the  disease  appears  very  rarely. 

In  Germany,  blackleg  was  observed  during  the  years  1888  to  1905  most  fre- 
quently in  the  Prussian  provinces,  Schleswig-Holstein,  Khineland  and  Westphalia, 
and  on  the  mountain  pastures  of  the  Rhine  provinces;  before  the  introduction  of 
the  protective  vaccination,  4  to  8%,  at  some  places  even  12  to  15%,  of  the  young 
cattle  were  destroyed  by  the  disease.  During  the  10  years  1899  to  1908,  in  about 
188  districts  7  (?)  horses,  1,193  cattle,  36  sheep  and  2  goats  were  infected  with 
the  disease;  the  number  of  districts  varied  between  157  (1897)  and  214  (1908), 
while  the  number  of  cases  varied  between  928  (1902)  and  1973  (1906).  More  than 
two-thirds  of  the  communities  and  cases  were  in  Prussia,  where  the  government  dis- 
trict Schleswig  was  particularly  attacked;  then  follow  Bavaria,  Hesse,  and  Wurttem- 
berg.  According  to  Seheibel,  blackleg  is  often  observed  in  Upper  Hesse  in  sheep 
and  goats. 

In  Austria  the  disease  appears  chiefly  in  Lower  Austria  and  Tyrol,  while  the 
coast  regions,  Silesia  and  Dalmatia,  are  nearly  free  from  it.  During  the  years  1891 
to  1900,  the  average  loss  amounted  to  552  head  of  cattle  or  0.006%  of  the  "total  stock 
in  the  involved  regions.  The  number  of  infected  localities  varied  between  142  (1892) 
and  227  (1898). 

In  Hungary,  the  disease  appears  on  the  mountain  pastures  of  Siebenbiirgen 
and  in  the  Northeastern  part  of  the  country,  and  also  in  the  former  inundation  dis 
trict  of  the  Tisza  Eiver.  Although  the  disease  is  not  subject  to  obligatory  notifi- 
cation, 1,460  cases  were  reported  from  30  communities  in  1907. 

In  Switzerland  the  average  annual  loss  during  the  years  1897  to  1802  amounted 
to  687  head  of  cattle,  two-thirds  of  which  must  be  charged  to  the  cantons  of  Berne, 
Friebourg  and  Waadt.  During  the  year  1908,  in  272  communities,  779  animals  were 
attacked. 

In  the  other  European  countries  blackleg  is  also  in  evidence,  and  in  1908 
Belgium  had  274  cases  of  the  disease,  mostly  in  the  provinces  Liege  and  West 
Flanders;  Italy  had  407,  and  Norway  67  cases,  while  in  Sweden  there  were  56 
infected  farms.  In  France  the  northerly  and  southeasterly  mountain  districts  are 
severely  infected,  while  in  Great  Britain  it  is  Scotland,  and  in  Denmark,  Jutland. 
In  Holland  the  disease  causes  greater  losses  than  anthrax. 

In  Africa,  lilaekleg  has  been  ol)served  in  Algeria  and  the  southern  part  of  the 
continent  (there  known  as  Spons-Ziekte  and  Swamm-Ziekte),  and  it  is  said  that  in 
many  regions  of  the  Transvaal  10  to  25%,  sometimes  even  50%,  of  the  young  cat- 
tle are  destroyed  annually  by  the  disease.  In  America  the  disease  has  been  observed 
in  most  of  the  northern  states  and  seems  to  be  very  common.  During  the  year  1906, 
from  the  Federal  Bureau  of  Animal  Industry  alone,  there  were  shipped  1,250,000 
doses  of  protective  vaccine  to  40  states  and  territories.  Most  exposed  to  attacks  are 
the  vast  regions  between  the  Mississippi  Valley  in  the  east  and  the  Eocky  Moun- 
tains in  the  west.     In  South  America  (Chile)  the  disease  has  also  been  observed. 

Etiology.  The  blackleg  bacillus,  bacillus  gangraenae  em- 
physematosae  (Clostrydium  sarcophysematos  bovis  Kitt,  bac- 
terium chauveaui)  is  on  an  average  2  to  6f^  long,  0.5^  thick, 
slender  and  straight,  rounded  at  the  ends,  and  motile  by  means 
of  flagella.  At  a  certain  stage  of  its  development,  the  "bacillus 
assumes  a  whetstone  or  lemon-like  shape  (clostrydium  form), 
while  in  the  interior  a  spore  develops  at  the  center  or  at  the 
end.     (Figs.  13  and  14.) 

Staining-.  For  this  the  common  watery  solutions  of  aniline  dyes  as 
well  as  Gram's  method  are  suitable. 

Culture.  Cultures  develop  in  the  presence  of  hydrogen 
and  illuminating  gas,  wdth  the  exclusion  of  oxygen,  as' well  as 
in  vacuum,  particularly  in  Martin's  pepton-bouillon  (Leclainche 
&  Vallee) ;  also  in  chicken  bouillon  (Arloing),  and  on  gelatin 
and  agar  containing  blood-serum,  pepton,  glycerin  or  a  re- 
ducing substance  (Kitasato).     The  bacillus  thrives  best  at  36 


Etiology. 


41 


to  38°C.,  poorly  at  14°C.  The  gelatin  becomes  liquelied;  in 
the  depth  of  tlie  agar  culture  iiiediuiii  along  the  needle  punc- 
ture radiating  white  growth  devel- 
ops (Fig.  15).  The  boudlon  at 
first  becomes  iinifonnly  turbid, 
small  gas  bubbles  appearing  on  the 
surface  and  later  a  white  sediment 
is  formed,  above  which  the  solution 
is  clear.  From  dextrose  and  lactose 
(not  from  saccharose)  the  bacillus 
develops  a  gas  which  is  either  odor- 
less or  resembles  rancid  butter 
(Preisz,  Smith).  Milk  is  curdled 
only  imperfectly.  ^.^  ^,    ^^^^^,.,^,^  ^^,^..„.  ^,.^^^,  „,^ 

Tenacity.  Fresh  blackleg  meat  is  star-  uyar  culture.  Flaj;ella  staining, 
ilized  iu  2  hours  at  a  tenii)eratiire  of  80 °C.  or 
in  -20  minutes  at  lOCC;  fresh  virus  inclosed  iu 
glass  tubes  is  made  inactive  in  2  minutes  when 
kept  in  hot  water.  On  the  other  hand,  m 
drie«l  meat,  the  spores  are  made  inactive  only 
by  heating  to  110°C.  for  6  hours,  or  boiling 
in  water  for  2  hours,  while  at  room  tempera- 
ture the  spores  in  dried  muscular  tissue 
are  kept  virulent  at  least  2  years  (according 
to  Mattel  even  10  years)  ;  in  salted  meats  they 
are  kept  virulent  for  more  than  2  years,  and 
in  decaving  flesh  6  months.  Temperature  be- 
tween 85  and  100°C.  decreases  the  virulence 
of  the  spores  through  the  destruction  of  the 
toxi-ns.  Extreme  cold  has  hardly  any  effect 
In  the  summer,  exposed  to  direct  sunlight,  the 
dried  virus  loses  its  activity  in  24  hours,  and 
the  fresh  virus  in  18  hours.  The  spores  show 
also  considerably  more  resistance  to  chemical 
disinfectants  than  the  bacilli.  The  most  ef- 
fective are  carbolic  acid  (2%),  salicylic  acid 
(1:100),  nitrate  of  silver  (1:1000),  and  bi- 
chloride of  mercury  (1:5000);  vapors  of  thy- 
mol and  eucalyptus  weaken  fresh  virus,  as  it 
is  destroyed  by  the  action  of  these  media 
in  100  hours  (Arloing,  Cornevin  &  Thomas). 
Virus  contained  in  blackleg  meat  possesses 
a  greater  resistance  than  do  cultures  (A. 
Schmidt). 

Pathogenicity.  After  subcu- 
taneous or  intramuscular  injection 
of  larger  quantities  of  meat  juice 
containing  spores  there  appear  in 
the  inoculated  cattle,  marked  fever- 
ish s>niiptoms,  and,  at  the  place  of 
injection,  a  painful,  warm,  edema- 
tons,  and  later  crepitant  swelling,  which,  after  the  death  ot  the 
animal  produces  a  black  color  of  the  musculature  of  the  in- 
volved region.  These  muscles  together  with  the  serous 
infiltrated  subcutaneous  and  intramuscular  tissue  are  found  in- 
terspersed with  gas  bubbles.  If  an  animal  is  inoculated 
subcutaneously,  with  only  a  small  amount  of  the  infectious  sub- 


Fig.     13.     Blackleg     hacilH    icith 

spores.     Muscle   juice  from 

a  guinea  pig;  unstained. 


Fig.     14.      Bluchlcg     hacilli     icith 

spores.      :Muscle    juice    from    a 

guinea   i)ig;    dried   cover   glass 

preparation;  fuchsin  staining. 


42  Blackleg. 

stance,  no  edema  will,  as  a  rule,  appear  at  tlie  place  of  injec- 
tion itself,  but  at  some  distance  a  small  swelling  appears,  which 
disappears  in  a  few  days.  If  the  inoculated  amount  has  been 
very  small,  the  injection  will  only  cause  a  small  indisposition 
and  a  moderate  increase  in  temperature  for  a  few  days. 

The  intravenous  injection  of  a  larger  amount  of  virus 
produces  typical  blackleg,  but  a  smaller  amount  causes  only 
2  or  3  days  of  indisposition,  indicated  by  trembling  and  an  in- 
considerable increase  of  temperature.  A  similar  effect  follows 
the  intratracheal  injection  of  the  virus.  In  animals  which  have 
gone  through  the  short  indisposition,  the  disease  cannot  be 
produced  by  a  second  injection  of  even  a  larger  amount.  In- 
oculation in  the  tail  of  the  animal  only  causes  a  crepitant  swell- 
ing and  fever,  if  the  tail  is  covered  up,  since  its  temperature, 
which  is  normally  29.8° C,  is  thus  artificially  raised  to  38.6° C. 

In  calves  less  than  six  months  old,  the  subcutaneous  or  in- 
travenous injection  of  an  amount  of  fresh  and  virulent  virus 
which  in  90%  of  cases  w^ould  be  fatal  to  a  grown  animal  (1  to  6 
drops)  only  produces  a  slight  indisposition.  Larger  amounts 
of  virus,  7  to  10  drops  for  1  to  14  days  old  and  10  to  20  drops 
for  3  to  10  weeks  old  calves,  produce  typical  blackleg  (Arloing, 
Cornevin  &  Thomas). 

Small  amounts  of  virus  inoculated  intramuscularly  kill 
guinea  pigs,  goats  and  sheep  within  12  to  36  hours;  mice  are 
also  very  susceptible,  while  rabbits,  rats  and  pigeons  are  in- 
fected only  in  exceptional  cases.  In  horses  and  asses  only  an 
inconsequential  swelling  appears  after  the  injection;  hogs  are 
slightly  and  other  animals  are  not  at  all  susceptible  to  the 
infection. 

In  artificial  culture  media  both  toxins  and  gases  are  produced,  but 
most  abundantly  in  Martin's  bouillon.  Intravenous  injection  of  10  to 
12  cc.  of  an  old  culture  kills  horses  in  5  minutes,  evidently  through 
the  action  of  the  toxin.  The  toxin  is  mostly  confined  to  the  bodies 
of  the  bacteria,  culture  filtrates  being  much  less  effective.  The  toxin 
very  soon  becomes  inactive  in  the  air,  while  heating  for  10  min- 
utes at  115 ^C.  only  weakens  without  destroying  it  (Roux)  ;  its  nega- 
tive chemotaxis  turns  positive  at  75°C.  (Leclainche  &  Vallee). 

According  to  Grassberger  and  Schattenfroh,  the  toxin  is  a  product 
of  the  bacilli  and  is  particularly  in  evidence  in  the  presence  of  car- 
bonate of  calcium.  In  calves  40  cc.  of  the  filtrate  of  a  culture  cause 
edematous  swelling,  fever,  perspiration,  diarrhea,  prostration  and,  after 
5  to  6  days,  death.  Contrary  to  other  bacterial  toxins,  these  show  their 
poisonous  effect  on  the  injected  animal  at  once,  without  any  distinct 
period  of  incubation  (Leclainche  &  Vallee,  Eisenberg). 

In  many  cases  natural  infection  results  from  the  fact  that 
mud  from  the  swampy  and  rough  soil  of  certain  regions  pene- 
trates under  the  skin  of  the  cattle,  particularly  through  wounds 
on  the  tail  and  the  extremities  (Liipke  observed  the  disease 
after  castration). 

More  frequently  the  infection  results  from  the  consumption 


Etiology.     Susceptibility.  43 

of  infected  feed  or  d linking  water.  Artificially  it  is  successful 
in  this  way  only  in  exceptional  cases  (i^olliiiger,  Arloing),  but 
the  fact  that  in  blackleg  regions  the  intestinal  canal  as  a  rule 
contains  blackleg  bacilli  (Leclainche  &  Vallee),  while  lesions 
on  the  surface  of  the  body  are  observed  only  in  exceptional 
cases,  and  furthermore,  that  crepitant  areas  are  present  in  tlie 
internal  organs,  s])eaks  in  favor  of  the  frequency  of  infection 
through  the  intestines.  In  the  rare  cases  when  such  swellings 
originate  in  the  region  of  the  throat  or  in  the  wall  of  the 
esophagus,  the  infection  is  evidently  brought  a1)out  through  the 
mucous  mendu'ane  of  the  throat  or  the  mouth. 

Attacks  of  the  disease  in  swine  have  so  far  only  been  ol)- 
served  in  fattening  establishments,  where  tlie  s\inptonis  also 
have  indicated  infection  of  the  tonsils  (Marek). 

Blackleg  is  a  disease  connected  with  infected  soil,  and  trans- 
mission from  annual  to  animal,  as  in  contagious  diseases,  or 
through  intermediary  objects,  evidently  occurs  very  seldom. 
The  blackleg  bacilli  seem  to  be  capable  of  multiplying  in  the 
soil,  and  tlirough  their  resisting  'spores,  to  preserve  their 
capacity  of  development  and  infectiveness  even  under  unfavor- 
able conditions.  This,  as  well  as  the  fact  that  bacteria  from 
carcasses  of  dead  animals  again  infect  the  soil,  explains  the 
stationary  occurrence  of  blackleg  in  certain  regions.  In  fact,  it 
appears  most  frequently  in  swampy,  low  pastures,  and  in 
regions  subjected  to  occasional  inundations;  also  in  pastures 
where  carcasses  of  cattle  infected  ^vitll  blackleg  had  previously 
been  buried,  and  sometimes  after  feeding  hay  or  other  feed 
in  the  neighborhood  of  which  carcasses  had  been  skinned,  or 
after  drinking  from  creeks  in  which  parts  of  blackleg  carcasses 
had  been  thrown. 

Sauer  suggests  the  possibility  that  flies  which  have  been  feeding  on  blackleg 
carcasses,  and  in  whose  bodies  the  bacilli  have  increased  in  number,  may  be  capable 
of  transmitting  the  infection. 

Susceptibility.  In  blackleg  regions  the  cattle  contract  the 
disease  with  few  exceptions  only  at  the  age  of  from  i/>  to  4 
years;  sucking  calves  are  only  attacked  in  exceptional  cases 
(Strebel  ol)served  the  disease  in  a  3  days  old  calf),  and  animals 
over  4  years  as  a  rule  only  when  they  are  transferred  at  an 
advanced  age  from  disease-free  places  to  an  infected  place. 
Whether  or  not  the  breed  has  any  influence  on  the  suscepti- 
bility is  not  yet  determined  with  certainty;  it  is  a  fact  that 
cattle  of  the  native  breed  contract  the  disease,  but  not  as 
often  as  the  improved  breed;  the  same  also  is  true  of  the 
Algerian  cattle  (Bremond).  As  to  the  susceptibility  of  the 
buJtalo,  no  satisfactory  data  are  so  far  available  (Cronevin  ol»- 
served  in  2  buffaloes  inoculated  with  virulent  material  only 
intermittent  changes  of  temperature,  while,  according  to 
Makoldy,  these  animals  contract  blackleg).  In  sheep  Vogdt  and 
Monseur.  and  in  swine  Marek,  Battistini  and  Born  have  found 


44 


Blackleg. 


isolated  cases  of  the  disease,  but  it  is  still  a  matter  of  con- 
tention whether  the  disease  appears  in  horses  or  not. 

According  to  a  compilation  by  Tillmann,  out  of  614  animals  suffering  from 
blackleg,  7  were  from  1  to  4  weeks  okl,  23  from  2  to  3  months,  94  from  3  to  6 
months,  449  from  14  to  4  years,  and,  finally,  41  were  above  4  years  old. 

Symptoms  similar  to  those  of  blackleg,  and  analogous  anatomical 
changes  may  also  be  produced  by  other  bacteria  (the  so-called  pseudo- 
blackleg  bacilli).  Thus  Kerry  has  isolated  a  bacillus  from  a  guinea 
pig  which  had  been  inoculated  with  blood  from  a  cow  supposed  to 
have  died  from  blackleg.  This  bacillus  grows  at  a  higher  tem- 
perature than  the  blackleg  bacillus,  produces  no  spores,  and  is  patho- 
genic not  only  for  guinea  pigs,  but  also  for  rabbits  (bac.  edematis 
thermophilus).  Preisz  found  in  one  case,  which  otherwise  was  similar 
to  blackleg  in  every  way,  a  considerably  longer  and  thicker  bacillus 
than  in  common  blackleg. 

Lignieres  and  Bidart  in  their  clinical  reports  on  diseases  similar 
to  blackleg  in  Argentine  refer  to  an  affection  which  is  known  under 
the  name  of  Mancha  (=spot,  owing  to  the  dark  color  of  the  skin  over 
the  edema).  Calves  from  6  to  10  months  old  contract  the 
disease  exclusively  and  succumb  within  24  to  28  hours.  The 
disease  is  caused  by  a  bacillus  similar  to  the  blackleg  bacillus, 
hut  it  is  pathogenic  for  young  rabbits,  horses,  and  pigeons. 
Protective  vaccination  with  blackleg  virus  is  without  effect. 

Pathogenesis.  Toxin-free  spores  which  have 
penetrated  into  normal  healthy  tissues  are  soon  taken 
up  by  phagocytes  and  digested;  if,  however,  at  the 
same  time,  other  bacteria  or  grains  of  dust  have 
gathered,  and  the  tissue,  particularly  the  muscula- 
ture, is  not  quite  sound,  or  if,  at  the  involved  place 
an  extravasation  of  blood  exists,  then  the  spores, 
protected  against  the  phagocytes,  begin  to  germinate, 
and  the  bacilli  thus  created  continue  to  multiply 
through  fission.  Under  natural  conditions  a  small 
disturbance  in  the  tissue,  a  strain  of  the  muscles  or  a 
hemorrhage  (blow  by  a  stick  or  a  horn),  may  cause 
the  bacteria  which  have  reached  the  blood  from  the 
intestines,  and  otherwise  are  soon  destroyed,  to  locate 
at  these  points,  to  increase  in  number,  and  excite  the 
pathological  process. 

Where  the  bacilli  appear  in  abundance,  a  serous 

inflammation  and  sometimes  also  small  hemorrhages 

will  be  observed.     Under  the  influence  of  the  toxins, 

tureofthe   the  iiiusculature  degenerates,  and,  through  the  de- 

Biaekieg   structioii    of    tlic    nitrogcnous    matter,    gases    are 

grapesugar  formed.     The  toxins  are  also  absorbed  by  the  body 

agar.  fluids  aiid  cause  the  general  symptoms  accompanying 

the  local  process ;  they  also  reduce  the  power  of  resistance  of  the 

tissues  against  the  pathogenic  effect  of  the  virus  (Roger). 

According  to  the  investigations  of  Leclainche  &  Vallee,  cultures 
containing  spores  and  heated  from  80  to  85° C.   are  inactive,  as  the 


Fig.  15. 
Stab  cul- 


Pathogenesis.     Anatomical  Changes.  45 

spores  in  the  tissues  are  digested  by  the  phagocytes  within  48  hours. 
These  spore-eontaining  cultures  cause  the  disease,  however,  if  active 
toxin  is  added  or  if  they  are  injected  mixed  with  sand  or  saprophytic 
bacteria  (bac.  prodigiosus,  proteus  vulgaris,  staphylococcus  alhus). 
The  spores  will  also  show  a  greater  pathogenic  activity  by  the  addi- 
tion of  a  small  amount  of  20%  lactic  acid,  salt  solution  or  diluted 
alcohol,  and  als(»  through  a  traumatic  injury  imm<'(iiately  before  or 
after  the  infection.  These  saprophytic  bacteria,  the  sand  and  the  dead 
tissue  protect  the  spores  mechanically  against  the  phagocytes  and  make 
their  tfevelopment  possible.  The  same  result  is  produced  by  the  chem- 
ical substances  as  well  as  by  the  inoculation  of  toxins  contained  in 
unheated  cultures,  through  negative  chemotaxis. 

Anatomical  Changes.  Characteristic  of  blackleg  is  the 
crepitant  swelling  occurring  anywhere  on  the  rump  or  extremi- 
ties, more  or  less  distinctly  circumscribed,  above  which  the  skin 
appears  sound,  or  in  rare  cases,  partly  necrotic,  and  therefore, 
stiff,  parchment-like,  and  dark  colored.  The  subcutaneous  tissue 
is  red  or  infiltrated  with  a  yellowish,  gelatinous  exudate,  at 
places  intermixed  with  hemorrhages  and  gas  vesicles,  and  in  the 
deeper  parts  similarly  changed  connective  tissue  separates  the 
single  muscle  fibres  from  each  other.  The  musculature  of  the 
swollen  part  is  dirty  brown  or  dark  red;  at  the  periphery  it 
is  darker  red  or  dull  yellow  with  black  stripes,  and  either  in- 
tersected with  bloody  serous  liquid  or  is  spongy  and  dry  (the 
latter  with  great  development  of  gas).  The  dirty  red,  or  claret 
colored  liquid  squeezed  from  the  swellings  contains  gas  bubiiles 
in  abundance  which  give  off  an  odor  suggesting  rancid  liutter. 
In  the  tissue  surrounding  the  swelling  the  lymph  vessels  are 
sometimes  distended,  filled  with  lymph  and  gas,  while  the 
h^nphatic  glands  are  acutely  swollen,  edematously  infiltrated, 
and  sometimes  intermixed  with  hemorrhages. 

Crepitant  swellings  appear  in  rare  cases  in  the  musculature 
of  the  tongue,  throat,  and  diaphragm,  from  which  points  they 
may  also  involve  the  muscles  of  the  shoulder  and  arm  (Hen- 
ninger).  They  may  likewise  be  found  in  the  loin  or  in  the 
muscles  between  the  ribs. 

The  internal  organs  show  few  conspicuous  lesions  and  no 
constant  changes.  Relatively  often  a  reddish  serous  liquid  is 
found  in  varying  amounts  in  the  thoracic  cavity.  Further,  there 
may  be  present  on  the  pleura,  as  well  as  on  the  epicardium,  a 
reddish  gray  fibrinous  exudate  sometimes  mixed  \\ith  dirty  red, 
jellv-like  substances,  or  the  parietal  pleura  may  be  covered 
witii  soft,  jelly-like,  wine-colored  deposits  (Foth,  Katona,  Till- 
mann).  Iii  the  lungs,  the  interloliular  septa  may  be  infiltrated, 
and  the  lobules  themselves  edematous.  In  very  rare  cases  the 
heart  muscle  at  localized  points  is  dark  red  and  edematous 
(Tillmann)  or  necrotic  (Blome),  and  the  epicardium  is  covered 
with  strips  or  tufts  of  exudate. 

In  the  abdominal  cavity  lesions  are  frequently  found  which 
are  similar  to  those  in  the  thoracic  cavity.    The  spleen  is  gen- 


46  Blackleg. 

erally  unclianged  or  only  moderately  swollen,  but  sometimes 
a  well  developed  tumefied  spleen  is  found  where  the  capsule  is 
distended  by  gas  bubbles,  but  without  hemorrhages. 

The  liver  frequently  appears  mottled  on  section,  owing  to 
ochre-yellow  foci  from  a  pea  to  a  walnut  in  size,  which  increase 
after  death,  and  owing  to  the  development  of  gas,  assume  a 
porous,  friable  consistency  (Kasselmann,  Foth,  Warringholz, 
Tillmann).  According  to  Warringholz,  there  exist  in  the  cortex 
of  the  kidneys,  light  gray  foci  of  the  size  of  a  millet  grain. 
The  mucous  membrane  of  the  intestines  is  catarrhal,  reddened 
and  loosened;  sometimes  it  is  dark  red,  swollen,  intersected 
with  hemorrhages,  and  covered  with  bloody  mucus.  Finally, 
the  blood  is  dark  red  and  forms  a  coagulum  in  the  heart  and 
the  large  vessels. 

In  rare  cases  with  rapid  course  the  characteristic  external 
swelling  is  lacking,  but  by  thorough  examination  dark  red  dis- 
colored portions  of  muscles  may  be  found  in  hidden  places,  as 
under  the  shoulder  blade,  in  the  sexual  organs,  masseter 
muscles,  psoas  muscles  or  in  the  pillars  of  the  diaphragm. 

Rgebiger  found  vesicles  under  the  endocardium  varying  in  size 
from  a  pea  to  a  pigeon  egg,  which  were  filled  with  a  dark  red,  turbid 
liquid  containing  numerous  blackleg  bacilli.  Scheibel  sometimes  found 
a  crepitant  swelling  of  the  spleen  and  a  gray-brown,  porous,  and 
spongy  appearance  of  the  kidneys.  According  to  Schmitt,  an  intes- 
tinal infection  is  especially  indicated  by  numerous  small  hemorrhages 
in  the  omentum  and  in  the  serosa,  particularly  in  the  neighborhood 
of  the  spleen  which  is  swollen  on  account  of  hemorrhagic  infiltration. 
There  is  also  a  serous  infiltration  of  the  reticulum  and  a  bloody  dis- 
coloration of  its  mucous  membrane. 

In  swine  a  swelling  of  the  region  of  the  throat  is  mostly  observed 
where  the  subcutaneous,  intermuscular,  and  peripharyngeal  tissues 
show  a  serous  gelatinous  fluid  containing  gas  vesicles.  The  adjoining 
muscles  appear  striped  with  dark  red  streaks,  the  lymphatic  glands 
are  acutely  swollen,  and  the  mucous  membrane  of  the  throat  shows  a 
catarrhal  condition  with  small  hemorrhages  (Marek).  In  other  cases 
the  crepitant  swelling  has  been  found  on  one  of  the  posterior  extremities 
(Battistini). 

In  horses  the  occurrence  of  blackleg  has  not  been  definitely  deter- 
mined. The  literature  contains  reports  by  Ganter,  Hafner,  Schmidt, 
Velmelage,  Fischer,  and  others,  but,  in  these  cases,  a  confusion  with 
pseudo-blackleg  or  malignant  edema  is  not  only  not  excluded,  but  even 
probable.  Hasenkamp,  for  instance,  found  in  a  horse  a  serous-hemor- 
rhagic  fluid  in  the  thoracic  cavity  and  pericardial  sac,  hemorrhages  in 
the  serous  membranes,  and  black,  crepitant,  softened  muscles  of  the 
shoulder  region,  the  neck,  and  the  hind  leg  which  were  also  infiltrated 
with  a  sero-sanguinolent  fluid.  Quadekker  observed  in  a  similar  case 
a  sweetish  odor  in  the  diseased  parts  which  was  neither  pleasant  nor 
foul. 

Blackleg  bacilli  are  generally  present  in  large  numbers  in  the  serous  liquid 
of  the  crepitant  swellings  as  well  as  in  the  yellow  foci  of  the  liver  (frequently  in 
company  with  various  other  bacteria,  as  staphylococci,  micrococcus  prodigiosus, 
proteus  vulgaris,  bacillus  coli  anrl  others,  particularly  at  the  edges  of  the  swell- 
ing), and  a  certain  time  after  death  they  are  also  found  in  the  transudate  of  the 
serous  cavities,  in  the  bile,  in  the  lymphatic  glands,  and  in  the  blood.     In  the  juices 


Symptoms. 


47 


of  the  diseased  niusclcs  miinoroiis  clostrydian  forms  are  seen,  and  if  the  course  of  the 
disease  is  not  acute  the  bacilli  •will  be  found  to  contain  spores  at  the  time  of  death 
and  still  more  24  to  4S  hours  later. 

Miiller  recommends  to  submit  for  bacteriological  examination  pieces  of  muscles 
covered  with  salt,  liei-ause  the  decaying  process  is  arrested  by  the  salt  and  the  black- 
leg bacilli  are  stimulate<l  to  a  ra\)'ul  formation  of  cIostry<Iian  forms  and  spores. 

The  gases  formed  in  the  crepitant  swellings  have  not  always  the  same  com- 
position; according  to  Koux,  they  consist  of  carbonic  acid  aii<l  hydrogen  in  equal 
proportions,  while  Tappeiner 's  chemical  analysis  shows  13.15%  of  carbonic  acid, 
76.51%  of  hydrogen,  and  10.34%  of  nitrogen. 

Symptoms.  The  period  of  inciil)atioii  of  tlie  disease  is 
generally  o  days,  although  in  exceptional  cases  it  may  be  more, 
but  does  not,  however,  exceed  5  days. 

In  cattle  the  disease  starts  with  sudden  febrile  symptoms; 
the  animals  stop  eating,  grazing  and  ruminating,  the  tempera- 
ture rising  in  a  few  hours  to  41-4-2° C.  (Fig.  IG.)  In  many 
cases,  however,  the  disease  seems  to  progress  with  a  moderate 
temperature  or  without 
fever  (Schiitt  &  Warring- 
holz,  Steinbriick).  In  graz- 
ing animals  lameness  or 
stiff  dragging  of  an  extrem- 
ity is  also  frequently  ob- 
served. 

Shortly  thereafter  may 
be  seen  the  characteristic 
blackleg  swelling,  particu- 
larly in  portions  of  the  body 
with  thick  layers  of  muscle. 
Most  frequently  they  appear 
on  the  upper  leg,  on  the 
buttocks,  in  the  region  of 
the  loin,  on  the  shoulder, 
chest  or  neck  (in  exceptional 
cases  also  in  the  submaxil- 
lary space  [Fig.  17],  on  the 
tongue  or  on  the  throat),  while  they  never  appear  below 
the  carpal  or  tarsal  joints  or  on  the  tail.  At  one  of 
the  above  named  places  a  distinctly  bordered  or  diffuse 
swelling  of  irregailar  shape  develops  rapidly,  which,  from  the 
beginning,  is  hot  and  painful,  later  becoming  cold  and  torpid 
in  the  center,  so  that  the  animal  finally  does  not  feel  pain  on 
touch  or  when  an  incision  is  made.  The  skin  over  the  swelling 
is  dry,  stiff,  dark  colored,  incidentall}^  black  and  parchment-like, 
and  in  exceptional  cases  also  necrotic.  On  palpating  or  pressing 
the  tumor  a  peculiar  crepitation  is  observed,  while  percussion 
brings  forth  a  pronounced  t^nnpanitic  sound.  If  the  swelling 
is  cut  at  the  beginning  of  the  disease,  dark  red  blood,  later  a 
dirty  red,  foamy  and  singularly  sweet  smelling  liquid  will  be 
discharged  from  the  wound.  The  tissues  surrounding  the  tumor 
are  edematously  infiltrated.  The  lymph  glands  are  swollen 
and  may  be  felt  under  the  skin  as  firm  knots  the  size  of  apples. 


T 

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A.  M. 

p.  JI. 

A.M. 

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12 

2 

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8 

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S 

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39.5 

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386 

Fig.  16.     Fever  curve  in  blackleg.     The 

animal  became  affected  on  the 

previous  evening. 


48 


Blackleg. 


In  the  meantime,  pronounced  respiratory  disturbances  de- 
velop, while  the  activity  of  the  heart  is  accelerated  (90  to  100 
contractions  a  minute)  and  becomes  weak.  Sometimes  attacks 
of  colic  are  observed.  At  last  the  animal  lies  on  the  ground 
stretched  out  motionless,  the  temperature  is  lowered  to 
37-35° C.  or  rises  once  more,  and  then  death  follows  immediately, 
The  disease  generally  lasts  from  y^  to  2  days ;  in  rare  cases, 
however,  it  may  last  from  4  to  10  days. 

The  crepitant  swelling  mostly  develops  at  one  place,  but 
in  some  cases  tumors  appear  at  several  parts  of  the  body,  grow 

rapidly  and  coalesce  to 
form  a  single  large 
swelling. 

If  the  swelling  is  de- 
veloped in  the  deep 
layers  of  the  hip  or 
shoulder  muscles,  its 
other  properties  can- 
not be  exactly  deter- 
mined, aside  from  the 
increase  in  volume  of 
the  involved  part  of  the 
body.  The  skin  appears 
relatively  healthy,  and 
no  crepitation  is  ob- 
served on  touch;  how- 
ever, by  a  stronger  per 
cussion,  a  hollow  sound 
may  be  observed  in  the 
periphery  of  the  swell 
ing  even  in  these  cases 
If  the  cavity  of  the 
mouth  or  the  throat  is 
the  seat  of  the  disease 
s5^nptoms  of  a  severe 
inflammation  of  the 
throat  are  usually  ob- 
served whose  specific 
nature  is  indicated  hy  the  crepitation  of  the  swollen  parotid 
region.  Infection  of  the  tongue  is  indicated  by  considerable 
swelling,  while  the  tip  of  the  organ  crepitates  on  touch  and 
projects  from  the  mouth.  In  the  extremely  rare  cases  of 
primary  infection  of  the  diaphragm,  the  cause  of  the  fever  as 
well  as  of  the  difficult  respiration  can  only  be  determined  by 
autopsy. 

According  to  Arloing,  Cornevin  &  Thomas,  and  also  Feser,  black- 
leg, especially  in  older  animals,  sometimes  appears  in  a  much  milder 
form.  In  such  cases  there  may  or  may  not  appear  a  moderate,  indis- 
tinct swelling  on  any  part  of  the  body,  the  animals  show  moderate  fever 


Fig.  17.    BlacMeg.    Crepitating  swelling  of 
the   forehead   and    submaxil- 
lary  space. 


Symptoms.     Diagnosis.  49 

for  1  to  3  days,  stop  eating  and  ruminating,  and  also  develop  symptoms 
of  colic  or  tympany,  after  which  recovery  takes  place.  After  intravenous 
injection  of  blackleg  virus  a  similar  mild  infection  sometimes  appears. 

Very  severe  cases  of  infection  occur  sometimes  in  which  the 
animals  suffer  from  general  indisjjosition,  tympany,  and  diarrhea  and 
succumb  in  8  to  12  hours,  without  the  appearance  of  a  distinct  swelling. 

The  existence  of  a  genuine  parturient  blackleg,  according  to  the 
latest  investigations,  seems  doubtful  (see  page  37)  and  could  at  best 
be  ascertained  by  autopsy,  and  then  only  in  cases  where  the  nuisch'S 
in  the  neighborhood  of  the  genital  organs  sliow  the  characteristic 
necrotic  changes  (such  a  case  was  observed  by  Kosselmann). 

In  sheep  the  disease  has  a  sudden  onset,  and  is  indicated 
by  a  stiff  walk,  weakness  of  the  back,  moderate  t^Tiipany, 
champing  of  foam,  and  high  fever.  On  the  surface  of  the 
front  portion  of  the  body,  particularly  on  the  neck  and  lower 
chest,  the  wool  is  raised  at  one  place,  and  here  a  swelling  may 
be  found  the  size  of  the  palm  of  the  hand  (Scheibel). 

In  swine  blackleg  mostly  appears  vdth  a  severe  acute  inflammation 
of  the  throat  and  heavy  phlegmonous  swelling  of  the  surrounding  parts 
(Marek,  Born).  The  development  of  the  tumor  Avhich  may  extend 
backwards  and  to  the  shoulder  is  also  accompanied  with  feverish  symp- 
toms, by  vomiting  and  diarrhea,  and  the  latter  symptoms  are  also  ob- 
served when  the  crepitant  swelling  has  developed  on  a  posterior  ex- 
tremity (Battistini), 

Diagnosis.  The  rapid  course  and  the  development  of  a 
crepitant,  edematous  swelling,  in  cases  where  the  latter  appears 
on  the  surface  of  the  body,  make  the  diagnosis  fairly  easy.  If, 
however,  the  swellings  are  in  the  interior  of  the  body,  the  nature 
of  the  acute  feverish  attack  can  only  be  surmised  through  other 
factors,  particularly  by  the  fact  that  blackleg  frequently  ap- 
pears in  the  particular  region.  The  disease  may  be  mistaken, 
especially  for  malignant  edema,  in  the  course  of  w^hicli  crepitant 
swellings  appear  on  the  surface  of  the  body  also.  The 
appearance  of  the  swellings,  wdiich  are  restricted  to  certain  re- 
gions and  to  young  animals,  in  those  parts  of  the  body  with 
abundant  musculature  is  suggestive  of  blackleg.  Besides,  the 
swelling  is  here  more  emphysematous,  the  contained  fluid  dark 
red  and  foamy,  and  the  muscles  are  black  colored,  while  in 
malignant  edema  the  swelling  is  more  edematous,  the  fluid 
gray-red  or  colorless,  and  the  muscles  diffusely  reddcMied  or 
only  red-gray  (Gutzeit).  The  development  of  an  edematous 
crepitant  swelling  in  the  neighborhood  of  the  external  genital 
organs  at  the  time  of  birth  "will  in  itself  be  an  indication  of  the 
presence  of  malignant  edema. 

Blackleg  is  differentiated  from  anthrax  more  readily,  for 
in  the  latter  edematous  swellings  are  rare  and,  if  present,  al- 
ways hot  and  painful  w^ithout  crepitation.  In  phlegmonous 
inflammations  of  the  subcutaneous  tissue,  from  pyogenic  wound 
infection  the  local  character  of  the  disease  is  distinctly  indicated 


50  '  Blackleg.  - 

and  the  course,  as  a  rule,  is  slower.  In  subcutaneous  emphy- 
sema, leaving-  out  of  consideration  the  etiological  factors,  the 
total  absence  of  acute  symptoms  of  inflammation  and  the  normal 
condition  of  the  skin  are  characteristic. 

At  the  autopsy,  aside  from  the  microscopic  results  and 
the  serous-emphysematous  infiltration  in  the  region  of  the 
swelling,  blackleg  is  indicated  especially  by  the  odor  of  rancid 
butter,  the  black  discoloration  of  the  musculature,  and  the 
absence  of  a  strictly  acute  tumefaction  of  the  spleen. 

In  doubtful  cases  the  diagnosis  is  verified  through  microscopic  examination 
of  the  diseased  muscles  or  the  yellow  foci  in  the  liver  and  the  kidneys,  and  through 
injection  of  such  material  into  test  animals.  For  this  purpose  Wulff  recommends 
drying  the  piece  of  muscle  in  an  air  current  at  30-32°C.  and,  after  pulverization,  to 
heat  the  material  5  minutes  in  distilled  water  at  65 °C.  From  a  mixture  made  of 
0.1  gm.  of  dried  muscle  substance  and  10  cc.  water,  0.002  cc.  is  sufficient  to  kill 
guinea  pigs  by  intermuscular  inoculation.  At  the  autopsy  of  such  guinea  pigs 
numerous  bacilli  are  found  in  the  liver,  which,  however,  never  form  chains  (Foth; 
forming  of  chains  characterizes  the  bacilli  as  edema  bacilli).  On  the  other  hand, 
pigeons,  rats  and  rabbits  are  never,  or  at  least  only  exceptionally,  killed  by  0.01  cc. 
of  the  emulsion. 

Owing  to  the  extreme  rarity  of  blackleg  in  other  kinds  of  animals,  the  diag- 
nosis should  always  rest  upon  an  exact  bacteriological  examination,  because,  other- 
wise, confusion  with  pseudo-blackleg  and  malignant  edema  is  liable  to  occur. 

Treatment.  The  treatment  of  blackleg  is  hardly  ever  suc- 
cessful and  only  consists  in  a  local  antiseptic  treatment  of  the 
swellings.  For  this  purpose,  it  is  advisable  to  incise  the  tumor 
at  several  places  and  then  press  it  out  and  wash  the  exposed  dis- 
eased tissue  carefully  and  repeatedly  with  disinfecting  liquids. 
The  most  suitable  for  this  are :  3%  carbolic  acid,  5%  lysoformic 
acid,  0.1%  salicylic  acid,  0.1%  formalin  solution,  and  tincture 
of  iodine,  of  which  liquids  the  first  ones  should  also  be  sub- 
cutaneously  injected  at  several  places  in  the  immediate  sur- 
rounding tissue. 

If  the  swelling  has  developed  in  the  middle  of  an  extremity, 
a  bandage  or  other  ligature  may  be  applied  above  the  tumor, 
and  the  latter  may  then  be  scarified  (Wallraff).  Tolstouchow 
obtained  good  results  from  applications  of  ice  and  snow,  and  by 
rubbing  with  oil  of  turpentine. 

Leclainche  &  Vallee  recommend  the  treatment  mth  immune 
serum,  of  which  first  60  to  100  cc.  are  injected  into  the  jugular 
vein,  and  thereafter  this  amount  is  injected  every  2d  to  4th 
hour  under  the  skin  in  the  region  of  the  shoulder.  In  the  be- 
ginning of  the  infection  and  in  cases  of  a  protracted  course, 
the  results  are  said  to  be  favorable. 

Prevention.  As  the  disease  seems  to  be  limited  to  certain 
regions,  and  to  certain  places  within  those  regions,  especially 
damp,  swampy  pastures,  the  cattle  should  be  kept  away 
from  such  places.  Through  rational  amelioration  of  the  soil 
(draining  away  the  water,  regulating  the  rivers,  planting  trees 
and  plowing)  places  which  have  been  considered  dangerous 
may  be  made  harmless.    In  Denmark,  according  to  Jensen,  the 


Prevention.     Immunization.  51 

disease  has  decreased  considerably  in  the  course  of  the  last 
30  to  50  years,  owino-  to  such  iTn))rovoiiients  of  tlie  jjrouiid. 
When  this  is  not  practicable,  and  the  danger  of  infection  re- 
mains, the  appearance  of  the  disease  can  be  prevented  by  means 
of  protective  vaccination;  otherAnse,  the  immediate  change  of 
pasture  or  stable  often  results  in  the  disappearance  of  the 
disease. 

Immunization.  Arloing,  Cornevin  &  Thomas  have  stated 
that  cattle  raised  in  blackleg  districts  mostly  contract  the  disease 
at  a  young  age,  \vhile  animals  brought  there  from  disease-free 
regions  are  liable  to  be  infected  at  an  older  age.  This  is  ex- 
plained by  the  supposition  that  the  young  animals,  during  their 
stay  in  blackleg  districts,  become  inmiunized  early  by  repeated 
absorption  of  smaller  amounts  of  virus.  When  these  authors 
produced  a  mild  attack  of  the  disease  by  means  of  injection 
of  small  amounts  of  virus,  they  also  found  that  the  inoculated 
animals  later  resisted  otherwise  fatal  infections.  Based  on  this 
experience  they  have  devised  a  very  valuable  and  practicable 
method  of  protective  vaccination,  which  has  since  been  modified 
in  many  ways  by  other  authors. 

I.  Two  inoculations  with  attenuated  virus.  (Method  of 
Arloing,  Cornevin  &  Thomas.)  A  vaccine  is  prepared  frotti 
diseased,  powdered  muscles  by  attenuating  the  virus  through 
heating  to  a  high  degree  of  temperature.  For  this  purpose, 
the  diseased  part  of  the  muscle  is  ground  in  a  mortar  \\ith  some 
water,  and  dried  in  a  thin  layer  at  37°C. ;  then  the  dry  mass 
is  mixed  with  2  parts  of  water,  and  the  one  half  heated  at 
100-104°  C,  the  other  at  90-94° C.  for  7  hours.  The  former 
makes  the  first  Aveaker  vaccine,  the  latter  the  second  stronger 
one. 

The  high  temperature  attenuates  the  virulence  of  the 
A^rus,  and  the  longer  and  stronger  it  has  been  heated  the  more 
attenuated  it  becomes.  The  spores,  however,  in  spite  of  the 
influence  of  the  heat,  remain  capable  of  germinating,  but  the 
toxin  having  been  weakened  through  heat,  the  spores  are  not 
capable  of  exerting  their  pathogenic  influence.  Being  to  a  cer- 
tain degree  protected  against  the  phagocytes  by  the  coagulated 
albumin,  the  spores  begin  to  germinate  and  to  multiply  slowly, 
and  thus  little  by  little,  the  newly  produced  toxin  immunizes 
the  tissues.  The  immunity  reaches  the  necessary  degree  in  8 
to  10  days  after  the  second  vaccination.  Until  then,  however, 
the  animals  have  a  lower  resistance  aganst  an  artificial  or 
natural  infection  (negative  phase). 

The  practical  value  of  the  protective  vaccination  is  already 
definitely  established.  The  first  experiments  proved  that  ani- 
mals, vaccinated  at  the  end  of  the  tail,  subsequently  withstand 
the  intramuscular  inoculation  of  a  very  virulent  culture  without 
hanii,  and  that  the  immunity  obtained  lasts  at  least  17  or  18 


52  •  Blackleg. 

months.  Later  vaccinations  on  thousands  of  animals  performed 
in  many  sections  have  shown  that  the  artificial  immunity  also 
protects  against  natural  infection.  The  vaccinations  have  re- 
sulted in  a  large  decrease  in  cases  among  vaccinated  animals 
(11  to  12  times  fewer  cases  than  among  non-vaccinated  animals) ; 
besides  in  the  infected  localities  the  percentage  of  mortality  has 
decreased  during  recent  years,  wdiicli  evidently  is  owing  to  the 
fact  that  there  have  been  fewer  diseased  carcasses  and  less 
contaminated  material  to  infect  the  ground.  The  protective 
vaccination  is  now  practiced  with  good  results  in  those  districts 
where  the  disease  usually  appears  as  an  epizootic. 

The  method  was  modified  by  Preisz  so  that  the  powdered  muscle 
substance  is  heated  for  6  hours  in  live  steam,  and  0.05  gm.  is  used 
for  the  first,  and  0.10  gm.  for  the  second  vaccination. 

In  18S0,  Arloing,  Cornevin  &  Thomas  subjected  13  head  of  cattle  to  protec- 
tive vaccination  at  Chaumont  before  a  commission;  when  these  cattle  were  later  inocu- 
lated with  virulent  material  they  all  remained  healthy,  while  out  of  12  non-vac- 
cinated animals  11  acquired  blackleg  as  a  result  of  a  similar  artificial  inoculation, 
and  9  of  them  died. 

According  to  Strebel,  out  of  82,5.'i0  cattle  vaccinated  during  the  years  1884 
to  1898,  in  Switzerland,  0.75%  contracted  blackleg,  while  out  of  35,400  non-vac- 
cinated animals,  kept  under  the  same  conditions,  2.6%  succumbed.  According  to 
another  compilation  by  Strebel,  during  the  years  1885  to  1894,  out  of  325,892  vac- 
cinated cattle  in  various  countries,  0.056%  died  from  vaccination  blackleg,  and  later 
0.38%  died  from  spontaneous  blackleg.  There  were  129,705  vaccinated  animals  kept 
during  the  summer  on  the  same  pasture  with  240,560  unvaccinated  animals;  out  of 
the  former  0.42%  and  out  of  the  latter  1.76%  were  the  victims  of  blackleg.  Strebel 
considers  vaccination  in  the  tail  as  less  dangerous  than  in  the  shoulder,  since  with 
the  former,  23  out  of  107,080  vaccinated  animals  (0.021%)  and  with  the  latter  181 
animals  out  of  26,816  (0.67%  or  31  times  more)  died  as  a  result  of  the  vaccina- 
tion. On  the  other  hand,  Suchanka  at  Salzburg  was  satisfied  with  the  vaccination 
in  the  shoulder.  In  the  canton  of  Berne  in  the  years  1885  to  1908,  out  of  463,613 
vaccinated  animals  580  (0.125%)  died  after  vaccination,  and  1,915  (0.41%)  in  the 
following  14  months  (Belavoine).  In  the  Austrian  alpine  regions,  during  the  year 
1909,  33,056  head  of  cattle  were  vaccinated,  out  of  which,  during  the  pasture  sea- 
son, 114  (0.345%)   died,  against  1.094%  among  the  unvaccinated  herd-mates. 

In  Hungary  the  protective  vaccinations  have  had  good  effect  both  on  the  improved 
breeds  and  on  the  native  cattle.  First  the  Lyons  vaccine,  and  later  Preisz '  vaccine 
were  used.  According  to  Hutyra's  compilations,  during  the  years  1893  to  1900,  out 
of  16,679  vaccinated  animals  22  (0.13%)  were  lost.  In  the  year  1907,  out  of  14,029 
animals  vaccinated  in  infected  herds,  30  died  after  the  first  vaccination,  and  sub- 
sequently by  the  end  of  the  year  36  had  died;  on  the  other  hand,  in  previously  unin- 
fected herds,  the  loss  amounted  to  only  1  and  15  respectively  out  of  14,148  vaccinated 
animals. 

Technique  of  Vaccination.  The  10  doses  (1.0  g.)  of  vaccine  contained  in  folded 
paper-wrappers  (yellow-red  powder)  are  ground  carefully  with  5.0  cc.  of  sterilized 
water  in  a  small  mortar,  and  the  mixture  is  filtered  through  sterilized,  moistened 
linen  cloth.  The  filtrate  is  drawn  into  a  syringe  5  cc.  capacity  made  for  the  pur- 
pose, and  the  fluid  kept  agitated  in  order  to  avoid  sedimentation.  The  piston  of  the 
syringe  is  divided  into  10  divisions;  after  filling  the  syringe  the  indicator  is  placed 
at  the  1st  division. 

According  to  the  original  French  method  (Lyons),  the  place  of  injection  is  on 
the  lower  part  of  the  tail;  the  first  injection  is  made  3,  and  the  second  2  hand- 
breadths  from  the  end  of  the  tail.  While  the  animal  is  secured  at  the  head  and 
at  the  hind  part,  the  tail  is  taken  up  with  the  left  hand,  the  hair  is  shaved  from 
the  site  of  injection  and  the  skin  disinfected ;  then  the  trocar  going  with  the  syringe 
is  pushed  under  the  skin  to  the  handle,  thereby  making  a  canal  about  5cm.  long. 
The  trocar  is  then  carefully  withdrawn  and  in  its  place  the  dull  hollow  needle  is 
inserted,  and  one  dose  is  injected  into  the  canal.  Then  the  needle  is  pulled  out,  the 
place  of  injection  pressed  together  with  the  left  thumb,  the  syringe  delivered  to  the 
assistant,  and  the  injected  vaccine  pressed  upward  by  means  of  the  right  thumb ; 
finally,  the  tail  is  bandaged  with  a  narrow  linen  bandage  over  the  place  of  injection. 


Iiimiunization.  53 

Thp  batidape  is  rpmoved  after  four  hours,  although  it  may  safely  be  left  on  in  cattle 
kept  in  the  pasture.  After  10  to  12  tlays  the  animals  are  ayain  vaccinate.l  in  the 
same  manner  but  with  the  stronjjer  vaccine. 

Many  firms  ship  emulsions  of  the  vaccine  powiler  in  scaled  jrlass  tubes  for 
immeiliate  use.  Such  vaccine  is  easily  contaminated  and  should  l>e  used  as  soon 
as  possible,  but  the  powder  vaccine  keeps  unchanged  for  months. 

According  to  recent  experiences,  the  vaccination,  at  least  on  fhe  hardy  range 
cattle,  may  be  performetl  behiml  the  shoulder  with  the  same  results  and  more 
conveniently  (see,  however,  Strebel's  statistics).  Here  it  is  also  advisable  to  per- 
forate the  skin  by  means  of  a  trocar,  while  the  bandage  after  the  injection  of 
course  is  dispensed  with.  The  second  vaccination  likewise  follows  10  to  12  days 
later,  but  on  the  opposite  side  of  the  chest. 

It  is  advisable  to  apply  the  vaccination  at  the  end  of  winter  or  in  the 
spring,  if  possible,  before  the  cattle  are  sent  to  pasture.  Otherwise  the  animals 
are  liable  to  be  infected  before  vaccination,  and  the  summer  heat  may  cause 
unpleasant  complications  after  tail  vaccination,  according  to  the  Lyons  method, 
because  the  animals  do  not  keep  the  vaccinated  part  of  the  body  quiet.  Calves  less 
than  six  months  old  and  cattle  over  4  years  old  raised  in  blackleg  districts,  as  well 
as  pregnant  heifers  in  the  last  four  weeks  of  pregnancy,  should  not  be  vaccinated. 
Sucking  calves  are  not  immunized  by  the  vaccination,  and  old  animals  as  a  rule  do 
not  contract  the  disease. 

Immediate  results  of  the  raccination.  Vaccinations  if  properly  ])er- 
formeii  only  cause  a  slight  local  swelling  at  the  place  of  injection,  which  rarely 
is  accompanied  by  general  indisposition  and  only  by  a  slight  rise  in  the  tem- 
perature. Ihipleasant  complications  are  seldom  observed  and,  as  a  rule,  occur  only 
when  the  vaccination  has  not  been  performed  with  the  necessary  care  and  cleanli- 
ness. Such  complications,  which  usually  appear  3  to  G  days  after  the  vaccination, 
consist  in  necrosis  of  the  3  or  4  last  vertebra  of  the  tail,  bending  of  the  tail,  forma- 
tion of  abscesses,  inflammation,  etc. 

Protective  vaccination  of  sheep.  Scheibel  vaccinated  sheep  successfully 
with  vaccine  prepared  fiom  diseased  muscles  of  sheep.  The  meat  is  dried  at  30°  C. 
and  ground;  one  half  is  heated  at  100°  C.  and  the  other  half  at  85°  C.  for  6 
hours;  of  this  1.0  gm.  is  used  for  every  20  sheep.  The  vaccination  is  jterformed,  as 
with  cattle,  near  the  end  of  the  tail,  and  in  docked  sheep  on  the  inside  of  the 
leg.  ,  Such  vaccinated  animals  prove  immune  against  the  infection  with  fresh  diseased 
muscle  or  blackleg  virus. 

II.  One  inoculation  with  attenuated  virus.  Acoordinc:  to 
experiments  by  Kitt,  a  powder  prepared  from  diseased  muscles, 
after  having  been  heated  for  6  hours  in  dry  air  at  85  to  90°  C, 
or  still  better,  in  live  steam  at  97° C,  gives  a  suitable  vaccine. 
One  injection  of  such  vaccine  into  cattle  immunizes  them  suffi- 
ciently and  lastingly,  without  causing  conspicuous  s^miptoms 
of  disease  (the  vaccine  kills  sheep  in  doses  from  0.2  to  0.6  gm. ; 
smaller  doses  produce  only  slight  fever). 

This  method  which  is  conducted  in  tlie  same  way  as  vac- 
cination with  Lyons  vaccine,  except  that  the  operation  is  per- 
formed in  one  act,  is  especially  to  be  recommended  for  vaccina- 
tion of  the  more  hardy  native  cattle,  but  it  also  gives  satis- 
factory results  in  the  improved  breeds  which  have  less  power  of 
resistance. 

Tn  Bavaria,  during  the  years  1S98  to  190(1,  out  of  02,178  vaccinated  head 
of  cattle  8  died  shortly  after  the  vaccination  and  134  later,  in  all  0.22%,  while  in  the 
first  5  years,  on  the  same  pastures  out  of  23,324  non-vaccinated  animals  3!ts  or 
1.70%  died  from  blackleg  (Kitt).  In  the  years  1903  to  1905,  out  of  25,(509  vac- 
cinated animals  G8  or  0.26%  died  later  from  natural  infection.  In  Austria,  accord- 
ing to  the  official  reports,  in  the  years  1891  to  1S94,  28,855  head  of  cattle  were 
vaccinated  by  one  inoculation  with  the  Kitt  vaccine;  out  of  those  47  or  CK)*/?  died 
from  vaccination  lalackleg  and  86  or  0.29%  from  spontaneous  blackleg. 

In  Hungary,  in  the  year  1S92,  Makoldy  vaccinated  230  head  of  cattle  from 
1  to  4  years  old  by  Kitt's  method,  one-half  belonging  to  the  Hungarian-Sieben- 
biirgen   breed,   and    the   other   half   to   the   Pinzgau    breed.      The   vaccination   itself 


54  Blackleg. 

caused  no  loss,  and  no  case  o^  blackleg  appeared  among  the  vaccinated  animais 
during  the  following  year. 

In  the  United  States  this  method  has  been  much  in  use  since  1897,  with  the 
modification  however  that  Norgaard  heats  the  dried  ground  muscle  intended  for  vacci- 
nation only  to  93-94°C.  The  Bureau  of  Animal  Industry  sends  out  IVi  millions  of 
doses  of  vaccine  every  year,  and  the  results  of  the  vaccinations  have  been  favorable. 
Thus,  in  the  years  1907-08,  out  of  690,828  vaccinated  animals  227  died  within  48 
hours  after  vaccination,  507  from  2  to  7  days  after,  and  2,734  later  within  a 
year   (total  loss  0.50%). 

In  India,  Holmes  obtained  the  best  results  from  one  injection  of  a  mixture 
of  the  first  and  second  Lyons  vaccine,  which  by  means  of  a  particularly  con- 
structed syringe  was  placed  under  the  skin  in  the  shape  of  a  pill. 

III.  Immunization  with  serum  and  attenuated  cultures. 
Kitt  (1893-1899)  obtained  from  sheep  which  had  been  treated 
repeatedly  with  intravenous  and  later  with  subcutaneous  in- 
jections of  muscle  juice  from  blackleg  tumors,  a  blood  serum 
which  in  5  to  10  cc.  doses  protected  sheep  against  an  injection 
of  the  virus  made  3  to  8  days  later,  and  15  cc.  injected  into  a 
goat  cured  the  already  developing  disease.  According  to  later 
investigations  (1899),  goats,  cattle  and  horses  also  produce 
similar  active  blood  sera,  and  the  last  named  animal  partic- 
ularly seems  to  be  suitable  for  the  purpose. 

These  results  were  later  confirmed  by  Arloing,  and  still 
later  by  Leclainche  &  Vallee;  besides,  the  latter  authors  have 
ascertained  that  blood  serum  and  virus  mixed  together,  or  each 
for  itself  w^hen  injected  at  the  same  time,  do  not  immunize, 
but  that  the  successive  application  of  blood  serum  and  virus 
affords  a  mode  of  immunizing,  which  may  be  used  for  practical 
purposes. 

The  method  which  has  so  far  oeen  tested  only  in  France  is  as 
follows :  For  vaccination  two  different  vaccines  are  used.  The  one 
is  blood  serum  from  horses,  which,  through  repeated  intravenous  injec- 
tions with  bouillon  cultures  of  the  blackleg  bacillus  containing  toxins, 
have  been  highly  immunized ;  the  other  is  a  bouillon  culture  of  the 
same  bacillus  attenuated  by  being  heated  to  70°  C.  for  3  hours.  First 
the  animals  are  injected  with  10  to  20  cc.  of  blood  serum,  according  to 
their  weight,  in  the  region  of  the  shoulder,  and  5  to  6  days  later  a 
second  injection  is  given  subcutaneously  with  0.5  to  1.0  cc.  of  attenu- 
ated pure  culture  at  the  same  place  or  in  the  neck,  ear  or  tail.  This 
form  of  protective  vaccination  may  also  be  applied  without  hesitation 
in  already  infected  herds. 

Leclainche  &  Vallee  vaccinated  in  the  year  1902,  447  head  of  cattle  without 
any  direct  loss,  but  subsequently  one  animal  died  from  blackleg;  later  statistics 
indicate  8  deaths  among  7,987  vaccinated  animals  (0.1002%). 

According  to  Leclainche  &  Vallee  some  of  the  animals  on  blackleg  pastures 
harbor  the  virus  in  the  intestinal  canal  (latent  infection),  but  they  are  protecteil 
against  its  pathogenic  action  by  the  intestinal  juices  and  phagocytosis;  if,  however, 
such  animals  are  inoculated  with  live,  even  attenuated,  virus,  the  body  thus  attacked 
from  two  sides,  can  no  longer  combat  the  infection.  Through  the  preceding  vaccina- 
tion with  serum,  the  resistance  of  the  animal  is  increased  to  such  a  degree  through 
the  production  of  passive  immunity  as  to  make  it  efficient  even  against  the  double 
danger.  This  conception  can  hardly  be  recognized  as  correct  in  its  present  form, 
because  after  vaccination  of  already  disea!-e<l  herds  with  live  virus  direct  losses  from 
the  vaccination  are  seldom  observed.  To  the  occurrence  of  such  losses  other  factors 
are  contributory,  particularly  the  relative  susceptibility  of  the  animal  in  comparison 
with  the  degree  of  virulence  of  the  vaccine. 


lummiiizatlon.  55 

IV.  Protective  vaccination  with  thread  covered  with  spores. 
(Method  of  Thomas.)  Thomas,  a  veterinary  surgeon  at 
Verdun,  recommends  a  spore-containing  vaccine,  the  prepara- 
tion of  which  is  not  given  (supposedly  through  growth  in  frog's 
l)odies) ;  with  tliis  vaccine  silk  threads  (Ills  virulents,  hlack- 
legine)  are  impregnated  which  lie  introduces  into  the  sub- 
cutaneous tissue  of  the  tail.  In  his  opinion,  this  method  is 
more  effective  than  the  original  Lyons  method,  l)ecause  a 
hlackleg  culture  develops  around  the  threads  left  under  the 
skin  which  exerts  a  continued  immunizing  action  on  the 
organism  (in  an  experiment  with  sheep,  he  found  virulent 
spores  and  bacilli  between  the  silk  threads  328  days  after  the 
vaccination). 

The  vaccination  instniment  consists  in  a  trocar  fastened  to  a  handle  of  wood 
behind  the  tip  of  which  is  a  cut  for  placing;  the  silk  threads.  One  dose  of  the 
vaccine  consists  of  7  to  S  short  threads  which  are  fastened  together  at  the  ends 
by  means  of  a  metal  nipper.  At  the  vaccination,  after  the  threads  have  been  placed 
in  the  notch  and  the  nipper  is  cut  awaj%  the  needle  is  stuck  deep  into  the  sub- 
cutaneous tissue  near  the  end  of  the  tail  (in  calves  behind  the  shoulder)  as  nearly 
as  possible  parallel  with  the  surface  of  the  skin,  and  inuiiediately  pulled  out  again, 
whereby  the  threads  slip  off  from  the  needle  and  remain  in  the  depth  of  the  vac- 
cination canal.  The  vaccination  is  either  performed  twice  with  a  weaker  and  a 
stronger  vaccine,  or  only  once  with  the  latter. 

In  America  13.'),000  head  of  cattle  were  vaccinated  in  the  years  1899  and  1900 
according  to  this  method  (one  single  vaccination).  According  to  the  reports  of 
the  results,  the  vaccination  itself  caused  no  losses,  while  later,  as  a  result  of  natural 
infection,  0.4  to  0.7%  of  the  vaccinated  animals  die<l. 

Lately  this  method  has  also  been  used  in  Germany,  and  Warringholz  obtained 
good  results  in  406  and  Witt  in  700  animals;  on  the  other  hand,  in  Alsace-Loraine 
(1901)  22  vaccinated  animals  out  of  260  died,  while  in  Hungary,  Viasz  lost  16  out  of 
70  vaccinated  animals  within  3  weeks. 

According  to  investigations  by  Eegn,  the  vaccine  is  very  impure  and  con- 
tains particularly  a  large  number  of  staphylococci ;  in  connection  herewith,  Guillebeau 
frequently  observed  vaccination  abscesses  among  cattle  in  the  canton  of  Berne. 

V.  other  methods  of  immunization.  It  is  also  possible  to 
immunize  cattle  l)y  means  of  other  methods,  which,  however,  are 
little  used  in  practice,  and  only  deserve  attention  from  a  scien- 
tiiic  point  of  view. 

1.  Protective  vaccination  with  non-attenuated  virus.  Cattle 
may  l)e  iininuiiiztHl  by  sulK'Utaneoiis  injection  of  a  small  amount  of 
the  juice  from  tiie  swellings  into  parts  of  the  })ody  with  low  tem- 
perature and  dense  subcutaneous  tissue.  The  su])cutaneous  injection  of 
1  to  6  drops  into  the  end  of  the  tail  causes  neither  local  nor  general 
symptoms;  10  to  15  drops  will  cause  an  increase  in  temperature  of 
1.5  C,  while  20  drops  will  cause  a  local  swelling.  The  further  away 
from  the  trunk  the  injection  is  made  the  milder  the  symptoms  appear; 
injections  in  the  vicinity  of  the  root  of  the  tail,  however,  often  cause 
severe  disease. 

According  to  Arloing,  the  direct  intravenous  injection,  although 
it  re(|uires  more  manual  skill,  is  the  most  favorable.  It  consists  in 
injecting  3  to  4  drops  of  the  serous  tiuid  of  a  swelling  into  a  vein  of 
the  animal,  care  being  taken  that  none  of  the  li(|uid  gets  into  the  peri- 
vascular connective  tissue.  After  a  regularly  performed  vaccination, 
general  symptoms,  such  as  a  slight  elevation  of  temperature  and  loss  of 
appetite,   will   appear,    after   the   disappearance   of   which   the   animal 


56  Blackleg. 

will  resist  a  subsequent  artificial  or  natural  infection.  The  results  of 
these  experiments  are  very  favorable,  but  the  operation  reijuires  great 
care  and  skill,  because,  if  some  of  the  vaccine  should  locate  in  the 
porous  tissue  of  the  neck,  fatal  blackleg  will  almost  surely  result 
(Eloire).  Intratracheal  injection  with  fluid  from  the  swellings  is 
subject  to  the  same  consideration  as  to  the  immunizing  effect  and  the 
danger. 

Poels  used  virulent  cultures  of  blackleg  bacilli  for  protective  vac- 
cination. As  soon  as  the  formation  of  spores  has  begun  in  the  culture 
small  cotton  pads  are  immersed  and  afterwards  dried ;  at  the  time  of 
vaccination  they  are  pushed  under  the  skin  of  the  tail  where  they 
cause  a  violent,  but  harmless,  inflammation.  During  the  years  1904  to 
1906,  21,329  calves  from  2  to  10  months  old  were  vaccinated  in  Hol- 
land according  to  this  method  with  an  annual  total  loss  of  from  1.0 
to  1.4%    (Balavoine). 

2.  Protective     vaccination     with     attenuated     pure     culture. 

Kitasato  found  that  fresh  bouillon  cultures  more  than  2  weeks  old 
or  heated  to  80° C.  for  half  an  hour  did  not  kill  guinea  pigs,  but  im- 
munized them  effectively.  Kitt  had  a  similar  experience  (1894)  with 
subcutaneous  injections  of  1  to  5  cc.  of  bouillon  culture  in  sheep  and 
cattle,  which,  6  weeks  later,  resisted  a  virulent  infection.  Owing  to  these 
favorable  experimental  results  the  method  was  used  in  practice  for  a 
time.  (In  Austria,  out  of  7,434  cattle  vaccinated  during  the  years  1894 
to  1895,  8,  or  0.11%  died  as  a  result  of  the  vaccination  and  93  or  1.25% 
from  spontaneous  blackleg.) 

Leclainche  &  Vallee  injected  cattle  subcutaneously  with  a  5  to  8 
days  old  bouillon  culture  which  had  been  heated  at  70°  C.  for  2  hours, 
whereafter  the  animals  thus  treated  were  subjected  one  week  later  to 
a  subcutaneous  injection  of  2.0  cc.  of  a  very  virulent  culture  without 
any  harmful  effect.  This  single  vaccination,  however,  has  not  been 
kept  up  in  practice,  because  out  of  39  animals  4  died  as  a  result  of 
the  vaccination.  Later  the  vaccination  was  performed  in  2  acts,  the 
first  with  a  culture  heated  for  3  hours  to  75''C.  and  the  second  with 
one  heated  to  68-70° C.  The  result  this  time  was  also  unsatisfactory, 
one  animal  dying  after  the  first  vaccination  and  six  after  the  second. 

Of  the  vaccine  prepared  by  the  sero-therapeutic  institute  at  Toulouse  0.5  cc. 
is  injected  into  calves  less  than  6  months  old,  and  1.0  cc.  into  older  animals,  under 
the  skin  of  the  ear  or  the  end  of  the  tail. 

Detre  recommends  a  liquid  vaccine  which  he  prepares  by  separating  the 
muscle  fibers  and  albumin  coagula  from  the  spores  and  toxins  in  the  Lyons  vac- 
cine, obtaining  a  liquid  which  contains  the  same  active  substances  as  the  Lyons 
vaccine.  The  spores  and  toxins  attenuated  through  higher  temperature  at  two 
different  degrees  of  exposure  in  a  hypertonic  solution  of  salt,  are  offered  for  sale  in 
the  market,  and  the  vaccine  is  said  to  prove  its  efficiency  in  practical  experiments. 

3.  Immunizing  with  toxins.  Roux  succeeded  in  immunizing 
guinea  pigs  against  blackleg  by  repeated  injections  of  15-day  old  bouillon 
culture  heated  to  115°  C.  or  a  filtrate  of  such  culture,  into  the  ab- 
dominal cavity,  and  also  by  subcutaneous  injection  of  a  l)aeteria-free 
filtrate  of  the  juice  of  the  swellings.  Duenschmann  obtained  similar 
results  with  only  the  filtrate  of  the  juice  of  the  swellings  from  animals 
that  had  died  from  spontaneous  blackleg.  Finally,  Schattenfroh  used 
pure  solutions  of  toxins  from  which  the  bacteria  had  ])een  removed  by 
means  of  clearing  powder,  but  with  very  unfavorable  results,  as  23 
out  of  306  vaccinated  animals  died  from  the  effect  of  the  poison,  and 
40  to  50  more  became  very  sick. 


Ininiiuiization.      Veteriiiaiy    Police.      I-Jradsot.  57 

4.  Protective  inoculation  with  immune  serum.  In  lilOf)  Grass- 
l)prgor  &  ydiattenfroh  injected  about  800  head  of  cattle  in  Tyrol  and 
Ijower  Austria  with  serum  from  an  animal  which  had  been  immuni/ed 
])y  means  of  toxin  and  afterwards  with  virulent  nuiterial.  The  results 
M'ere  unsatisfactory,  inasmuch  as  8  animals  later  succumbed  to  l)lacklej^ 
when  placed  on  infected  pastures. 

5.  Immunization  with  toxins  and  immune  serum.  Grassberger 
&  Schattenfroh  i)repared  a  very  elTective  antitoxic  serum  (0.0025  cc. 
of  serum  neutralized  1.0  ec.  of  toxin)  by  treating  cattle  with  their 
toxin  (page  4.')),  40.0  cc.  of  which  killed  young  cattle,  and  used  this  for 
vaccination  after  having  mixed  it  with  toxin.  According  to  their  ex- 
perience iiniininity  may  be  attained  by  means  of  such  a  mixture  as 
well  as  with  toxin  alone,  the  former,  however,  having  the  advantage 
that  it  does  not  cause  edema  nor  interfere  with  the  general  health  of 
the  animal.  The  vaccination  consists  in  one  single  subcutaneous  injec- 
tion with  5  to  10  cc.  of  the  neutralized  mixture  of  toxin-serum. 
In  the  Austrian  mountain  districts,  more  than  4,500  head  of  cattle  were 
vaccinated  in  1904  without  direct  loss,  but  later  78  died  from  natural 
blackleg  while  at  pasture. 

Veterinary  Police.  Owing  to  the  enzootic  appearance  of 
blackleg  in  many  regions,  as  well  as  to  the  considerable  losses 
caused  by  it,  the  disease  has  recently  been  made  subject  of 
obligatory  notification  in  several  countries,  among  others  Ger- 
many and  Austria.  The  legal  methods  of  prevention  are  similar 
to  those  employed  for  anthrax,  special  attention  ])eing  paid  to 
the  destruction  of  the  carcass,  and  also  to  the  indemnification 
of  the  owner  and  the  application  of  vaccination. 

Accordinpf  to  the  results  of  the  investigations  of  Saner,  hides  from  animals 
having  died  from  blackleg  may  be  thoronghly  disinfected  by  being  placed  for  10 
days  in  a  1:1.000  solution  of  bichloride  of  mercury,  5%  creolin  or  carbolic  acid 
solution,  and  also  in  freshly  prepared  whitewash. 

Literature.  Bollinger,  D.  Z.  f.  Tm.,  1875,  I,  297.— Feser,  Z.  f.  pr.  Vet.  Wiss., 
1876,  IV,  13;  D.  Z.  f.  Tm.,  1880,  IV,  371.— Arloing,  Cornevin  &  Thomas,  Le  Charbon 
svmpt.  du.  boeuf,  Paris,  1887.— Eoux,  A.  P.,  1887,  I,  62.— Kitt,  (1)1.  f.  Bakt..  1887 
1,  684,  and  1888,  III,  .572;  Monh.  1893,  IV;  1896,  VIII,  and  1901,  XIII  (Review); 
Hb.  d.  p.  M.,  1903,  II,  600  (Etiology),  and  1904,  IV,  1001  (Immunization;  with 
literature).— Kitasato,  Z.  f.  Hvg.,  1889,  VI,  105.— Leclainche  &  Valiee,  A.  P., 
1900,  XIV,  202  and  590  (Lit.).— Thomas,  Eep.  de.  pol.  san.,  1900,  31— Kerrv,  O.  Z 
f.  wiss.  Vk.,  1894,  V,  228.— Marek,  Monh.,  1896,  YU,  489;  1897,  VIII,  174.— Grass- 
berger &  Schattenfroh,  Uber  d.  Eauschbrandgift,  1904.— Smith,  Z.  f.  Infkrkh.,  1906, 
T,  26.— Scheibel,  I),  t.  W.,  1907,  61.— Balovoinc,  Diss.,  Bern,  1909  (Literature  and 
vaccination  statistics).— Tillman,  Diss.,  Bern,  1909.— Foth,  Z.  f.  Infkrkh.,  1909,  VI, 
201.— Wulff,  Z.  f.  Tm.,  1909,  XIII,  241. 


"Bradsot"  of  sheep  (Gastromycosis  ovis).  This  destructive  dis- 
ease of  sheep  occurs  on  the  western  coast  of  Norway,  in  Iceland,  and 
on  the  Faroe  Islands  of  Denmark,  in  Scotland  where  it  is  known  as 
Braxy,  also  in  INIecklenburg  and  Prussia  (Peters,  Dammann  &  Opper- 
mann,  Hilbrand).  Ivar  Nielsen  established  the  fact  that  the  disease 
is  caused  by  a  specific  bacterium  which  causes  severe  inflammation 
especially  of  the  abomasum  and  duodenum. 

The  disease  (Bradsot,  Braasot  or  Brosot — quick  plague)  is  chiefly 
observed  late  in  the  fall  or  winter  when  the  sheep  are  driven  from 


58 


Bradsot. 


the  mountain  pastures  to  the  farms  and  are  pastured  on  lower  lands 
which  have  been  infected  by  unburied  carcasses.  The  disease  also 
occurs  frequently  during  stable  feeding  in  the  winter,  and  exception- 
ally in  summer  during  pasturing.  Yearlings  are  most  susceptible,  while 
lambs  and  animals  over  3  years  old  rarely  become  affected.  Well  nour- 
ished animals  appear  more  predisposed. 

Frequently  the  course  of  the  disease  is  very  rapid,  and  the  animals 
die  within  a  few  hours.  In  the  slow^er  form  a  marked  weakness  is 
observed.  Later  the  animals  pass  into  a  comatose  stage,  grind  their 
teeth,  respiration  is  difficult,  and  soon  death  results.  In  some  cases 
frothy  saliva  drips  from  the  mouth,  and  frequently  tympanitis  develops 
in  association  with  colicky  symptoms.  R.  Frohner  also  observed  swell- 
ing of  the  head,  throat  and  tongue,  bleeding  from  the  mouth,  nose  and 
vulva,  swelling  and  bluish-red  discoloration  of  the  vaginal  mucous 
membrane. 

On  post  mortem  the  most  conspicuovis  change  is  a  severe  acute 
inflammation  of  the  abomasum  and  duodenum,  the  mucous  membrane 


Fig.  18.  Bacilli  of  Bradsot  with 
spores.  Kidney  fluid  from  sheep; 
staining  by  Gram.    (After  Jensen.) 


Fig.    19.     Bacilli  of  Bradsot  with 
flageUa.      (After  Tokishige.) 


and  submucous  connective  tissue  of  which  appear  edematously  swollen 
and  permeated  with  extensive  hemorrhages  which  may  sometimes  be 
necrotic.  Similar  changes  are  occasionally  found  in  the  small  intestine, 
whereas  in  some  of  the  cases  the  autopsy  reveals  a  general  infection 
with  parenchymatous  degeneration  of  all  organs  and  a  considerable 
enlargement  of  the  spleen,  wiiich  may  crepitate.  A  sero-liemorrhagic 
exudate  is  present  in  the  abdominal  cavity,  and  gelatinous  infiltration 
of  the  subcutaneous  connective  tissue  may  be  observed  while  the  serous 
fluid  may  also  contain  gases. 

Bacilli  2.6m  long,  1/*  thick  which  stain  by  Gram,  may  be  demonstrated 
in  the  affected  mucous  membrane  and  in  the  subjacent  gelatinous  con- 
nective tissue,  while  in  a  general  infection  they  are  also  present  in  the 
blood.  They  frequently  form  chains,  and  mostly  contain  centrally  located 
oval  spores,  and  may  grow  into  long  threads.  The  bacillus  is  supplied 
with  numerous  long  screw-like  flagella  (Fig.  18  and  19).  It  is  an  anae- 
robe and  multiplies  in  the  depth  of  the  media,  forming  gas,  and  therefore 
resembling  the  bacillus  of  blackleg.  From  this,  however,  it  may  be 
distinguished  by  the  formation  of  threads  and  chains.  It  is  also  patho- 
genic for  pigeons,  chickens  and  mice  (Jensen,  Tokishige), 


Bradsot.  59 

Subcutaneous  injections  of  j)iire  cultures  produce  only  excep- 
tionally a  generalized  atVection  in  sheep  when  the  clinical  picture  re- 
sembles blackleg  (heiuorrliagic-gelatinous  intiltrations  and  gas  lonna- 
tion  in  the  subcutaneous  connective  tissue  and  muscles).  In  most 
instances  only  a  local  swelling  develops  which  later  disappears.  Ajii- 
mals  thus  affected  which  recover  later  resist  natural  infection.  Guinea 
pigs,  rabbits  and  pigeons  are  also  susceptil)le.  The  natural  mode  of 
infection  is  at  present  not  known  with  certainty,  but  it  is  possible  that 
the  infection  occurs  through  slight  injuries  along  the  upper  digestive 
tract.  After  the  appearance  of  the  disease  a  change  of  pasture  and 
stable  as  well  as  a  thorough  disinfection  of  the  premises  is  indicated. 

Immunization.  Nielsen  used  a  heated  powder  made  from  kidney 
tissue,  containing  numerous  bacilli  and  spores  ol)tained  from  sheep 
which  had  died  spontaneously.  This  method  was  principally  employed 
in  Iceland,  but  with  uncertain  results.  Tokishige,  on  the  other  hand, 
proved  that  horses  and  goats  treated  intravenously  with  the  virus 
yielded  a  potent  serum.   Jensen  worked  up  the  three  following  methods: 

1.  Eight-day  old  spore-containing  bouillon-serum  cultures  of  the 
bradsot  bacillus  are  rapidly  evaporated  at  50 'C,  finely  pulverized 
and  mixed  with  a  small  (|uantity  of  gum  tragacanth.  The  dose 
(0.005-0.03  gni.)  must  be  established  by  test  inoculations,  as  the  suscepti- 
bility of  sheep  varies  in  dififerent  breeds  and  ages.  The  immunity  is 
satisfactory,  and  no  losses  were  ol)served  from  the  vaccinations  in  the 
Faroe  Islands,  while  in  Iceland  they  amounted  to  1.5%. 

2.  Blood  serum  of  horses  immunized  by  intravenous  injections  of 
virulent  cultures  (0.02  gm.  serum  protect  guinea  pigs  against  fatal 
infection)  is  dried,  pulverized  and  mixed  with  the  vaccine  descri])ed 
under  1.  For  practical  purposes  a  mixture  of  0.005  gm.  each  of  culture 
and  immune  serum  is  used. 

3.  Threads  are  placed  in  3-4  weeks  old  dextrose  bouillon  cultures 
and  then  dried  at  40-50"  C.  These  threads  are  inserted  with  a  suitable 
needle  under  the  skin  on  the  inside  of  the  thigh  and  left  there.  The 
practical  results  appear  uniformly  satisfactory.  In  some  cases,  how- 
ever the  acquired  immunity  was  insut!icient. 

In  Iceland  and  the  Faroe's  about  three  quarters  of  a  niillion  sheef)  were  vac- 
cinated by  the?e  three  methods  previous  to  1906.  The  losses  in  the  first  group 
whirh  included  20S,80.5  animals  amounted  to  1.4.5%  as  a  result  of  the  vaccination, 
and  0.327c  later  on.  In  the  second  group  of  .52,.327  the  losses  were  0.0.3%  and  1.93% 
respectivelv.  In  the  third  group  of  1-3,934  animals  0.03  and  4.65%  succumbed,  while 
in  the  unvaccinated  sheep  it  reached  4.21,  5.04  and  5.80%  respectively  (Jensen). 

In  opposition  to  the  above  conception  of  the  etiology  of  the  dis- 
ease, Miessner  believes  it  is  (juestionable  whether  bradsot  represents  a 
uniform  disease,  being  rather  a  clinical-anatomical  name  for  any  dis- 
ease in  sheep  which  causes  death  within  a  few  hours,  and  which 
manifests  on  autopsy  an  extensive  hemorrhagic  inflammation  of  the 
abomasum  in  addition  to  an  injection  of  the  subcutis.  He  also  con- 
cluded from  his  numerons  bacteriological  examinations  of  cases  con- 
sidered as  representative  of  the  disea.se,  that  the  etiological  significance 
of  the  bradsot  bacillus  is  very  questionable,  principally  on  the  ground 
that  it  has  not  been  possible  to  produce  the  anatomical  picture  of  the 
disease  with  bradsot  bacilli.  He  also  failed  as  a  rule  in  demonstrating 
the  mentioned  micro-organism  in  fresh  carcasses  of  animals  dead  of 
the  disease  or  which  were  killed  shortly  before  the  fatal  termination. 
He,  however,  failed  to  ascertain  the  true  causative  agent. 


60  Bradsot.     Reindeer  Pest.      Swine  Erysipelas. 

Literature.  Krabbe,  D.  Z.  f.  Tm.,  1875,  I,  34.— Nielsen,  Monh.,  1896,  VIII,  .55. 
—Jensen,  D.  Z.  f.  Tm.,  1896,  XXII,  249  (Lit.);  Hb.  f.  p.  M.,  1903,  II,  685  (Lit.).— 
Hamilton,  The  Vet.  J.,  1901,  286.— Peters,  A.  f.  Tk.,  1897,  XXIII,  73.— Tokishige, 
Monh.,  1901,  XII,  1.— Hilbrand,  Z.  f.  Infkrkh.,  1907,  III,  325  (Lit.).— E.  Froehner, 
D.  t.  W.,  1906,  359.— Miessner,  Mitt.  d.  Inst.  f.  Landw.  in  Bromberg,  1909,  I,  217 
(Lit.).  

Reindeer  Pest.  This  devastating  disease  occurs  periodically  (the 
last  time  in  1895  and  1896)  among  the  reindeer  herds  of  the  Lap- 
landers in  northern  Sweden  and  probably  also  in  Norway.  In  such 
outbreaks  many  thousands  of  animals,  mostly  calves,  but  also  yearlings 
and  two  year  olds  become  victims  of  the  disease.  It  usually  rages  dur- 
ing the  summer  time  when  the  animals  drift  during  the  warm  weather 
from  the  cool  high  pastures  into  the  valleys.  The  etiology  of  the  dis- 
ease was  established  by  Lundgreen  (1897),  and  the  virus  has  been 
more  extensively  examined  by  Bergmann    (1901). 

The  symptoms  of  the  disease,  which  is  usually  fatal  in  from  6  to 
12  hours,  are  excitement,  inappetence,  cessation  of  rumination,  in- 
creased thirst,  staggering  and  uncertain  gait,  difficult  and  accelerated 
respiration,  cough,  and  particularly  the  appearance  of  edematous- 
emphysematous  swellings  at  various  points  of  the  body.  The  tem- 
perature which  is  at  first  high,  drops  at  the  approach  of  death.  There 
is  bleeding  from  the  nose,  and  a  very  repulsive  odor  is  apparent. 

The  post  mortem  examination  reveals  fluid  containing  considerable 
gas  in  the  subcutaneous  connective  tissue,  as  well  as  collection  of  gas 
in  the  internal  organs.  In  addition  to  a  reddish  transudate  in  the 
body  cavities  a  yelloA\ash  discoloration  of  the  liver  and  a  moderately 
acute  swelling  of  the  spleen  may  be  observed. 

From  the  subcutaneous  serous  fluid,  the  transudates  of  the  body 
cavities  and  the  blood  the  reindeer  pest  bacillus,  which  resembles  the 
blackleg  organism,  may  be  obtained  in  pure  culture.  It  is  Gram-posi- 
tive, motile,  forms  oval  spores  in  the  animal,  and  in  artificial  media 
at  a  temperature  of  30-38°  C.  It  may  be  cultivated  on  the  ordinary 
media  aerobically  as  well  as  anaerobically,  and  the  growth  is  especially 
luxuriant  at  body  temperature,  when  a  great  amount  of  fetid  gas  and 
acid  is  formed;  gelatin  becomes  liquefied. 

By  subcutaneous  and  intramuscular  inoculation  of  pure  cultures 
the  disease  may  be  reproduced  in  reindeer.  Sheep  and  guinea  pigs 
as  well  as  mice  and  cattle  are  also  susceptible  to  artificial  infections, 
whereas  rabbits,  hogs,  dogs  and  chickens  are  immune.  Natural  infec- 
tion probably  results  through  wounds  in  the  skin  and  intestinal  mucous 
membrane. 

Inoculations  of  sheep  into  the  tail  produce  only  passive  elevation 
of  temperature,  and  result  in  an  increased  resistance  against  an  other- 
wise fatal  subcutaneous  infection  into  the  rump.  Animals  immunized 
against  reindeer  pest  are  not  immune  to  blackleg  or  bradsot. 

Literature.  Lundgreen,  Z.  f.  Tm.,  1898,  II,  301.— Bergmann,  Ibid.,  1901,  V, 
241. 

4.    Swine  Erysipelas.    Erysipelas  suis. 

{Stdbchenrotlauf,  Rotlaufseuche  [German];  Rhusiopathia  suis, 

Rouget  du  pore  [French];  Red  fever  [English];  Antrace 

eresipelatoso,  Mai  rosso    [Italian].) 

Swine  erysipelas  is  an  acute,  septicemic  infections  disease 
of  young  hogs  caused  by  a  very  fine,  rod-shaped  bacterium, 


Occurrence.     Etiology.  gj_ 

Bacillus  erysipelatis  suis,  which  is  found   in  the  hlood  of  th<i 
affected  animals. 

History.  Tlio  disease  which  until  the  eighties  was  not  distin- 
guisiied  from  anthrax  was  first  studictl  hy  Pasteur  &  Thuillier  (1882). 
These  investigators  did  not  estahlish  the  etiology  of  the  disease,  since 
they  accepted  as  its  cause  the  eight-shaped  hacteriuni  which  was  first 
recognized  by  Detmers.  Nevertheless  their  investigations  resulted  in 
the  preparation  of  a  satisfactory  serum  for  practical  immunizations. 
The  bacillus  of  erysipelas  was  discovered  by  Liiffler  in  1885,  who 
together  with  Schiitz  differentiated  the  disease  from  hog  cholera.  The 
differentiation  had,  however,  also  previously  l)een  made  by  Eggeling 
from  his  clinical  observations.  Later  the  etiological  knowlcelge  was 
advanced  by  the  work  of  Lydtin  &  Schottelius,  Bang,  Jensen,  Preisz, 
Lorenz,  Voges  and  Schiitz,  while  Lorenz,  Leelainche  and  Schiitz  worked 
extensively  on  the  problem  of  serum  immunization. 

Occurrence.  Swine  erysipelas  occurs  everywhere  on  the 
European  continent,  and  is  usually  prevalent  in  the  infected 
territory  in  summer,  with  varied  severity  in  an  enzootic 
form,  and  not  infrequently  epizootically.  During  the  last  dec- 
ades the  disease  has  become  more  widespread  as  a  result  of 
the  propagation  of  pure-bred  animals.  The  disease  usually 
appears  during  the  warmer  periods,  increases  in  intensity 
during  the  course  of  the  summer,  and  abates  at  the  approach 
of  autumn;  wdiereas,  during  the  winter  only  sporadic  cases 
are  observed. 

In  Germany  erysipelas  is  very  extensive.  Since  the  inauguration  of  com- 
pulsory reporting,  the  number  of  infected  townships  increased  from  8,491  in  1897  to 
21,.522  in  1907 ;  and  the  number  of  in<lividual  infections  in  hogs  from  3.S,9.50  to 
75,619,  of  which  80%  died  or  were  killed.  During  the  last  years  the  disease  raged 
in  the  Prussian  government  districts,  particularly  in  Posen,  Oppeln,  Bromberg, 
Marienwerder,  Liegnitz,  and  Breslau. 

In  France  the  disease  also  occurs  extensively.  Optimistic  figures  show  that 
the  annual  losses  amount  to  at  least  100,000  hogs  valued  at  over  $1,000,000  (Nocard 
&   Leelainche). 

In  Austria  the  disease  is  more  prevalent  in  Bohemia,  Galicia;  also  in  Moravia 
and  Southern  Austria;  while  in  the  Alpine  countries  the  erysipelas  invasions 
are  very  slight.  During  the  period  from  1S91  to  1900  the  number  of  infected 
districts  increased  from  9.53  to  2,368;  that  of  the  affected  animals  from  9,286,  to 
14,891    (0.2.5  and  0.32%   of  all  the   hogs). 

In  Hungary  the  disease  was  hardly  known  three  decades  ago  in  the  flat  lands 
around  the  river  Tisza,  but  since  that  time  it  has  become  quite  prevalent.  In 
the  years  between  1899-1908  the  average  number  aft'ected  amounted  to  30,7.57 
hogs,  but  fluctuated  between  7,624  in  254  townships  (1899)  and  56,4.55  iu  1878 
townships    (1906). 

The  disease  is  also  widely  spread  in  Belgium  (annually  about  2,000  cases), 
in  Holland  1,514  cases  in  1908,  in  Denmark  330  new  herds,  in  Eussia  55,996  cases  in 
3,929  townships;  further  it  prevails  in  the  southern  European  countries,  whereas 
in  Sweden  and  Norway  it  occurs  more  rarely,  while  in  Great  Britain  only  sjtoradi- 
cally,  and  in  a  chronic  form.  The  disease  also  occurs  in  the  United  States  of  North 
America,  but  in  the  benign  form  mentioned.  [Urticaria  but  not  infectious  swine 
erysipelas  occurs  in  the  United  States]. 

Etiology.  The  causative  agent,  Bacillus  erysipelas  suis 
(Bac.  rhusiopathiae  suis,  Kitt)  is  a  very  slender,  straight  or 
slightly  curved,  non-motile  organism  which  multiplies  by 
fission,  and  is  from  1  to  l.o'*  long  (1-4  to  1-5  the  diameter  of 


62 


Swine  Erysipelas. 


a  red  blood  corpuscle,  Fig.  20).  In  bacilli  grown  in  cultures 
fine  Gram-positive  granules  may  be  demonstrated  which  are 
considered  by  Fedorowitsch  and  by  Rosenbach  to  be  lasting 
forms  (protospores). 

Staining-.     They  stain  readily  with  aqueous  aniline  dyes  as  well  as 
by  Gram's  method. 

Cultivation.  The  bacilli  grow  well  on  the  ordinary 
artificial  media  with  the  exception  of  potato.  It  is 
aerobic  as  well  as  anaerobic  and  grows  in  cultures  some- 
times as  long  rods  or  curved  threads.  On  gelatin  plates 
the  cultures  form  whitish,  cloudy,  very  fine  flakes  with 
coarse  granular  centers,  which  spread  out  towards  the 
periphery,  into  a  delicate  thready  meshwork.  More 
rarely  they  form  bright  shiny,  branching  small  colonies, 
whereas  in  stabs  pinhead  sized,  white  points  develop  in 
2  to  3  days  which  later  fuse  into  grayish-white,  cloudy 
colonies,  from  which  tine  horizontal  radiating  branches 
run  in  all  directions  of  the  gelatin  (test  tube-brush 
shape.   Fig.   21).      On   agar   and   on   blood   serum   the 

bacillus  forms  very  tine 
punctiform,  dew-drop- 
like colonies.  Bouillon 
is  made  slightly  cloudy, 
while  later  a  fine,  flaky 
sediment  forms  on  the 
bottom  of  the  tube. 


Fig.  20.    Bacilli  of  swine  erysipelas:. 

Smear  prepared  from  blood  of  a 

hog.     Gram-eosin  staining. 


Fig.  21.  Gela- 
tin stab  culture 
of  swine  ery- 
sipelas    bacilli. 


Tenacity.  The  ery- 
sipelas bacilli  manifest  con- 
siderable resistance  towards 
harmful  influences,  which 
they  probably  owe  to  a  wax- 
like capsule  (Schiitz  & 
Voges).  Drying  kills  them 
only  gradually  as  they  re- 
main alive  when  subjected 
to  a  temperature  of  37°C. 
for  31,  and  to  direct  sun- 
light for  12  days  (Sirena  &  Alessi).  Heating  to  70°C.  destroys  them  in  about  5 
minutes.  Pieces  of  meat  not  over  15  cm.  thick  require  21/2  hours  boiling  for  a 
complete  sterilization  (Stadie).  Putrefaction  does  not  destroy  the  bacilli  in  meat  in 
4  months  (Stadie).  Salting  and  pickling  destroys  them  very  slowly;  pieces  of  meat 
and  bacon  may  contain  the  virulent  bacilli  after  lying  in  pickle  for  170  days,  and  in 
a  mixture  of  salt  and  saltpeter  for  30  days,  while  in  smoked  ham  virulent  bacilli  were 
found  even  after  3  months  (Petri).  On  the  other  hand,  continued  smoking  for  2 
weeks  or  shorter  periods  of  smoking  once  repeated  destroys  the  virus  of  erysipelas 
in  pieces  of  pickled  meat  not  over  2%  kg.  in  weight  (Stadie). 

Of  the  disinfectants  the  following  are  effective:  Chlorate  of  lime  (1%),  hot 
lye  (1%),  soda  (5%),  iron  sulphate  (3%),  copper  sulphate  {Vi%),  corrosive 
sublimate  (.1%),  carbolic  acid,  ereolin  and  lysol   (Petri). 

Pathogenicity.  Pure  cultures  inoculated  subcutaneously 
kill  white  and  gray  mice  as  w^ell  as  pigeons  in  2  to  4  days.  In 
rabbits  the  inoculation  produces  erysipelas-like  reddening  and 
sw-elling  at  the  point  of  inoculation,  which  is  occasionally  fol- 
low^ed  in  5  to  6  days  by  a  fatal  general  affection.  In  hogs  an 
inunction  of  virulent  bouillon  cultures  into  superficial  wounds 


Pathogenicity.      Natural    In  tVctioii.  63 

of  the  skin  as  well  as  subeiitaiu'ous  injoctioii  procliices  a  typical 
affection  of  erysipelas  which  terminates  fatally  in  6  to  9  days 
(Preisz).  The  feeding  of  cultures  also  makes  hogs  ill  (Corne- 
vin,  Kitt),  but  this  mode  of  infection  is  not  always  successful. 
Other  animals  cannot  1)0  infected.  Repeated  passage  of  the 
bacilli  through  the  body  of  hogs  increases  their  virulence  for 
hogs  (Schutz),  and  passage  through  pigeons  results  similarly 
for  mice  (Stickdorn),  while  the  virulence  is  gradually  dmun- 
islied  by  continued  cultivation. 

Natural  infection  usually  occurs  through  the  intestinal 
canal,  more  rarely  through  injuries  to  the  skin.  The  greater 
frequency  of  the  infection  per  os  is  proven  by  the  presence  of 
the  bacilli  in  the  intestinal  contents  of  affected  hogs,  also  by  the 
numerous  affections  which  occur  in  a  herd.  The  infection  may 
also  occur  through  the  uninjured  intestinal  mucous  membrane. 
Injuries  such  as  those  from  the  echinorhynchus,  however,  facili- 
tate infection. 

Food  and  drinking  water  are  usually  the  carriers  of  the 
infective  agent,  and  become  readily  contaminated  through  feces 
or  excrement,  urine  and  other  offal  of  affected  animals.  The 
infection  may  also  occur  through  the  ingestion  of  l)lood  and 
meat  of  dead  or  slaughtered  hogs. 

The  disease  is  introduced  into  territories  which  have  been 
free  from  the  infection,  and  is  thus  spread  mostly  by  animals 
sick  or  dead  of  the  disease,  or  by  their  products.  The  bacilli 
are  present  both  in  the  blood  and  the  excrement  of  the  affected 
animals,  of  which  the  infectivity  has  been  established  by  the 
experimental  Avork  of  Cornevin  and  Kitt.  The  infection  is 
present  in  the  excrement  even  when  the  hogs  are  infected 
through  the  skin.  Therefore  the  bacilli  reach  the  lumen  of 
the  intestines  through  the  blood.  The  urine  of  affected  animals 
may  also  contain  erysipelas  bacilli.  Therefore  pastures  in 
which  affected  animals  have  been  kept  or  fields  wdiich  have  been 
fertilized  with  the  manure  of  such  hogs  are  particularly  dan- 
gerous. The  annual  occurrence  of  erysipelas  in  herds  Avhich 
have  been  exposed  to  such  pastures  or  fields  is  thus  readily 
explained.  On  the  other  hand,  pastures  are  frequently  con- 
taminated bv  improperly  buried  carcasses,  especially  since  the 
carcasses  of  such  animals  are  frequently  dug  up  by  dogs  and 
hogs  which  scatter  the  infection  over  the  pastures.  If  dead  ani- 
mals are  thrown  into  flowing  water  the  infection  is  transmitted 
to  herds  of  hogs  wdiich  are  pastured  along  the  banks  of  the 

stream. 

Peddling  of  hogs  and  hog  markets  greatly  aid  in  the  dis- 
semination of  the  disease,  inasmuch  as  affected  animals  driven 
over  the  roads  contaminate  the  roads  and  the  halting  places 
with  their  manure. 

The  infection  is  further  spread  through  the  meat  of  hogs 
slaughtered  in  emergency,  particularly  when  healthy  animals 


64  Swine   Erysipelas. 

are  given  water  in  which  contaminated  meat  has  been  washed. 

The  spread  of  the  disease  is  also  frequently  brought  about 
by  wandering  gypsies  who  carry  the  carcasses  given  to  them,  or 
which  they  dig  up,  from  one  town  to  another,  at  the  same  time 
scattering  the  viscera  in  the  pastures.  Furthermore,  butchers, 
hog  herders  and  castrators  may  spread  the  infection,  particu- 
larly through  utensils  and  containers  in  which  meat  and  meat 
offal  have  been  kept  and  which  have  afterwards  been  used  in 
feeding  or  watering. 

By  the  findings  of  Olt,  Jensen,  Bauermeister  and  Pitt  it  has 
been  proven  that  true  erysipelas  bacilli  may  be  present  in  the 
intestinal  canal,  particularly  in  the  secretion  of  the  tonsils  as 
well  as  in  the  mucous  plugs  of  the  ileo-cecal  valve  of  healthy 
animals.  It  is  therefore  possible  that  on  the  one  hand  the 
contagion  may  be  spread  through  healthy  hogs,  while  on  the 
other  the  disease  may  break  out  in  healthy  herds  without  a 
direct  introduction  of  affected  animals  or  products  originating 
from  them.  Healthy  carriers  of  bacilli  may  thus  become 
affected,  if  through  weakening  influences  such  as  cold,  heat, 
starvation,  etc.,  their  normal  resistance  is  reduced,  and  the 
bacilli  which  were  present  in  the  intestinal  canal  may  then  set 
up  the  disease  process. 

In  examining  the  intestines  of  66  animals  Pitt  found  the  true  erysipelas 
bacilli  in  26  cases,  and  28  times  in  50  tonsil  examinations.  He  believes  that  through 
their  presence  the  hog  becomes  gradually  immuniyed  which  explains  why  animals 
strictly  guarded  from  exposure  have  been  foun<l  to  possess  a  lower  resistance, 
such  animals  becoming  severely  affected  if  exposed  to  infection  in  spite  of  all  pre- 
cautions. 

In  territories  once  infected,  erysipelas  usually  recurs 
almost  annually,  although  with  varying  intensity,  provided  that 
in  the  meantime  no  measures  have  been  undertaken  for  its 
suppression.  This  fact  also  proves  that  the  infection  may 
remain  virulent  in  the  soil  and  in  stable  floors  for  a  considerable 
length  of  time.  It  will  multiply  in  the  summer  time  and  infect 
young  hogs  which  will  then  reinfect  the  soil  with  their  excre- 
ment and  carcasses. 

The  bacillus  of  mouse  septicemia  (Bac.  murisepticiis)  which  cor- 
responds morphologically  and  in  its  cultural  characteristics  with  the 
erysipelas  bacillus,  and  which  has  been  formerly  distinguished  from 
the  latter  by  its  very  slight  virulence  for  hogs  must  at  the  present 
time  be  considered  identical  with  the  erysipelas  bacillus  or  as  an  at- 
tenuated variety  of  it.  These  conclusions  were  reached  by  Jensen, 
Lorenz,  Loffler  and  Prettner,  who  proved  that  animals  immunized 
against  erysipelas  are  also  immune  against  the  virus  of  mouse  septi- 
cemia and  vice  versa.  As  the  virulence  of  the  mouse  septicemia  bacillus 
may  increase  under  natural  conditions,  and  as  it  has  been  repeatedly 
found  in  stagnant,  polluted  water  (Koch),  in  putrefactive  meat 
(Johne),  and  in  blood  of  cattle  (Preisz),  it  is  possible  that  the  mice 
affected  with  septicemia  contribute  to  the  dissemination  of  erysipelas. 

Rohrbach  has  recently  (1909)  been  inclined  to  consider  the  bacillus  of  swine 
erysipelas   and  mouse   septicemia   as  two   different   micro-organisms,   and   to   group 


Suscoplihility.      Patlinnciicsis.  g5 

them  with  tho  erysipeloids  of  man  in  a  special  class  (  Krysipelotriches:  Erysipelothrix 
porci,  E.  eiysipeloiiles  ami  K.  iimriM^ptica).  This  conception,  however,  apjiears  to  have 
insuHicient  foiiiuiation  as  the  inorpholoijical  difierences  are  only  slii^iit  ami  since 
the  variance  in  the  ra[»idity  of  their  j^iowth  in  artilicial  media  is  i)ronoiinced.  (The 
quickest  growth  is  obtained  with  the  mouse  bacillus;  less  rapid  is  the  Bac.  erysipe- 
loides,  while  the  slowest  is  the  erysipelas  bacillus).  Stickdorn  observed  similar  dif- 
ferences in  the  erysipelas  bacillus  after  ])assa^e  through  mice  and  pigeons  in 
spite  of  the  fact  that  serum  examination  showed  no  dilierences  in  the  sliains  or 
species;  and  Overreck  also  foumi  that  the  erysipelas  bacillus  and  the  mouse  bacil- 
lus agglutinate  practically  uniforndy  (1:2U00  to  4000)  when  the  organism  of  the  one 
is  ajiplied  to  the  immune  serum  of  the  other. 

Schip{)  found  a  bacillus  in  the  blood  of  a  chicken  which  was  identical  with 
the  erysipelas  bacillus.  On  that  particular  farm  many  animals  died  in  a  short 
time  and  the  autopsies  revealed  princii)al!y  an  enteritis  and  a  parenchymatous  de- 
generation of  the  heart  muscle.  The  same  author  also  isolated  a  bacillus  from  the 
spleen  of  a  cow  wliich  died  with  symptoms  of  anthrax  and  which  on  autopsy  re- 
vealed only  petechiae  on  the  serous  membranes  and  on  the  heart.  This  organism 
corresponded  morphologically  and  culturally  with  the  erysipelas  bacillus.  Jt  was, 
however,  jiathogenic  for  field  mice  and  Avas  not  influenced  by  erysiiielas  H'ra.  As 
a  secondary  linding  crysij^elas  bacilli  were  also  obtained  from  a  cow  wliich  died 
from  vaginal  diphteria  and  septic  metritis,  and  by  Hiiuser  in  diphtheritic  mem- 
branes of  chickens. 

Susceptibility.  Hogs  are  particularly  susceptible  to  nat- 
ural iiil'ectioii  l)et\veen  the  ages  of  three  months  and  one  year. 
Sucking  pigs  manifest  a  higher  resistance  while  annuals  over 
one  year  old  become  only  exceptionally  affected  as  they  have 
probably   acquired  immunity  during  their   earlier  life. 

According  to  Lydtin  the  English  breeds  are  more  suscep- 
tible, particularly  the  Suffolk  and  Poland  China  breeds,  while 
Yorkshires  are  less  susceptible.  The  German  hogs  are  highly 
resistant,  while  the  Hungarian  breeds  (Mangalicza)  occupy  a 
middle  position  in  the  order  of  suscepti])ility.  The  disease  usu- 
ally rages  more  severely  among  imported  hogs  than  in  the 
hogs  which  have  been  raised  in  the  infected  locality.  The 
disease  has  not  yet  been  established  in  wild  hogs. 

Pathog"enesis.  The  entrance  of  highly  virulent  erysipelas 
bacilli  in  large  quantities  into  the  intestinal  canal  of  healthy 
hogs  will  reduce  the  normal  resistance  of  the  animals,  and  on 
the  other  hand  the  entrance  of  such  bacilli  will  promote  the 
pathogenic  action  of  such  bacilli  as  were  already  present  in 
the  intestinal  canal,  by  their  weakening  influences  upon  the 
system.  Their  penetration  into  the  depth  of  the  intestinal 
mucous  membrane  is  facilitated  liy  injuries  through  intestinal 
parasites  (strongylids,  echinorhynchus  gigas),  whereupon  they 
multiply  in  the  lymph  spaces  of  the  tissues,  enter  the  lymph 
glands  and  finally  the  lilood  circulation.  The  bacilli  which  enter 
the  blood  in  this  manner  or  through  injuries  in  the  skin  will 
continue  to  multiply  there,  and  then  they  accumulate  in  large 
masses  in  certain  blood  vessels,  producing  weakening  of  the 
vessel  walls,  serous  transudations  and  small  hemorrhages 
probably  by  the  action  of  the  metabolic  products.  The 
reddening  of  the  thinner  parts  of  the  skin  may  ])e 
traced  to  this  cause,  whereas  the  necrosis  of  the  skin  wliicli 
occasionallv  occurs  is  the  result  of  the  obstruction  of  the  blood 

5 


66  Swine  Erysipelas. 

vessels.  The  accumulation  of  the  bacilli  in  certain  parts  is 
probably  favored  by  their  being  engulfed  by  leucocytes  which 
then  adhere  to  the  intima  of  the  vessel.  In  chronic  cases  when 
they  become  attached  to  the  valves  of  the  heart  they  produce  an 
affection  of  the  valvular  tissue  (endocarditis  verrucosa  s.  bacil- 
losa)  or  a  bacillary  thrombosis  develops  in  some  of  the  vessels 
of  the  corresponding  valves. 

In  some  cases  especially  those  in  which  the  bacilli  are  not 
very  virulent,  their  multiplication  occurs  only  in  the  lymph 
spaces  of  the  skin  whereby  reddening  of  the  skin  with  circum- 
scribed edema  develops  (urticaria,  diamond-skin  disease)  which 
symptoms  disappear  after  the  death  of  the  bacilli. 

These  changes  prove  that  the  erysipelas  bacilli  produce  toxins  in 
the  body  tissues,  and  in  cases  of  general  infection  the  fever,  depres- 
sion, paralysis  and  finally  death  may  also  be  traced  to  the  action  of 
the  toxins.  This  is  substantiated  by  the  experience  that  hogs  some- 
times die  as  a  result  of  a  cutaneous  infection  with  the  symptoms  of 
the  disease,  yet  bacilli  are  only  found  at  the  point  of  inoculation  and 
in  the  immediately  surrounding  tissue  (Preisz).  Until  the  present 
time,  however,  it  has  been  impossible  to  demonstrate  toxic  substances 
either  in  artificial  cultures  of  erysipelas  bacilli  or  in  the  carcasses  of 
animals  succumbing  to  the  disease.  (According  to  Petri  &  Maassen, 
erysipelas  bacilli  produce  toxin  in  media  containing  hydrogen  sulphide.) 

Anatomical  changes.  In  the  acute  form  of  hog  erysipelas 
the  post  mortem  on  animals  which  have  succumbed  to  the 
disease  shows  in  most  instances  only  slight  changes  in  the  inter- 
nal organs.  The  mucous  membrane  of  the  stomach,  particularly 
at  the  pylorus,  shows  an  inflammatory  swelling,  reddening,  and 
numerous  small  hemorrhages.  The  surface  is  covered  with  a 
sticky,  glassy  mucus.  The  mucous  membrane  of  the  small  intes- 
tine, especially  in  the  duodenum  and  ileum,  appears  catarrhal 
and  congested.  The  solitary  follicles  and  Peyer's  patches  are 
also  swollen,  the  superficial  layer  of  the  mucous  membrane  may 
sometimes  show  desquamation  and  even  ulceration  (Schotte- 
lius).  Small  ulcers  also  occur  on  Bauhin's  valve  as  well  as 
in  the  large  intestine. 

The  spleen  is  usually  only  slightly  swollen  and  congested. 
The  liver  and  kidneys  show  indications  of  cloudy  swelling;  the 
cortical  substance  of  the  latter  is  mostly  darker  and  often 
mottled  by  dark  red  points  (glomerulonephritis).  The  lungs 
are  hyperemic  and  edematously  infiltrated ;  sometimes  they  are 
atelectatic  at  their  borders  as  a  result  of  catarrhal  inflamma- 
tion. All  the  lymph  glands  are  markedly  swollen,  rich  in  blood 
and  fluids.  The  serous  membranes  may  be  covered  with  fine 
fibrin  membranes.  Small  hemorrhages  also  occur  with  relative 
frequency  on  the  serous  and  mucous  membranes,  under  the  epi- 
and  endocardium  as  well  as  in  the  subcutaneous  connective 
tissue. 


Anatomical  Changes.      Symptoms.  67 

Haase  found,  2  to  4  weeks  after  the  disappearam-e  of  the  disease,  small  dark 
red  areas  in  the  kidneys  and  in  the  later  stajjes,  imruient  nodules,  sometimes  accom- 
panied by  extensive  inflammation  of  the  kiilney  tissue. 

The  blood  vessels,  correspondinft"  to  the  red  spots  of  the 
skin,  appear  dilated,  tilled  with  ))lood,  while  the  skin  and  sub- 
cutaneous connective  tissue  is  edematously  inliltrated  and 
studded  with  small  heniorrhaii^es.  The  muscles  either  appear 
healthy  or  they  are  grayish  red  and  lustreless,  while  the  inter- 
muscular connective  tissue  may  be  edematous.  In  rare  cases 
certain  parts  of  the  body  (ears,  tail,  nostrils,  etc.)  or  larger 
areas  of  the  skin  may  be  necrotic  (e.  g.,  on  the  back). 

In  the  chronic  form  the  disease  manifests  an  endocarditis 
(verrucosa  or  ulcerosa)  in  the  majority  of  cases.  In  one  or 
more  orifices  of  the  heart,  particularly  in  the  left  arterial  ori- 
fice, the  convex  surface  of  the  valves  is  covered  with  a  cauli- 
flower-like li))rin  coagulum  which  sometimes  reduces  the  orifice 
to  such  an  extent  that  it  is  hardly  possible  to  insert  the  quill 
of  a  pigeon  feather.  After  the  removal  of  the  fibrin  deposit 
small  wart-like  vegetations  or  ulcerations  appear  on  the  thick- 
ened valve.  Such  carcasses  also  manifest  the  secondary  changes 
which  are  usually  produced  by  affections  of  the  heart,  such  as 
hydrothorax,  passive  hyperemia  of  the  lungs,  liver  and  spleen, 
infarcts  of  the  kidneys,  etc. 

In  some  cases  the  autopsy  also  reveals  chronic  enteritis, 
hypertrophy  of  the  Ijniiph  glands  (without  necrotic  areas), 
small  necrotic  foci  in  the  liver  and  chronic  inflannnation  of  the 
serous  membranes  as  well  as  of  some  of  the  joints. 

The  bacilli  may  be  demonstrated  easily  in  acute  cases  in  the  blood  in  the 
capillary  vessels  of  the  internal  organs  (especially  spleen,  liver  and  kidneys),  in 
the  lymph  spaces  of  the  skin,  and  the  subcutaneous  connective  tissue,  in  the  red 
areas'  of  the  skin  and  plaques,  as  well  as  in  the  regional  lymph  glands.  In  the 
blood  they  are  present  either  free  in  the  plasma  or  inclosed  in  the  leucocytes.  In 
chronic  cases  the  bacilli  are  usually  only  present  in  the  affected  tissues,  particularly 
in  the  valves  of  the  heart  and  in  the  fibrin  coagulum  as  well  as  in  the  bile  where 
they  remain  for  a  longer  time  even  after  the  acute  affection  has  subsided  (Kitt). 
With  Gram  's  stain  thoy  may  be  demonstrated  even  in  putrefactive  tissues  (Opalka, 
Eosso).  However,  it  is  advisable  to  cover  the  parts  of  organs  with  salt  in  order  to 
prevent  putrefaction  when  shipped  for  laboratory  examination. 

Symptoms.  The  time  of  incubation  of  erysipelas  after  arti- 
ficial inoculation  is  3  to  5  days  (Preisz,  Kitt).  ,'Vfter  natural 
infection  from  the  ingestion  of  infectious  meat  or  of  contami- 
nated water  the  first  indications  of  the  disease  appear  as  early 
as  24  hours,  otherwise  the  time  of  incubation  is  usually  3  to 
5,  and  exceptionally  probably  as  long  as  7  days. 

Tlie  clinical  s^anptoms  show  a  considerable  variance  in 
different  cases;  in  general  tlie  following  three  readily  distin- 
guishable forms  of  the  disease  nuty  l)e  observed  which  may  also 
differ  from  each  other  in  their  course. 

1.  Urticaria  (Diamond-skin  disease)  represents  the  mild- 
est form  of  erysipelas.  In  its  course  the  animals  show  after 
1  to  2  davs  a  disturbance  of  their  general  health,  and  sharp 


68 


Swine  Erysipelas. 


circumscribed,  round  or  more  frequently  quadrangular  or  rliom- 
boidal  spots  develop  in  various  parts  of  tlie  body,  especially  on 
tlie  chest  and  back,  outside  of  the  thighs  and  on  the  neck,  but 
sometimes  over  the  entire  body,  which  are  warm  to  the  touch 
and  dark  red  or  violet  in  color.  Later  they  aijjjear  elevated 
above  the  surface  of  the  surrounding  skin  as  much  as  2  to  3 
mm.  The  center  usually  becomes  pale  while  the  border  retains 
the  bright  color.  In  other  cases  the  raised  parts  remain  red 
and  even  become  darker,  while  on  their  surface  a  serous  fluid 
exudes,  which  raises  the  epithelium  in  the  form  of  small  vesi- 
cles w^hich  later  dry  to  crusts.  As  a  rule  the  plaques  are  of 
dollar  size,  but  by  their  confluence  swellings  may  be  formed  as 
large  as  the  palm  of  the  hand. 

The  development  of  the  eruptions  is   usually   associated 
with  fever  (up  to  42.8^  C),  dullness,  loss  of  appetite,  thirst. 


Fig.  22.     Swme  erysipelas.     Gangrene  of  the  skin  of  the  back. 
(After  Schwarzbart.) 

constipation,  conjunctivitis,  sometimes  symptoms  of  paralysis 
and  nausea.  After  the  development  of  the  eruptions  the  symp- 
toms diminish.  Soon  afterwards  the  eruptions  also  disappear, 
and  after  2  to  3  days,  sometimes  however  only  after  8  to  12 
days,  the  animal  recovers. 

In  some  of  the  cases  the  changes  in  the  skin  take  on  a 
malignant  character.  On  the  parts  of  the  body  mentioned, 
more  frequently,  however,  on  the  ears,  head  and  tail,  the  skin 
swells  considerably  in  certain  spots,  becomes  dark  red  and 
warmer;  soon  these  places  become  insensitive,  cooler  and 
dry,  and  finally  become  separated  from  the  surrounding  and 
underlying  tissues,  or  the  animal  loses  one  or  both  ears,  its 
tail  or  distal  digits.  Sometimes  the  inflamed  skin  over  the  back 
dies  off  in  its  entire  extension  so  that  it  covers  the  upper  part 
of  the  body  in  the  form  of  a  shield  (Fig.  22),  and  gradually 
loosens  from  the  borders  and  is  cast  off.  The  resulting  raw 
surfaces  heal  later  should  the  animal  remain  alive,  causing  dis- 


Syinptonis.  GO 

iii;iiroiiioiit     in    tlic     foi'in    of    thick,     somctiiiU'S    cartila.ii^o-likc' 
cicatrices. 

In  some  cases  an  erysi])elatons  endocarditis  dcvelo})s  after 
the  disappearance  of  tiie  eniptions  wliicli  terminates  fatally, 
or  a  paralytic  condition  results  Avhicli  may  remain  for  a  longer 
time. 

Jensen  (1891),  Lorenz,  Liipke  and  others  found  in  urticaria  the 
erysipelas  haeillus  in  the  lymph  spaces  of  the  affected  parts;  on  the 
other  hand,  JMarkus  succeeded  in  producing  a  ven-ucose  endocarditis 
as  well  as  kidney  infarcts  in  a  pig  hy  intravenous  injection  of  2  cc. 
of  a  bouillon  culture  which  was  derived  from  a  dermatitis,  while 
Schiitz  observed  urticaria  in  ordinary  country  hogs  and  erysipelas  in 
English  breeds  after  the  injection  of  the  same  culture.  Jensen  and 
Lorenz  proved  the  presence  of  the  erysipelas  bacillus  in  the  lymph  spaces 
of  the  chorion  to  be  a  cause  of  dry  gangrene. 

2.  Erysipelas  septicemia.  In  this,  the  most  frequent  form 
of  the  disease,  the  animals  snddeidy  cease  to  root  and  to  run. 
They  lie  exhausted  and  dull  upon  the  ground,  they  crawl  under 
the  straw  in  the  stall  and  when  caught  they  do  not  squeal  or 
show^  the  usual  resistance.  They  show  inappetence,  nausea  and 
vomiting.  The  body  temperature  rises  even  at  tlie  onset  very 
high  (up  to  41°  to  42°  C.)  and  remains  practically  constant. 
The  eyelids  are  frequently  edematously  sAvollen,  the  conjunctiva 
is  injected,  the  canthus  of  the  eye  is  filled  wdth  a  slimy  secre- 
tion. At  first  there  is  constipation,  later,  however,  diarrhea 
appears,  wlien  the  animals  pass  frequently  soft,  mushy,  later 
entirely  fluid  stools,  which  are  light  gray  or  dark  brown  from 
the  admixture  of  blood. 

On  the  second  day,  rarely  earlier,  or  only  immediately 
before  death  the  characteristic  reddening  of  the  skin  appears 
on  various  parts  of  the  body.  On  the  abdomen,  the  inner  sur- 
face of  the  thighs,  in  the  axillary  region,  sometimes  also  on 
the  neck  and  ears,  various  sized,  irregular,  pale  red  spots 
appear,  wdiich  later  take  up  a  darker  and  brighter  color,  and 
confluate.  The  skin  over  the  affected  areas  is  only  sliglitly 
swollen  if  at  all,  and  not  painful.  The  redness  disappears  when 
pressure  is  applied  but  returns  when  it  is  removed.  In  a  few 
cases  hempseecl  sized  vesicles  containing  a  serous  fluid  de- 
velop on  the  surface  of  the  spots  which  later  dry  and  form 
brownish  crusts.  Exceptionally  gangrene  of  the  skin  is  ob- 
served in  some  parts,  especially  on  the  ears,  nose  and  the  point 
of  the  tail. 

In  severe  cases  in  addition  to  the  described  spuptoms  there 
are  weakness  of  the  hind  quarters,  cyanosis  of  the  mucous 
membranes  as  well  as  manifestations  of  pulmonary  edema.  As 
the  symptoms  become  more  progressive,  a  sudden  drop  of  tem- 
perature follows,  and  finally  the  animals  die  in  3  to  4  days. 
Exceptionally  death  results  at  the  end  of  the  first  day  or  then 
only  after  8  to  9  days.     In  milder  cases  the  intensity  of  the 


70  Swine  Erysipelas. 

symptoms  diminishes  from  the  second  to  the  third  day  on, 
whereupon  the  animals  recover  in  a  short  time,  or,  on  the  other 
hand,  a  chronic  type  of  the  affection  ensues. 

In  France,  according  to  Cagny,  they  distinguish  a  mild  and  severe 
form  of  acute  swine  erysipelas ;  to  the  latter  belongs  the  ' '  rouget  f oud- 
royant"  which  terminates  in  a  very  short  time  in  death,  and  the 
"rouget  blanc"  in  which  death  results  so  quickly  that  the  reddish 
coloration  of  the  skin  cannot  develop  (also  observed  by  Zschokke  in 
Switzerland). 

3.  Chronic  erysipelas.  It  occurs  most  frequently  as 
chronic  erysipelatous-endocarditis  in  animals  which  have  recov- 
ered from  the  acute  affection.  After  the  disappearance  of  the 
acute  manifestations  the  pigs  are  usually  lively  and  have  a  good 
appetite  for  a  time,  but  on  careful  observation  it  may  be  no- 
ticed by  comparison  that  they  are  stunted  in  their  development. 
After  6  to  12  weeks  they  eat  less,  are  dull,  dislike  to  move 
around,  and  lie  down  much,  and  almost  always  on  the  sternum 
and  elbo^vs.  In  the  meantime  a  cough,  accelerated  and  super- 
ficial respiration  as  well  as  a  bright  red  discoloration  of  the 
skin,  ears,  neck  and  sometimes  the  rump,  is  observed.  If  the 
animal  is  urged  to  move  about  the  dyspnoea  and  cyanosis  in 
a  short  time  become  more  marked.  The  heart  action  is  in- 
creased, at  times  pounding,  and  may  be  easily  detected  over 
the  region  of  the  heart.  The  pulse  is  threadlike ;  besides  this, 
mstead  of  one,  mostly  the  systolic,  or  both  heart  sounds,  a 
blowing  or  harsh  murmur  may  be  heard  (endocarditis  verru- 
cosa, stenosis  of  the  •orifices).  The  body  temperature  is  nor- 
mal or  sometimes  increased  from  one  to  one  and  a  half  degrees. 

With  such  manifestations  the  animals  may  live  for  several 
weeks.  However,  they  become  emaciated,  very  weak,  a  crusty 
eczema  frequently  develops  on  the  skin  and  even  paralysis  of 
the  hind  quarters  may  result.  (According  to  Eisenmann,  the 
duration  of  the  disease  in  four  cases  was  34  to  112  days.) 

As  a  particular  form  of  chronic  erysipelas  Cornevin,  Hess 
and  recently  Eisenmann  describe  an  affection  which  is  in  gen- 
eral only  manifested  by  chronic  debility.  It  develops  several 
weeks  after  the  acute  affection  and  consists  principallv  in 
accelerated  and  difficult  respiration,  digestive  disturbances, 
emaciation,  hemorrhages  and  ulceration  of  the  buccal  mucous 
membrane,  hemorrhages  into  the  hair  follicles  with  subsequent 
falling  out  of  the  bristles,  eczema  or  also  necrosis  of  the  skin, 
edema  of  the  extremities  as  well  as  serous  inflammation  of  the 
joints  and  tendons  which  may  later  result  in  deformity  (most 
frequently  the  hip  joint). 

Course  and  Prognosis.  The  urticaria  of  erysipelas  termi- 
nates as  a  rule  in  recovery.  Exceptionally,  however,  manifesta- 
tions of  a  general  infection  or  a  chronic  disease  may  develop, 
when  it  results  in  death.  The  septicemic  form  terminates  in  the 
majority  of  cases  in  death,  but  the  number  of  fatalities  varies 


Course  and  Prognosis,   Diagnosis  7J 

within  wide  ranges  in  different  years  and  territories.  In  Hun- 
gary it  Hiictnated  in  tiie  last  ten  years  l)etween  53.27o  and  83.8% ; 
according  to  Friedberger  &  Frohner  the  average  loss  amounts 
to  50-85% ;  according  to  Lydtin  to  50-75%.  Chronic  erysipelas 
always  terminates  fatally. 

If,  in  the  acute  cases,  the  affection  lasts  over  four  days,  it 
is  a  favorable  indication ;  otherwise  the  disease  takes  a  threat- 
ening character  particularly  in  poorly  nourished  and  badly  de- 
veloped young  animals.  Complete  recovery  is  sometimes  very 
slow  and  takes  place  only  after  several  weeks.  In  most  cases, 
however,  the  convalescence  lasts  only  a  few  days.  Nevertheless 
there  always  exists  the  possibility  that  the  chronic  form  of  the 
disease  may  develop. 

Diagnosis.  The  septicemic  form  of  erysipelas  mav  be 
especially  easily  mistaken  for  swine  plague  and  hog  cholera, 
but  these  diseases  may  be  distinguished  from  it  by  their  usual 
slow  course  as  well  as  by  the  predominating  affection  of  the 
lungs  and  intestinal  tract,  or  by  the  indications  of  S3^nptoms 
indicating  a  diphtheritic  inflammation  of  the  throat.  Red  dis- 
colorations  may  occur  in  the  course  of  the  above  diseases  but 
they  result  usually  from  hemorrhages  and  therefore  do  not 
disappear  on  pressure.  On  autopsy  erysipelas  is  distinguished 
from  the  peracute  cases  of  hog  cholera  and  swine  plague  only 
by  the  more  pronounced  hemorrhages,  whereas  from  the  more 
frequent  chronic  cases  it  can  be  differentiated  by  the  necrotic 
pneumonia  and  fibrinous  pleuritis  or  round  intestinal  ulcers, 
further,  by  the  extensive  exfoliation  of  the  intestinal  mucous 
membrane  and  caseation  of  the  lymph  glands  which  does  not 
occur  in  erysipelas. 

Anthrax,  which  rarely  occurs  in  hogs,  is  differentiated  from 
erysipelas  by  the  frequent  swelling  in  the  region  of  the  neck 
and  the  difficulty  in  swallowing,  on  post  mortem  by  the  charac- 
teristic affection  of  the  tonsils  as  well  as  by  the  difference  in 
the  bacteriological  findings.  Wound  erysipelas  occurs  only  on 
the  head  when  the  reddened  skin  is  greatly  swollen  and  painful 
and  the  temperature  higher.  The  cerebral  hyperemia  which 
causes  death  during  transportation  in  the  warm  weather  is 
characterized  by  sudden  death  of  animals  which  were  well  only 
a  short  time  previous,  and  usually  occurs  in  older  and  well- 
fattened  animals.  The  autopsy  reveals  marked  lesions  of 
asphyxiation.  On  the  other  hand,  there  are  no  lesions  of 
gastro-intestinal  inflammation,  or  of  acute  swelling  of  the  Ipnph 
glands. 

The  erysipelatous  nature  of  urticaria  is  indicated  by  the 
preexisting  general  sjniiptoms  of  the  infection,  whereas  chronic 
erysipelas  is  distinguished  from  other  similar  affections  (rheu- 
matic arthritis,  catarrhal  pneumonia,  chronic  swine  plague) 
only  by  the  post  mortem  lesions. 


72  Swine  Erysipelas  • 

In  doubtful  eases,  especially  if  acute  swine  plague  be  suspected, 
the  diagnosis  of  erysipelas  can  only  be  assured  by  microscopical  demon- 
stration of  the  erysipelas  bacilli  in  the  blood  or  in  the  tissue  of  the 
spleen,  kidneys  or  lymph  glands,  and  if  necessary  by  subcutaneous 
inoculation  of  such  material  into  mice  or  pigeons.  (See  also  diagnosis 
of  swine  plague.) 

In  sliippiiig  material  to  laljoratories  for  examination,  S(iiiee7e  preparations  or 
thin  smears  from  the  spleen  or  kidneys  should  he  made,  as  according  to  Joop, 
the  virulence  of  the  bacilli  of  such  material  is  retained  for  10  to  12  days,  while  they 
remain  alive  from   16   to   IS   days. 

Treatment.  In  acute  cases  the  treatment  with  immune 
serum  gives  the  best  results,  provided  the  animals  are  treated 
immediately  after  the  onset  of  the  disease,  as  the  injections 
when  undertaken  not  later  than  6  to  12  hours  after  the  appear- 
ance of  the  first  symptoms,  exert  a  curative  action  in  many 
cases  (Leclainche;  according  to  Scliiitz  the  serum  destroys  the 
bacilli  which  are  present  in  the  body  or  which  may  enter  the 
body  later).  The  blood  serum  is  the  same  as  is  used  for  pro- 
tective inoculation  (see  page  76),  only  it  is  necessary  to  use 
considerable  amounts;  10  to  30  cc,  according  to  the  body 
w^eight,  should  be  injected  subcutaneously;  it  is  also  advisable 
to  repeat  the  treatment  every  6  to  8  hours  until  tli3  appearance 
of  a  decided  improvement. 

In  Germany  1315  hogs  affected  between  1^97  and  1901  with  erysipelas  were 
treated  with  Lorenz's  serum,  of  which  1111  that  is  84%  recovered,  of  C)r)6  affected 
animals  treated  with  susserin  535,  that  is  82%,  recovered.  In  Hessen  1451  out  of  1570 
treated  animals,  that  is  92.5%,  recovered  between  1901  and  1903  (Lorenz)  ;  in  Hol- 
land 88.3%  of  5830  animals  were  successfully  treated  (Wirtz)  ;  in  Hungary  Detre's 
serum  was  employed  in  1903  on  711  animals  of  which  fi77,  that  is  95%,  recovered; 
and  since  then  results  have  also  been  favoralde  in  different  localities  in  which 
the  serum  treatment  has  been  employed.  According  to  Nocard,  in  France  8483 
hogs  affected  with  erysipelas  had  been  successfully  treated  up  to  1901  with  Le- 
clainche 's  serum. 

The  symptomatic  treatment  has  hardly  any  beneficial  influ- 
ence upon  the  disease.  Nevertheless,  the  occasional  internal 
administration  of  remedies  wdiich  possess  an  intestinal  disin- 
fectant action  may  be  tried,  and  for  this  purpose  is  recom- 
mended; calomel  (2-3  gms. ;  only  in  the  early  stages  of  the 
disease,  as  later  when  the  kidneys  are  affected  it  is  harmful), 
creolin  or  lysol  (5%  solution  in  tablespoonful  doses),  wdiich 
may  be  given  wdth  mild  cathartics.  Besides,  the  nervous  system 
may  be  stimulated  by  douches  and  w^ashing  Avitli  cold  ^vater. 

Prevention.  The  fact  that  the  erysipelas  bacilli  remain  as 
saprophytes  for  a  long  time  in  the  ground  in  infected  localities, 
and  that  they  are  also  frequently  present  in  the  tonsils  as  w^ell 
as  the  intestinal  canal  of  healthy  animals,  renders  the  com- 
bating of  the  disease  very  difficult.  As,  how^ever,  the  infection 
is  most  successfully  conveyed  by  affected  hogs  and  their  car- 
casses, healthy  animals  must  in  the  first  place  be  protected  from 


Pi'cvciit  ion,   Iiniinini/.al  ion  73 

this  source  of  dan<?er.  Aooordino-ly,  licaltliy  animals  sliould  he 
so])ai'at(Ml  I'l-oiii  the  alToctcd  ones,  and  tlicy  should  he  kept  Uoni 
contaminated  pastures  aiul  stahk's.  Carcasses  should  he  deeply 
buried,  or  still  better  cremated.  Infected  stables  and  premises 
should  be  ])ro])erly  disinfected,  and  the  excrement  of  the 
affected  animals  collected  and  destroyed.  Infected  pastures 
should  not  be  used  as  rani^es  for  swine  for  a  loni;-  time. 

If  the  disease  has  already  appeared  in  a  herd  it  is  advisable 
to  place  the  apparently  healthy  animals  in  an  unsuspected 
pasture,  or  in  the  absence  of  such,  pasturing-  sliould  not  be  per- 
mitted uidil  the  complete  disap|)earance  of  the  disease;  in  this 
way  it  is  frequently  possible  to  eradicate  the  outbreak.  Inas- 
much as  the  infective  a^ent  is  present  in  all  parts  of  the  emer- 
^•ency  slauiihtered  hoi>-s  the  disease  may  be  disseminated  Ijy 
the  marketing-  of  such  carcasses,  and  therefore  the  sale  of  meat 
of  such  carcasses  should  not  be  permitted  until  it  has  been 
sterilized.  Such  a  procedure  appears  the  more  advisable,  as 
accordin,i>-  to  Petri's  and  Stadie's  investig-ations  ordinary  con- 
servation of  the  meat  and  the  products  prepared  therefrom 
( salting-,  pickling-,  smoking)  destroys  the  erysipelas  bacilli  only 
after  a  long  time.     (See  page  62.) 

When  the  possibility  or  even  probability  of  an  infection  ex- 
ists, the  occurrence  of  the  disease  may  be  successfully  pre- 
vented by  means  of  protective  inoculation. 

Immunization.  One  attack  of  erysipelas  conveys  immunity 
to  hogs  against  later  natural  infection.  This  experience  would 
also  indicate  that  the  artificially  produced  mild  affection  affords 
a  similar  immunity.  This  idea  was  practically  demonstrated 
by  Pastenr  in  1882  by  inoculations  of  artificially  attenuated  cul- 
tures, M'hile  later  Lorenz  as  well  as  Leclainche  established  the 
value  of  protective  inoculation  with  immune  serum  and  cultures 
in  practice. 

I.  Protective  inoculation  with  attenuated  cultures  (Pas- 
teur's method).  Pasteur  showed  in  his  experiments  that  the 
passage  of  erysipelas  virus  through  the  body  of  rabbits  in- 
creases its  virulence  for  these  animals.  On  the  other  hand,  it 
reduces  it  for  hogs,  so  that  the  inoculation  with  such  virus  in 
the  latter  animals  causes  only  a  slight  febrile  disease.  Virus 
attenuated  up  to  a  certain  degree  retains  this  degree  of  viru- 
lence even  if  transferred  from  the  rabbit  blood  to  a  suitable 
artificial  medium,  for  instance,  bouillon  and  if  further  cultivated 
at  body  temperature.  The  bouillon  culture  attemuited  by  th<^ 
above  method  produces  the  vaccine  which  is  injected  siibcu- 
taneously  into  young  pigs  in  form  of  a  weaker  and  a  stronger 
modification. 

The  effectiveness  of  Pasteur's  protective  inoculation  has 
been  positively  established.  Besides  Pasteur,  Schiitz,  Schotte- 
lius  and  others  found  that  vaccinated  hogs  cannot  be  infected 


74  Swine  Erysipelas 

either  by  subcutaneous  injections  of  highlj^  virulent  virus  nor 
by  feeding  with  organs  from  animals  which  died  of  erysipelas ; 
on  the  other  hand,  the  experiences  made  in  practice  proved 
that  the  immunity  produced  by  the  inoculation  protects  the 
animals  against  natural  infection. 

In  Hungary  the  considerable  losses  caused  by  erysipelas  have  been 
reduced  to  1  to  2%  in  formerly  badly  infected  herds.  In  the  great 
majority  of  cases  erysipelas  has  not  caused  losses  either  immediately 
after  the  inoculation  or  later  during  the  favorable  summer  weather 
among  the  vaccinated  animals,  whereas  among  the  control  animals 
which  were  not  vaccinated,  the  disease  raged,  and  in  many  cases  the 
vaccination  suppressed  already  existing  outbreaks.  The  age  of  the 
animals  influenced  the  results  of  the  vaccination  in  such  a  way  that 
the  inoculation  failed  to  produce  in  the  sucking  age  a  sufficient  im- 
munity or  none  at  all ;  on  the  other  hand,  it  has  not  proven  dangerous 
in  animals  even  up  to  3  years  of  age.  The  vaccinated  animals  were 
partly  of  the  native  Mangalicza  breed.  However,  animals  of  the  Poland- 
China  and  Suffolk  breeds  were  also  vaccinated  with  the  same  beneficial 
results  (Wirtz  also  found  that  vaccination  of  the  Mangalicza  breed 
was  without  danger),  whereas  in  Yorkshire  hogs  sometimes  dangerous 
affections  resulted   (Bleyer). 

Pasteur's  protective  inoculation  accordingly  appears  to  be 
especially  effective  in  herds  of  common  or  less  highly  bred 
animals,  particularly  in  localities  where  erysipelas  annually 
causes  considerable  loss,  and  it  may  be  employed  without  dan- 
ger in  already  affected  herds  of  such  breeds. 

At  the  initiative  of  Azary,  Pasteur's  vaccination  has  been  extensively  used 
m  Hungary  since  1887.  From  1889-1894,  1,085,686  hogs  were  vaccinated  and  after 
the  first  vaccination  0.14%,  after  a  second  0.07%,  and  later  in  the  year  0.54%  died 
of  erysipelas.  On  account  of  hog  cholera  which  appeared  in  1895  the  results  of  the 
later  inoculations  cannot  be  determined  accurately  as  the  affections  and  deaths  which 
resulted  from  the  heretofore  unknown  hog  cholera  were  often  simply  attributed  to 
erysipelas.  But  since  greater  stress  was  placed  on  differential  diagnosis  the  re- 
sults appear  favorable.  Thus  in  1907  of  28,642  hogs  in  already  infected  herds 
637  died  after  the  vaccination,  later  421  additional  fatalities  were  observed.  In 
healthy  herds  out  of  288,950  vaccinations  125  and  623  died. 

Pasteur's  vaccination  is  used  less  extensively  in  France  and  Eussia  probably 
on  account  of  the  fact  that  in  some  of  the  herds  the  losses  following  vaccination 
amounted  to  6  to  10%,  which  condition  may  be  attributed  to  a  feebler  resistance 
of  the  native  breeds.  In  Germany  this  method  has  not  attained  extensive  ap- 
plication owing  to  the  unfavorable  results  obtained  by  Lydtin  &  Schottelius,  but  in 
recent  years  it  has  been  more  extensively  used,  especially  in  the  southern  part  of 
the  Empire. 

Technique  of  Vaccination.  The  vaccination  is  carried  out  in  the  same 
way  as  anthrax  vaccination  in  sheep  (see  page  27);  the  quantity  of  the  im- 
munizing material  is  in  this  case  also  0.12  ec.  ( Vs  of  the  contents  of  Pasteur  vac- 
cination syringe),  and  the  second  vaccination  follows  12  days  after  the  first.  It 
is  advisable  to  vaccinate  pigs  in  the  spring  after  weaning  at  the  age  of  3-5  months, 
before  the  appearance  of  hot  weather. 

Direct  results  of  vaccination.  This  is  manifested  in  some  cases  by  debility 
lasting  from  1  to  2  days,  impaired  appetite,  and  sometimes  a  weakness  of  the 
hind  quarters;  on  the  second  and  third  day  after  the  vaccination  the  temperature 
rises  on  an  average  of  0.8°C.  Sometimes,  however,  it  may  rise  up  to  41.7°C. 
(Mihaly),  whereupon  the  animals  rapidly  recover  their  normal  condition.  Occa- 
sionally a  swelling  of  considerable  size  may  appear  at  the  point  of  inoculation, 
and  stiffness  of  the  joints  may  also  develop,  particularly  in  the  higher  breeds,  and 
here  and  there  death  may  result  from  erysipelatous  endocarditis. 


luiuiunizatiuii  75 

II.  Protective  inoculation  with  immune  serum  and  cultures 

(Siiiiiiltaiieous  iiiethoil  of  Loreiiz  aiul  of  Leclaiiiclie ;  sero- 
vacc'iiiatioii).  Blood  serum  of  animals  which  have  been  highly 
immunized  by  repeated  subcutaneous  or  intravenous  injections 
of  living-  cultuies  of  the  erysipelas  l^acilhis  will  protect  healthy 
animals  for  a  short  time  ai^'ainst  fatal  infection.  The  passive 
immunity  produced  in  this  manner  may  l)e  clian<^ed  into  active 
innnunity  by  simultaneous  or  subsequent  injections  of  virulent 
cultures  of  the  bacilli. 

After  Emnierich  and  Mastbaum  (1891)  found  tliat  llic  ])lood  serum 
of  rabbits  wliieh  had  been  iiinnunized  against  erysii)elas  possessed  ini- 
nnnuzing  pi'operties,  Lorenz  (1893)  produced  an  eff'eetive  serum  from 
artifieially  inniiunized  hogs.  This  serum,  concentrated  to  one-third  of 
its  original  volume,  was  etfective  for  protective  inoculation  of  hogs. 
As  hogs  as  well  as  sheep  (Voges)  produce  only  small  (juantities  of  serum, 
Leelainche  (1898)  and  Schiitz  &  Voges  hyperiimnunized  horses  for  that 
purpose,  and  at  the  present  time  serum  for  the  inoculation  of  hogs  is 
obtained  almost  exclusively  from  these  latter  animals.  Potent  blood 
serum  may  also  be  prepared  from  cattle  (Schreibcr,  Kitt),  and  the 
"double  serum"  of  Landsl)erger  consists  of  a  mixture  of  horse  and 
cattle  immune  serum  (Schu])ert). 

The  results  of  protective  inoculations  with  immune  serum 
and  bacilli  culture  have  generally  given  good  satisfaction  in 
practice.  Hogs  which  have  not  yet  become  infected  withstand 
the  vaccination  as  a  rule  without  marked  reaction,  and  they  will 
later  resist  natural  infection.  As  a  sequel  of  the  vaccination, 
however,  urticaria,  swelling  at  the  point  of  inoculation  extend- 
ing to  the  throat,  stiffness  of  the  joints,  occasionally  erysipe- 
latous endocarditis,  and  even  death  after  36  hours  from  severe 
toxic  action,  have  been  observed  to  follow  injections  of  the 
culture.  The  advantage  of  this  method  over  Pasteur's  consists 
in  the  development  of  the  passive  immunity  immediately  after 
the  serum  injection,  which  condition  in  case  of  immediate  dan- 
ger of  infection  is  of  great  importance — and  further  it  is  well 
tolerated  even  by  breeds  of  hogs  with  low  resistance.  The  some- 
what high  cost  of  the  vaccinating  material  is  a  disadvantage. 

Latent  diseased  processes  are  unfavorably  influenced  by  the  inocula- 
tion. Thus,  it  was  repeatedly  observed  in  Germany  that  chronic  pneu- 
monia of  pigs  (the  so-called  chronic  swine  plague  of  pigs)  became  aggra- 
vated after  vaccination,  and  in  Hungary  also  it  was  noticed  that  the 
first  year  after  the  appearance  of  hog  cholera  severe  outbreaks  of  the 
latter  disease  developed  following  the  vaccination  of  hei-tls  against 
erysipelas. 

In  Prussia  217,376  hogs  were  vaccinated  in  the  years  1897-1899  by  Lorenz 's 
method,  and  after  the  first  injection  0.018%,  after  the  second  0.042%,  later  in  the 
course  of  the  year  0.058%  died  as  a  result  of  erysipelas  (Joest  &  Heifer).  In 
Baden  102,448  hogs  were  vaccinate. 1  in  the  years  1899-19()fi  of  which  21,466  animals 
received  the  serum  alone;  of  those  116  (0.09%)  dieil  inside  of  3  days,  later  until 
the  close  of  the  year,  108  (0.08%)  succundied.  In  Hessen  only  2  out  of  35,258  in- 
oculated animals 'died  in  the  period  from   1901  to  1903   (Lorenz).     In   Wiirttemberg 


76  Swine  Erysipelas 

only  4  out  of  59,625  hogs  vaccinated  in  the  years  1904-1905  died  of  acute  erysipelas; 
of  the  original  number,  however,  29,1249  animals  received  the  usual  two  injections 
(Beisswanger),  while  in  the  Province  of  Saxony  in  the  year  19U4-1905  of  175,150 
animals,  12  died  of  vaccination  erysipelas,  6  of  endocarditis,  and  15  succumbed  to 
erysipelas  later  (Eaebiger).  In  Holland  in  the  years  1899  to  1905  out  of  165,884 
inoculated  hogs  136  (0.08%)  died  as  a  result  of  the  vaccinations.  Keports  from 
Baden  (Fehsenmeier),  Moravia  (Rudovsky),  Canton2.urich  (Zschokke)  and  others 
are  much  in  favor  of  the  value  of  the  simultaneous  injections,  and  the  Leclainche 
method  is  also  used  extensively  in  Hungary  with  favorable  results. 

Preparation  of  the  immune  serum.  For  this  purpose  healthy  horses  are 
used  which  receive  weekly  injections,  into  the  jugular  vein  of  virulent  bouillon 
cultures  of  erysipelas  bacilli  in  increasing  quantities  (50  to  500  cc).  The  animals 
react  to  the  injection  with  fever,  nuiscular  trembling  an<l  sometimes  with  diarrhea. 
After  2  to  3  months  of  such  treatment  they  produce  a  blood  s-erum  which  strongly 
agglutinates  the  erysipelas  bacilli  of  which  0.5  cc.  protects  a  pigeon  against  a  like 
quantity  of  virulent  culture  which  ordinarily  would  kill  it  in  21/2  to  3  days 
(Leclainche)  ;  exceptionally  0.1  of  such  serum  has  such  a  pi-otective  action 
(Deutsch)  ;  it  retains  this  action  for  months  after  heating  for  %  hour  to  55°  C.  In 
Germany  only  serum  can  be  marketed,  0.015  cc.  of  which  will  protect  a  mouse  of  15- 
grams  weight  against  a  sinuiltaneous  subcutaneous  (Lorenz),  or  against  an  intra- 
peritoneal  (Marx)  injection  of  0.1  cc.  of  virulent  bouillon  culture  24  hours  later. 

The  inunune  serum  used  for  the  inoculation  of  hogs  must  possess  the  strength 
mentioned  and  should  not  be  more  than  one  year  old,  but  the  virulent  bouillon 
cultures  should  be  fresh  and  not  over  a  week  old.  In  Germany  the  immune  serum  is 
prepared  in  various  laboratories  under  different  nan'.es  (Prenzlauer  &  Lands- 
berger 's  serum,  Susterin),  and  is  placed  on  the  market  with  the  necessary  direc- 
tions for  its  use. 

Technique  of  vaccination.  Leclainche 's  method :  In  a  carefully  sterilized 
syringe  of  lU  co.  capacity,  1  cc.  of  the  bouillon  culture  is  drawn  up  and  then 
the  syringe  is  filled  up  with  the  immune  serum.  After  the  contents  are  well  mixed 
hogs  of  not  over  50  kg.  weight  are  injected  subcutaneously  with  5  cc.  on  the  inner 
surface  of  the  thigh.  If  the  hogs  are  heavier,  1  cc.  of  additional  blood  serum  is 
given  for  each  10  kg.  above  50  kg.,  or  in  general  each  heavy  hog  is  injected  sub- 
cutaneously with  9.5  cc.  of  serum  and  0.5  cc.  of  culture.  The  second  injection 
follows  10  to  12  days  after  the  first,  when  the  syringe  is  filled  with  Viouillon 
culture,  and  of  this  each  animal  receives  0.5  cc.  without  consideration  of  the  animal 's 
weight.     The  injection  is  also  made  on  the  inner  surface  of  the  thigh. 

Method  of  Lorenz.  In  this  method  the  immune  serum  is  first  injected 
under  the  skin  of  an  ear  and  immediately  afterwards  0.25  to  1  cc.  of  culture  is  in- 
jected into  the  other  ear;  12  to  15  days  later  the  hog  is  injected  with  double 
the  quantity  of  the  culture  used  in  the  first  do^e.  The  second  injection  is  also 
made  under  the  skin  of  an  ear.  Relative  to  the  results  of  the  inoculation,  it  is 
immaterial  whether  the  blood  serum  and  virus  are  injected  in  a  mixture  (Leclainche) 
or  simultaneously,  but  in  difi'erent  parts  (Lorenz,  Schiitz),  or  if  the  virus  is  in- 
jected several  da3's  following  the  serum  (Lorenz). 

*  A   sufficient   protection    is   onlj'   assured    after   both   inoculations,    as   the   first 

simultaneous  inoculation  produces  only  a  passing  rise  in  the  resistance  as  proven 
experimentally  by  I'rettner,  inasmuch  as  the  bacteria  are  influenced  liy  the  injected 
serum  to  such  an  extent  that  a  sufficient  quantity  of  inunune  bodies  is  not  pro 
duced. 

III.  Passive  immunization.  The  immune  serum  may  also 
be  used  by  itself  for  the  immunization  of  already  infected  herds 
(5  to  10  cc).  The  serum  very  rapidly  produces  a  passive  im- 
munity which  prevents  the  development  of  the  disease  in  ani- 
mals threatened  l)y  the  infection  or  when  the  infection  is  in 
the  stage  of  incubation  (see  also  page  72).  The  imnninity 
produced  in  such  a  way  lasts,  however,  only  a  short  time. 
(According  to  Leclainche,  17  days.)  Therefore,  these  animals 
should  be  given  the  combined  or  Pasteur's  inoculation  after 
their  recovery  or  from  8  to  10  days  after  the  serum  treatment 
in  order  to  produce  a  lasting  immunity. 


Imiiiiiiii/.atioii.   The   Disease   in    Mnii  77 

Veterinary  Police.  Police  incasures  adoj^ted  Tor  other  con- 
ta^oiis  diseases  may  also  be  recommended  for  erysipelas,  and 
partienlai'ly  quarantine  of  the  promises — in  more  extensive 
onthreak  even  the  township,  prohibition  of  marketing-  tlie  ani- 
mals, harmless  disposition  of  carcasses,  disinfection  of  infected 
localities,  etc.  From  the  quarantined  premises  or  townships 
the  transportation  of  animals  to  abattoirs  for  immediate 
slan.s>-hter  shonld  be  permitted.  The  observation  period  after  the 
apparent  disap])earance  of  the  disease  shonhl  extend  from  10 
to  15  days. 

Literature.  Pasteur.  TJev.  vet.,  1883,  30.— Pasteur  &  Thuillier,  Bull,  de 
I'Acad.  (le  iiied.,  1SS3.  Nr.  4:3.— Eggeliiig.  D.  Z.  f.  Tni.,  1884,  X,  234.— Loonier, 
Arb.  (1.  G.-A.,  18S.5,  I,  4ri.— Schiitz,  Ibid.  p.  .56.— Lydtin  &  Rchottelius,  D.  Rotlauf  <1. 
Schweine,  W^iesbaden,  1885.— Bang,  D.  Z.  f.  Tni.,"l892,  XVITI,  27.— Jensen.  Jbi.l., 
p.  278.— Kitt.  :\ronh.,  180-1.  Y,  10.— Lorenz,  D.  t.  W.,  1807,  01;  Cbl.  f.  Bakt.,  1803, 
XIII,  3.07.- Leclainehe,  Roe.  biol.,  1897.  428;  1800,  346.— Voges  &  Schiitz,  A.  f. 
Tk.,  1808,  XXrV,  173.— Bauernieister,  1002,  XXA'TIT,  6(3  (Lit.).— Preisz,  Hb.  d.  p. 
M..  10(13,  111,  71(1  u.  TV.,  1236  (Lit.  on  etiol.  and  imnnniization). —  Stadie,  Diss., 
Berlin,  1004  (Lit.  on  biol.  of  ervsip.  bac). — Eisenniann,  Monh.,  1906,  XVli,  07. — 
Schipp,  D.  t.  \\\,  1010,  08. 


The  Disease  in  Man.  From  the  literature  a  considerable  numher  of 
cases  are  known  (Casper,  Nevermann,  "Welzel,  Ilennig,  Gleich,  Zipp  and 
others)  to  have  occuri-ed  in  men  occupied  in  handling  hogs  affected 
with  erysipelas,  or  who  worked  with  cultures  of  the  bacilli  (inununiza- 
tion).  It  Avas  observed  that  after  slight  injuries  to  the  skin  erysipelas- 
like reddening  of  the  skin  and  swelling  of  the  neighboring  lymph  gland 
developed  sometimes  even  exfoliation  of  the  blackish-red  epidermis  with 
exudation  of  serum,  and  occasionally  even  swelling  of  the  neighhoring 
joints.  The  disease  usually  terminated  within  four  Aveeks  in  recovery 
(in  R()der's  case  it  lasted  for  12  weeks),  which  is  considerably  hastened 
hy  subcutaneous  injections  of  immune  serum  (10  cc). 

From  eating  meat  of  hogs  affected  with  erysipelas  no  attacks  have 
been  observed.  Luhowsky,  however,  found  large  (luantities  of  hacteria 
in  the  feces  of  a  boy  which  were  identical  with  the  erysipelas  bacillus. 
The  boy  suffered  from  jaundice  and  intestinal  catarrh,  the  cause  of  whicli 
was  unknown. 

Literature.  Rosenbach,  Z.  f.  Hvjr.,  lOdO.  LXIH.  343  ( Lit.).— Roder.  Mitt, 
d.  had.  Til.  1908,  IL— Gleich.  B.  t.  W.,  1000.  .376.— Zipp,  Ti.jdsskr.,  1909,  98.— 
Luhowsky.  D.  ni.  W.,  1910,  116. 

5.    Hemorrhagic  Septicemia.    Septicaemia  Hemorrhagica, 

Hueppe 

{Septicaemia  pluriformis,  Kitt;  Pasteurellosis,  Lignieres.) 

Under  the  collective  name  of  hemorrhagic  septicemia  are 
included  all  those  diseases  which  are  produced  Ijy  varieties  of 
the  bacillus  bipolaris  septicns  (Bac.  mnltocida  s.  plurisepticns, 
Kitt;  Pastenrella,  Ligniei-es)  and  in  Avhicli  the  acute  cases  are 
characterized  by  manifestations  of  a  general  infection  and 
hemorrhagic  inflammatory  processes  of  the  internal  organs. 

History.  Perroncito  and  Semmer  (1878)  and  later  Pasteur  (1880) 
hy  t\u'  study  of  chicken  cholera,   Gaffky    (1881)    of  rahbit  septicemia, 


78  Hemorrhagic   Septicemia 

Kitt  (1883)  of  Bollinger's  Wildseuche,  and  Loffler  (1886)  of  swine 
plague,  proved  that  these  diseases  are  caused  by  small  bacilli,  all  of 
which  showed  the  same  characteristics  by  taking  the  stain  intensely  at 
the  poles  and  only  very  slightly  or  not  at  all  in  the  middle,  therefore 
resembling  somewhat  the  figure  8. 

Based  on  a  comparative  study  of  these  four  diseases,  Hueppe  (1886) 
came  to  the  conclusion  that  their  causative  agents  coincided  in  all  their 
principal  morphological  and  biological  characteristics,  and  that  the 
diseases  greatly  simulated  each  other  in  their  course  and  anatomical 
changes.  From  these  he  concluded  that  the  causative  agents  of  the 
diseases  mentioned  represent  one  species  of  bacteria,  and  that  the  existing 
differences,  especially  with  reference  to  their  virulence,  justified  his 
conclusion  that  they  were  varieties  of  the  same  species.  Inasmuch  as 
in  the  acute  cases  there  are  manifestations  of  a  general  blood  infection 
and  the  presence  of  hemorrhages  in  the  internal  organs,  Hueppe  included 
the  four  diseases  in  one  group  and  recommended  the  name  of  hemor- 
rhagic septicemia  for  their  designation. 

The  observations  made  since  these  investigations  proved  the  cor- 
rectness of  this  conclusion,  and  have  at  the  same  time  shown  that  similar 
bacteria  play  an  important  part  in  the  etiology  of  other  diseases.  Thus, 
this  was  established  by  Poels  (1886)  for  the  infectious  pleuro-pneumonia 
of  calves,  by  Oreste  and  Armanni  (1887)  for  the  barbone  disease  of 
buffalo,  by  Galtier  (1889)  for  the  infectious  pneumo-enteritis  in  sheep. 
Therefore  these  diseases  may  also  be  included  in  the  group  mentioned. 
In  the  diseases  mentioned  and  also  others  of  less  importance  the 
bipolar  bacteria  appear  to  be  the  exclusive  factors  in  the  development 
of  the  pathological  processes.  Lignieres  (1900),  however,  includes  those 
diseases  in  which  the  bipolar  bacilli  are  usually  involved  only  indirectly, 
by  predisposing  the  body  for  an  infection  with  other  bacteria.  Such 
diseases  are  influenza  or  pleuro-pneumonia  of  horses,  and  distemper  of 
dogs  and  cats,  to  which  Nocard,  on  the  strength  of  his  own  investiga- 
tions, added  white  scours  and  the  catarrhal  pneumonia  of  calves  which 
are  due  to  navel  infections.  In  the  meantime  Lignieres  in  supporting 
Trevisan's  suggestion,  named  the  bacteria  of  chicken  cholera  and  of  the 
related  diseases,  pasteurella,  and  the  diseases  caused  by  these  bacteria 
pasteurellosis.  This  nomenclature  has  been  accepted  in  general  by  the 
French  authors. 

Recent  experiences  with  the  diseases  mentioned  and  a  more  accurate 
consideration  of  the  etiological  part  of  the  ovoid  bacteria,  make  the  cor- 
rectness of  Lignieres '  conception  very  doubtful,  and  at  least  they  appear 
to  be  remote.  While  it  cannot  be  doubted  that  the  bacteria  under  dis- 
cussion may  independently  produce  diseases,  their  occurrence  in  affected 
organs  and  tissue  fluids  is  not  a  sufficient  proof  that  the  disease  was 
originally  produced  by  them.  Since  they  may  not  infrequently  be  met 
in  healthy  animals,  it  is  possible  for  them  to  invade  secondarily  the 
tissues  which  have  been  already  affected  from  other  causes.  It  will 
require  further  investigations  to  establish  the  significance  of  their  pres- 
ence. However,  their  part  in  distemper  of  dogs,  in  pneumonia  of  calves 
and  pigs,  in  the  pectoral  form  of  hog  cholera,  and  in  influenza,  may  even 
now  be  accepted  as  secondary.  On  these  grounds  it  appears  advisable 
to  restrict  the  conception  of  Lignieres'  pasteurellosis,  and  therefore 
only  those  diseases  will  be  considered  here  in  which  it  has  been  positively 
established  that  the  ovoid  bacteria  play  the  primary  etiological  part. 
The  results  of  investigations  in  the  future  will  showwhether  a  change 
of  this  viewpoint  will  be  necessary. 


History.     Morphology  and  Biology 


79 


In  the  <lcsip;iiation  of  tho  disoases  belonging  to  this  group  the  former  appropiate 
name  of  hemorrhagic  septicemia  will  be  used  as  it  appears  justifiable  from  a 
pathological-anatomical  standpoint.  The  causative  agent  is  the  species  of  bacteria 
known  as  bacillus  bipolaris  sei)ticus,  while  the  various  organisms  of  the  group 
causing  this(lisease  will  be  designated  according  to  the  species  of  animals  affected, 
viz.,  Bac.  avisepticus,  Bac.  bovisepticus,  Bac.  suisepticus,  etc. 

Morphology  and  Biology  of  the  Infective  Agent.  The 
bacillus  bipolaris  septicus  (Bac.  multocida  s.  pkirisepticus, 
Kitt;  pasteiiiella,  Li.^nieros,  ovoid  or  girdle  bacterium)  mani- 
fests the  following  characteristics  without  consideration  of  the 
diseases  belonging  to  this  group  or  from  what  species  of  ani- 
mals it  originates  (Lignieres).  It  is  short,  stains  intensely 
at  the  poles  but  only  slightly  in  the  middle,  polymorphous, 
non-motile,  does  not  form  spores,  principally  aerobic;  does  not 
stain  by  Gram,  grows  in  bouillon,  gelatin  and  agar,  but  does 
not  grow  on  acid  potatoes,  nor  liquefy  gelatin,  nor  coagulate 
milk;  it  does  not  produce  indol  in  pancreatic  bouillon,  nor 
redden  Wirtz's  agar;  the  bouillon  cultures  have  a  peculiar 
characteristic  odor. 

Besides  these  characteristics  of  the  hipolar  bacillus,  the  special 
characteristics  of  the  bacteria  belonging  to  this  group  are  the  following : 

Form.  In  the  tissue  fluids  and  still  more  so  in  cultures  the  bacillus 
represents  a  short  rod  about  1^  long,  with  rounded  ends  (Fig.  23). 
It  also  occurs  in  the  form  of  cocci,  diplococci ;  exceptionally  also  as 
longer  rods,  threads  and  streptobacilli.  Its  dimensions  vary  according 
to  the  origin  of  the  disease  in  certain  although  not  wide  limits. 


Fig.  23.   BaciUtif!  bipolaris  septicus. 

Smear  prepared  from   a  fresh 

agar  culture  of  the  bacillus 

of  fowl  cholera.     Fuch- 

sin  staining. 


Fig.  24.  Bacillus  bipolaris  septicus. 
Smear  from  the  blood  of  a  chicken 
dead  from  fowl  cholera.  Polar 
staining  with  fuchsin,  and  subse- 
quent washing  with  a  1% 
acetic  acid. 


Staining.  The  bacilli  stain  quite  readily  with  the  aqueous  aniline 
dyes,  and  in  the  preparations  made  from  the  tissues  or  from  the  body 
fluids  (best  in  the  blood  of  affected  chickens)  they  appear  stained  only 
at  the  poles,  while  the  middle  remains  unstained  (Fig.  24).  These 
results  are  obtained  when  the  preparations  are  not  stained  too  intensely 


80 


Hemorrhagic   Sejjticeiuia 


or  after  subsequent  ^vashiug  in  alcohol  or  Vi>  to  1%  acetic  acid.  On  the 
other  hand,  it  is  difficult  to  obtain  the  polar  stain  in  bacilli  originating 
from  artificial  cultures. 


"'GS5 


Cultivation.  The  l)acilli  are  easily  isolated  from 
cases  of  an  acute  septicemic  character,  while  from 
chronic  cases  this  is  more  difficult  and  sometimes  im- 
possible. The  requirements  of  artificial  cultivation  are : 
temperature  of  13-28 °C.  and  alkaline  or  at  least  neutral 
reaction  of  the  medium.  In  vacuum  the  l)acteria  grow 
only  \\-hen  the  medium  is  inoculated  with  numerous 
organisms,  and  then  only  for  a  short  time. 

A  frequent  characteristic  of  the 
cultures  is  their  viscosity  (this  is  also 
striking  in  the  peritoneal  exudate  of 
inoculated  guinea  pigs),  probably  due 
to  tlie  sticlcy  capsule  which  covers  the 
bacteria. 

The  colonies  formed  on  gelatin  are 
no  larger  than  a  millet  seed.  They  are 
at  first  transj^arent,  often  resembling 
a  dew-drop,  and  frequently  iridescent. 
Later  they  are  whitish,  of  a  hyaline- 
cartilage-like  appearance.  In  the  deptli 
of  the  medium  the  punctiform  colonies 
unite  along  the  stab  and  form  a  con- 
tinuous white  streak  (Fig.  25).  Sim- 
ilar colonies  develop  on  the  surface  of 
the  agar  cultures,  but  do  not  extend 
to  the  wall  of  the  test  tu])e  (Fig.  2i>)  ; 
cultures  several  days  old  are  viscid  ; 
when  still  older  they  adhere  firmly  to 
the  medium  On  coagulated  blood 
serum  a  very  fine  membrane  forms 
which  is  at  first  transparent  and  latei' 
whitish.  Bouillon  with  the  addition  of 
peptone  or  blood  serum  usually  bo- 
comes  more  or  less  uniformly  cloudy; 
in  some  of  the  varieties,  however,  the 
fluid  clears,  sometimes  first  forming  a 
slimy  and  later  a  fine  granular  sedi- 
ment ;  occasionally  also  a  delicate, 
whitish  membrane  develops  on  the  sur- 
The  addition  of  sugar  or  glycerin  does  not  promote,  but  rather 


Fiji.  25.  (Jela- 
tin  stab  culture 
ofthe  hacillusbi- 
polaris  septicus. 


face. 


l"ig.  26.  Agar 
stab  cultm-e  of 
tbe  bacillus  bi- 
polar is  septicus. 


retards  the  growth.  Dextrose  bouillon  is  not  fermented.  No  growth 
takes  place  on  potatoes  with  a  natural  acid  reaction ;  when  artificially 
alkalinized  a  grayish-yellow  deposit  forms. 

Animals  inoculated  with  a  certain  variety  produce  a  serum  which  will  have 
the  highest  agglutination  for  that  particular  variety  (up  to  1:60,000),  but  it  will 
also  agglutinate  to  a  lesser  degree  other  varieties  (1:1000-6000).  Sometimes,  how- 
ever, seme  of  the  varieties  are  in  no  way  influenced.  Therefore  the  agglutination 
cannot  be  utilised  for  the  identification  or  separation  of  the  different  varieties 
(Chamberland  &  Jouan). 


Cultivatidu.     ratlioyeiiicily  81 

Pathogenicity.  In  coiitradistiiu'tiou  to  tlie  connnon  char- 
acteristics (lescril)C(l,  tlicrc  are  marked  dilTerences  in  tlie  viru- 
lence of  the  bacilli  which  depend  on  their  origin,  the  nature 
of  the  disease  and  the  species  of  animals  affected.  However, 
all  the  varieties  coincide  in  exertin.^'  their  strongest  patho^-enic 
action  when  inoculated  with  blood  or  exudate  of  animals  which 
died  of  the  disease  (aggressin  action,  see  page  84). 

Another  common  characteristic  of  tlie  bacteria  belonging 
to  this  gioup  is  that  tliey  develop  the  highest  virulence  towards 
that  species  of  animals  for  wliich  they  are  naturally  pathogenic, 
while  towards  other  species  their  action  shows  a  great  variance. 
It  is,  however,  possible  to  increase  the  virulence  for  other 
s])ecies  tlirough  repc^ated  reinoculations,  but  such  a  strain  of 
the  bacilli  will  even  then  possess  the  strongest  pathogenic  action 
for  tlie  species  from  which  it  originated. 

The  animals  -which  are  susceptible  to  the  bipolar  bacteria, 
although  not  to  the  same  extent,  are  the  guinea  i)ig,  rabbit  Mud 
mouse,  while  the  domestic  aninuils  show  a  great  variation  in 
susceptibility.  The  gaiinea  pig  is  best  adapted  for  test  inocu- 
lations, and  by  using  this  test  animal  for  repeated  intraperi- 
toneal reinoculations  the  virulence  of  any  of  the  varieties  may 
be  greatly  increased. 

The  result  of  artificial  infection  depends  also  on  the  nature 
and  method  of  the  inoculation.  The  most  pronounced  action  is 
obtained  by  direct  injection  into  the  circulation,  by  wiiich  means 
the  disease  may  be  transmitted  to  any  species.  Somewhat  less 
effective  is  the  intraperitoneal  and  intratracheal  injection  of 
cultures,  whereas  the  subcutaneous  and  intramuscular  inocula- 
tion produces  a  severe  affection  only  in  very  susceptible  species 
of  animals.  The  feeding  of  virulent  material  only  exceptionally 
gives  positive  results,  these  being  most  frequently  obtained 
w^hen  the  cholera  virus  of  chickens  is  fed. 

Variability  of  the  Virulence.  The  bipolar  bacilli  are  very 
widely  spread,  and  may  produce  disease  in  any  species  of  ani- 
mals, particularly  in  the  domestic  animals.  As  original  sapro- 
phytes they  occur  in  nature  in  the  soil,  in  slow-flowing  or 
stagnant  water,  on  various  i)lants,  and  in  all  kinds  of  dead 
organic  material.  Under  normal  conditions  they  do  not  mani- 
fest pathogenic  characteristics.  Hence  they  occur  not  infre- 
quently in  the  digestive  tract  and  in  the  air  passages.  Under 
certain  conditions,  wliich  at  present  are  still  unknown,  they  be- 
come virulent  and  then  they  may  attack  the  tissues  of  the 
healthy  body.  On  the  other  hand,  their  pathogenic  action  is 
favored  by  all  those  influences  wiiich  weaken  the  resistance  of 
the  organism,  as  colds,  exertion,  anemia,  starvation,  mixed  in- 
fection, catarrhs,  etc.  Parasites  in  the  aii-  passages  and  digestive 
tract  also  favor  the  development  of  infection  by  loosening  the 
epithelium  of  the  mucous  membrane,  or  by  causing  penetrating 
injuries  to  the  mucous  niembrane,  whereby  the  entrance  of  the 
bacteria  into  the  lym])h  vessels  is  facilitated. 


82  Hemorrhagic  Septicemia 

The  bacteria  which  through  some  cause  become  parasitic 
lose  in  some  of  the  cases  their  pathogenic  character  after  leav- 
ing the  affected  animal,  and  may  change  again  to  saprophytes. 
In  the  majority  of  cases,  however,  after  having  become  accus- 
tomed to  the  organism  of  a  certain  animal,  they  attain  an  in- 
creased virulence  for  animals  of  this  particular  species,  and 
therefore  infect  the  animals  more  easily  even  without  the 
influences  of  predisposing  causes.  This  relative  virulence  may 
even  increase  for  a  time  in  the  course  of  further  generations, 
or  may  become  constant.  More  frequently,  however,  it  dimin- 
ishes again  after  a  certain  time. 

These  characteristics  of  the  bipolar  bacteria  explain  the 
variation  which  is  observed  in  the  appearance  and  spread  of 
the  diseases  belonging  to  this  group.  The  common  experience 
with  these  diseases  is  that  they  appear  periodically  in  certain 
localities  without  any  apparent  connection  to  which  the  intro- 
duction could  be  traced.  In  such  cases  the  outbreaks  can  be 
explained  by  a  sudden  increase  in  the  virulence  of  the  bacteria 
which  are  present  in  the  soil  or  in  the  healthy  animal  favored 
by  influences  which  reduce  their  resistance.  Some  of  the  infec- 
tions develop  through  such  conditions.  In  these  the  disease 
does  not,  or  only  exceptionally,  spread  from  animal  to  animal, 
and  it  therefore  remains  sporadic,  or  at  least  confined  to  cer- 
tain localities.  In  other  cases  although  the  disease  appears 
spontaneously  the  organisms  which  pass  through  the  body  of 
the  animals  retain  their  pathogenic  character  for  a  long  time, 
thus  spreading  the  disease  by  direct  or  indirect  infection,  and 
disseminating  the  contagion  to  distant  localities.  Further, 
among  the  diseases  of  this  group  there  are  some  in  which  the 
bacteria  adapt  themselves  in  the  course  of  time  to  the  animal 
body  to  such  an  extent  that  as  saprophytes  they  are  no  longer 
capable  of  propagation,  and  therefore  these  diseases  spread 
almost  exclusively  by  being  introduced  from  outside  or  by 
direct  communication. 

The  acquired  or  inherited  virulence  of  the  different  varie- 
ties of  the  bacteria  is  usually  only  manifested  for  certain  species 
of  animals,  so  that  a  certain  disease  spreads  usually  only 
among  the  animals  of  the  same  species.  Exceptionally  how- 
ever, the  infective  agent  may  become  dangerous  for  other 
species.  Thus  frequently  the  infection  of  buffalo  disease  and 
hemorrhagic  septicemia  of  cattle  causes  in  hogs  symptoms  re- 
sembling swine  plague.  On  the  other  hand,  the  virus  of  swine 
plague  sometimes  produces  a  septicemic  affection  in  sheep, 
while  feeding  it  to  chickens  causes  a  disease  which  corresponds 
to  fowl  cholera. 

Lignieres  succeeded  in  artificially  producing  a  variety  of  forms  of  hemorrhagic 
septicemia  in  different  animals  by  injections  of  cultures  of  the  bipolar  bacillus  of 
different  origin.  Koske  successfully  infected  different  species  of  fowl  per  os  with 
swine  plague  bacteria.  On  the  other  hand,  he  failed  in  hogs  to  produce  a  disease 
resembling  swine  plague  with  the  fowl  cholera  organism. 

The   ovoid    bacteria    may   retain    their    virulence    for   months    in   the   original 


Patliogeiiesis  g3 

exudates  or  body  fluids  uiidcr  artificial  coinlitions,  if  liylit  and  air  an-  excdiided ; 
whereas,  in  artificial  media  in  the  presence  of  air  they  are  soinrtinies  very  rapidly 
attenuated  and  finally  lose  their  virulence. 

Pathogenesis.  Bipolar  bacilli  which  penetrate  into  the 
tissue  tlnids  of  the  animal  org-anism,  produce  different  i)atli()- 
logical  changes,  according  to  the  degree  of  their  virulence  and 
the  susceptibility  of  the  animals.  In  case  of  a  severe  infection 
a  peracute  hemorrhagic  sejjticemia  develops.  The  bacilli  mul- 
tiply very  rapidly  and  in  a  short  time  permeate  the  entire  body, 
causing  death  in  from  18  to  24  hours.  The  animals  manifest 
high  fever,  weakness  of  the  heart,  debility,  sometimes  diarrhea. 
Autopsy  reveals  numerous  hemorrhages  in  the  tissue  of  the 
serous  and  mucous  meml)ranes  and  parenchymatous  organs. 
The  spleen  is  only  slightly  swollen,  while  the  Ij^nph  glands  show 
a  marked  acute  swelling. 

When  the  infection  is  somewhat  less  severe  the  acute  attack 
lasts  for  several  days  when  frequently  a  sero-fibrinous  inflam- 
mation develops  on  the  serous  membrane,  while  the  nnicous 
membranes  are  affected  with  a  hemorrhagic  inflammation.  With 
these  an  inflammation  of  the  joints  and  tendons  is  not  infre- 
quently associated.  The  autopsy  reveals  in  these  cases  a  mod- 
erate acute  swelling  of  the  spleen  and  a  pronounced  swelling  of 
the  lymph  glands  in  addition  to  blood  extravasations. 

An  infection  of  a  milder  degree,  for  instance  an  intravenous 
injection  of  a  small  quantity  or  very  weak  virus,  results  in 
some  cases  in  a  chronic  affection,  lasting  for  several  weeks 
or  months.  The  animals  become  emaciated  slowly  but  gradu- 
ally, frequently  in  spite  of  their  good  appetite;  they  have  an 
intermittent  fever,  and  inflammatory  processes  develop  in  dif- 
ferent joints,  especially  in  the  knee,  carpal  and  tarsal  joints. 
The  animals  also  show  a  marked  predisposition  for  secondary 
infections,  especially  for  catarrhal  pneumonia. 

The  bipolar  bacillus  may  produce  these  varied  clinical 
manifestations  independently.  In  the  acute  cases  the  organism 
is  found  in  great  numbers  in  the  blood  and  also  in  the  exudates 
in  pure  culture.  The  pathological  processes  in  some  of  the 
chronic  cases  may  be  also  attributed  to  its  action  even  if  the 
bacilli  have  since  disappeared  from  the  body. 

The  local  action  of  bipolar  bacilli  is  manifested  in  the 
production  of  serous  and  fibrinous  inflammations,  later  in 
degeneration  of  the  exudate  and  tissue  elements,  as  a  result  of 
which  dry  caseous  masses  occur,  while  necrotic  areas  develop 
in  the  affected  organs.  The  necrosis  is  very  pi-obably  the  result 
of  the  action  of  toxins.  Filtrates  of  bouillon  cultures  free  from 
bacteria  usually  produce  only  a  very  slight  or  no  toxic  action. 
Killed  masses  of  bacteria,  however,  possess  distinct  toxic  prop- 
erties. Inasmuch  as  in  the  body  of  the  animal  both  multipli- 
cation and  destruction  of  bacilli  take  place,  and  as  dead  bacilli 
are  dissolved  in  the  tissue  fluids  the  toxins  which  are  eliminated 
may  cause  general  effects  and  local  necrotic  processes.    There 


g4  Hemorrhagic   Septicemia 

is  also  a  possibility  of  the  bacteria  producing  strongly  acting 
exogenic  toxic  substances   and  aggressins  in  the  living  body. 

According  to  the  investigations  of  Klett  &  Braun,  the  bacilli  of 
fowl  cholera  and  swine  plague  secrete  even  in  artiiicial  fluid  cultures 
soluble  poisons  in  large  quantities  which  can  be  demonstrated.  These 
toxins  have  an  identical  poisonous  action  (in  pigeons  and  chickens 
lethargy  and  intoxication)  and  their  endotoxins  are  also  identical ;  a 
difference  is  indicated  in  that  the  Bacillus  avisepticus  produces  greater 
(juantities  of  filterable  toxins  and  endotoxins,  and  these  are  also  more 
constant. 

According  to  Weil  the  virulence  of  the  bacteria  is  considerably 
increased  when  heated  to  44°  C.  in  the  exudate  of  artificially  infected 
animals,  and  also,  according  to  Citron,  in  extracts  of  cultures.  Accord- 
ing to  iiail's  theory  the  bipolar  bacilli,  like  the  other  pathogenic  bac- 
teria, produce  specific  substances  in  the  animal  body  (aggressins)  which 
possess  the  character  of  changing  non-fatal  amounts  of  bacteria  to 
fatal  ones,  without  themselves  having  marked  toxic  properties.  Further, 
Tschistovitch  believes  that  virulent  fowl  cholera  bacilli  contain  strictly 
specific  thermo-stable  antiphagins  which  protect  them  from  the  digestion 
by  leucocytes. 

The  bipolar  bacilli  manifest  a  particular  affinity  towards 
certain  organs,  and  therefore  pathological  changes  develop  in 
the  less  acute  cases  only  in  certain  organs.  In  such  predisposed 
organs  either  acute  or  chronic  inflammations  may  be  present. 
The  serous  memljranes  in  general,  the  lungs,  the  synovial  mem- 
branes of  the  joints  and  tendons  and  probably  the  liver  are  the 
favored  organs. 

According  to  Lignieres  the  Inpolar  bacilli  nui}^  also  give 
rise  to  the  development  of  secondary  disease  processes. 
Through  their  toxins  and  probably  indirectly  through  a  tem- 
porary arrest  of  the  phagocytosis,  the  resistance  of  the  body 
may  be  reduced,  whereby  bacteria  which  are  more  or  less  harm- 
less may  produce  disease  processes,  while  the  bipolar  bacilli 
may  in  the  meantime  disappear  from  the  body.  Even  in  nuiny 
of  the  acute  cases  which  are  associated  with  an  inflammation 
of  the  lungs  and  joints  other  probably  pathogenic  organisms 
may  be  found  in  the  affected  tissues,  or  in  the  inflammatory 
products  in  addition  to  the  bipolar  bacilli.  However,  in  the 
chronic  cases  only  secondary  bacteria  are  as  a  rule  present. 

The  intravenous  injection  of  a  weak  virus,  for  instance  older 
cultures  of  the  bipolar  bacillus,  produces  as  has  already  been  mentioned, 
a  chronic  affection  which  results  in  cachexia.  In  these  cases  the  bac- 
teriological examination  of  the  affected  tissues  and  exudates  discloses 
other  bacteria  (streptococci,  colon  bacteria,  etc.)  in  spite  of  the  fact  that 
the  infection  was  brought  on  by  the  bipolar  ])aci]li.  Similar  results  may 
occasionally  be  obtained  from  the  injection  of  filtrate  free  from  bacteria 
made  from  cultures  of  the  bipolar  bacillus. 

The  very  frequent  occurrence  of  mixed  infections  makes  it 
possible  for  other  bacteria  to  prepare  the  field  for  the  propa- 


Palliojiciu'sis.    Iniinuiiizalidii.  g5 

gation  of  the  l)ii)()lai-  bacilli.  Tliroiii^li  the  destruction  of  tlie 
tissues  by  the  other  organisms  the  entrance  and  i)ropag"ation 
of  the  ovoid  bacteria  are  favored. 

Their  invasion  is  without  doul)t  of  a  secondary  character 
in  tlioso  cases  in  wliicli  a  i>'eneral  septic  affection  is  caused  by 
an  ultraWsible  virus,  as  for  instance  in  doi;-  distemper  and  hog 
cholera  (see  those  diseases).  In  these  affections  disease  proc- 
esses may  develop  subsequently  which  are  exclusively  or  at 
least  partly  the  result  of  the  action  of  the  ovoid  bacteria.  In 
recognition  of  this  fact,  the  etiological  importance  of  these  bac- 
teria has  already  been  considerably  limited. 

Immunization.  Pasteur  proved  that  cultures  of  the  chicken 
cholera  organism  when  attenuated  by  keei)ing  in  the  air  pro- 
duce a  suitable  vaccine  for  the  immunization  of  chickens  against 
artificial  infection.  Similar  results  are  obtained  with  cultures 
attenuated  by  higher  temperature  or  by  disinfectants.  How- 
ever, the  results  of  such  iiumunizations  which  are  mostly  limited 
to  laboratory  experiments  are  by  no  means  uniform.  This 
irregularity  is  probably  due,  on  the  one  hand,  to  the  variance 
of  the  virulence  of  the  cultivated  bacteria,  and  on  the  other 
hand,  to  the  difference  of  action  of  the  methods  employed  in 
the  attenuations,  accurate  control  of  which  is  almost  impossible. 

More  ref-ently  J.  and  M.  Lignieres  (1902)  produced  a  potent  vaccine  for  all  the 
diseases  of  this  group  from  cultures  which  had  been  reinoculated  several  hundred 
times  from  agfar  to  ag-ar  at  two  days '  intervals,  as  a  result  of  which  they  possessed  a 
uniform  virulence.  Flasks  with  a  wide  bottom  are  filled  to  a  height  of  ^4  cm. 
with  jieptone-bouillon  and  inoculated  with  the  stock  culture.  The  flas-ks  are  then 
placed  in  a  thermostat  and  kept  at  a  temperature  of  42-43°  C.  The  cultures 
which  are  grown  for  five  days  at  this  temperature  produce  the  first,  while  those 
grown  only  for  two  days,  the  second  vaccine. 

"With  the  attenuated  cultures  immunity  may  be  produced 
not  only  against  the  same  variety  but  also  against  related 
varieties  of  the  bipolar  bacillus.  Kitt  was  the  first  to  point  out 
the  possibility  of  a  uniform  procedure  for  the  control  of  the 
diseases  of  this  group.  He  successfully  immunized  chickens 
against  fowl  cholera  with  the  virus  of  rabbit  septicemia.  Later 
Jensen  obtained  the  same  results  with  the  virus  of  infectious 
pneumonia  of  calves.  Lignieres  also  proved  that  this  reci- 
pi'ocity  ol)tains  with  regard  to  all  strains  of  the  varieties  of 
bacteria  belonging  to  this  group.  He  succeeded  in  demonstrat- 
ing experimentally  that  a  vaccine  prepared  from  a  culture  of 
a  certain  variety  is  potent  in  the  first  place  against  this  variety, 
but  that  it  also  has  a  protective  action,  although  of  a  lesser 
degree,  against  the  bipolar  organism  of  the  other  diseases  of 
this  group.  But  its  protective  action  for  the  latter  diseases  is 
so  slight  and  uncertain  that  it  does  not  meet  with  practical 
requirements,  and  besides  the  preparation  of  the  different  vac- 
cines for  each  of  the  diseases  would  be  very  troublesome. 
Lignieres   therefore   prepared  a   so-called   polyvalent   vaccine 


86  Hemurrliagic  Septicemia. 

which  is^  potent  against  all  the  diseases  of  this  group.  The 
vaccine  is  prepared  from  mixed  cultures  of  the  hemorrhagic 
septicemia  bacteria  of  sheep,  cattle,  dogs,  horses,  hogs  and 
chickens  and  attenuated  at  a  temperature  of  42-43 °C. 

The  vaccine  prepared  from  the  six  varieties  of  virus  is  supposed  to  immunize 
against  all  of  the  six  diseases.  Test  animals  inoculated  with  this  vaccine  will 
show  a  resistance  against  a  virulent  infection,  while  control  animals  will  die  or 
become  severely  affected  (with  the  exception  of  very  virulent  intravenous  infections). 
In  practice  the  vaccinations  are  supposed  to  have  given  good  results,  especially 
against  the  acute  septicemic  forms  of  hemorrhagic  septicemia,  as  for  instance  against 
chicken  cholera  and  hemorrhagic  septicemia  of  sheep.  On  the  other  hand,  the  re- 
sults in  the  slower  forms  which  are  frequently  associated  with  mixed  infections 
were  less  favoralde,  although  even  in  these  eases  the  mortality  has  been  supposedly 
reduced  from  50%  to  12%. 

The  immunization  consists  in  a  subcutaneous  or  intraperitoneal  injection  of 
the  vaccine;  the  second  inoculation  follows  in  from  12  to  15  days.  In  infected 
localities  it  is  advisable  to  undertake  the  vaccination  on  sucking  animals  8  to  10  days 
after  their  birth,  or  at  least  shortly  before  weaning.  The  immunity  produced  by  the 
vaccination  lasts  for  about  a  year,  and  therefore  it  is  advisable  in  infected  localities 
to  repeat  it  annually. 

Serum  Immunization.  Kitt  (1897)  found  that  animals 
(among  others,  horses  and  cows)  w^hich  have  been  injected 
with  the  virus  of  chicken  cholera  produce  a  blood  serum  which 
protects  chickens  against  an  artificial  infection-  of  virulent 
material.  This  fact  w^as  later  confirmed  in  connection  A^ith 
swine  plague  by  Schweinitz  and  Leclainche  while  Lignieres  & 
Spitz  (1902)  showed  that  this  principle  applies  to  all  diseases 
of  the  hemorrhagic  septicemia  group. 

_  With  regard  to  the  immune  sera,  there  exists  a  similar 
reciprocity  as  in  the  case  in  w^hich  the  vaccines  are  prepared 
from  living  cultures,  Kitt  &  Mayr  have  established  these  facts 
for  swine  plague  and  fowl  cholera,  Grosso  for  hemorrhagic  sep- 
ticemia of  cattle,  fowl  cholera  and  swine  plague,  while  Lignieres 
generalized  the  principle.  Accordingly  an  immune  serum  pre- 
pared from  certain  varieties  of  the  bipolar  bacillus  protects,  in 
the  first  place,  against  a  virulent  infection  caused  by  the  respec- 
tive varieties.  However,  it  is  also  protective,  although  in  a 
lesser  degree,  against  the  other  related  varieties.  Blood  serum 
of  animals  wdiich  have  been  hyperimmunized  with  different 
varieties  of  the  bipolar  bacillus  has  likewise  a  protective  action 
against  all  the  "varieties  wdiich  were  used  in  the  preparation  of 
the  serum. 

Based  on  these  experimental  observations  Lignieres  &  Spitz  pre- 
pared a  so-called  polyvalent  immune  serum  against  all  the  pastenrellosae. 
The  serum  is  prepared  by  inoculating  peptone  bouillon  with  the  above 
mentioned  six  varieties  of  the  bipolar  bacillus,  and  with  the  mixed 
cultures  prepared  in  this  manner  horses  are  at  first  subcutaneously, 
later  intravenously  injected  with  increasing  quantities  (5  to  20  cc). 
Horses  highly  immunized  in  this  way  produce  a  serum  which  affords 
protection  against  all  of  the  diseases  of  this  group,  and  it  even  possesses 
a  curative  action  to  a  certain  degree  if  emploved  in  the  early  stages  of 
the  disease.    Similar  results  were  also  obtained  by  Klepzoff,  while  Broil 


Fowl  Clioleia.  87 

&  Angeloff  sliowed  that  by  the  use  of  swine  plague  serum  the  opsonic 
index  is  not  only  raised  for  swine  plague  l)ut  also  for  the  bacteria  of 
hemorrhagie  septieeiuia  of  cattle  and  fowl  cholera. 

The  polyvalence  should  be  considered  here  in  a  different  sense  from  tliat  applied 
in  the  Wasserniann-Ostertag 's  polyvalent  swine  plague  serum  (see  swine  plague). 

The  very  close  morphological  resemblance  of  the  bipolar 
bacilli  from  the  various  sources,  the  similarit}^  of  the  cultures  in 
their  princii)al  cultural  characteristics,  the  great  similarity  of 
the  pathological  processes  produced  by  them,  the  possilnlity 
of  intertransmissibility  to  the  different  species  of  animals,  like- 
wise the  common  immunizing  properties,  indicate  that  the 
bipolar  bacilli  belong  to  one  species  of  bacteria,  while  the  few 
deviating  characteristics  such  as  the  variance  of  virulence  are 
only  characteristics  peculiar  to  the  different  strains  or  varieties. 
The  bacteria  which  probably  developed  from  a  common  strain 
originally  have  undergone  modifications  in  the  bodies  of  the 
different  species  of  animals  by  adapting  themselves  to  exist- 
ing environments  similar  to  that  which  occurs  in  other  species 
of  bacteria,  and  which  may  also  be  produced  artificially.  On 
the  other  hand,  the  differences  in  the  pathological  processes  in 
the  various  diseases  may  be  satisfactorily  explained  by  the 
special  characteristics  of  the  different  animal  species.  The 
close  relationship  of  the  causative  factors  of  the  several  dis- 
eases brings  the  affections  produced  by  them  into  closer  rela- 
tion. Moreover,  the  similarity  of  the  etiological  factors  also 
indicates  uniformity  in  methods  to  be  used  in  the  control  of 
these  diseases. 

Literature.  Hueppe,  B.  klin.  W.,  1886,  753.— Lignieres,  Bull.  1900,  329, 
(Lit.).— Kitt,  Hb.  d.  p.  M.,  1903,  II,  559,   (Lit.). 

(a)  Fowl  Cholera.     Cholera  Gallinarium. 

{Foul    ijiphoid;    PasteureUosis    ariion,    Choh'ra    des    poules 

[French];  HiiJuiercJiolera  [Germau];  Cholera 

dei  polli  [Italian].) 

Fowl  cholera  is  an  acute,  contagious  and  usually  an  epizo- 
otic affection  of  fowls,  particularly  of  chickens,  geese  and 
ducks,  and  is  manifested  in  a  general  infection  associated  with 
a  profuse  diarrhea.  It  is  caused  by  a  bacterium  of  the  typo 
of  the  hemorrhagic  septicemia  organism,  the  bacillus  avi- 
septicus. 

History.  This  dangerous  fowl  plague  was  described  by  veter- 
inarians as  early  as  the  18th  century,  and  in  the  middle  of  the  last 
century  some  of  the  authors  (Benjamin,  1851,  Delafond  &  Renault, 
1851,  and  Hering,  1858)  have  recognized  its  contagious  nature  and 
also  substantiated  it  experimentally.  Perroncito  (1878)  and  also  Sem- 
mer  described  a  diplococcus  as  the  cause  of  the  disease  which  they 
constantly  found  in  the  blood  of  chickens  dead  of  the  disease.    Toussaint 


88  Fowl  Cholera. 

(1879)  and  later  Pasteur  (1880)  conlinned  their  findings  and  succeeded 
in  growing  the  bacteria  in  artificial  bouillon,  thus  enabling  them  to 
study  their  pathogenic  characteristics.  Pasteur  carried  out  his  first 
fundamental  experiments  on  the  attenuation  of  bacterial  cultures  and 
on  immunization  with  such  attenuated  cultures  with  the  bacilli  of  fowl 
cholera.  Valuable  contributions  regarding  the  etiology  of  the  disease 
were  also  furnished  by  Kitt  and  Lignieres. 

Occurrence.  Fowl  cholera  occurs  extensively  in  Europe 
(with  the  exception  of  Great  Britain),  in  North  America  and 
in  South  Africa,  and  causes  very  heavy  losses,  especially  among 
the  finer  breeds.  The  extent  and  value  of  the  losses  cannot 
be  accurately  estimated;  as  a  matter  of  fact,  in  some  of  the 
localities,  occasionally  half  or  even  a  larger  proportion  of  the 
flocks  are  annihilated.  Aside  from  the  money  value  of  the 
dead  and  slaughtered  fowls,  the  total  loss  is  considerably  in- 
creased by  the  temporary  retrogression  of  fowl  breeding  in 
the  affected  localities  as  well  as  by  the  reduction  of  the  egg 
production. 

In  the  year  of  1908,  14,397  chickens,  13,877  geese,  4,795  ducks,  272  pigeons  and 
256  other  fowls  died  or  were  slaughtered  in  776  townships  in  Germany  on  account 
of  cholera.  The  greatest  number  of  losses  occurred  in  the  government  districts, 
Potsdam,  Broniberg,  Oppeln,  Allenstein,  andPopen  (in  the  last  3  years  the  number  of 
cases  was  reduced  from  74,329  to  33,597).  The  lo^^ses  of  the  other  countries  are 
not  known,  but  the  disease  exists  at  the  present  time  to  a  great  extent  in  Kussia, 
Italy,  Austria,  Hungary,  France,  Bulgaria,  California,  etc. 

Etiology.  The  bacillus  (bipolaris)  avisepticus  (bacillus 
cholerae  gallinarium  s.  avicida,  pastenrella  avium)  l)elongs  to 
the  smallest  of  the  Inpolar  bacilli  with  which  it,  however,  cor- 
responds in  the  morphological  and  cultural  characteristics  (see 
page  79).  In  fowl  blood  the  bipolar  staining  is  particularly 
well  marked  (see  fig.  24  on  page  79)  ;  peptone  bouillon  is  made 
uniformly  cloudy  with  or  without  the  formation  of  a  slimy  sedi- 
ment (according  to  Hertel  the  ])acilli  sometimes  pass  through 
a  porous  Berkefeld  filter). 

Tenacity.  The  bacteria  of  fowl  cholera  remain  alive  in  manure  for  at  least 
3  months  (Gaertner),  in  putrefactive  carcasses  and  in  garden  soil  for  3  months 
(Kitt),  in  water  with  the  exclusion  of  air  and  at  a  tem])erature  of  5  to  6  de- 
grees for  18  days  (Hertel).  They  also  show  a  considerable  resistance  to  cold 
(according  to  Kitt  they  resist  freezing  for  14  days,  and  according  to  Hertel  their 
virulence  is  gradually  reduced  at  minus  13  degrees),  but  they  are  less  resistant 
towards  other  harmful  influences.  Thus,  when  dried  in  exudate  in  the  air,  and 
under  the  influence  of  sunlight  they  lose  their  virulence  in  48  hours,  if  the  light  is 
excluded  in  72  hours  (Heifer),  whereas  organs  of  carcasses  are  sterilised  by  a 
temperature  of  45  to  50°  C.  in  %  hour,  and  in  10  minutes  at  a  temperature  of 
80-85°C.  (Kitt).  The  following  disinfectants  have  a  destructive  action  on  the  organ- 
isms: 1%  carbolic  acid,  1/.%  sulphuric  acid  (Salmon),  1%  chlorate  of  lime,  and  5% 
milk  of  lime  (Jager).  The  blood  and  loose  excrements  are  positively  disinfected 
by  thoroughly  mixing  them  with  a  5%  copper  sulphate  solution  (Colin).  Turf 
dust  has  also  a  disinfecting  action  (Ulmic  acid),  for  when  bloody  intestinal  con- 
tents are  mixed  with  it  the  infectiveness  of  the  bacilli  is  destroyed  in  48  hours 
(Hertel). 

Pathogenicity.  The  blood  of  chickens  affected  with  cholera 
as  well  as  fresh  pure  cultures  produce  the  disease  in  fowds  after 


Pathogenicity.  89 

cutaneous  or  ^iihcmtanGDUs  iujection  ovon  in  minimal  closes. 
Tlie  transmission  may  Ix'  ma(l<'  snccc'ssf'iilly  l)y  takin.i;-  tlic  point 
of  a  needle  (li])i)e(l  in  Itlood  and  scaiifyini^-  or  pricking-  the 
skin  at  any  part  of  the  body.  In  this  manner  as  well  as  by 
sul)Cutaneons  and  intranniscular  inoculations  most  of  the  dif- 
ferent species  of  domestic  fowl  (chickens,  ducks,  geese,  turkeys, 
piii:eons,  ])lieasants  and  fancy  l)irds)  and  small  wild  birds 
(sparrows,  finch,  etc.)  are  easily  infected.  These  birds  also 
l)ecome  affected  by  the  dropping  of  a  culture  into  the  conjunc- 
tiva, nose  or  the  laryngeal  nmcous  membrane,  as  well  as  on 
superficial  wounds  of  the  comb,  wattles  and  feet  (ITertel). 
Further,  the  disease  nuiy  be  produced  by  feeding  of  blood,  meat, 
organs  and  intestinal  contents  of  affected  animals  as  well  as 
of  pure  cultures.  The  disease  produced  by  inoculation  usually 
results  in  death  in  from  ll'  to  24  hours,  while  when  produced 
by  feeding  of  the  virus  it  terminates  only  after  a  longer  period 
(according  to  Semmer  sometimes  only  after  8  to  12  days). 

Of  other  animals  rabbits  and  mice  are  susceptible  to  the 
disease,  whereas  in  guinea  pigs  (Pasteur),  cattle,  sheep  and 
horses  (Kitt)  the  subcutaneous  inoculation  produced  only  an 
abscess  at  the  point  of  injection  (guinea  pigs,  however,  are 
easily  infected  by  intraperitoneal  inoculation).  Intravenous 
injections  of  very  virulent  cultures  are  pathogenic  for  domestic 
numnnals  (hogs,  dogs  and  cats),  while  through  feeding  of  such 
material  infection  is  successful  only  in  rabbits.  Stange  & 
Persdorf  observed  a  simultaneous  infection  in  chickens  and 
hogs  which  they  traced  to  an  infection  with  the  fowl  cholera 
virus.  On  the  other  hand,  Koske  has  not  succeeded  in  infecting 
hogs  artificially  with  the  cholera  virus.  On  man  the  eating  of 
affected  fowl  lias  apparently  no  harmful  effects. 

Repeated  passage  of  the  bacteria  through  the  bodies  of 
chickens,  pigeons  or  sparrows  increases  their  pathogenicity 
which  is  stiil  more  increased  by  passage  through  guinea  pigs 
(intraperitoneally).  In  this  way  the  virulence  may  be  increased 
to  such  an  extent  that  intravenous  injections  of  such  virus 
may  kill  domestic  mammals  in  a  few  hours  (Tjignieres).  On 
the  other  hand,  the  air,  and  more  so  the  combined  action  of 
air  and  snnlight,  attenuates  the  virulence  of  the  bacteria 
(Pasteur,  see  page  94). 

The  bacteria  produce  toxins  in  artificial  cultures.  Pasteur  found 
that  the  subcutaneous  injections  of  large  quantities  of  filtrate  of  bouillon 
cultures  free  from  bacteria  cause  in  chickens  a  somnolence  and  stupor 
lasting  for  several  hours,  similar  to  that  seen  in  the  disease.  This  fact 
was  later  confirmed  by  Salmon,  Stangje,  Kitt,  as  well  as  by  Klett  & 
Rraun.  (See  page  84.)  On  the  other  hand.  Oalamida  obtained  from 
a  12-day  old  bouillon  culture  a  hemolysin  -which  has  the  strongest 
action  on  rabbits,  less  on  guinea  pigs  and  still  less  on  the  red  blood 
corpuscles  of  chickens. 

Natural  infection  usually  results  from  the  ingestion  of 
droppings  or  saliva  of  affected  fowls,  contaminated  feed,  viscera 


90  Fowl  Cholera. 

of  slaughtered  or  any  parts  of  the  l)Ocly  of  affected  animals; 
besides,  when  healthy  fowl  drink  from  the  same  vessels  or  from 
a  pond  from  which  infected  birds  have  watered.  The  infection 
from  cages  as  well  as  from  the  premises  may  also  be  dissemin- 
ated in  various  ways  to  neighboring  localities  where  an  outbreak 
may  follow. 

The  disease  is  mostly  introduced  into  premises,  which  have 
been  free  from  the  disease,  by  the  introduction  of  infected  fowls, 
and  less  frequently  by  the  sale  for  food  purposes  of  birds 
which  have  been  slaughtered  while  ill.  The  disease  is  also  very 
frequently  disseminated  by  poultry  shows  in  which  the  veteri- 
nary supervision  is  very  deficient.  Further,  it  may  also  be 
disseminated  by  pigeons  which  take  up  the  contagion  in  in- 
fected premises,  become  infected  themselves  and  by  their  in- 
testinal excrements  infect  the  other  birds  of  the  premises 
(Cagny,  Nocard).  Finally,  the  disease  may  be  spread  by  wild 
birds,  particularly  sparrows  (Hertel  demonstrated  virulent 
bacilli  in  dermanyssus  mites  which  he  took  from  the  body  of 
sick  chickens). 

The  possibility  of  the  spontaneous  occurrence  of  fowl  cholera  in 
localities  in  which  this  disease  or  one  of  this  group  has  existed  is  not 
excluded  in  view  of  the  general  statements  made  on  page  81,  but  this 
possibility  has  not  yet  been  demonstrated  by  satisfactory  observations 
(accordiug  to  Gamaleia  the  intestinal  canal  of  healthy  pigeons  contains 
fowl  cholera  bacteria,  but  Joest  did  not  succeed  in  demonstrating  them 
in  the  intestinal  contents  of  chickens.  Ostertag  &  Ackermann  likewise 
failed  to  find  them  in  chickens  and  geese). 

A  fluctuation  of  virulence  in  the  cholera  virus  is  observed  under 
natural  conditions  as  some  outbreaks  are  limited  to  certain  species  of 
fowls,  while  other  species  in  spite  of  exposure  to  the  infection  fail  to 
contract  the  disease  (for  instance,  chickens  and  water  fowl  are  exclu- 
sively affected).  These  observations  show  a  still  closer  accommodation 
of  the  virus  to  the  organism  of  a  certain  species,  as  a  result  of  which 
such  accommodated  bacteria  are  strongly  virulent  for  only  a  certain 
species  of  fowl,  whereas  for  another  species  they  are  less  virulent  or 
non-pathogenic.  However,  such  differences  in  the  virulence  are  rare 
and  are  not  constant,  and  therefore  the  infections  of  various  species  of 
fowls  should  not  be  considered  on  this  basis  alone  as  independent 
affections. 

Susceptibility.  Purebred  and  water  fowl  are  particularly 
susceptible  to  natural  infection,  whereas  the  common  breeds 
of  fowl  show  greater  resistance.  Fowl  which  have  withstood 
an  infection  by  ingestion  a  short  time  before  are  more  suscepti- 
ble to  a  second  infection. 

Pathogenesis.  The  bipolar  bacilli  penetrate  the  intestines, 
probably  even  through  the  uninjured  mucous  membrane,  into 
the  lymph  spaces  of  the  intestinal  wall,  and  soon  gain  entrance 
to  thie  blood  stream  where  they  multiply  with  great  rapidity 
and  cause  the  death  of  the  animals.  If  the  entrance  of  the 
bacilli  takes  place  through  a  separation  of  the  continuity  of 


Pathogenesis.  qi 

the  skin  or  mucous  luonibrane  diroctly  into  ilio  blood  stroain, 
death  results  in  a  shoi'ter  time  (Tiede  found  bacilli  in  the  in- 
ternal organs  of  a  mouse  15  minutes  after  subcutaneous  inocul- 
ation). Death  is  caused  in  the  first  place  by  the  action  of  the 
toxins  which  without  a  doubt  form  in  the  animal  body  in  such 
a  nuinner  that  through  the  negative  chemotaxis  of  the  virulent 
bacteria  the  phagocytes  ar(^  uiud)le  to  exert  their  action  (Gabrit- 
schewsky,  Silberbeg  &  Zeliony).  The  chemotaxis  of  the  at- 
tenuated bacteria  is  on  the  other  hand  positive,  and  this  ex- 
])lains  the  local  suppurative  inflanmiation  which  usually  ter- 
minates in  recovery  after  a  subcutaneous  injection  of  such  a 
virus. 

Injections  of  attenuated  virus  into  the  chest  muscles  of 
chickens  produce  a  serous  inflammation  of  the  connective  tissue 
and  degeneration  of  the  musculature  (see  page  95). 


The  bacteria  penetrate  from  the  bloocl  circulation  into  eggs,  and 
they  have  been  found  in  the  yolks  of  eggs  of  affected  animals  (Celli 
&  Marchiafava,  tiarthelemy).  The  first  two  authors  have  also  demon- 
strated the  transmission  of  the  disease  to  the  progeny;  on  the  other 
hand,  Kitt  found  that  young  rabbits  (4-6  weeks  old)  descending  from 
artificially  immunized  animals  resist  a  virulent  infection. 

Anatomical  changes.  The  principal  anatomical  findings  in 
acute  cholera  consist  in  an  acute  hemorrhagic  inflannnation 
of  the  intestines  and  lungs  in  association  with  small  hemor- 
rhages on  the  serous  membranes  and  sometimes  a  fibrinous 
exudate  on  the  same.  The  l)lood  vessels  of  some  of  the  loops 
of  the  intestines  are  injected  and  their  peritoneal  covering 
also  contains  small  punctiform  hemorrhages.  The  intestinal  con- 
tents are  fluid,  mixed  with  mucus  and  fine  bloody  streaks,  or 
of  a  uniform  reddish  color  from  the  admixture  of  a  considerable 
quantity  of  blood.  The  intestinal  mucous  membrane  appears 
reddened  sometimes  only  in  spots  and  again  in  longer  portions, 
particularly  in  the  duodenum.  It  shows  an  inflammatory  swell- 
ing and  is  studded  with  dark  red  hemorrhages;  exceptionally 
small  round  diphtheritic  ulcers  are  also  found  on  the  intestinal 
mucous  membrane  (frequently  in  water  fowl). 

The  serous  content  of  the  pericardium  is  frequently  cloudy 
and  contains  small  fibrinous  flakes;  the  epicardium  appears  as 
if  sprinkled  Avitli  blood  and  is  frequently  covered  with  fine 
fibrinous  membranes,  particularly  in  water  fowl. 

The  lungs  are  congested  and  edematous,  sometimes  dark 
brownish  red  in  spots  and  hepatized  as  an  indication  of  a 
croupous  hemorrha.gic  inflammation  which  is  sometimes  as- 
sociated with  a  fibrinous  pleuritis.  Tlie  mucous  membrane  of 
the  upper  air  passages  shows  catarrhal  reddening  and  swelling. 

In  the  parenchymatous  organs  the  first  stages  of  parenchy- 
matous degeneration  may  be  observed.  The  regional  h^nph 
glands  of  the  spleen  and  cecum  are  almost  invariably  decidedly 
swollen  and  hemorrhagic.    Exceptionally  a  fibrinous  inflamma- 


92  Fowl  Cholera. 

tion  (Kitt,  Rjitz)  is  present  in  all  the  air  cells  and  on  all  serous 
membranes. 

In  the  less  frequent  chronic  cases  yellowish,  grey,  dry 
caseous  foci  are  frequently  present  in  lungs,  liver  and  on  the 
intestinal  mucous  membrane,  sometimes  also  under  the  en- 
docardium, which  may  become  quite  extensive,  especially  in  the 
lungs.  Exceptionally  even  both  lobes  of  the  lungs  may  show 
hepatization  resembling  caseous  pneumonia  (Jungklaus).  At 
the  same  time  there  may  be  a  fibrinous  pleurisy  and  pericarditis, 
and  in  some  of  the  joints  and  tendon  sheaths  a  caseous  exudate 
may  be  present  (Sticker,  Hensel,  Willach). 

In  the  acute  form  bacteria  may  be  found  in  great  numbers  in 
the  blood,  between  the  blood  corpuscles  and  only  sparingly  in  the  white 
blood  corpuscles  as  well  as  in  the  exudates.  The  intestinal  contents  are 
also  virulent.  In  chronic  cases  the  caseous  foci  also  contain  virulent 
bipolar  bacilli,  while  they  are  present  in  only  small  numbers  iu  the 
blood. 

Symptoms.  Ostertag  &  Ackermann's  experiments  showed 
the  time  of  incubation  after  a  single  feeding  with  organs  of 
fowl  affected  with  cholera  to  be  1  to  2  days  in  geese,  and  4 
to  9  days  in  chickens.  After  the  recovery  from  a  feeding  in- 
fection a  new  infection  produced  death  in  geese  (feeding)  as 
early  as  19  hours  and  in  chickens  (subcutaneous  infection)  as 
early  as  8  hours.  The  time  of  incubation  is  very  likely  the 
same  in  natural  infection. 

The  acute  form  of  the  disease  sometimes  runs  a  very  rapid 
course ;  the  animals  drop  to  the  ground  while  running,  or  they 
fall  to  the  ground  from  an  elevated  place,  such  as  the  rod  of  a 
cage,  or  from  a  tree,  and  die  after  flapping  their  wings  a  few 
times. 

In  the  large  majority  of  cases,  however,  conspicuous  symp- 
toms precede  death.  The  birds  suddenly  become  depressed,  they 
assume  a  crouching  position,  seek  secluded  places,  and  sit 
trembling.  Sometimes  the  head  is  hidden  under  the  wing  or 
it  may  be  turned  backwards.  The  plumage  is  ruffled,  the  wings 
may  droop,  and  if  they  move  a  staggering  and  wabbling  gait 
is  manifest  with  the  wings  hanging  and  the  head  drooped. 
The  appetite  is  impaired  from  the  onset,  while  thirst,  on  the 
other  hand,  is  increased.  A  foamy  slime  drips  from  the  nasal 
and  oral  openings;  and  from  time  to  time  the  birds  turn  their 
necks  convulsively,  or  stretch  out  their  heads  on  which  the 
bills,  combs  and  wattles  show  a  bluish-red  discoloration.  At 
the  same  time  they  may  vomit  a  greyish-yellow  slimy  mass. 
At  the  height  of  the  disease  a  profuse  diarrhea  develops;  the 
droppings  are  at  first  yellowish-grey,  mushy  in  appearance, 
later  very  fluid,  dirty,  greenish  or  reddish,  mixed  with  coagu- 
lated albumin-like  flakes,  and  of  a  repulsive  odor.  The  plumage 
around  the  rectum  becomes  soiled  and  matted  with  the  feces. 

The  affected  birds  show  difficult  respiration  which  is  mani- 


Syniptoiiis  9*1 

fesled  by  opoiiod  iiioiitli,  inspiration  as  well  as  cx]:>iration  l)tnii,i;' 
associated  with  moist  rales.  As  the  weakness  progresses  they 
lie  with  closed  eyes  and  in  a  stupor  in  one  place.  If  they  at- 
tempt to  rise  they  soon  collai)se  and  linally  die  witli  manifesta- 
tions of  eonvnlsions  or  coma. 

In  the  chronic  form  of  the  disease  progressive  anemia  de- 
velops after  the  disappearance  of  the  acute  symptoms,  or  from 
the  onset  of  the  disease,  attended  by  emaciation ;  finally  a  per- 
sistent diarrhea  occurs.  Sometimes  one  or  more  joints  of  the 
wings  or  feet  swell;  later  the  swelling  ))ursts,  whereupon  a 
caseous  purulent  mass  containing  bacilli  is  discharged  from 
the  joints.  The  arthritis  interferes  to  a  great  extent  witli  the 
movements  of  the  already  weakened  l)irds. 

The  duration  of  the  disease  is  from  1  to  3  days  in  the 
majority  of  acute  cases  with  the  exception  of  the  peracute 
cases.  It  may,  however,  exceptionally  extend  from  7  to  12 
days.  In  these  cases  the  s^^llptoms  are  less  severe  from  the 
onset,  and  the  exliaustion  appears  later.  The  course  of  the 
chronic  form  extends  over  several  weeks. 

The  prognosis  is  very  unfavorable.  Frequently  entire  flocks 
of  chickens  succumb  to  the  infection,  while  in  other  cases  a  cer- 
tain percentage  of  the  birds  escape  probably  owing  to  a  slighter 
intensity  of  the  infection.  However,  in  exceptional  cases  re- 
coveries may  take  place. 

.Diagnosis.  Chicken  cholera  in  its  course  and  symptoms 
greatly  resembles  chicken  pest.  The  latter  comes  into  con- 
sideration particularly  when  it  affects  chickens  exclusively. 
From  this  as  well  as  from  other  septicemic  atfections  of  fowls, 
and  also  from  acute  poisonings  which  are  frequently  suspected 
by  the  owners,  the  disease  can  be  differentiated  with  certainty 
by  an  autopsy  and  bacteriological  examination  (see  also 
chicken  pest.)  Intestinal  worms  (for  instance,  the  trichosoma 
collare)  may  also  produce  cholera-like  symptoms. 

Chronic  cases,  particularly  those  which  are  associated  with 
arthritis,  may  be  mistaken  for  tuberculosis  and  gout.  A  dif- 
ferentiation is  here  also  only  possible  by  microscopical  exam- 
ination of  the  exudates  from  the  joints,  as  well  as  by  autopsies. 

On  autopsy  the  presence  of  intestinal  inflammation,  the 
fibrinous  exudate  contained  in  the  serous  cavities,  and  the 
hemorrhages  are  strongly  suggestive  of  fowl  cholera,  but  to 
establish  a  definite  diagnosis  even  in  such  cases  a  bacteriological 
examination  of  the  blood  and  the  inflammatory  products  is 
necessary. 

The  niieroRcoiiifal  oxaniination  consists  in  the  preparation  of  cover-glass  smears 
in  which  usually  large  masses  of  l)ipolar  rods  can  be  easily  recognized  by  the  aid 
of  the  previously  mentioned  staining  methods  (see  page  79).  Pigeons  are  best 
suited  for  test  inoculations,  especially  since  they  are  not  susceptible  to  chicken 
pest.  For  this  purpose  the  point  of  a  knife  is  dipped  into  lilood  or  exudate  and  then 
used  for  scarifying  the  skin,  or  a  small  quantity  of  the  material  is  in.iected,  sub- 
cutaneously  or  it  may  be  introduced  into  the  breast  muscles.  The  inoculation 
usually  results   in  a  short  time  in  the  death  of  the  test  animals  and  when  the  in- 


94  Fowl  Cholera 

fection  is  produced  by  an  injection  into  the  breast  muscles,  a  yellow  gelatinous  in- 
filtration of  the  subcutaneous  tissue  develops  at  the  point  of  inoculation  around 
which  the  surrounding  muscles  show  a  yellow  discoloration  and  necrosis.  Mice  may 
also  be  used  for  diagnostic  purposes.  In  these  the  bipolar  bacilli  may  be  demonstrated 
in  large  numbers  in  the  blood. 

Treatment.  At  the  onset  of  the  disease  the  treatment  of 
the  affected  as  well  as  the  exposed  fowls  with  highly  potent 
immune  serum  is  indicated  (see  page  95) ;  otherwise,  the  af- 
fected birds  are  given  the  customary  weak  solutions  of  disin- 
fectants, which  may  be  added  to  the  drinking  water.  These 
solutions,  viz.,  iron  sulphate,  salicylate  acid,  tannin  (V2  to  1%), 
sulphuric  or  hydrochloric  acid  (2%),  may  also  be  given  in 
tablespoons  or  teaspoons  (Ward  and  Stange  give  a  1  to  1500 
or  2000  corrosive  sublimate  solution  as  drinking  water).  The 
same  methods  may  be  also  applied  as  preventive  measures 
against  the  disease  in  healthy  birds  which  are  threatened  by 
infection.  The  subcutaneous  injection  of  a  5%  carbolic  acid 
solution  (Nocard,  Barberio)  is  followed  by  little  or  no  bene- 
ficial results. 

Prevention.  Great  care  should  be  exercised  in  order  that 
the  introduction  of  the  disease  by  the  purchase  of  new  birds 
may  be  prevented.  In  addition  to  careful  examination  of  the 
source,  it  is  advisable  to  keep  new  birds  separated  for  at  least 
1  week,  and  only  after  that  period  should  they  be  allowed  to 
mingle  with  the  birds  of  the  flock. 

If  the  disease  has  already  appeared  in  a  flock,  entirely 
healthy  birds  should  be  taken  to  an  absolutely  clean  place  with- 
out delay.  Those  already  affected  or  suspected  should  im- 
mediately be  slaughtered  or  taken  to  a  separate  place  for  treat- 
ment. The  carcasses  should  be  buried  deep,  or,  still  better, 
burned.  After  burning  or  burying  the  droppings,  the  walls 
and  roosts  of  the  chicken  houses  as  well  as  the  drinking  vessels 
and  containers  used  for  feeding,  should  be  scalded  with  hot 
water  or  washed  with  hot  lye.  They  should  also  be  sprinkled 
with  lime,  and  the  previously  cleaned  floors  should  be  sprayed 
with  a  3%  creolin  or  lysol  solution.  Airing  of  the  chicken 
houses  for  several  days  promotes  good  results  from  this  method 
of  prevention.  The  droppings  from  the  affected  as  well  as  the 
healthy  birds  should  be  collected  at  least  once  daily  and  burned. 

Immunization.  Formerly  attenuated  cultures  were  used 
for  this  purpose,  while  recently  the  immunization  with  blood 
serum  is  more  extensively  employed. 

I.  Immunization  with  attenuated  cultures  (Pasteur's 
method).  According  to  the  investigations  of  Pasteur  (1880) 
the  bacteria  of  chicken  cholera  in  bouillon  cultures  are  gradually 
attenuated  under  the  influence  of  the  atmospheric  air  until  after 
about  two  months  standing  they  lose  their  virulence  entirely. 
If  allowed  to  stand  for  a  shorter  time  the  bacteria  are  attenuated 


Imnmnization,  95 

to  a  certain  degree,  which  virulence  they  retain  if  their  culti- 
vation is  continued.  Cultures  attenuated  to  two  different  de- 
grees produce  two  vaccines  with  which  chickens  nuiy  be  im- 
munized against  virulent  infections. 

This  method  of  inununization  is  of  great  scientific  im- 
portance but  has  not  proven  successful  in  practice.  Irrespec- 
tive of  the  inconvenience  of  this  method,  in  consideration  of 
the  relative  small  value  of  fowls,  the  inoculations  in  their  prac- 
tical applications  sometimes  cause  considerable  losses.  Fur- 
thermore, the  desired  protection  is  not  afforded  wdiich  is  very 
probably  due  to  the  uncertainty  of  the  applied  attenuation. 

Pasteur's  vaccine  produces  local  necrosis  of  the  muscles  and  serous 
inflanmiation  of  the  connective  tissue  when  injected  under  the  skin  of 
the  breast  of  chickens.  The  corresponding  part  of  the  breast  muscle 
separates  from  the  living  tissue  towards  thii  end  of  the  second  week, 
whereupon  the  se(iuestrum  is  reabsorbed  in  3  to  4  weeks,  or  is  cast  off 
tln-ough  a  fistula  which  may  have  formed.  Kitt  found  by  repeating 
Pasteur's  experiments  with  the  two  original  vaccines  that  both  produced 
such  local  affection  in  chickens  and  ducks,  and  in  the  majority  of  these 
birds  produced  an  effective  imnmnization.  On  the  otlier  hand,  pigeons, 
rab])its  and  small  l)irds  were  killed  by  the  inoculation. 

Attempts  to  prepare  suitable  vaccines  from  cultures  through 
attenuation  at  higlier  temperatures  (Salmon,  Jess)  and  through  the 
addition  of  chemicals  (Jess)  were  unsuccessful. 

Lignieres  recommends  his  polyvalent  vaccine  (see  page  84)  against 
chicken  cholera,  and  in  this  disease  the  best  results  are  supposed  to 
have  been  obtained.     The  dose  consists  of  %  cc.   (subcutaneously). 

II.  Immunization  with  immune  serum.  Kitt  (1892)  es- 
tablished by  experiments  that  the  l)lood  of  chickens  immunized 
against  cholera  has  an  immunizing  effect  upon  healthy  chickens, 
and  further  that  the  white  and  yolk  of  eggs  of  immune  chickens 
(5  to  10  cc.)  possesses  a  similar  eifect.  Later  Kitt  &  Mayr 
(1897)  prepared  a  serum  by  means  of  intravenous  injections 
of  virulent  cultures  in  horses  of  which  2  to  20  cc.  produced  pas- 
sive immunity  in  rabbits  and  i/4  to  i/>  cc.  in  mice,  nevertheless 
it  w^as  inetfeetive  in  chickens.  Still  later  Kitt  (1902-3)  produced 
an  active  immunity  in  rabbits  by  injecting  them  subcutaneously 
first  with  immune  serum  from  chickens  or  horses  (1  to  10  cc.) 
and  following  this  with  the  injection  of  virulent  cultures. 
Rabbits  highly  immunized  in  this  manner  produce  a  serum  of 
wdiich  Vii  to  3  cc.  protect  rabbits  and  mice  against  a  virulent 
infection,  and  in  some  cases  chickens  and  pigeons  were  also 
immunized  with  it.  Finally  Kitt  obtained  a  serum  from  horses 
by  subcutaneous  injection  of  virulent  cultures,  of  which  2 
to  5  cc.  conveyed  effective  protection  to  rabbits,  geese,  ducks, 
chickens  and  sometimes  also  to  pigeons  against  a  fatal  cutaneous 
or  subcutaneous  infection.  The  immunity  develops  not  later 
than  24  hours,  and  is  also  effective  against  intestinal  infection. 

The  serum  inoculations  naturally  produce  a  passive  im- 
munity lasting  only  from  1  to  2  weeks,  and  therefore  their 


96  Fowl  Cholera. 

application  is  indicated  only  in  flocks  already  infected  or  in 
those  wliicli  are  threatened  by  infection.  (Experiments  to 
change  immunity  through  subsequent  inoculation  of  virulent 
material  into  an  active  form  have  thus  far  been  unsuccessful.) 

Through  a  procedure  similar  to  that  of  Kitt  &  Mayr,  Schreiber 
succeeded  in  preparing  a  blood  serum  of  which  .5  cc.  protected  a  pigeon 
against  a  virus  which  was  fatal  in  24  hours.  The  dose  of  this  serum 
is  for  geese  or  ducks  1  cc,  for  smaller  birds  .5  cc.  Hartel  obtained  a 
serum  by  treating  an  ass  with  living  bouillon  cultures  (intravenous) 
of  which  .5  cc.  protected  a  pigeon  against  a  dose  of  virus  of  which 
1-10,000  part  was  fatal. 

Jess  &  Piorkowski  inject  fresh  horse  serum  containing  alexin  under 
the  skin  of  fowl  before  the  use  of  the  immune  serum  in  order  that  the 
antibodies  contained  in  the  horse  serum  may  find  a  sufficient  quantity 
of  alexins  in  the  tissue  fluids.  The  single  dose  is  .5  to  4  cc.  of  inunune 
serum,  depending  on  the  size  of  the  bird,  and  1  to  8  cc.  of  normal  serum. 
The  mixture  is  supposed  to  effect  also  a  curative  action  when  applied 
not  later  than  6  hours  after  the  infection  has  taken  place.  Hosier  found 
the  mixture  also  more  effective  in  mice  than  the  immune  serum  alone.  • 
The  experiments  made  in  Prussia  are,  however,  contradictory  (Rae- 
biger). 

Klett  &  Braun  immunize  horses  with  4-day  old  bouillon  cultures 
of  the  fowl  cholera  bacteria  which  have  attained  the  highest  degree  of 
virulence  by  passage  through  the  bodies  of  sparrows.  The  treatment 
conunences  with  a  dose  of  .25  cc.  of  culture  subcutaneously  and  intra- 
venously, which  quantity  of  culture  is  gradually  increased  to  20  cc.  and 
is  later  injected  directly  into  the  circulation.  Horses  thus  prepared 
produce  an  innnune  serum  of  which  0.0015  to  0.005  cc.  will  protect 
gray  mice  for  a  period  of  aliout  3  weeks  against  the  fatal  action  of  a 
loopful  of  a  4-day  old  bouillon  culture.  The  results  obtained  in  practice 
met  tlie  expectations  based  on  the  laboratory  experiments,  and  the  sera 
sometimes  appear  to  have  a  curative  action  in  animals  already  affected. 

In  consideration  of  the  close  etiological  relation  of  swine  plague 
and  chicken  cholera  Schreiber  employed  for  the  inoculation  of  fowl  a 
serum  (septizidin)  which  affords  protection  against  the  former  disease, 
and  some  other  authors  (Hartenstein,  Graffunder,  Schmidt  and  others) 
also  obtained  with  it  satisfactory  results.  The  official  reports,  however, 
of  Prussia  and  Saxony  are  mostly  unfavorable.  Finally,  Lignieres' 
polyvalent  serum  may  also  come  into  consideration. 

The  ^'Hochst  Farliwerke"  prepare  a  polyvalent  serum  (Galloserin)  with 
which  Kovacs,  Sioke  &  Szabo  and  others  obtained  quite  satisfactory  results  in  ex- 
posed as  well  as  already  affected  birds.  Eaebiger  made  comparative  experiments  with 
the  various  vaccines  on  the  market  and  found  that  pigeons  inoculated  with  Hoehst 
serum  or  with  septizidin  withstood  the  infection  in  66%,  while  those  injected  with 
Gans'  (Frankfurter)  and  Piorkowski 's  (Berlin)  sera  died.  The  seruni  of  Klett- 
Braun  proved  effective  in  laT)oratory  experiments  and  also  once  in  practice.  Pel- 
fino  found  Lignieres'  vaccine  effective  in  rabbit  experiments. 

Technique  of  vaccination.  Pasteur  originally  inoculated  into  the  point  of 
the  wing,  later  the  inoculation  was  made  under  the  skin  of  the  breast  or  into  the 
breast  muscle.  According  to  the  suggestion  of  Jess  it  is  more  satisfactory  when 
made  under  the  skin  of  the  neck.  An  assistant  secures  the  bird  with  both  hands 
on  the  rump  while  the  operating  veterinarian  raises  a  fold  of  the  skin  of  the  neck 
with  his  left  hand.  The  dose  to  be  inoculated  is  indicated  specially  for  each 
preparation. 

III.  Immunization  with  Aggressins.  "Weil  employs,  according  to 
the  procedure  of  Bail,   a  pleural  exudate  produced  by  injections  of 


Immunization.  97 

fowl  cholera  bacteria  into  rabbits.  After  the  addition  of  .5%  c;ul)olic 
acid  this  is  heated  for  3  hours  at  44°  C.  Repeated  injections  of  small 
doses  (.5  to  3  ce.)  or  a  siuj^le  injection  of  5  cc.  protected  guinea  pigs 
and  rabbits  as  well  as  a  hcii  and  a  jngeon  against  a  subse(|nent  letJial 
infection.  Rabbits  higldy  inuuunized  with  sterile  exudate  produce  serum 
of  which  .5  cc.  protected  rabl)its  against  a  dose  of  the  culture  which  is 
fatal  in  20  hours.  According  to  the  aggressin  theory  (see  page  30) 
the  body  is  supposed  to  form  an  anti-aggressin  as  a  result  of  the  injec- 
tion of  aggressins  which  destroys  the  aggressiveness  of  the  bacteria 
and  their  unlimited  i)ower  of  multii)lication.  Hunteiniiller,  however, 
found  that  sinnlar  good  results  may  be  obtained  in  rabl)its  with  wash- 
ings of  cholera  cultures  heated  to  44""  C.  He  also  learned  that  the 
filtrate  of  exudates  was  ineffective,  and  he  therefore  concurs  in  his 
belief  with  AVassermann  and  Citron,  that  in  immunization  the  toxic 
body  substances  of  the  bacteria  are  the  effective  agents.  Bisanti's 
experiments  suggest  also  the  possibility  of  a  toxin  immunization.  This 
investigator  sewed  coUodiuni  sacs  filled  with  virulent  cultures  into  the 
abdominal  cavity  of  rabbits  and  thereby  protected  them  against  a 
cerebral  infection. 

Veterinary  Police.  Chicken  cholera  has  been  recently  in- 
cluded among-  the  diseases  requiring  compulsory  official  notifica- 
tion in  Germany,  Austria  and  Hungary.  Upon  the  appearance 
of  the  disease  the  infected  premises  or  in  case  of  a  greater  ex- 
tension, localities  and  even  entire  townships  are  quarantined 
against  traffic  in  fowls.  The  inland  and  foreign  traffic  in  fowls 
as  well  as  the  premises  of  dealers  are  subject  to  official  super- 
vision. 

Literature.  Eenault,  Eec,  1851,  321.— Hering,  Spez.  Path.,  1858,  355  (Lit.).— 
Perroneito,  A.  f.  Tk.,  1879,  V,  22. — Toussaint,  Rec,  1879,  946.— Pasteur,  C.  R., 
1880,  XC.  u.  XCI.— Ziirn,  D.  Gefliigelkrankh.,  Weimer  1882.— Kitt.  D.  Z.  f.  Tm., 
1888,  XIII,  1;  Hb.  d.  p.  M.,  1903,  II,  543  u.  1904,  IV,  969  (Lit.  on  etiology 
and  immunization).— Lignieres,  Bull.,  1900,  332,  \i.  1902,  444.— Klett  &  Braim,  D.  t. 
W.,  1904,  545.— W>il,  A.  f.  Hyg.,  1905,  LTI,  412;  1908,  LVX,  85.— Ostertag  & 
Ackermann,  Z.  f.  Infkr.,  1906,  I,"  431.— Jungklaus,  Diss.  Leipzig  1906. 

Other  Diseases  of  Fowl  of  a  Septicemic  Character.  Various  ob- 
servers have  described  in  the  course  of  the  last  decade  different  epi- 
zootic affection  in  fowl  in  addition  to  chicken  pest  which  simulate 
chicken  cholera  more  or  less.  In  some  of  these  their  identity  witli 
cliicken  cholera  was  established.  Others,  however,  were  sho\\Ti  to  be 
different,  while  the  nature  of  some  of  the  diseases  is  doubtful  even  at 
the  present  time.  On  account  of  their  relatively  slight  importance  and 
their  prevention  by  other  means  than  immunization  for  which  it  is 
essential  to  establish  the  causative  agent,  the  same  principles  mentioned 
for  chicken  cholera  are  also  applicable.  Therefore  these  diseases  will 
only  be  briefly  mentioned  here,  emphasis  being  placed  on  their  most 
important  differences  from  fowl  cholera. 

The  following  diseases  are  identical  with  chicken  cholera: 

Lisi's  chicken  septicemia  fCliii.  vet.,  1895.  176),  and  the  hemor- 
rhagic septicemia  of  ducks  and  chickens  described  by  Rabieaux  (Soc, 
bioL,  1900,  141). 

7 


98  Fowl  Cholera. 

Diseases    simulating    chicken    cholera: 

Infectious  enteritis  of  chickens;  observed  repeatedly  in  England 
and  Ireland  by  Klein.  The  causative  agent  (Bac.  gallinarum)  greatly 
resembles  the  bacillus  of  fowl  cholera.  However,  it  does  not  kill  pigeons 
and  only  exc<-ptionally  rabbits.  (Cbl.  f.  Bakt.,  1889,  V,  689;  1895, 
XVIII,  105.) 

Enzootic  pneumo-pericarditis  of  turkeys;  observed  by  M'Fadyean 

and  later  by  Jowett.  The  bacillus  also  resembles  that  of  chicken  cholera. 
However,  it  is  motile  and  non-pathogenic  for  chickens  as  well  as  for 
water  fowl.     (J.  of  Comp.  Path.,  1893,  VI,  334;  Ibid.,  1908,  XXI,  324.) 

Cholera  of  water  fowl;  observed  in  Germany  by  Willaeh.  The 
bacillus  is  distinguished  from  that  of  fowl  cholera  by  its  motility,  is 
only  slightly  pathogenic  for  hens,  and  non-pathogenic  for  pigeons.  ((^bU 
f.  Bakt.,  1896,  XX,  187.) 

Disease  of  swans;  observed  in  the  Zoological  Garden  of  Antwerp 
by  Tretrop.  The  bacterium  develops  only  slightly  on  potato,  and  causes 
in  swans  a  caseation  of  the  Ivmph  glands ;  chickens  are  not  susceptible. 
(A.  P.,  1900,  XIV,  224.) 

Diseases  apparently  different  from  fowl  cholera: 

Cholera  of  ducks;  observed  in  the  Zoological  Garden  of  Paris 
by  Cornil  &  Toupet.  The  bacillus  stains  well  by  Gram's  method  and 
grows  well  on  potato ;  chickens,  pigeons  and  guinea  pigs  are  not  sus- 
ceptible, rabbits  to  only  a  slight  extent.     (C.  R.,  1888,  CVIII,  1747.) 

Epizootic  dysentery  of  chickens  and  turkeys;  described  by  Lueet. 
The  course  of  the  disease  is  from  9  to  13  days.  The  bacillus  thrives 
well  on  potato  and  kills  guinea  pigs  by  intravenous  inoculation.  (A.  P., 
1891,  V,  312.) 

Disease  of  ring-dove;  observed  in  France  by  Leclainche,  and  is 
characterized  by  its  rapid  course,  somnolence  and  diarrhea.  The  bacillus 
(Bac.  cholerge  columbarum)  thrives  on  potato;  chickens  are  not  at  all 
susceptible,  while  other  fowl  show  only  a  slight  susceptibility.  (A.  P., 
1894,  VIII,  490.) 

Disease  of  pigeons;  observed  in  New  Jersey  by  Moore.  Cerebral 
symptoms  predominate  in  this  disease.  On  autopsy  meningitis  is  found 
to  be  present,  while  intestinal  symptoms  are  absent.  The  bacillus  re- 
sembles Bac.  suipestifer;  it  grows  on  potato.  (Bur.  Anim.  Indus.,  Bull. 
No.  8,  1895,  71.) 

Infectious  enteritis  of  pheasants;  observed  in  the  Zoological  Gar- 
den of  Milan  by  Fiorentini.  The  affected  animals  are  not  somnolent. 
Autopsy  does  not  reveal  small  hemorrhages.  The  bacillus  is  not  motile ; 
it  forms  on  potato  a  honey-like  growth  and  produces  indol  in  peptone 
bouillon.  Chickens,  guinea  pigs  and  rabbits  are  not  susceptible.  (Soc. 
ital.  di.  sc.  nat.,  1896,  89.) 

Septicemia  of  ducks ;  observed  in  Italy  by  Lisi.  The  affected  birds 
show  purulent  conjunctivitis  and  keratitis.  The  bacillus  liquefies  gelatin 
gradually  and  forms  a  brownish  growth  on  potato;  chickens  are  not 
susceptible  to  artificial  infection.     (II  Med.  zooiatrio,  1890,  415.) 


Differentiated    Diseases.  99 

Hemorrhagic  septicemia  of  swans;  observed  in  the  Zoological  Gar- 
den of  ^lilan  by  Fioreiitini  in  pheasants  and  Egyptian  geese.  The 
baeillns  is  motile,  bouillon  is  made  eloiidy  antl  of  a  yellowish  discolora- 
tion, grows  on  potato  in  tlu'  form  of  ehocolatc-l)rown  colonies;  the  cul- 
tures liberate  a  fetid  odor.     (Cbl.  f.  liakt.,  18U6,  XIX,  <J;i2.) 

Exudative  septicemia  of  geese;  diagnosed  first  in  Mecklenburg 
by  Rienier,  later  in  Stralsund  by  Frosch  &  Birnbauni  (the  disease 
described  by  Bugge  as  infectious  infianuuation  of  the  air-sacs  of  geese 
is  probably  identical).  Characteristic  lesions;  pronounced  sero-fibrinous 
l)ericarditis  and  fibrinous  peri-hepatitis.  The  slender  rod-shaped  bacil- 
lus (Hac.  septicttmia^  anserum  exsudativa^)  which  resend)les  Pfeitfcr's 
intluenza  bacillus  forms  threads  in  cultures,  is  not  motile,  does  not  form 
spores,  decolorizes  by  Gram,  and  is  strongly  pathogenic  for  geese  and 
less  for  ducks.     (Lit.  Cbl.  f.  Bakt.,  1909,  LII,  433.) 

Epizootic  pneumo-enteritis  of  turkeys ;  described  by  Dodd,  is  char- 
acterized l)y  swelling  of  the  sub-orl)ital  region,  emaciation  and  diarrhea 
or  hepatization  and  small  necrotic  nodules  in  the  lungs,  as  well  as 
fibrinous  exudates  in  the  pleural  cavitv.  The  causative  agent  resembles 
the  ovoid  cholera  bacillus.     (J.  of  Coinp.  Path.,  1905,  XVIII,  239.) 

Infectious  leukemia  of  chickens;  studied  in  the  United  States  by 
Moore;  its  course  extends  from  1  to  3  weeks  with  symptoms  of  a  severe 
leukemia.  The  causative  agent  (Bac.  sanguinarium)  ;  forms  yellowish- 
white  colonies  on  potato.     (Bur.  Anim.  Indus.  Rpt.  1895-96,  185). 

Chicken  plague;  observed  by  Mazza  in  northern  Italy.  In  the 
course  of  the  disease  caseous  foci  develop  in  the  lungs.  The  bacillus 
is  motile,  develops  gases  in  bouillon  containing  sugar,  grows  on  potato 
in  the  form  of  colorless,  lustrous  deposits;  rabbits  are  slightlv  sus- 
ceptible.    (Cbl.  f.  Bakt.,  1899,  XXVI,  181.) 

Disease  of  canary  birds;  described  by  Rieck.  A  soot-like  dis- 
coloration of  the  skin  develops,  while  the  liver  contains  punctiform 
necrotic  foci.  The  bacillus  is  motile  and  grows  on  potato  in  the  form 
of  yellowish-gray  colonies.     (D.  Z.  f.  Tm.,  1889,  XV,  69.) 

Cholera  of  canary  birds;  studied  in  Budapest  by  F.  Kern.  The 
bacillus  does  not  take  bipolar  staining,  is  not  motile,  develops  fetid 
gases  in  agar  containing  sugar,  and  forms  yellowish  colonies  on  potato, 
the  medium  showing  a  l)luish  discoloration.  Chickens  and  pigeons 
are  not  susceptible.^  (D.  Z.  f.  Tm.,  1896.  XXIT,  171;  according  to 
Noeard  Ziirn's  canary  plague  is  supposed  to  be  identical  with  this 
disease.) 

Infectious  malady  of  canaries;  described  by  Pfaff  as  a  different 
disease  from  the  above.  The  l)acillus  is  somewhat  larger  than  that  of 
Kern,  forms  fine  flakes  in  bouillon,  does  not  grow  on  potato,  is  harmless 
for  chickens,  and  pathogenic  for  pigeons.  Constant  lesions ;  small  ne- 
crotic foci  in  the  liver  and  spleen  (Cbl.  f.  Bakt.,  1905.  XXXVIIT,  275)  ; 
a  similar  disease  was  described  by  Wasielewskv  &  Hoffmann  (A.  f.  Hvg., 
1903,  XLVII,  44)  and  recently 'by  Zwick  (Z.  f.  Infkr.,  1908,  IV.  33.) 

Septicemia  of  canary  birds;  described  by  Freese  as  a  very  severe 
disease  similar  to  the  cholera  of  canaries,  but  does  not  liquefy  gelatin 


100  Fowl  Cholera. 

and  is  Gram  positive ;  milk  is  coagulated  and  it  does  not  ferment 
dextrose.  There  is  no  necrosis  of  the  liver  or  spleen.  (D.  t.  W., 
1907,  501.) 

Infectious  necrosis  of  canary  birds ;  described  by  Miessner  &  Schern 
as  a  very  infectious  disease  which  is  characterized  principally  by  ne- 
crotic foci  in  the  spleen  and  liver,  and  is  also  frequently  associated  with 
diphtheria  of  the  buccal  mucous  membrane.  The  causative  agent  is  a 
short  stubby,  Gram  negative,  non-motile  organism  (Bac.  canariensis 
necrophorus).     (A.  f.  Tk.,  1908,  XXXIV,  133.) 

T3rphoid  of  canary  birds.  As  Joest  had  done  before  him,  Zsupan 
mentions  under  this  name  a  disease  of  canary  birds  caused  by  bacteria 
of  the  enteritis  group.  It  runs  a  rapid  course  with  symptoms  of  marked 
debility,  difficult  respiration  and  diarrhea.  The  constant  lesions  are 
acute  gastro-intestinal  catarrh,  and  besides,  from  case  to  case  acute 
spleen-tumor,  fibrinous  inflammation  of  the  serous  membranes,  cloudy 
swelling  of  the  liver  and  kidneys.  The  causative  agent  (Bac.  typhi 
canariensis)  is  very  similar  to  Eberth's  typhoid  bacillus,  and  is  patho- 
genic in  general  for  small  birds,  as  well  as  for  rabbits,  guinea  pigs, 
rats  and  mice.     (Dresdn.  Ber.  pro  1906;  KozL,  1909,  VIII,  149.) 

Disease  of  guinea  keets  (Mykosis  intestinalis  phasianidum)  ;  ob- 
served in  Germany  by  Enders ;  affects  exclusively  species  of  chickens. 
The  causative  agent  resembles  that  of  fowl  cholera,  is  pathogenic  for 
pigeons  and  water  fowl,  and  grows  W'cll  on  potato.  Autopsy  shows 
hemorrhagic  enteritis  and  osteomyelitis.  Maggiora  &  Valenti  consider 
the  disease  identical  w^ith  chicken  pest,  and  the  described  bacillus  is 
supposed  to  be  a  frequent  inhabitant  of  the  healthy  intestines  of  fowl 
(D.  t.  W.,  1902,  339). 

Septicemia  of  chickens  caused  by  coli  bacteria;  according  to 
Claussen  it  is  supposed  to  develop  spontaneously  in  chickens  which 
are  exposed  in  long  railroad  transportations  to  thirst,  hunger  and  cold 
as  a  result  of  which  the  normal  coli  organism  becomes  virulent.  The 
symptoms  and  post  mortem  lesions  resemble  those  of  fowl  cholera,  but 
the  blood  contains  bacteria  of  the  coli  bacillus  type  (Z.  f.  Infkr.,  1907. 
Ill,  69). 

White  diarrhea  of  chicks;  according  to  Rettger  this  disease  affects 
chicks  in  the  first  three  weeks  of  life,  and  is  caused  by  a  bacterium  of 
the  coli-typhus  group  which  is  present  in  the  blood,  internal  organs 
and  also  in  the  yolk  (J.  of  Med.  Research,  1909,  XXI,  115). 

Salmonellosis  of  chickens;  described  by  Lignieres  &  Zabala  as  an 
infectious  and  mostly  fatal  disease  which  in  its  course  resembles  fowl 
cholera  (spleen  always  swollen).  The  bacillus  resembles  the  Bac. 
suipestifer,  but  is  non-motile.  Besides  chickens,  pigeons  and  rabbits 
are  also  susceptible  (Bull.,  1905,  XXXII,  453). 

Mycosis  of  parrots  (Psittacosis)  ;  a  disease  of  parrots  imported 
to  Europe  from  Africa  and  America,  characterized  by  dullness,  diarrhea 
and  later  by  marked  debility.  In  its  course  small  grayish-white  foci 
develop  in  the  internal  organs,  especially  in  the  liver.  The  causative 
agent  is,  according  to  Ajello  &  Parascandolo,  a  specific  bacillus;  ac- 
cording to  Rho,  a  paracolon  bacillus  which  produces  toxins  in  cultures. 


Diflferentiated   Diseases.  101 

With  this  disease  the  cause  of  some  forms  of  pneumonia  in  man  is 
associated,  hut  according  to  the  investigations  of  Liclitenstein  this  sup- 
position is  not  well  founded  (0.  M.,  1902,  385;  Cbl.  f.  liakt.,  18!i9, 
XXV,  651). 

Grouse  disease;  described  hy  Klein  as  a  very  fatal  disease  of 
Scottish  grouse.  The  principal  symptoms  are  (|uick  tiring  on  tlying, 
hoarseness,  cyanosis  of  the  conjunctiva,  emaciation.  On  autopsy  ne- 
crotic foci  in  the  liver  and  small  blood  extravasations  are  o})served. 
The  bacillus  is  motile.  Gram  negative,  thrives  on  potato,  (luickly 
coagulates  milk,  and  produces  indol  (Cbl.  f.  Bakt.,  1899,  VI,  36;  1890, 
VII,   81). 

Cholera-like  gastro-enteritis  of  fowl  ( Vibrionen-cholera,  gastro- 
enteritis cholerica  avium).  Gamaleia,  who  observed  the  disease  in 
Odessa,  described  as  the  cause  a  short,  curved  bacillus  (Vibrio 
IMetschnikovi),  which  morphologically  and  culturally  closely  resembles 
the  comma  bacillus  of  Asiatic  cholera.  Affected  fowl  die  with  symptoms 
of  somnolence  and  diarrhea  within  2-3  days.  The  bacilli  are  present 
in  the  lumen  of  the  inflamed  intestine,  and  produce  the  symptoms  by 
the  eliminated  toxins   (A.  P.,  1888,  II,  482). 

Apoplectic  septicemia  of  chickens;  this  very  disastrous  American 
disease  runs  its  course  in  from  12  to  24  hours  with  paralytic  symptoms 
and  is  caused,  according  to  Norgaard  &  Mohler,  by  a  very  virulent 
streptococcus  which  in  addition  is  pathogenic  for  chickens  and  also  for 
rabbits,  mice,  ducks,  pigeons  and  dogs.  It  is  harmless  for  guinea  pigs 
and  sheep   (Bur.  Anim.  Industry,  Bull.,  1902,  No.  36). 

Sleeping  sickness  of  chickens;  was  found  ])y  Dammann  &  Mane- 
gold  in  the  vicinity  of  Hannover,  later  by  Greve  in  Oldenburg.  The 
most  striking  symptom  is  the  more  or  less  pronounced  somnolence. 
Further,  reddening  and  swelling  of  the  conjunctiva,  if  the  course  is 
prolonged,  also  paleness  of  the  comb  and  wattles,  diarrhea  and  emacia- 
tion. In  the  heart  blood  the  Gram-positive  encapsulated  streptococci 
are  found  in  great  numbers  (Str,  capsulatus  gallinarum)  thriving  best 
on  coagulated  blood  serum  and  in  milk.  It  is  also  pathogenic  for 
pigeons,  rabbits,  mice  and  lambs  (D.  t.  W.,  1905,  577;  1908,  213). 


Septicemic  and  Pyemic  Affections  of  Rabbits.  Among  rabbits 
mostly  in  laboratories,  but  not  infre(iuently  also  in  valuable  rabbit 
breeding  establishments  septicemic  affections  occur,  some  of  which  will 
be  described  briefly. 

Rabbit  Septicemia.  Davaine,  later  Koch  &  Gaffky  produced  this 
disease  in  rabbits  by  subcutaneous  injections  of  putrid  fluids,  unclean 
river  water  and  putrid  pickling  fluid.  After  such  injections  the  animals 
die  in  from  16  to  20  hours  with  rapid  falling  of  the  body  temperature, 
diarrhea  and  convulsions.  On  autopsy  the  spleen  and  lymph  glands 
are  swollen,  the  lungs  hyperemic,  the  intestinal  mucous  membrane  in- 
flamed, serous  membranes  sprinkled  with  petechiae.  The  blood  con- 
tains small  bacteria  (Bac.  cuniculisepticus  s.  cuniculicida),  which  in 
their  form  and  cultural  characteristics  are  practically  identical  with 
the  fowl  cholera  bacterium  and  are  very  probably  identical  organisms 
(Kitt).  Cultures  kill  fowls  with  manifestations  of  septicemia.  On 
the  other  hand,  rabbits  infected  with  the  virus  of  fowl  cholera  also 


102  Rabbit   Septicemia,      Etc. 

die  within  a  short  time.  Therefore  there  is  a  possibility  that  the 
appearance  of  fowl  cholera  may  be  associated  with  the  cause  of  rabbit 
septicemia  and  vice  versa.  Selter  observed  the  disease  in  a  spontaneous 
enzo-otic  form,  and  found  swine  plague  serum  effective  in  the  treat- 
ment. (Koch  &  Gaffky,  Mitt.  d.  G.-A.,  1881,  I.-Lignieres,  Bull.,  1900, 
356   [Lit.].— Selter,  Cbl.  f.  Bakt.,  1907,  XLI,  432.) 

Pleuro-pneumonia  of  Rabbits.  Various  authors  describe  the  dis- 
ease under  different  names,  thus  Beck,  and  recently  Kurita  as  "pleuro- 
pneumonia," Kraus  as  "influenza-like  rabbit  plague,"  Volk  as  "rabbit 
plague,"  Siidmersen  as  "infectious  rabbit  pneumonia,"  Eberth  & 
Mandry  as  "spontaneous  rabbit  septicemia,"  all  these  are,  however, 
probably  identical  or  closely  related.  In  all  cases  there  was  a  fibrinous 
inflammation  of  the  pleura,  sometimes  also  of  the  pericardium,  fre- 
quently associated  with  a  catarrhal  pneumonia.  The  symptoms  con- 
sisted in  a  purulent  nasal  discharge,  difficult  respiration,  emaciation 
and  rapid  course.  As  the  causative  agent  a  fine.  Gram-negative,  spore- 
less  aerobic  bacillus  was  described  which  resembles  the  influenza  bacillus 
of  man.  They  are  distinguished  from  each  other  by  unimportant  char- 
acteristics. (Lit.  see  Z.  f.  Tm.,  1906,  X,  429;  also  Cbl.  f.  Bakt.,  1906, 
XLIX,  508.) 

Rabbit  Distemper.  Described  by  Lucet  as  "septic  disease  of 
rabbits. ' ' 

It  manifests  itself  in  a  phlegmonous  swelling  of  the  tracheal  and 
laryngeal  regions,  nasal  discharge,  difficult  respiration  and  emaciation. 
The  autopsy  shows,  in  addition  to  a  purulent  inflammation  of  the 
subcutis  at  the  places  mentioned  and  regional  inflammatory  edema, 
pronounced  acute  swelling  of  the  spleen,  enteritis  and  serous  exudate 
in  the  thoracic  and  abdominal  cavities.  A  small  bacillus  (Bac.  septicus 
cuniculi)  is  indicated  as  the  causative  agent.     (A.  P.,  1892,  VI,  558.) 

Pyemia  of  rabbits ;  observed  by  Koppanyi  in  Belgian  hares  usually 
as  a  severe  affection.  In  acute  cases  purulent  fibrinous  pleuritis  and 
pericarditis  are  present,  while  in  chronic  cases  subcutaneous  cold 
abscesses  develop  which  may  reach  the  size  of  a  man's  fist.  After 
rupturing,  which  sometimes  only  occurs  after  6  to  8  months,  recovery 
follows  not  infrequently.  The  disease  is  caused  by  a  polymorphous 
capsulated  bacillus  (Pyobacillus  capsulatus  cuniculi).  (Z.  f.Tm.,  1906, 
X,  429.) 

Streptothrichosis  of  rabbits  is  characterized  by  a  progressive 
necrosis  of  the  skin  which  extends  to  the  muscles  and  tendons.  Thrombi 
develop  in  the  blood  vessels  and  as  a  result  emboli  occur  in  the  inter- 
nal organs,  especially  the  lungs.  The  streptothrix  cuniculi  Avhich  was 
demonstrated  by  Schmorl  as  the  causative  agent  of  the  disease,  is 
identical  with  Bang's  bacillus  necrophorus.  Basset  produced  an  effec- 
tive immune  serum  by  treating  a  horse  with  pure  cultures.  (D.  Z.  f. 
Tm.,  1891,  XVII,  375;  Bull.,  1908,  345.) 

Myxomatous  affection  of  rabbits ;  observed  by  Sanarelli  in  ]\Ionte- 
video  and  by  Splendore  in  Sao  Paolo.  At  the  onset  a  purulent  blepharo- 
conjunctivitis develops  and  is  rapidly  followed  by  a  large  swelling  of 
the  head,  also  in  the  vicinity  of  the  rectum  and  the  opening  of  the 
urethra  and  genital  organs.  Post  mortem  examination  reveals  tumors 
in  the  subcutis  which  have  a  gelatinous  appearance.     Further,  there 


HeiiKiniiajiic   Scpf  ict'iniii   nl'   Cat  lie.  ]{)',] 

is  hypertrophy  of  the  lyinpli  ^WmikIs.  orchitis  jiiid  spleen  tninor.  'I'lie 
disease  is  vei\v  easily  ti-aiisniitted  aiMilieiallv  and  appears  to  be  caused 
by  a  filterable  virus."  (Cbl.  f.  Bakt.,  18'J8,  XXUi,  8G5 ;  11)08,  XLVlil, 
300.) 

(b)     Hemorrhagic  Septicemia  of  Cattle.     Septicaemia  hemor- 
rhagica bovum. 

{BoU'u^per's   Wild-  uud  Rinderseiiche,  HemorrliagiscliP  Septi- 

Txiimip  der  Hinder  [German];  Pasfe}(reJlnsis  hovmn, 

rasteurellose  on  Scpficemie  hemorrhagique 

du  boeiif  [French].) 

Homorrlia.^'ic  septioomia  is  mostly  an  acute,  less  frequently 
a  subacute,  infectious  disease.  In  its  course  the  febrile  symp- 
toms are  usually  accompanied  by  manifestations  of  an  aeute 
gastro-enteritis,  inflammatory  edema  of  the  skin  or  interal- 
veolar  connective  tissue,  and  is  frequently  associated  with 
necrotic  pneumonia.    The  causative  agent  is  Bac.  bovisepticus. 

History.  Bollinger  described  in  1878  a  very  fatal  disease,  which 
was  previously  unknown,  occurring  in  the  vicinity  of  ]\Iunich  among  the 
deer  and  wild  boars.  Later  it  was  observed  in  cattle,  and  in  some 
instances  among  horses  and  domestic  hogs.  The  infectious  character  of 
the  disease  has  been  established  by  Bollinger  and  later  by  Franck 
(1881)  as  well  as  by  Friedberger  (1881).  The  causative  agent,  how- 
ever, was  discovered  by  Kitt  (1885)  and  somewhat  later  studied  by 
Hueppe  (1886).  Recently  especially  Jensen  (1889)  and  Lignieres 
(1898  and  1900)  investigated  the  etiology  of  the  disease. 

Occurrence.  The  disease  occurs  ever^^vhere  either  sporadi- 
cally pr  enzootically,  especially  during'  the  summer.  Some- 
times it  originally  occurs  in  deer  and  wild  hogs,  spreading  later 
to  domestic  cattle,  and  from  the  latter  hogs  may  often  become 
affected. 

Tn  the  beffinning  of  the  eiirhties  of  the  last  eentiiry  the  disease  was  repeatedly  ob- 
served in  northern  Bavaria,  but  it  has  been  since  found  in  other  parts  of  Gernianv 
as  well  as  in  different  European  countries.  The  losses  were  sonietinies  consider- 
able. In  the  year  1S7S,  l.l.T  deer  and  2.34  wild  hogs  died  in  the  Eeservations  in  the 
vkinitv  of  Munich;  in  1S87  in  the  District  of  Bindlach  more  than  100,  and  in 
one  district  of  Prussia  the  annual  loss  was  more  than  100  cattle.  In  recent  times 
it  is  ])rincipallv  observed  in  Prussia  (Oovernment  districts  Posen  and  Broniberg) 
as  well  as  in  Bavaria.  In  190.3,  57  cases  were  reported  from  Posen  an<l  30  from 
Hannover. 

Tn  Austria  the  disease  occurs  in  Bohemia,  Moravia  and  Silesia.  Tn  Moravia 
1.5.5  cattle  and  29  hogs  were  affected  in  1900,  in  44  townships,  of  which  number  1.5 
oattle  and  1.5  hogs  died.  One  hundred  and  one  cattle  and  14  hogs  were  slaughtered 
in  emergency  (Taufer).  Tn  Hungary  the  disease  was  first  observed  in  1900  in 
the  County  of  Oonior,  in  one  township  where  17  cattle  were  affected.  Dnrin<T  the 
period  from  1901  to  1902,  12  yearlings  and  2  cows  died  in  TTansag;  in  1004,  14  out  of 
a  herd  of  49  yearlings  in  the  vicinity  of  T\apuvar  became  affected.  From  time  to 
time  sporadic  cases  occur  in  fattening  establislinients. 

Tn  France  the  disease  was  observed  by  Leclainche  and  in  Swit/cerland  by 
Guillebeau    and    Hess. 

The  disease  also  exists  in  "North  America  (the  broncho-pneumonia  of  cattle 
described  by  Xocard  is  a  form  of  this  disease),  in  Tndo-China,  in  the  Malavean 
Peninsula,  in  the  Philippines  and  in  Java. 


104  Hemorrhagic   Septicemia  of  Cattle. 

There  is  sometimes  oliserved  a  septic  pleuro-pneiimonia  in  calves  which  occurs 
simultaueously  with  hemorrhagic  septicemia  in  adult  cattle.  This  disease  is  either 
closely  related  to  or  identical  with  hemorrhagic  septicemia  of  cattle  (See  page 
111). 

Etiology.  The  cause  of  the  disease  is  the  bacillus  (bipolaris) 
bovisepticus  which  is  a  variety  of  the  bacillus  of  hemorrhagic 
septicemia.  In  its  principal  characteristics  it  conforms  to  the 
organisms  of  this  group  (see  page  79). 

Hueppe  succeeded  in  growing  it  in  spring  water  containing  a  large  amount  of 
organic  substances,  and  also  in  garden  soil.  It  grows  best  at  body  temperature, 
while  at  a  temperature  from  12-13°C.  it  no  longer  propagates.  A  1:5000  sublimate 
solution  kills  it  in  1  minute,  .3%  carbolic  acid  in  6  hours,  moist  heat  of  80°C.  in  10 
minutes  (Hueppe).  The  gastric  juice  appears  also  to  have  a  bactericidal  action 
(Taufer).    Dried  virulent  blood  loses  its  infectiveness  in  14  days  (Kitt). 

The  virulence  of  the  contagion  varies  in  the  different  enzo- 
otics within  wide  limits.  Deer  and  wild  hogs  are  very  suscep- 
tible, cattle  and  domestic  hogs  are  somewhat  less  predisposed. 
Under  natural  conditions  the  disease  affects  only  animals  of 
these  species,  but  sometimes  solipeds  and  also  goats  may  be- 
come affected.  Subcutaneous  inoculations  of  virulent  bouillon 
cultures  produce  a  severe  inflammatory  edema  which  is  fol- 
lowed by  suppuration  and  finally  by  recovery.  Calves,  how- 
ever, have  died  within  several  days  after  such  an  injection. 
Intravenous  injection  acts  more  energetically.  By  this  metliod 
calves  may  be  killed  with  10  cc,  and  cattle  with  100  cc.  of 
the  culture  in  1  to  3  days,  with  manifestations  of  acute  septi- 
cemia. After  a  less  severe  infection  the  animals  gradually 
emaciate  in  spite  of  a  good  appetite;  at  the  same  time  an  in- 
flammation develops  in  the  knee  and  hip  joints,  as  well  as  a 
broncho-pneumonia,  whereupon  the  animals  die  from  extreme 
exhaustion.  Autopsy  reveals  in  such  cases  as  a  rule  oiily 
foreign  bacteria  in  the  inflammatory  products  (Lignieres). 
Among  other  animals  rabbits  are  susceptil)le  to  artificial  infec- 
tion; horse,  giiinea  pig,  dog  and  pigeon  are  less  susceptible, 
while  domestic  fowls  are  not  susceptible  to  this  disease 
(Bollinger,  Kitt,  Taufer). 

The  natural  infection  results  in  most  cases  through  the 
digestive  tract ;  exceptionally  the  virus  may  enter  the  circula- 
tion through  injuries  in  the  buccal  mucous  memlirane  and  the 
skin.  The  latter  method  of  infection  is  possibly  transmitted 
through  flies  and  mosquitoes  (Franck,  Dammann  &  Oppermann 
recently  connected  an  outbreak  of  the  disease  in  the  Province 
of  Hannover  [1905]  with  swarms  of  insects  [Simulia  ornans] 
as  they  succeeded  in  finding  in  their  bodies  bipolar  bac- 
teria, although  these  were  only  slightly  virulent  for  rabbits). 
Bollinger  also  believes  a  pulmonary  infection  possible,  but  this 
mode  of  infection  has  been  proven  so  far  only  in  rabbits.  The 
viru?  may  also  l)e  disseminated  into  remote  localities  through 
the  meat  and  hides  of  affected  animals. 

The  sporadic  cases  as  well  as  the  first  attacks  of  an  enzo- 


Natural  Infection.  105 

otic  outbreak  occur  as  a  rule  tlirougli  iiircetioiis  of  tlie  soil, 
the  causative  a^eiit  in  some  localities  ac(iuiriii,n-  a  strong'  viru- 
lence through  unknown  influences,  or  they  nuiy  he  due  to  a 
(liniiuished  resistance  of  the  animals.  As  local  enzootics  fre- 
quently develop  first  among  deer  and  black  game  the  moist  soil 
of  the  forests  apjx'ars  to  be  especially  favorable  for  the  ])ropa- 
gation  of  the  bacteria  and  for  the  change  in  their  virulence 
mentioned  above.  The  warm  spring  weather  is  particularly 
favorable  for  the  development  of  the  bacteria.  During  this 
period  the  disease  occurs  most  frequently  among  cattle. 

The  virus  which  originates  from  the  soil  retains  its  in- 
creased virulence  for  a  certain  time  in  the  l)ody  of  the  animals, 
and  this  may  even  be  increased  further.  The  blood  is  highly 
infectious  in  the  latter  stages  of  the  disease,  and  during  this 
time  the  blood  as  well  as  other  body  fluids  and  excrements  may 
also  infect  other  animals,  and  in  this  way  the  enzootic  nuiy 
continue  to  spread  in  a  contagious  form.  (Bollinger  observed 
an  infection  in  a  steer  which  died  from  pneumonia  within  54 
hours  after  the  ingestion  of  1  gram  of  feces  from  a  calf  affected 
with  an  acute  form  of  the  disease.)  After  a  certain  time  tliese 
enzootics  which  do  not  as  a  rule  extend  over  large  territories, 
usually  subside  very  probably  as  the  result  of  an  attenuation 
of  the  virus  Avhicli  takes  place  in  the  meantime  (Carrouaeau 
observed  a  gradual  attenuation  of  the  virus  from  repeated  re- 
inoculations  of  cattle). 

The  cornstalk  disease  or  corn  fodder  disease  which  occurs  among 
cattle  in  America,  especially  in  the  middle  and  upper  Mississippi 
Valley,  is  also  supposed  to  he  caused  l)y  an  ovoid  bacterium,  and  to 
l)e  identical  Avith  hemorrhagic  septicemia  of  cattle.  This  disease  usually 
occurs  in  the  fall  and  early  Minter  after  the  animals  are  turned  into 
the  cornstalk  fields.  It  is  characterized  hy  a  very  rapid  course.  The 
autopsy  reveals  numerous  hemorrhages  in  the  internal  organs,  espe- 
cially in  the  serous  memhranes.  Recently,  however,  INIoore  showed 
that  the  disease  was  not  of  an  infectious  nature,  but  was  due  to  toxic 
substances  (according  to  IMayo,  potassium  nitrate)  which  are  sometimes 
pn^sent  in  large  quantities  in  the  stalks,  and  which  are  responsible 
for  the  intoxication.  As  a  matter  of  fact  the  disease  may  be  actually 
prevented  by  cutting  the  stalks  early  and  only  feeding  them  after  they 
have  been  carefully  cured  and  removed  from  the  field. 

Anatomical  changes.  The  autopsy  reveals  a  marked 
hyperemia  of  the  internal  organs  as  well  as  fresh  hemorrhages 
in  the  serous  and  mucous  membranes,  and  in  some  of  the 
organs,  es])('cially  the  lungs  and  muscles.  The  spleen  has  either 
a  normal  appearance  or  contains  circumscribed  bloody  areas; 
the  liver  and  kidneys  show  cloudy  swelling.  The  other  ana- 
tomical changes  vary  in  the  different  cases. 

In  the  edematous  or  exanthomatous  form  the  subcutaneous 
connective  tissue  of  the  head,  the  throat  region  and  the  neck, 
show  a  gelatinous  infiltration,  which  may  in  some  places  be 
studded  with  hemorrhages.    The  serous  infiltration  may  extend 


106 


HemoiThagic  Septicemia  of  Cattle. 


to  the  deeper  layers  of  the  muscles.  The  tongue  appears  more 
or  less  enlarged,  dark,  of  a  dirty  brownish-red  color,  and  of  a 
very  firm  consistency.  On  incising  this  organ  a  large  quantity 
of  a  light  yellow  serous  fluid  escapes,  while  in  parts  of  the 
infiltrated  tissue,  especially  under  the  mucous  membrane,  flat, 
diffused,  fresh  hemorrhages  are  present.  The  frenum  of  the 
tongue  and  the  surrounding  parts  as  well  as  the  submucous 


Fig.    27.     Pneumonia  in    hemorrhagic   septicemia  of  cattle.       Above,    brownish  lefl 
hepatization  with  hemorrhages ;    below,   grayish-red  hepatization   with 
commencing  necrosis.     Inter-lobular   connective    tissue    edem- 
atously  infiltrated,  lymph  spaces  dilated  in  parts. 


connective  tissue  of  the  pharynx  and  the  larynx  show  gelatinous 
infiltration  and  appear  as  flabby  masses.  The  mucous  mem- 
Jjrane  of  the  upper  air  passages  shows  a  catarrhal  swelling 
and  is  sometimes  covered  with  croupous  membranes.  The 
retropharyngeal  lymph  glands  and  those  of  the  neck  show  pro- 


nounced acute  swelling. 


Anatomical   (Mianaes.  107 

The  abdominal  cavity  sonietimes  contains  several  liters  of 
a  yellowish  or  reddish  seVous  fluid.  The  small  intestine  mani- 
fests lesions  of  a  i)rononnced  acute  hemorrhagic  inflamma- 
tion, which  while  also  present  in  the  large  intestine  are  less 
marked  there.  The  content  of  the  intestinal  canal  is  thin, 
fluid,  vellowish-gray,  or  from  an  admixture  of  l)lood,  dirty- 
reddisii  in  color,  the  spleen  is  normal,  or  at  most  in  parts, 
somewhat  swollen.     The  blood  is  also  normal  in  color. 

In  the  pectoral  form  the  thoracic  cavity  contains  serous 
or  sero-fibrinous  exudate  wiiich  is  sometimes  mixed  with  blood. 
The  pleura  is  inflamed  and  studded  with  small  hemorrhages, 
especiallv  the  visceral  layer  which  appears  to  be  covered  with 
fibrinous  membranes.  In  one  or  l)oth  lungs  smaller  or  larger 
connecting  parts  are  hepatized  and  friable.  The  cut  surfaces 
are  uniformlv  dark,  brownish  or  reddish  in  color,  finely  grai> 
ular,  and  contain,  in  less  acute  cases,  small,  dry,  caseous  areas. 
Sometimes  the  interlolmlar  connective  tissue  septa  appear 
thickened  and  vellowish-white  through  serous  infiltration,  so 
that  the  cut  surface  of  the  lung  has  a  mottled  marbled  appear- 
ance (the  appearance  in  such  cases  is  very  similar  to  the  lungs 
in  contagious  pleuro-pneumonia  [Fig.  27]).  The  parts  which 
are  not  hepatized  show  marked  hyperemia  and  edema.  The 
pericardium  mav  also  contain  an  exudate  mixed  with  fibrinous 
flakes.  The  connective  tissue  of  the  mediastinum  is  gelatinously 
infiltrated  and  studded  with  hemorrhages.  The  peril)ronchial 
Ivniph  glands  are  acutely  swollen;  usually  there  is  also  an 
acute  enteritis  present,  while  the  spleen  preserves  a  normal 
appearance  even  in  severe  cases. 

Nocard,  who  diagnosed  the  disease  in  cattle  imported  from  America 
to  Paris,  (broncho-pneumonia  of  American  cattle)  emphasizes  the  fact 
that  the  serous  fluid  in  the  lungs  differs  from  that  of  contagious  pleuro- 
pneumonia. It  is  not  so  markedly  yellow,  and  has  not  the  appearance 
of  lymph,  also  the  thickened  lymph  spaces  are  filled  with  a  whitish, 
tenaceous.  fibrinous  coagulum.  The  individual  lobules  appear  firmer  m 
the  center  and  more  markedly  hepatized  than  in  the  periphery,  which 
is  probably  on  account  of  the  fact  that  the  inflammatory  process 
extends   from  the  bronchi   and  not   from  the  interlobular  connective 

tissue. 

According  to  the  anatomical  findings  in  the  different  cases,  Bollinger 
distinguished  a  pectoral  and  an  exanthematous  form  of  the  disease, 
the  former  occurring  principally  in  wild  animals,  while  the  latter  is 
supposed  to  be  more  freciuent  in  cattle.  Later  a  so-called  intestinal 
form  was  also  described,  which,  however,  does  not  occur  independently, 
but  only  in  association  with  one  of  the  previously  mentioned  forms  (the 
designation  "exanthematous  form"  is  not  appropriate  as  there  is 
no  exanthema  present  but  only  an  inflammatory  edema). 

Symptoms.  The  time  of  incubation  of  the  disease  in  inocu- 
lation and  feeding  experiments  proved  to  be  from  6  to  24  hours. 
In  natural  infections  it  is  probably  somewhat  longer,  but  it 
hardlv  ever  extends  over  2  days. 


108  Hemorrhagic   Septicemia  of  Cattle. 

As  the  first  symptom  a  rapid  rise  in  the  body  temperature 
to  over  40° C.  is  observed.  This  is  accompanied  by  an  acceler- 
ated pulse,  dullness,  rough  coat  and  muscular  trembling.  At 
the  same  time  the  surface  of  the  body  feels  alternately  hot  and 
cold,  while  the  muzzle  is  cold  and  dry.  There  is  also  cessation 
of  appetite,  rumination  and  milk  secretion.  The  peristalsis 
of  the  rumen  and  intestines  is  retarded;  constipation  at  this 
stage  may  also  be  noticed.  Later,  symptoms  of  colic  appear 
with  much  straining  when  the  animals  pass  instead  of  the 
usual  dry,  dark  brown  feces,  a  mushy  and  finally  a  thin,  fetid 
fluid  which  is  not  infrequently  mixed  with  fibrin  and  mucous 
flakes  as  well  as  with  blood.  In  the  meantime  blood  frequently 
exudes  from  the  nose  and  sometimes  the  urine  may  also  con- 
tain blood.  In  addition  to  these  manifestations  one  or  the  other 
form  of  the  disease  finally  develops  during  the  further  course 
of  the  malady. 

According  to  Carrougeau  as  well  as  Reynolds,  Wilson  and  Brim- 
hall,  the  temperature  may  be  either  normal  or  subnormal,  and  ]\Iezey 
observed  in  a  fallow  deer  a  temperature  of  only  37°  C.  with  symptoms 
of  a  marked  apathy,  inappetence  and  bloody  excrements. 

Guerrieri  observed  the  disease  in  Sardinia  (Male  della  ferula)  in 
a  peracute  form  when  the  animals,  while  ruminating  or  feeding,  sud- 
denly ran  away  like  mad,  staggered,  collapsed,  and  died  with  escape  of 
blood  from  the  nose. 

In  the  edematous  (exanthematous)  form  the  head  and  neck 
swell,  especially  in  the  region  of  the  throat  and  dewlap,  as  a 
result  of  the  rapidly  increasing  inflammatory  edema  of  the 
subcutaneous  connective  tissue,  causing  a  deformity  of  these 
parts.  There  is  also  swelling  of  the  legs  and  in  rare  cases 
the  swelling  may  commence  at  one  of  the  extremities  and  spread 
from  there  to  the  neck  and  body  (Eatz).  In  such  cases  in- 
flammatory enlargement  of  the  different  joints  may  be  observed. 
Over  the  swollen  parts  of  the  body  the  skin  is  very  tense,  warm 
and  sensitive.  On  the  eyes  an  acute  conjunctivitis  develops, 
frequently  with  a  yellowish  coloration  of  this  membrane.  There 
is  profuse  lachrATiiation,  the  tears  running  down  the  face.  The 
buccal  mucous  membrane  is  bright  red,  warm,  dry  and  swollen. 
Deglutition  is  difficult  or  impossible,  so  that  the  saliva  accumu- 
lates in  the  mouth,  and  dribbles  from  the  corners  of  the  mouth 
in  long,  tenacious  strings.  The  tongue  swells  to  such  an  extent 
that  it  entirely  fills  the  buccal  cavity,  and  a  part  of  it  may  even 
protrude  between  the  teeth.  It  is  bluish-red,  or  dirty  reddish- 
brown  and  shows  on  its  lower  surface  impressions  of"  the  teeth, 
while  at  both  sides  of  the  frenum  the  mucous  membrane  of 
the  floor  of  the  mouth  is  bunched  up  in  thick,  flabby,  gelatinous 
rolls. 

Respiration  is  very  difficult  and  frequently  stertorous.  All 
the  mucous  membranes  are  cyanotic,  often  studded  with  hemor- 
rhages,  and  finally  the   animals   die   of  asphyxiation,   or  the 


Symptoms.     Course.     Diagnosis.  109 

asthenia,  which  is  caused  by  the  marked  enteritis,  produces 
death. 

Taufer  observed  the  following  additional  symptoms  during  an 
outbreak  of  the  disejuse :  A  very  extensive  infiltration  of  the  masticatory 
and  ehoek  muscles  as  well  as  of  the  back  of  the  nose,  the  lii)s  and  llu; 
nasal  mucous  membrane  (hippopotamus  head),  cloudiness  of  the  cornea 
(in  two  cases  also  ])anopiithalmia).  In  one  case  he  obsi'rved  necrosis 
of  the  cheeks  and  lips,  and  lastly  in  24  cattle  a  skin  eruption  over 
the  entire  body.  These  skin  lesions  were  developed  most  extensively 
above  the  carpal  and  tarsal  joints,  and  resulted  in  circumscribed 
necrosis.  Carrougeau  has  also  observed  skin  eruptions  in  the  form  of 
nodules  which  were  closely  set  in  rows,  from  which  the  thickened 
epidermis  separated  in  thick  shreds. 

According  to  Robertson  and  SpreuU  the  disease  of  cattle  known 
in  South  Africa  as  "lamziekte"  is  supposed  to  belong  to  hemorrhagic 
septicemia.  However,  a  confusion  with  "heart  water"  (see  this  disease) 
is  not  excluded. 

The  pectoral  form  is  characterized  by  symptoms  of  an  acute 
pleuro-pneumonia.  The  animal  stands  immovable  with  back 
arched,  has  a  dry  and  painful  cough,  and  a  colorless  or  reddish, 
foamy  serous  discharge  from  the  nose.  On  one  or  both  sides 
of  the  thorax  there  is  dullness  over  different  areas  with 
bronchial  breathing  and  vesicular  rales.  There  may  be  a  total 
absence  of  respiratory  sounds.  Friction  sounds  may  be  heard 
over  the  liepatized  areas.  Respiration  is  greatly  accelerate(^ 
and  labored.  Rumination  ceases.  Peristalsis  of  the  rumen  and 
intestines  is  frequently  suppressed.  Constipation  is  followed 
by  bloody  diarrhea,  whereupon  the  greatly  weakened  animal 
rapidly  succumbs. 

According  to  Carrougeau  the  disease  may  take  a  chronic  course. 
The  emaciated,  feverless  animals  cough  frequently;  their  appetite  is 
capricious,  and  there  is  profuse  lachrymation.  At  the  same  time  a 
persistent  diarrhea  is  present  in  which  feces  mixed  with  blood  are 
passed.  Over  the  lungs  rales  can  be  heard,  and  percussion  sounds  are 
sometimes  dull.  The  disease  may  terminate  in  recovery,  but  in  such 
cases  the  cough  persists  for  a  long  time.  In  other  cases  the  animals 
die  from  exhaustion  as  a  result  of  the  long  continued  sickness  and 
emaciation.  The  autopsy  of  such  animals  reveals  caseated  areas  in 
the  lungs,  chronic  catarrh  of  the  stomach  and  intestines,  enlargement 
of  the  lymph  glands  and  indications  of  cachexia  (in  some  cases  only 
the  latter  lesions  are  present). 

The  belief  of  Simader  that  the  "endemic  pharynpfeal  paralysis  (Wasenmeister- 
kraiikheit)  "  is  a  form  of  hemorrhagic  septicemia  is  not  substantiated  as  aside  from 
the  different  post  mortem  findings  and  its  continuous  afebrile  course  (Sohmid)  there 
are  no  proofs,  and  especially  since  an  identical  etiological  factor  has  not  been 
established. 

Course  and  prognosis.  The  duration  of  the  disease  varies, 
mth  the  exception  of  the  chronic  cases,  between  6  hours  and 
8  days.  The  edematous  form  usually  runs  the  more  rapid 
course,  mostly  from  12  to  36  hours,  while  the  pectoral  form, 


110  Hemorrhagic  Septicemia  of  Cattle. 

which  occurs  very  frequently  in   some   enzootics,   rarely  ter- 
minates in  less  than  3  days. 

The  prognosis  is  very  unfavorable.  According  to  past 
observations  85  to  95%  of  the  affected  animals  die.  Recovery 
may  exceptionally  be  observed  in  the  pectoral  form,  but  even 
in  these  cases  it  is  not  complete,  as  in  the  patients  a  chronic 
lung  aifection  usually  follows. 

Diagnosis.  The  disease  resembles  first  of  all  those  cases 
of  anthrax  in  which  edematous  swelling  and  signs  of  enteritis 
are  present.  Hemorrhagic  septicemia  is  indicated  by  the  de- 
velopment of  edematous  swelling  of  the  throat,  marked  swelling 
of  the  tongue  and  the  fact  that  hogs  may  be  simultaneously 
affected.  On  the  other  hand,  in  anthrax  the  edema  which  is 
less  frequent  is  more  apt  to  develop  on  the  neck,  dewlap  and  in 
front  of  the  chest ;  hogs  are  only  exceptionally,  while  sheep  are 
frequently  affected.  On  autopsy  the  absence  of  acute  swelling 
of  the  spleen  excludes  anthrax  with  a  high  degree  of  certainty, 
while  bacteriological  examination  of  the  blood  from  carcasses 
recently  dead  of  the  disease  makes  differentiation  easy  on  ac- 
count of  the  great  difference  in  the  appearance  of  the  causative 
agents.  If  the  carcass  is  no  longer  fresh  cutaneous  or  sub- 
cutaneous inoculations  of  the  blood  or  inflammatory  products 
are  advisable,  as  the  blood  of  such  test  animals  (mice,  rabbits 
and  pigeons)  contains  the  respective  bacteria  in  great  numbers. 

From  rinderpest  hemorrhagic  septicemia  may  be  differ- 
entiated by  the  fact  that  the  latter  may  occur  without  being 
introduced  from  outside  into  a  locality,  and  that  in  its  course 
the  mucous  membranes,  especially  those  of  the  air  passages, 
do  not  show  an  intense  croupous  inflammation  and  ulceration. 
Blackleg  and  malignant  edema  are  characterized  by  crepitating, 
edematous  swellings ;  moreover^  these  diseases  cannot  be  trans- 
mitted to  test  animals  by  cutaneous  or  intravenous  injections. 

The  pectoral  form  of  hemorrhagic  septicemia  can  easily 
be  mistaken  for  pleuro-pneumonia.  In  the  majority  of  cases 
hemorrhagic  septicemia  may  be  recognized  by  the  appearance 
of  inflammatory  changes  in  the  lungs,  as  they  occur  in  this 
disease  in  larger  extension  or  in  numerous  centers  of  the  same 
stage  of  development.  Occasionally,  however,  the  lesions  may 
simulate  acute  or  subacute  pleuro-pneumonia  to  such  an  extent 
as  to  render  diagnosis  from  the  microscopic  findings  almost 
impossible.  In  such  cases  a  microscopical  examination  will 
establish  the  correct  disease,  as  in  hemorrhagic  septicemia  the 
serous  fluid  of  the  lungs  contains  bipolar  bacilli,  while  in  pleuro- 
pneumonia the  findings  are  negative.  Test  inoculations  may 
also  be  made  to  differentiate  the  disease,  as  the  virus  of  sep- 
ticemia is  pathogenic  for  practically  all  test  animals,  while 
that  of  pleuro-pneumonia  is  harmless  (in  calves  infected  sub- 
cutaneously  with  the  latter  an  edematous  swelling  develops  at 
the  point  of  inoculation  in  1  to  2  weeks).     The  presence  of 


Diagnosis.     Tivatinoiit.  HI 

small  lioniorrliages  in  tlio  tissue  of  the  inllaincd  pleura,  and 
the  sudden  a))i)ea ranee  aiul  rapid  course  of  the  disease  are 
suggestive  of  iieniorrhagic  septicemia. 

Soinetimes  l)acterioIo;jic'al  exaiiiinatioii  may  lie  dillicult  as  occasionally  the 
blood  as  well  as  the  exudates  of  animals  ail'ected  with  hemorrhagic  se])ticemia  con- 
tain few  l>acteria  and  the  virus  may  lie  yreatly  attenuated.  In  donhtfiil  or  nejfative 
cases,  it  is  therefore  ailvisablc  to  inoculate  several  test  animals,  especially  rabbits. 

Lastly,  the  disease  is  diffei-entiated  from  simple  asphyxia- 
tion by  the  absence  of  inflammatory  changes ;  from  spontaneous 
(mycotic)  or  toxic  enteritis  by  the  absence  of  hemorrhages  in 
other  organs  which  will  also  differentiate  septicemia  from  in- 
flammatory changes  in  the  lungs  and  inflammatory  edemas  of 
the  subcutaneous  connective  tissue. 

Treatment  and  prevention.  The  treatment  of  affected 
animals  has  so  far  been  unsuccessful  and  can  at  best  consist 
in  the  scariHeation  of  the  swellings,  washing  of  the  wounds 
and  disinfection  of  the  intestinal  canal. 

For  the  suppression  of  the  disease  it  is  advisable  to  re- 
move cattle  and  hogs  from  the  infected  premises  to  dry,  and 
if  possible,  to  elevated  places.  When  the  disease  has  appeared 
in  a  stable,  it  is  well  to  withhold  the  suspected  feed  and  to  dis- 
infect the  premises. 

The  method  of  immunization  which  has  been  recommended  by 
BKn  &  Carrougeau  against  buffalo  disease  (see  page  118)  might 
perhaps  be  applied  to  hemorrhagic  septicemia  in  cattle. 

Veterinary  police.  Before  requiring  the  inclusion  of  hem- 
orrhagic septicemia  among  the  diseases  for  compulsory  report- 
ing, it  is  necessary  to  take  into  consideration  the  fact  that  it 
is  a  disease  of  the  soil.  Far  reaching  traffic  restrictions  do  not 
appear  justified,  while  hides  may  be  rendered  harmless  by 
simple  drying. 

Ostertag  found  in  his  investigations  that  dried  hides  from  affected  cattle  are 
always  free  from  the  infectious  agent  as  soon  as  their  moist  and  pliable  condition 
is  lost  and  they  become  hard.  Submerging  pieces  of  skin  in  milk  of  lime  or  in 
fresh  tanning  fluids  destroys  the  organisms  in  24  hours.  In  meat  the  infective  agent 
is  destroyed  by  advanced  putrefaction,  by  heating  to  70°C.  (immediately),  with  less 
certainty  by  salting,  pickling  or  injections  of  brine  (sometimes  only  after  4.5  days). 

Literature.  Bollinger,  t^b.  eine  neue  Wild-  und  Kinderseuche  usw.  Miinchen 
1878.— Franck,  D.  Z.  f.  Tm.,  ISS],  VII,  29.'?.— Friedberger,  Mch.  .Thb.  1S80-81,  21.— 
Kitt,  Sitzgsber.  d.  Ges.  f.  Morph.  Miinchen  188.1;  Mch.  ,Jhb.  1S8.J-86  u.  1886-87. — 
Nocard,  Bull.,  1891,  424.— Jensen,  Monh.,  1894,  IT,  188.— Ligniores,  Bull  1897, 
761;  1900,  537  (Lit.).— Taufer,  Fortschr.  d.  V.— Hvg.,  1904,  TI,  188  (Lit.).— 
Ostertag,  Z.    f.    Infkr.,   1908,    IV,   1.— Simader,   W.   f.   Tk.,   1908,   397    (Lit.). 


Septic  pleuro-pneumonia  of  calves.  The  disease  was  first 
described  by  Poels  in  Holland  (188G)  and  since  that  time  by  other 
authors  (Jensen,  Lienanx,  Bongartz.  Oaltier  and  others).  It  evidently 
represents  a  form  of  hemorrhagic  septicemia  of  cattle,   and  the  close 


J-|2  Septic  Pleuro-pneunumia   of  Calves. 

relation  of  the  two  diseases  appears  especially  indicated  by  the  fact 
that  in  certain  herds  adult  cattle  and  calves  are  frequently  affected 
at  the  same  time. 

The  causative  agent  (Bac.  vitulisepticus)  is  identical  with  the 
organism  of  septicemia,  and  natural  infection  appears  to  occur  princi- 
pally through  the  digestive  tract.  All  excretions  of  the  infected  animals 
may  transmit  the  infection. 

The  autopsy  reveals  a  large  amount  of  sero-fibrinous  exudate  in 
the  pleural  cavity,  punctiform  hemorrhages  in  the  serous  covering  of 
the  lungs,  reddish-brown  or  grayish-red  hepatizations  with  serous 
infiltration  of  the  interalveolar  connective  tissue  in  the  lungs,  and 
sometimes  dilatation  of  the  lymph  vessels  contained  therein  (marbled 
appearance).  The  finding  is  completed  by  the  presence  of  small 
hemorrhages  in  the  serous  and  mucous  membranes,  acute  catarrh  of 
the  air  passages  and  the  gastro-intestinal  canal,  acute  swelling  of  the 
lymph  glands,  and  cloudy  swelling  of  the  parenchymatous  organs. 

The  symptoms  consist  in  high  fever,  weakness,  inappetence,  indi- 
cations of  acute  pleuro-pneumonia  such  as  painful  cough,  diificulty  in 
respiration,  sensitiveness  over  the  thorax,  dullness  over  the  lower  parts 
of  the  lungs  wdth  friction  sounds,  bronchial  breathing,  or  a  total  absence 
of  respiratory  sounds.  Difficulty  in  respiration  increases,  and  in  most 
cases  death  results  in  1  to  2  weeks  after  diarrhea  sets  in,  or  after  a 
temporary  improvement  a  chronic   form  of  the   disease  may   develop. 

For  prevention  immune  sera  (calf -pneumonia  serum,  septizidin) 
prepared  from  horses  and  cattle  by  injecting  them  with  cultures  of  the 
bipolar  bacillus  were  used  with  varied  results.  According  to  the 
investigations  of  Schirop  promising  results  can  be  expected  only  from 
the  use  of  polyvalent  sera  (see  page  85).  However,  he  succeeded  in 
immunizing  rabbits  and  guinea  pigs  wdth  aggressins. 

On  the  relation  of  the  disease,  especially  in  its  chronic  form,  to  other  pneu- 
monias of  calves  see  the  chapter  on  enzootic  volume  II. 

Literature.  Poels,  Fortschr.  d.  Med.,  18S6,  IV,  388.— Jensen,  Monh.,  1890,  II, 
1.— Lienaux,  Ann.  vet.,  1892,  4fi.5.— Bongartz,  B.  t.  W.,  1892,  529.— Schirop,  Zbl.  f. 
Bakt.,  1908,  XLVII,  307   (Lit.). 


Hidebound.  Enteque.  The  disease  is  designated  in  Argentine 
by  this  name,  and  occurs  there  especially  along  the  shores  of  the  Atlan- 
tic Ocean  in  certain  nmrshy  localities,  where  the  outbreaks  cause 
considerable  annual  losses.  It  was  described  by  Monfallet,  Even,  and 
particularly  Lignieres  who  gave  a  careful  and  full  description  of  the 
disease.  In  acute  cases  occurring  in  animals  from  12  to  24  months 
old,  a  persistent  painless  diarrhea  and  gradual  emaciation  are  observed 
in  spite  of  a  good  appetite,  until  the  animals  finally  die  of  exhaustion 
in  from  3  to  4  months.  In  the  cachectic  form  of  the  disease,  which 
occurs  mostly  in  animals  which  recover  from  the  acute  affection,  the 
course  may  extend  over  several  years.  In  these  cases  the  progressive 
emaciation  and  anemia  which  develop  in  the  meantime  and  a  marked 
exhaustion  are  the  most  conspicuous  symptoms.  Normal  appetite  is 
suppressed,  but  the  animals  manifest  a  desire  to  eat  bones.  Along  the 
neck  in  the  jugular  groove  the  calcified  carotid  may  be  felt  in  some 
animals,  while  in  others  inflammation  of  the  joints  appears,  resulting 
in  deformities. 

On  autopsy  in  acute  cases  besides  the  general  anemia  and  emacia- 
tion,  sometimes  a  pleuritis,   broncho-pneumonia  or  a  fibrinous  pneu- 


llidi'ljomul.      I'.iilfali)    Disease.  113 

iiiMiiia  may  l)o  observed.  In  tlic  clironic  casos  Ihc  liuifrs  somctiint'S 
show  islands  or  cords  consisting  of  si)ongy  osseous  tissue  which  crepi- 
tate on  })ri'ssure  and  which  have  develojx'd  by  ossification  of  the  vessel 
walls,  lu  the  large  blood  vessels  of  the  body,  and  in  excei)tional  cases 
in  the  stiiall  arteries,  especially  those  of  the  heart,  a  pronounced 
arterio-selei-osis  exists;  the  endocardium  may  show  a  chronic;  endo- 
carditis, while  the  different  joints  may  show  indications  of  chronic 
infiamnudion  (similar  changes  were  found  by  Moussu  in  France  in 
chronic  forms  of  diarrhea  and  by  Brusaferro  in  a  yearling  steer 
slaughtered  in  Turin). 

The  disease  was  also  observed  in  horses  and  sheep  but  the  lungs 
failed  to  show  the  processes  of  ossification. 

According  to  the  investigations  of  Lignieres,  the  causative  agent  of 
the  disease  is  a  very  small  variety  of  the  l^ac.  l)ipolaris  septicus.  Intra- 
venous injections  of  large  ({uantities  of  fresh  cultures  i)roduce  septi- 
cemia which  is  fatal  in  1  to  3  days;  following  injections  of  older  cultures 
in  cattle  and  sheep  an  articular  and  peri-articular  inflammation  develops 
which  results  in  the  formation  of  new  connective  and  cartilaginous 
tissue. 

Natural  infection  occurs  in  marshy  localities  from  the  water  and 
food.  The  results  are  sometimes  an  enteritis,  or  a  chronic  inflammation 
of  the  joints  and  an  affection  of  the  vessel  walls. 

Lignieres  obtained  satisfactory  results  in  the  treatment  of  the 
acute  form  of  the  disease  by  intra  jugular  injections  of  diluted  blood 
serum  of  healthy  animals  (400  cc.  serum  and  500  cc.  sterile  water), 
or  artificial  serum  (1000  cc.  boiled  water,  9  grams  sodium  chloride 
and  4  grams  sodium  sulphate).  In  cases  where  recovery  was  prolonged, 
the  injections  were  repeated. 

Literature.     Even,  Revista  vet.,  1896,  301. — Lignieres,  Bull.,  1898,  761. 

(c)  Buffalo  Disease.    Septicaemia  hemorrhagica  bubalorum. 

{BcirJ)one  disease,  Pasteurellosis  huhaloiim,  Pasfeurellose  dcs 

huffles   [French];  Biiffelseuclie    [Gennan]; 

Barhone  hufalbio  [Italian].) 

This  affection  is  an  acute,  febrile,  infectious  disease  of 
buffalo,  and  is  characterized  by  febrile  manifestations,  difficult 
respiration  and  especially  by  an  edematous  swelling  of  the 
throat  region.     It  is  caused  by  the  bacillus  bubalisepticus. 

History.  The  disease  Avas  first  studied  in  Italy  by  Oreste  & 
Armanni  (1886),  and  included  in  the  hemorrhagic  septicemia  group. 
They  also  undertook  immunization  experiments.  In  Hungary  the  oc- 
currence of  the  disease  Avas  first  established  by  Sequens  (1889),  while 
Ratz  undertook  a  more  thorough  investigation  of  the  pathogenicity 
of  the  infective  agent. 

Occurrence.  Buffalo  disease  occurs  frequently  in  localities 
where  large  numbers  of  buffalo  are  kept  during  the  summer, 
and  at  times  causes  consideral^le  loss  in  some  herds.  It  usually 
occurs  as  a  disease  of  the  soil  in  marshy  pastures  and  in  dry 
stubble  fields.  Exceptionally,  however,  cases  may  occur  in 
animals  fed  in  stables.    The  economic  importance  of  the  disease 


J 14  Buffalo  Disease. 

is  increased  by  the  fact  that  it  may  be  transmitted  to  hogs, 
among  which  it  may  also  cause  considerable  loss. 

In  Italy  the  infection  is  especially  widespread  in  the  districts  of  Salerno,  Rome 
and  Terra  di  Livorno.  In  Hungary  the  disease  occurs  almost  exclusively  in  the 
southeastern  counties  (in  1908,  98  buffaloes  were  affected  in  56  townships,  and  95 
of  them  died;  considerably  less  than  in  former  years).  In  Russia,  Egypt,  East 
and  West  Indies,  and  Indo-China  the  disease  frequently  occurs  in  enzootic  form. 

The  dangerous  character  of  the  disease  is  readily  recognized  by  the  following 
data:  In  Italy,  in  a  herd  of  1,400  buffaloes,  200  died  in  the  year  1882  within  ten 
days;  in  another  herd  of  1,300  buffaloes,  530  succumbed.  In  one  township  of  the 
infected  districts  of  Hungary,  52  of  237  buffaloes  died  within  one  week;  in  another, 
of  663,  89  die<l  within  a  short  time.  The  losses  in  the  Netherland-West  Indies  (in 
Bantam  and  Batavia  alone)   amounted,  between  1888  and  1891,  to  11,000  buffaloes. 

Etiology.  The  established  cause  of  the  disease,  the  bacillus 
(bipolaris)  bubalisepticus,  appears  in  all  its  principal  charac- 
teristics as  a  variety  of  the  bacillus  bipolaris  septicus  (see 
page  79). 

Tenacity.  Blood  dried  in  the  air  loses  its  infectiveness  in  24  hours.  On  the 
other  hand,  wlien  kept  in  closed  glass  tubes  at  room  temperature  its  virulence  is  lost 
in  40  days.  Carbolic  acid  (2%),  sulphuric  acid  (5%),  and  alcoliol  (S7%)  render 
equal  quantities  of  blood  harmless  (Oreste  &  Arnianni,  Sanfelice). 

Pathogenicity.  According  to  the 
investigations  of  Ratz,  rabbits  are 
most  susceptible  to  artificial  infec- 
tions ;  somew^hat  less  susceptible  are 
the  guinea  pig,  the  mouse  and  the 
pigeon ;  to  a  still  lesser  degree, 
chickens,  while  the  dog  and  duck  are 
not  at  all  susceptible.  Of  the  large 
animals  the  horse  succumbs  to  sub- 
cutaneous infection  in  an  average  of 
20  hours,  cattle  in  from  20  to  48,  and 
Fig.  28.  Bacinus  bubalisepticus.     ^i^gs  m  from  20  to  40  hours.    The  in- 

Smear  preparation  from  rabbit       OCulatioilS  result  in  manifestations  of 

blood.    Polar  staining.  ^  general   infection   with   edematous 

swelling  at  the  point  of  infection. 
Buffalo  calves  die  from  a  cutaneous  or  subcutaneous  infection 
inside  of  24-36  hours  with  similar  symptoms,  while  infection  is 
not  successful  when  virulent  cultures  are  fed,  but  buffalo  calves 
treated  in  the  latter  manner  will  develop  an  immunity  against 
a  subsequent  virulent  infection.  Sheep  inoculated  with  virulent 
buffalo  blood  die  with  symptoms  of  an  acute  pharyngitis 
(Reischig). 

The  bacteria  are  present  in  large  numbers  in  the  blood, 
in  the  serous  exudates  and  the  feces  of  the  infected  animals. 
They  may  also  pass  into  the  saliva,  bile,  milk  and  the  urine. 

Natural  infection  may  occur  through  wounds  of  the  skin 
and  mucous  membranes.  Such  infections  are  favored  in  pas- 
tures w^hich  contain  thorny  plants  and  pools  of  water  in  which 
the  animals  lie  for  hours,  thus  constantly  reinfecting  the  water. 

In  the  great  majority  of  the  cases,  however,  natural  in- 


Natural    Infection.      Anatomical   Changes.  115 

fectioii  probably  results  from  the  in«;estion  of  infected  food 
and  water  through  the  uninjured  mucous  m('ml)rane  of  the 
di^-estive  tract.  This  mode  of  infection  is  indicated  by  the  con- 
stant swelling-  in  the  region  of  the  throat  and  also  by  the 
relatively  frequent  acute  infhunmation  of  the  abomasum.  On 
the  other  hand,  infection  through  the  air  passages  is  less  prob- 
able, as  intratracheal  injections  of  virulent  nuiterial  fail,  in 
most  cases  to  produce  the  disease.  A  direct  transmission  from 
animal  to  animal  or  a  spreading  over  extensive  territories  is 
not  observed  in  the  buffalo  disease. 

In  premises  where  the  disease  has  appeared  according  to 
the  experience  of  Hungarian  veterinarians  hogs  also  frequently 
become  affected  with  symptoms  of  an  acute  pharyngitis  and 
general  infection;  in  many  cases  this  has  been  observed  after 
the  ingestion  of  meat  from  buffaloes  Avhicli  had  died  from 
Buffalo  disease.  In  exceptional  cases  it  may  also  occur  that 
hogs  are  first  aiTected  and  the  disease  in  buffaloes  is  observed 
only  later  (Sequens).  The  disease  does  not  spread  to  hogs 
kept  on  other  premises. 

Exceptionally  the  infection  may  be  observed  simultaneously 
in  buffalo  and  cattle  probaldy  as  a  result  of  an  infection  with 
the  same  virus  (Betegh,  Sequens,  Sanfelice). 

Anatomical  Changes.  A  serous  infiltration  of  the  sub- 
cutaneous tissues  in  the  region  of  the  throat  and  trachea  is 
almost  a  constant  lesion  and  more  or  less  characteristic  of 
the  disease.  This  may  extend  posteriorly  reaching  to  the  ster- 
num. In  the  region  of  the  swelling  the  perilaryngeal  and  peri- 
tracheal loose  connective  tissue  as  well  as  that  of  the  lig.  ary- 
epiglottica  and  of  the  frenum  is  saturated  with  a  clear  Avatery, 
slightly  yellow^  serous  fluid.  In  rare  cases  the  edema  extends 
on  one  side  to  the  cheeks  and  on  the  other  side  also  to  the 
mediastinum  in  which  case  the  thoracic  cavity  sometimes  con- 
tains yellowish  clear  transudate  (Gal).  Occasionally  the  serous 
fluid  shows  red  coloration,  and  the  infiltrated  connective  tissue 
is  studded  with  small  hemorrhages. 

The  other  changes  usually  indicate  in  general  a  septic  in- 
fection. The  mucous  membrane  of  the  air  passages,  especially 
of  the  larynx  and  of  the  bronchi,  shows  a  catarrhal  swelling, 
redness  and  occasionally  punctiform  or  linear  hemorrhages. 
The  lungs  show  a  pronounced  acute  edema.  The  blood  vessels 
of  the  serous  membranes  are  highly  injected,  the  peritoneum 
is  sometimes  covered  with  a  fibrinous  meml)rane. 

The  mucous  membrane  of  the  abomasum  appears  highly 
reddened  and  swollen,  either  over  its  entire  surface  or  over 
certain  places,  while  in  the  intestines  the  catarrhal  manifesta- 
tions are  less  pronounced.  The  spleen  is  congested,  but  only 
very  slightly  swollen  or  not  at  all.  The  liver  and  kidneys 
usually  show  no  changes.  The  hTnph  glanrls  of  the  mesentery 
as  well  as  in  other  parts,  manifest  an  acute  swelling. 


116  Buffalo  Disease. 

Piot  observed  an  affection  of  the  lungs  in  Egypt  which  re- 
sembled pleural  pneumonia,  the  lesions  resembling  those  of 
hemorrhagic  septicemia  of  cattle  (see  page  107).  Sohns  has 
also  observed  a  pectoral  form  of  the  disease. 

Symptoms.  The  time  of  incubation  after  artificial  infec- 
tion is  usually  only  12  hours,  and  under  natural  conditions  it 
very  probably  extends  only  from  one  to  two  days. 

The  disease  commences  with  a  rapid  rise  of  the  body 
temperature  to  41-42  °C.  The  affected  animal  stands  indifferent 
with  extended  neck  and  closed  eyes.  From  the  corners  of  the 
mouth  foamy  saliva  drips  in  long  strings.  In  the  meantime 
the  swelling  of  the  throat  region  develops,  becomes  hot,  painful, 
first  of  a  doughy,  later  of  a  denser  consistency.  It  does  not 
crepitate  on  touch.  During  the  development  of  the  swelling 
the  animals  manifest  a  short  and  painful  cough ;  soon  the  swell- 
ing extends  over  the  cheeks,  also  over  the  parotid  region  and 
backwards  along  the  neck  to  the  breast,  and  even  over  the 
region  of  the  shoulder.  The  conjunctivae  of  the  eyes  as  well 
as  the  mucous  membrane  of  the  nose  and  of  the  mouth  is  bright 
red  in  color,  and  at  the  same  time  hot  and  dry.  There  is 
lachrjmiation  from  the  eyes  and  a  yellowish  mucous  secretion 
is  discharged  from  the  nose.  On  opening  the  mouth  the  tongue 
appears  usually  normal,  only  the  surrounding  of  the  frenum 
of  the  tongue  shows  a  serous  infiltration  and  swelling.  In  some 
cases,  however,  the  tongue  may  swell  considerably  so  that  it  is 
dark  brownish-red,  and  its  tip  protrudes  from  the  mouth  to 
the  length  of  several  centimeters. 

With  the  increase  of  the  swelling,  respiration  becomes 
more  difficult,  accelerated  and  later  rattling.  The  action  of  the 
accessory  respiratory  muscles  is  greatly  increased,  the  nasal 
openings  are  widely  distended.  The  long  inspiration  is  fol- 
lowed by  a  short,  jerky  expiration  accompanied  by  painful 
grunting. 

The  appetite  is  suppressed  from  the  onset  of  the  disease 
or  may  be  capricious.  Rumination  ceases.  There  is  first  con- 
stipation while  towards  the  termination  of  the  disease  diarrhea 
may  set  in  when  the  feces  are  thin,  fetid  and  mixed  with  dirty 
red  mucus.  The  animals  look  from  time  to  time  towards  the 
abdomen,  otherwise  they  hardly  move  from  the  place  and  can- 
not be  urged  to  walk.  In  case  there  is  a  water  pool  near  by 
the  animals  like  to  lie  down  in  it.  The  vulva  and  the  surround- 
ing parts  of  the  rectum  are  often  swollen  during  the  later 
course  of  t)ie  disease.     Pregnant  cows  frequently  abort. 

With  the  rapid  progress  of  the  symptoms  the  animals, 
shortly  before  death,  grunt  painfully,  and  the  rattling  respira- 
tion may  be  heard  at  a  distance  from  30  to  40  steps,  they  grind 
their  teeth  or  bellow  loudly.  Finally  the  animal  suddenly  rises 
from  the  ground,  takes  several  staggering  steps,  suddenly  col- 


Syinptoiiis.  11/ 

lapses,  whereupon  death  ensues  in  a  few  minutos  under  mani- 
festations of  asphyxiation  and  convulsive  movements. 

There  are  occasionally  deviations  from  the  described 
svmptoms.  Thus  the  swelling  of  the  throat  region  may  be 
absent,  and  the  autopsy  may  show  only  very  slight  changes 
in  the  mucous  membrane  of  pharynx  and  larynx,  in  spite  of 
the  fact  that  the  animal  died  with  symptoms  of  asphyxiation 
(Biro).  In  less  acute  affections  symptoms  of  a  malignant 
catarrhal  fever  develop  sometimes  (Makoldy). 

In  localities  where  rinderpest  prevails,  as  for  instance  in  Eastern 
Asia,  buft'alo  disease  has  been  freciuently  mistaken  for  the  fonuer, 
especially  in  cases  of  severe  catarrhal  symptoms  of  the  nasal  and 
intestinal  mucous  membrane  as  well  as  in  the  cases  of  somewhat  more 
chronic  forms.  However,  the  noncontagious  character  of  the  l)utfalo 
disease  and  the  great  susceptibility  of  rabbits  for  its  virus  offer  suffi- 
cient differential  signs.  i  i        •  u 

In  cattle  which  in  rare  cases  become  affected  simultaneously  with 
buffaloes  similar  clinical  manifestations  are  observed,  especially  high 
fever,  extension  of  the  head,  protrusion  of  the  swoUeu  tongue,  rattling 
respiration,  cyanosis  of  the  mucous  membranes,  further  an  edematous 
swelling  of  the  region  of  the  throat  and  cheeks. 

In  hogs,  which  sometimes  also  become  affected  on  premises  where 
buffaloes  are  sick,  the  disease  runs  a  course  of  severe  pharyngitis  with 
marked  swelling  of  the  region  of  the  throat,  which  sometimes  extends 
also  over  the  neck,  when  the  debihtated  animal  suffers  from  difficult 
and  rapid  respiration. 

Course  and  Prognosis.  In  rare  cases  the  disease  lasts  only 
six  to  eight  hours,  but  as  a  rule  death  results  on  the  second 
day.  Exceptionally  the  course  may  extend  up  to  eight  days,  and 
such  protracted  cases  sometimes  terminate  in  recovery,  espe- 
cially if  no  swelling  of  the  throat  develops  in  the  meantime. 

According  to  Italian  authors  the  percentage  of  mortahty 
amounts  to  from  50  to  60  per  cent.  According  to  the  observa- 
tions made  in  Hungary  it  varies  from  87  to  98  per  cent  and 
averages  94.2  per  cent. 

Treatment  and  Prevention.  The  treatment  of  affected 
animals  promises  little  success.  The  scarification  of  the  swell- 
ings in  the  region  of  the  throat  followed  by  washing  of  the 
wounds  with  a  disinfectant,  for  instance  three  per  cent  carbolic 
acid  solution  or  turpentine,  appears  most  appropriate.  Ke- 
peated  injections  of  the  first  solution  into  various  parts  of  the 
swelling  without  previous  scarification  may  also  be  beneficial. 
Beside  cold  applications  to  the  region  of  the  throat,  cold 
showers  and  laxatives  (salines  in  large  doses)  as  well  as  inter- 
nal    administration     of     disinfectants     (creolin,     lysol)     are 

indicated. 

The  most  effective  method  against  the  spreading  ot  the 
disease  is  the  removal  of  the  healthy  animals  from  the  infected 
pastures,  or  at  least  the   abandonment  of  low^-l>ing,  marshy 


118  Hemorrhagic   Septicemia  of  Sheep. 

pastures.  In  many  cases  the  disease  ceases  immediately  after 
tlie  animals  are  stabled.  Further  preventative  measures  are 
the  disinfection  of  the  infected  stables  and  premises  as  well  as 
the  amelioration  of  the  dangerous  pastures  by  drainage  and 
drying  of  the  swampy  areas. 

Immunization.  According  to  Oreste  &  Armanni  (1887)  the  blood 
of  pigeons  which  have  been  inoculated  and  have  died  in  from  three 
to  four  days  becomes  attenuated  and  adapted  for  immunization.  Three 
injections  of  0.1  ec.  of  such  blood  is  supposed  to  produce  an  active 
immunity  in  buffalo.  Such  immunizations  were  carried  out  by  the 
authors  in  their  practice  with  good  results. 

Oreste  and  Marcone  (1889)  prepared  a  vaccine  by  growing  the 
bacteria  in  the  presence  of  air  at  a  temperature  of  30°  to  32°  C.  which 
supposedly  protected  sheep  and  buffaloes  against  a  virulent  infection. 

Blin  and  Carrougeau  (1902)  produced  an  immune  serum  by 
careful  immunization  of  horses  with  old,  then  with  fresh  cultures 
(inside  of  5  months  150  cc.  of  cultures  were  injected  subcutaneously) 
of  which  the  protective  action  has  been  increased  by  the  addition  of 
killed  cultures.  Simultaneous  injections  of  the  serum  and  Vs-Vo  cc. 
of  virulent  culture  produced  a  lasting  immunity,  but  still  more  effective 
was  the  subcutaneous  injection  of  a  serum-culture  mixture  (20  cc. 
serum  plus  2  cc.  culture).  The  serum  must  have  such  a  strength 
that  20  cc.  of  the  same  will  protect  a  20  months  old  calf  against  an 
infection  with  2  cc.  of  culture  of  which  1  cc.  ordinarily  kills  the 
animal  in  from  24  to  30  hours.  The  results  are  supposed  to  be  satis- 
factory in  buffalo  as  well  as  in  cattle. 

Veterinary  Police.  A  similar  procedure  as  in  hemorrhagic 
septicemia  of  cattle  is  advisable.  Besides  buffalo,  hogs  should 
be  also  protected  against  infection. 

Literature.  Oreste  &  Armanni,  Eev.  Vet.  Jhb.,  1887,  VII,  4.5. — Oreste  & 
Marcone,  Clin,  vet.,  1891. — Sequens,  Vet.,  1894,  ,504. — Eatz,  D.  Z.  f.  Tm.,  1896, 
XXII,  331.— Lignieres,  Bull.,  1900,  541  (Lit.).— Blin  &  Carrougeau,  Eec,  1902, 
571.— Yersin,   A.   P.,    1904,   XVIII,   440. 

(d)  Hemorrhagic  Septicemia  of  Sheep.    Septicaemia 
haemorrhagica  ovum. 

{Catarrhal   Fever    of   Sheep;    Septicemia    pluriformis    ovnm, 

Pasteurellosis  Ovum,,  Lomhriz  [Spanish]; 

Schafrotz  [ German] . ) 

Hemorrhagic  septicemia  of  sheep  is  characterized  in  acute 
cases  by  septicemic  manifestations,  in  subacute  and  chronic 
cases  by  a  discharge  from  the  eyes  and  nose  as  well  as  by  a 
pleural  pneumonia.     The  cause  is  the  bacillus  ovisepticus. 

History.  Galtier  (1889-1890)  observed  in  the  Alps  of  France  a 
disease  of  sheep  which  he  associated  with  swine  plague,  describing  an 
ovoid  bacterium  as  its  cause.  Later  Lienaux  (1895)  described  an 
organism  as  the  cause  of  nifectious  pleuro-pneumonia  of  sheep  which 
entirely  corresponded  with  the  bipolar  bacillus.     Conte  (1897)  as  well 


History.      Occuneiict'.  \\[) 

as   Besnoit   and    Cuille    (1898)    obtaiued   siuiilar   results   during    their 
studies  of  diseases  of  sheep  in  France. 

Lignieres  (1898)  studied  this  disease  more  thoroughly  when  he 
established  that  the  disease  whieh  is  known  in  Argentine  under  the 
name  of  Lombriz  on  aeeount  of  the  usual  presenee  of  intestinal  para- 
sites, n'presents  in  its  eharaeter  a  disease  of  the  heuiorrhagie  sei)tieemia 
group.  He  as  well  as  Besnoit  and  Cuille  interestingly  demonstrated 
its  relation  to  verminous  bronchitis  and  verminous  gaiitritis  of  sheep. 

Similar  results  were  recently  obtained  by  Miessner  &  Schern  (1910) 
when  they  established  the  etiological  relation  of  the  bipolar  bacilli  in 
a  disease  of  sheep  which  was  considered  by  Spiuola  (18G.'i)  as  catarrhal 
fever  and  by  Friedberger  (188)3)  as  glandi-rs  of  sheep,  according  to 
their  clinical  and  anatomical  manifestations.  The  first  mentioned 
authors  succeeded  in  demonstratnig  virulent  bipolar  bacilli  in  the  lymph 
glands  and  sometimes  in  the  blood  of  animals  dead  from  this  disease. 
The  presence  of  this  bacterium  was  sometimes  only  demonstrable  by 
inoculations.  Pure  cultures  of  this  organism  produced  artificially  the 
acute  and  subacute  form  of  the  disease.  Accordingly  the  so-called 
glanders  of  sheep  (septicemia  pluriformis  ovis)  is  identical  with 
Lignieres'  Pasteurellosis.  On  the  other  hand  it  is  distinguished  from 
the  South  African  catarrhal  fever  of  sheep  (see  that  disease;  infection 
experiments  with  filtered  material  were  not  made).  This  new  con- 
ception will  be  given  consideration  in  the  following  description,  espe- 
cially concerning  the  chronic  cases. 

Occurrence.  The  disease  caused  considerable  loss,  espe- 
cially among  lambs,  while  older  animals  are  rarely  affected, 
and-  then  usually  in  a  chronic  form.  Most  frequently  it  is  ob- 
served in  low  marshy  localities,  more  rarely  in  higher  sections, 
and  especially  during  the  weaning  of  Iambs. 

In  Argentine  the  disease  occurs  almost  annually  in  an  en200tic  form,  fre- 
quently associated  with  verminous  bronchitis  and  gastritis,  which  has  also  been  found 
to  be  the  case  in  France  (Lignieres,  Besnoit  &  Cuille).  In  Germany  the  disease 
appears  to  be  quite  extensive  as  Miessner  &  Schern  established  its  presence,  in  1907, 
in  eight  herds  of  sheep  where  it  usually  caused  great  loss  among  the  lambs  (some- 
times '>0%  of  the  increase  of  lambs).  In  Hungary  it  was  observed  by  Keleti  in 
1896  when  it  appeared  in  association  with  an  outbreak  of  swine  plague,  in  this 
instance,  out  of  -SOO  sheep  of  Oxford  and  Cotswold  breeds  23  dieil  within  seven  days. 
The  disease  has  also  been  observed  in  Belgium,  England  and  Turkey,  and  the  fatal 
disease  known  in  Algeria  as  "El  K 'och ' '  is  probably  identical  with  this  disease 
(Gaze). 

Etiology.  The  bacillus  (bipolaris)  ovisepticus  represents 
a  variety  of  the  bacillus  bipolaris  septicus  with  which  it  is 
identical  in  its  principal  characteristics  (see  page  79).  It  is 
difficult  to  isolate  the  organism  fi-oni  the  affected  organs,  and 
sometimes  its  growth  suddenly  ceases. 

Pathogenicity.  Several  loopfuls  of  virulent  culture  in- 
jected into  the  eireulation  of  a  young  sheep,  and  5  cc.  in  an  old 
animal,  cause  death  inside  of  one  to  three  days  under  manifesta- 
tions of  hemorrhagic  septicemia.  Subcutaneous  injections  of 
a  culture  produce  a  serous  inflammation  at  the  point  of  injec- 
tion, further  acute  catarrh  of  the  conjunctiva  as  well  as  of  the 
nasal  mucous  membrane.    The  animals  then  become  emaciated 


120  Hemorrhagic   Septicemia  of  Sheep. 

and  finally  die  with  sj^iiptoms  of  enteritis,  diarrhea  and  anemia. 
The  same  results  may  also  be  obtained  by  repeated  injections 
of  one-third  to  one-half  cc.  of  a  fresh  virulent  culture  as  well 
as  by  intravenous  injections  of  5  to  10  cc.  of  an  older  culture 
(Lignieres).  The  infection  may  also  be  produced  with  ground 
lymph  glands  and  should  the  animals  remain  alive  for  a  longer 
time  certain  parts  of  the  lungs  become  hepatized,  and  as  in  the 
acute  cases  the  lymph  glands  are  markedly  swollen  (Miessner 
&  Schern).  By  feeding  50  to  60  cc.  of  culture  Lignieres  pro- 
duced the  disease  in  sheep,  although  the  attack  was  only  slight. 
On  the  other  hand  similar  experiments  by  Miessner  &  Schern 
with  150  cc.  of  calture  gave  negative  results.  Inhalation  of  50 
cc.  of  culture  killed  a  lamb  in  three  days. 

In  animals  which  died  from  the  acute  form  of  the  disease 
the  ])ipolar  bacilli  may  be  found  in  all  the  organs,  while  in 
the  chronic  cases  they  are  frequently  absent  and  other  bacteria 
may  be  demonstrated  in  the  affected  tissues.  Mice,  g-uinea  pigs 
and  rabbits  can  be  easily  infected  while  ])irds  are  more  resist- 
ant. In  large  animals  the  subcutaneous  injection  of  the  virus 
produced  a  serous  inflammation  at  the  point  of  infection.  Intra- 
venous injections  (50  to  100  cc.)  cause  the  death  of  the  animals 
from  septicemia  within  a  short  time  (Lignieres).  The  chronic 
form  of  the  disease  could  not  be  produced  artificially. 

Natural  infection  occurs  very  likely  through  the  digestive 
tract  as  a  result  of  the  ingestion  of  infected  food  or  drinking 
water  on  infected  pastures  or  in  contaminated  stal)les.  Young- 
sheep  are  particularly  susceptible  immediately  after  weaning, 
and  the  disease  usually  runs  a  rapid  course  in  these  animals, 
while  in  older  animals  it  is  more  likely  to  take  on  a  chronic 
character. 

Infectious  excrements  and  excretions  of  affected  animals 
naturally  add  sul)stantially  to  the  dissemination  of  the  disease. 
In  herds  which  are  kept  in  a  small  pasture  or  in  stables  the 
disease  usually  occurs  in  a  more  severe  form.  Affected  animals 
may  spread  the  disease  to  healthy  herds. 

External  influences  which  reduce  the  natural  resistance  of 
the  animals,  such  as  continued  cold  and  exposure  to  rain,  etc., 
increase  the  susceptibility,  and  therefore  the  disease  usually 
occurs  after  damp  weather  and  in  general  in  marshy  localities. 

Furthermore,  according  to  Lignieres'  view,  thread  worms 
(strongylides)  favor  the  infection  through  injuries  of  the 
mucous  membrane  of  the  stomach  and  intestines  thereby  render- 
ing possible  the  entrance  of  the  bipolar  bacilli,  which  are  pres- 
ent in  the  feces  or  in  the  mucous  secretions  of  the  air  passages, 
into  the  hnnph  spaces  of  the  mucous  memlirane  (according  to 
Besnoit  &  Cuille  the  dystomas  in  the  bile  ducts  exert  a  similar 
action). 

Lignieres'  view  on  the  close  connection  of  the  liaeterial  infection  with  the 
lung  and  intestinal  worms  must  be  considered  as  too  far  fetched.     Admitting  that 


Natural    In  IVt-tion.      l'atli(><;(Mi('sis.  \-2] 

these  i)arasites  may  iiuiepenilently  cauM'  a  sov(M-t'  iiit'cctuHi  ami  on  tlic  otluT  iiaml 
that  they  may  lio  f'oumi  in  apparoiitly  luviitliy  animals,  tlii/ir  relation  to  the  ctiolotiy 
of  tliis  ilisoase  is  ilimiiiislifil  liy  tiic  fact  that  not  infrtM|mMitiy  lii'morrliat^nc  i-cptifcinia 
of  sluH'p  is  prosont  I'vi-n  when  such  parasitos  are  not  fouinl  in  the  animal.  (.Mic^sncr 
&  Schern  do  not  oven  mention  the  presence  of  parasites  in  tlieir  anatomical  limlin^s. 
Lanilis  only  a  few  months  old  may  become  afl'octcd  with  the  disease,  and  the  dis- 
ease may  lie  produced  by  inoculation  of  pure  cultures.) 

Pathogenesis.  After  a  severe  infection  the  bipolar  l)aeiHi 
niuhii)ly  very  ra})i(lly  in  tlie  ))ody  and  })i-o(hioe  <leath  in  a  short 
liiiic  by  licmorrhagic  soptieeniia.  If  on  the  oilier  hand  the  ini'ee- 
lion  was  less  severe  or  the  resistance  of  the  animal  relatively 
higher,  the  action  of  the  bacilli  wonld  be  manifested  only  in  a 
chronic  intoxication  which  wonld  resnlt  in  progressive  emacia- 
tion and  anemia.  In  these  more  freqnent  forms  the  debility  of 
llie  animals  favors  the  entrance  of  other  bacteria  (especially 
streptococci)  from  the  intestinal  canal  and  the  air  passages  into 
the  tissnes  and  body  flnids.  As  a  resnlt  of  this  secondary  infec- 
tionchanges  develop  in  the  internal  organs  and  the  bipolar  bacilli 
in  the  meantime  may  have  entirely  disappeared  from  the  l)lo()d. 
The  relatively  freqnent  broncho-pneumonia  as  well  as  the  less 
freqnent  arthritis  and  tendonitis  are  as  a  rule  the  results  of 
such  secondary  infections,  while  the  pleuro-pneumonia  may  be 
produced  independently  by  the  bipolar  bacilli. 

Anatomical  Changes.  In  the  peracute  cases  the  autopsy 
reveals  the  typical  findings  of  a  hemorrhagic  septicemia  (see 
page  83 ) . 

In  the  acute  form  the  sul)Cutaneous  connective  tissue  of  the 
anterior  portion  of  the  body  sometimes  shows  a  gelatinous 
hemorrhagic  infiltration.  The  mucous  membranes  of  the  head, 
the  air  passages  and  of  the  intestines  also  those  of  the  aboma- 
sum  are  usually  inflamed,  reddened  and  swollen,  the  hnnph 
glands  are  enlarged,  their  cut  surface  is  moist  and  in  parts 
shows  diffuse  reddening.  Frequently  there  are  small  hemor- 
rhages in  the  serous  membranes,  in  the  Iddneys  and  in  the  hnnph 
glands.  In  some  cases  the  lungs  contain  even  in  this  stage  dark 
brownish-red  broncho-pneumonic  foci,  besides  serous  infiltra- 
tion of  the  intralobular  connective  tissue.  The  spleen  has 
usually  a  normal  appearance. 

In  the  subacute  form  lesions  of  broncho-pneumonia  iu  tlie 
anterior  and  inferior  portions  of  the  lung  are  almost  invariably 
present.  In  such  cases  the  pleura,  sometimes  also  the  peri- 
cardium, is  frequently  covered  with  fibrinous  pseudo-mem- 
branes, and  the  serous  cavities  contain  smaHer  or  larger  quan- 
tities of  a  yellow  clear  or  cloudy  fluid.  The  mucous  membrane 
of  the  bronchi  is  usually  inflamed,  reddened  and  swollen,  wdiile 
that  of  the  intestines  is  affected  less  frequently;  in  some  cases 
the  nasal  mucous  membrane  also  shows  yellow  mucous  or 
fibrinous  deposits.  The  lymph  glands  of  the  thoracic  cavity 
are  moderately  swollen. 

In  the  chronic  cases  larger  areas  of  the  lungs  usually  show 


222  Hemorrhagic   Septicemia  of   Sheep. 

a  grayish-red  hepatization,  the  pleural  covering  of  these  parts 
of  the  lungs  manifesting  indications  of  a  former  pleuritic  con- 
dition (thickening  and  adhesions).  The  hepatized  lung  tissue 
contains  numerous  necrotic  foci  which  may  sometimes  be  en- 
closed in  a  connective  tissue  capsule.  Some  of  these  smaller 
lesions  appear  in  the  form  of  onion-like  layers,  from  the  center 
of  which  a  tenacious,  pus-like  mass  may  be  squeezed  out,  while 
the  larger  ones  consist  of  a  smeary,  grayish-yellow  mass  which 
is  intermixed  with  granules.  In  some  of  the  chronic  cases  there 
may  only  be  present  manifestations  of  severe  anemia  and 
cachexia  without  any  affection  of  the  internal  organs. 

Bacteriological  examination  may  readily  reveal  the  presence  of  the  bipolar 
bacilli,  particularly  in  the  lungs,  the  exudates  of  the  serous  membranes,  the  lymph 
glands,  and  in  the  nasal  discharge.  On  the  other  hand  in  chronic  cases  the 
bacteriological  examination  is  quite  frequently  negative,  or  the  pres-ence  of  other 
bacteria  only  can  be  demonstrated  (streptococci,  coli  bacilli,  bacilli  of  pt-eudo- 
tuberculosis,  etc.),  although  Miessner  &  Schern  do  not  mention  secondary  organisms 
in  either  subacute  or  chronic  cases.  In  some  of  the  cases  the  presence  of  the 
bipolar  baeteria  can  be  proved  only  by  test  inoculations  (especially  with  material 
from  lymph  glands)  or  not  at  all;  thus  Lignieres  succeeded  in  demonstrating 
the  organism  in  only  77  out  of  258  acute  and  chronic  cases. 

Symptoms.  In  the  acute  form,  which  usually  runs  its 
course  in  from  two  to  five  days,  sometimes  even  more  rapidly, 
symptoms  of  severe  febrile  infections  are  present.  Marked 
dullness,  rising  temperature  to  41°  C.  and  higher,  inappetence, 
increased  thirst,  colicky  pains,  difficult  respiration,  allmminuria, 
muscular  trembling,  etc.,  are  the  indications  of  this  form  of 
infection. 

In  the  subacute  cases,  which  extend  from  one  to  three 
weeks,  the  symptoms  consist  of  febrile  changes  in  the  tem- 
perature, disturbed  appetite  and  weakness ;  at  first  serous  later 
purulent  discharge  from  the  eyes  and  nose.  In  addition  there 
may  be  present  either  an  acute  pneumonia  or  pleural  pneu- 
monia, or  an  enteritis.  In  the  presence  of  enteritis  the  excre- 
ments are  of  a  greenish-yellow,  later  of  a  dark  color,  and  fetid. 
Sometimes  there  may  be  present  granulations  and  also  ulcera- 
tions on  the  mucous  membrane  of  the  lips  and  in  the  surround- 
ing parts  and  possibly  caries  of  the  teeth  (Miessner  &  Schern). 
In  such  cases  the  lips,  the  cheeks  and  the  tongue  swell,  they 
show  a  dark  red  discoloration  (exceptionally  an  ulcerative 
keratitis  has  been  observed)  (Friedberger,  Tiede).  The  ani- 
mals are  very  weak  and  die  with  symptoms  of  cachexia.  Only 
in  rare  cases  do  the  symptoms  subside  after  a  while.  However, 
the  recovery  is  not  complete,  the  animals  often  developing  later 
symptoms  of  a  chronic  affection  of  the  lungs  with  cachexia. 

The  chronic  form,  which  usually  develops  in  older  sheep, 
sometimes  from  an  acute  form,  is  characterized  by  the  appear- 
ance of  a  severe  chronic  affection  of  the  lungs.  The  animals 
cough  frequently,  they  have  panting  respiration,  there  is  muco- 
purulent discharge  from  the  nose  and  eyes  and  gradual  emacia- 


Syiiipttiiiis.      I)iaj4:iiusis.  123 

tion.  In  some  cases  there  develops  a  swelling  of  the  carpal  and 
tarsal  joints,  or  a  suppurative  inflammation  of  the  coronary 
hiiud  and  of  the  sensitive  lamina. 

In  some  outbreaks  thread  worms  may  be  found  in  the 
abomasuni  and  the  air  passages,  or  in  both  places,  or  tape 
worms  in  the  small  intestines,  while  in  the  bile  ducts  dystonias 
may  be  present  in  varying  numbers. 

Diagnosis.  The  acute  cases  may  easily  l)e  mistaken  for 
anthrax,  from  which  the  disease  differs  clinically  only  by  the 
absence  of  the  hematuria.  On  autopsy,  however,  the  absence 
of  extensive  gelatinous  infiltrations  and  hemorrhages  as  well 
as  the  absence  of  an  acute  swelling  of  the  sjileen  nuikes  a  prob- 
able differentiation  possible.  In  the  subacute  and  chronic  cases 
the  presence  of  inflannnatory  changes  in  the  lungs  and  serous 
membranes  is  indicative  of  hemorrhagic  septicemia,  especially 
in  cases  in  Avhich  the  lungs  contain  no  lung  parasites.  "Bradsot" 
usually  affects  only  older  sheep  during  the  fall  and  winter 
months,  and  is  characterized  principally  by  rapid  putrefaction 
as  well  as  l)y  the  severe  inflammation  of  the  abomasum  and 
duodenmn.  In  piroplasmosis  there  is  a  pronounced  acute 
swelling  of  the  spleen  in  addition  to  the  characteristic  condition 
of  the  blood.  In  cases  in  which  the  lungs  and  intestinal  canal 
contain  intestinal  parasites  in  great  numl)ers,  especial  care 
should  he  taken  in  the  diagnosis  inasmuch  as  the  demonstration 
of  a  few^  bipolar  bacilli  does  not  of  itself  prove  the  presence  of 
hemorrhagic  septicemia. 

Treatment  and  Prevention.  As  there  is  no  method  of  suc- 
cessful treatment  it  is  advisable  to  kill  the  chronically  affected 
animajs.  The  remaining  animals  in  the  band  may  be  immunized 
and  a  further  spread  of  the  disease  avoided.  For  this  purpose 
the  affected  flock  should  if  possible  be  taken  to  a  large  pasture 
and  from  this  pasture  the  animals  should  be  changed  to  others 
from  time  to  time.  If  on  account  of  unfavorable  weather 
stabling  cannot  be  avoided,  the  stables  should  be  cleaned  and 
disinfected  at  frequent  intervals  in  addition  to  the  isolation  of 
the  affected  animals.  As  animal  endoparasites  favor  the  bacte- 
rial infection,  the  animals  should  not  be  pastured  on  damp 
ground,  in  order  to  prevent  the  disease. 

Immunization.  Lignieres  obtained  good  results  with  his  poly- 
valent vaccine  (see  page  85)  of  which  he  injected  one-quarter  cc. 
snbcutaneonsly  to  sucking  lambs.  Animals  inoculated  by  this  method 
later  resisted  an  intravenous  injection  of  virulent  culture,  while  the 
control  animals  died  either  from  an  acute  or  a  chronic  form  of  the 
disease.  The  polyvalent  immune  serum  (see  page  124)  is  also  sup- 
posed to  have  proved  effective  against  the  disease. 

IMiessner  &  Schem  obtained  satisfactory  results  in  protecting,  and 
sometimes  also  in  curing,  animals  from  the  disease  with  the  serum 
of  horses  v»'hich  had  been  hyperimmunized  \nth  cultures  of  the  bacillus 
ovisepticus.     However,  for  practical  purposes  they  preferred  a  simul- 


124  Infectious  Pneumonia  of  Goats. 

taneous  vaccination  with  immune  sera  and  bacterial  extracts.  But 
as  the  simultaneous  inoculation  produces  an  immunity  which  lasts 
only  about  6  weeks  it  is  advisable  to  vaccinate  again  after  4  to  6  weeks 
with  bacterial  extract.  The  simultaneous  method  has  proven  satisfactory 
in  large  flocks  of  lambs  by  checking  the  outbreak  of  the  disease,  and 
in  most  cases  affected  animals  recovered  after  this  form  of  vaccination. 

The  bacterial  extracts  are  prepared  by  washing  24-hour  agar  cultures 
with  salt  solution.  They  are  killed  with  formalin  and  shaken  for  7  days  in  a 
ball-mill  run  by  electricity.  Then  the  formalin  is  abstracted  from  the  fluid,  it  is 
centrifuged  and  the  clear  fluid  is  utilized  for  the  vaccination.  The  dose  for  the 
vaccination  in  practice  varies  between  2  and  5  cc.  The  bacterial  extract  is  injected 
subcutaneously.  The  immune  serum  is  used  in  doses  varying  from  5  to  18  cc. 
The  subsequent  vaccination  was  made  in  one  case  with  4  cc.  of  extract.  If  serum 
alone  is  used  for  the  inoculation  (10  to  20  cc.)  it  is  advisable  to  repeat  the  injec- 
tion after  4  weeks. 

The  serum  inoculation  alone  was  used  in  five  herds  with  good  results.  On 
the  other  hand  in  the  sixth  herd  68  out  of  171  lambs  died  in  spite  of  the  inocula- 
tions. In  five  herds  over  500  lambs  were  inoculated  with  serum  and  bacterial 
extract,  364  of  which  received  two  inoculations,  and  all  of  which  showed  uniformly 
favorable  results. 

Literature.  Friedberger,  Miinch.  Jahrb.  1882-1883  (Lit.). — Andum,  Unters. 
fiber  den  Schafrotz.  Dorpat  1888.— Galtier,  J.  vet.,  1889,  58  u.  1890,  481.— Lienaux, 
1896,  625.— Conte,  Eev.  vet.,  1897,  516.— Besnoit  &  Cuille,  ibid.,  1898,  465.— Lig- 
nieres.  Bull.,  1898,  797;  1900,  529  (Lit.).— Miessner  &  Schern,  A.  f.  Tk.,  1909, 
XLIV,   44    (Lit.). 

Infectious  pneumonia  of  goats.  Nicolle  &  Refik-Bey  (1896) 
studied  in  Anatolia  a  pneumonia  which  caused  periodically  great  losses 
in  the  goat  herds,  and  especially  among  the  kids.  The  disease  is 
probably  identical  with  the  affection  observed  by  Hutcheon  &  Steele 
in  South  Africa,  which  had  been  introduced  there  in  1880  from  Angora, 
causing  a  loss  of  more  than  12,000  goats. 

The  clinical  manifestations  are  those  of  acute  pneumonia,  such  as 
fever,  cough,  mucous  nasal  discharge,  dullness  on  percussion,  bronchial 
breathing  and  rales  over  one  or  both  sides  of  the  thorax.  Towards 
the  termination  of  the  disease,  which  on  the  average  lasts  for  10  days, 
paralysis  of  the  extremities  usually  appears.  Manifestations  of  enteri- 
tis are  as  a  rule  absent.  Three-fourths  to  four-fifths  of  the  affected 
animals  succumb,  while  those  which  remain  alive  retain  a  persistent 
cough  for  a  long  time. 

The  autopsy  reveals  a  lobular  pneumonia  of  the  lower  anterior 
parts  of  one  or  both  lungs.  The  cut  surface  of  the  hepatized  areas 
is  dry,  granulated,  its  color  violet  red  or  reddish-gray.  The  adjacent 
pleura  is  covered  with  a  moist  fibrinous  membrane.  In  exceptional  cases 
the  affected  part  of  the  lung  becomes  necrotic  and  may  be  found, 
lying  as  a  soft  caseous  mass,  in  a  cavity  formed  by  the  thickened  pleura 
and  the  hepatized  lung  tissue.  The  bronchi  frequently  contain  strongy- 
lides  in  great  numbers. 

Bacteria  which  morphologically  and  in  their  cultural  character- 
istics are  identical  with  the  bipolar  bacilli  may  be  demonstrated  in 
the  lung  tissue  and  in  the  nasal  discharge.  Intrapulmonary  or  intra- 
peritoneal injections  of  virulent  cultures,  especially  w^hen  mixed  with 
lactic  acid,  kill  goats  in  a  few  days.  "When  injected  intravenously  they 
saccumb  in  a  few  hours.  Subcutaneous  injection  results  in  a  pro- 
tracted infection  towards  the  end  of  which  paralysis  sets  in.  The 
intratracheal  infection  is  negative.  Mice,  guinea  pigs,  rabbits  and 
pigeons  are  also  susceptible  to  the  virus.     In  the  abdominal  cavity  of 


Swiiie  Playiie.  225 

guinea   pigs   the   virulence   of   the    virus   is   increased,    while    passage 
through  a  pigeon  increases  its  virulence  still  more. 

Goats  Avliich. alter  a  sul)cutaneous  injection  remain  alive  ac<iuire,  to 
a  certain  degree,  immunity  against  subse(iuent  virulent  infection.  (See 
also  Infectious  Pleuro-pneumonia  of  Goats.) 

Literature.  Hutcheon,  Vet.  J.,  1881,  XIII,  171,  u.  399.— Steele,  ibi.l.,  1S89, 
XXIV,  1.1.3.— Nie-olle  L^-  Refik-Bey,  A.  P.,  lS9(i,  X,  3J1. 

Takosis  of  Angora  Goats.  Under  this  name  ]\Iohler  and  Washljurn 
(1902)  described  a  very  malignant  chronic  infectious  disease  of  angora 
goats  Avliich  occurred  in  various  localities  of  the  United  States.  The 
principal  symptoms  are  at  tirst  moderately  high,  later  a  su])normal 
temperature,  pronounced  weakness,  gradually  progressive  anemia  and 
emaciation,  later  diarrhea  and  indications  of  pneumonia.  The  disease 
results  in  death  in  from  one  to  eight  weeks.  The  autopsy  reveals, 
besides  a  pronounced  general  anemia,  small  hemorrhages  in  the  serous 
membranes,  catarrhal  pneumonic  foci  in  the  lungs,  accumulation  of 
transudate  in  the  pericardium,  finally  chronic  catarrh  and,  in  parts, 
superficial  necrosis  of  the  intestinal  mucous  membrane. 

In  the  blood  as  well  as  in  the  transudates  a  small  Gram  positive 
coccus  (micrococcus  caprinus)  was  demonstrated.  Grown  on  artificial 
media  tlie  cultures  showed  great  resemblance  to  those  of  the  staphylo- 
coccus pyogenus  albus.  They  are  pathogenic  for  goats,  chickens,  ral)bits, 
guinea  pigs  and  white  mice.  Intra-abdominal  injection  of  cultures  pi"o- 
duced  in  angora  goats  a  fatal  infection  similar  to  the  natural  disease. 

The  disease  which  has  been  previoush'  observed  by  Pegler  (1885) 
causes  in  the  infected  herds  losses  amounting  from  30  to  85  per  cent, 
which  can  be  reduced  onlv  bv  an  early  isolation  of  the  affected  animals. 
(An.  Ind.,  1002,  XIX,  354.) 


(e)  Swine  Plague.     Septicaemia  suum. 

{Pasteurellosis  suum;  Sepficemie,Pneumonie    contagieuse    du 
pore,  [French];  Schweineseuche,  [German]). 

Swine  plague  is  usually  a  sporadic,  less  frequently  an 
enzootic  infectious  disease  of  hogs  which  with  the  exception 
of  the  peracute  septicemic  cases  is  characterized  principally 
by  a  multiple  necrotic  pleuro-pneumonia.  It  is  caused  by  the 
bacillus  suisepticus. 

History .  Swine  plague  in  its  septicemic  form  was  first  differ- 
entiated from  swine  erysipelas  by  lioffler  (1885)  and  recognized  as  an 
independent  disease.  Shortly  afterwards  Schiitz  (1886)  established  the 
etiological  identity  of  tlje  pectoral  form  with  the  septicemic  form. 
Later  the  disease  was  identified  by  various  authors  (Billings,  Silber- 
schmidt,  Voges)  with  hog  cholera.  In  America  Salmon  (1886)  and 
Smith  (1890)  separated  swine  plague  sharply  from  hog  cholera,  while 
in  Europe  Schutz,  Jensen,  P>ang  and  especially  Preisz  established  its 
independent  nature.  (See  Hog  Cholera.)  It  was  supposed  until  very 
recently  that  swine  plague  very  fre(|uently  occurred  in  association 
with    hog    cholera    as    an    independent    disease.     However,    with    the 


126 


Swiiie  Plague. 


establishment  of  the  etiology  of  the  latter  disease  (see  that  disease)  it 
has  been  proven  that  in  hogs  affected  with  the  filterable  virus  of  hog 
cholera  the  bipolar  bacillus  usually  produces  only  secondary  processes, 
so  that  these  cases  should  properly  be  considered  as  hog  cholera. 

The  over-estimation  of  the  importance  of  the  ovoid  bipolar  bacilli 
being  present  in  the  affected  lung  tissue  caused  many  to  connect  with 
this  disease  the  chronic  catarrhal  pneumonia  of  pigs  as  the  so-called 
chronic  swine  plague,  but  there  are  no  satisfactory  proofs  for  such  a 
conception.  On  our  part  we  separate  this  disease  from  the  true  swine 
plague  and  consider  it  closely  related  to  other  similar  pneumonic 
processes  of  young  animals,  and  principally  as  the  result  of  a  mixed 
infection.  Likewise  the  diseased  processes  caused  by  the  bacillus  pyo- 
genes suis  will  be  discussed  here  under  a  separate  heading  (see  pyo- 
bacillosis),  while  the  name  swine  plague  will  be  retained  for  the  disease 
caused  by  the  bacillus  suisepticus.  This  is  the  disease  which  is  origi- 
nally and  exclusively,  or  at  least  principally,  caused  by  this  organism 
and  which  in  its  anatomical  changes  corresponds  with  the  pathogenic 
nature  of  this  bacterium,  and  which  in  its  classical  form  was  first 
described  by  LofBler  and  Schiitz. 


Occurrence.  Pure  swine  plague  occurs  mostly  in  a  sporadic 
form  in  otherwise  healthy  herds.  Exceptionally  it  may  also 
attain  an  enzootic  form,  but  even  in  sucli  cases  it  remains  con- 
fined to  the  directly  affected  herds  without  spreading  in  the 
usual  way  of  epizootics  from  place  to  place.  In  Hungary  the 
disease  occurred  as  early  as  in  the  eighties  in  the  last  century 
as  a  necrotic  pneumonia  among  fattened  hogs,  but  always  in 
a  sporadic  form. 

In  the  conception  given  alove  for  pure 
swine  plague  the  disease  is  only  of  slight 
economic  importance.  The  losses  which  are, 
even  at  the  present  time,  attributed  to  swine 
plague  are  actually  the  result  of  either  hog 
cholera  or  of  the  catarrhal  pneumonia  of  pigs. 
The  occurrence  of  acute  and  destructive  epizo- 
otics of  pure  swine  plague  has,  at  least  in  cen- 
tral Europe,  never  been  positively  established. 

Borzoni  (1908)  reported  a  fatal  disease  in 
Sardinia  (Angina,  su  fogale,  su  mali,  de  sa  'ula) 
which  occurred  especially  after  long  floods,  pro- 
tracted rains,  or  in  poorly  fed  animals,  which 
caused  a  loss  up  to  90  per  cent,  the  blood  of  the 
affected  animals  showing  a  "  cocco  bacillus;" 
but  in  this  disease  inflammatory  and  necrotic 
changes  are  absent  in  the  organs  of  the  thoracic 
cavity.  Jowett  (1908)  reports  an  outbreak  of 
pure  swine  plague  in  Capland  in  which  on  one 
farm  out  of  100  hogs  40  died  of  pleuro-pneu- 
monia.  The  lungs  in  these  cases  contained 
only  bipolar  bacilli.  The  diagnosis  of  this  out- 
break was,  however,  based  on  the  autopsy  tind- 
ing  of  only  five  carcasses.  Theiler  observed  in  South  Africa  in  the  course  of  years 
only  one  case  of  swine  plague  in  which  hog  cholera  could  be  excluded. 


Fig.  29.  Bacillus  suisepticus. 
Smear  preparation  from  the  fluid 
of  the  lung  of  a  hog.  Fuchsin 
staining ;  and  subsequent  wash- 
ing with  1%  acetic  acid. 


Etiology.  The  bacillus  (bipolaris)  suisepticus  is  charac- 
terized by  the  peculiarities  of  the  l)acilli  of  hemorrhagic  septi- 
cemia (see  page  79),  but  it  is  usually  somewhat  larger,  can  be 
quite  readily  isolated  from  the  animal  body  (especially  from  the 


Etiolujiy      Patliuyx'iiii-ity.  127 

lungs    and   lynipli   glands),   and   also   grows    somewhat   l)etter 
anaerobically  than  do  the  other  varieties  of  this  organism. 

Tenacity.  In  ilistilleJ  water  the  bacilli  retain  their  virulence  up  to  14  days; 
heatintj  for  Vi  of  au  hour  to  58°  C.  kills  them  in  20  minutes,  direct  Bunlij,'ht  in  6 
to  a  minutes,  dill'usod  daylij,dit  in  about  one  hour  (Joest).  Exudate  <lrie(l  on  silk 
threads  loses  its  virulence  in  daylight  after  48,  in  darkness  after  72  hours.  In 
sterilized  milk  the  virus  retains  its  virulence  for  14  days,  in  sour  milk  not  more 
than  a  few  days.  In  hoj?  and  cow  manure,  at  a  depth  from  20  cm.  to  IVi!  m.,  they 
reniain  alive  for  about  14  days  (Beck  &  Koske).  Disinfectants  have  an  effective 
action  on  the  orj^^anism  even  in  nuld  solutions.  Thus  their  development  is  checked 
by  carbolic  acid  1:2000,  sulphuric  acid  1:5500,  potassium  hydrate  1:900;  while 
corrosive  sublimate  1:15000  as  well  as  1/^%  creolin  solution  destroys  the  bacteria 
in  one  minute,  1%  copper  sulphate  solution  in  three,  1%  solution  of  lime  water  and 
chlorate  of  lime  in  20,  1:2000  formalin  in  40,  lastly  iron  sulphate  solution  in  40 
minutes.      (Erdos   &    Koppanyi.) 

Pathogenicity.  The  virulence  of  various  strains  of  the 
bacillus  varies  within  very  wide  limits  and  changes  sometimes 
very  rapidly  even  in  cultures  of  the  same  strain.  Aside  from 
hogs,  animals  susceptible  to  artificial  infection  are  mice,  rabbits, 
guinea  pigs  and  domestic  fowl.  All  animals  of  these  species 
succumb  to  a  subcutaneous  infection  of  0.1  to  0.5  cc.  of  bouillon 
culture  inside  of  24  hours,  dying  of  septicemia.  Ra])bits  are 
especially  susceptible,  and  they  are  killed  in  36  hours  by  0.1 
ec.  of  a  bouillon  culture  diluted  to  a  trillionth  part  (Preisz). 
Some  strains  are  so  much  less  virulent,  that  they  kill  guinea 
pigs  injected  intraperitoneally  and  rabbits  intravenously  only 
with,  difficulty,  and  are  altogether  harmless  for  chickens,  which 
may,  however,  develop  a  chronic  affection  of  the  joints  (Lig- 
nieres).  Carnivorous  animals  succumb  to  intravenous  infec- 
tions. In  large  animals  a  subcutaneous  injection  results  in  a 
local  inflammatory  process  (calves,  however,  may  die),  while 
intravenous  injections  result  occasionally  in  death.  Feeding  of 
cultures  is  not  as  effective,  but  rabbits  may  easily  be  affected 
by  this  metliod.  After  repeated  inoculation  horses  develop  a 
diseased  condition  with  indications  of  a  chronic  intoxication 
and  interstitial  hepatitis. 

Intrapulmonary  injections  cause  multiple  necrotic  pneu- 
monia in  hogs  (Schiitz),  and  sometimes  this  may  also  be  pro- 
duced by  inhalation  of  a  virulent  culture  (Schiitz,  Olt,  Piitz, 
Beck  &  Koske).  Intertracheal  injections  of  the  culture  have  a 
similar  action  (Lignieres,  Karlinski),  and  intravenous  injec- 
tion produces  a  double  pneumonia,  pleurisy  and  pericarditis 
(Smith).  After  subcutaneous  injection  in  the  thigh  an  inflam- 
matory growth  develops  occasionally  at  the  point  of  injection, 
with  which  then  a  lymphangioitis  becomes  associated,  where- 
upon the  animal  dies  in  4  to  5  days  or  may  linger  for  several 
weeks  (in  the  latter  cases  not  infrequently  inflammatory  mani- 
festations of  the  different  joints  develop  in  addition  to  the 
cachectic  manifestations.  Autopsy  frequently  reveals  in  acute 
cases  a  necrotic  pleuro-pneumonia  with  hemorrhages  (Preisz). 
In  the  majority  of  cases,  however,  the  local  inflammatory  pro- 
cesses, subside,  and  the  animal  recovers,  or  the  inoculation  does 


128  Swine  Plague. 

not  produce  any  perceptible  symptoms.  After  intraperitoneal 
infection  an  acute  croupous  diphtheritic  enteritis  develops. 
Vigorous  hogs  cannot  be  infected  fatally  by  feeding  (Gniichtel 
succeeded  in  doing  so  by  weakening  the  pig  by  continued 
cooling). 

According  to  Ostertag  it  is  possible  to  produce  the  so  called  chronic  swine 
jjlague,  or  the  indiileut  pneumonia  of  entirely  cdirouic  catarrhal  nature,  which  charac- 
terises this  disease,  by  inhalation  of  pathologic  lung  substance  as  well  as  with  pure 
cultures  of  the  ovoid  bacterium.  However,  the  limited  number  of  experiments  do 
not  appear  sufficiently  conclusive  proof  for  Ostertag  's  contention,  inasmuch  as 
other  authors  always  produced  by  inhalation  an  acute  form  of  necrotic  pneumonia 
if  any  disease  at  all. 

Toxins.  Novy  isolated  from  cultures  of  the  bacillus  suisepticus 
a  basic  substance  which  he  named  "Susotoxin, "  and  which  in  a  watery 
solution  in  quantities  of  0.125  to  0.25  cc.  subcutaneously  injected  into 
rabbits  produced  death  in  36  hours.  Schweinitz  isolated  from  the 
cultures  a  toxin  and  an  albumose  which  he  named  "  Suplagotoxine " 
and  "  Suplagoalbumin. "  Filtrates  of  fresh  ])Ouillon  culture,  if  free 
from  bacteria,  are  not  toxic.  On  the  other  hand,  killed  masses  of 
bacteria  produce  a  toxic  action  on  small  test  animals.  (Guinea  pigs 
are  destroyed  by  8  to  10  mg.  of  killed  bacteria  [Voges] ).  Klett  &  Braun. 
could  by  their  method  demonstrate  toxins  in  large  (juantities  in  the 
filtrates  of  cultures  which  produced  the  characteristic  symptoms  of 
cholera  in  pigeons  and  chickens,  viz.,  somnolence  and  intoxication.  At 
the  same  time  the  toxicity  of  the  cultures  did  not  run  parallel  with 
their  virulence  (see  page  137).  According  to  Beck  &  Koske  fresh 
filtrates  of  cultures  produce  a  temporary  rise  in  temperature  while 
killed  cultures  as  well  as  filtrates  of  old  cultures  are  very  toxic. 
McFadyean  succeeded  in  extracting  from  the  bacterial  cells  a  filterable 
poison  which  was  found  to  be  very  toxic  for  rabbits,  guinea  pigs  and 
mice. 

Natural  infection.  The  experience  that  pure  swine  plague 
occurs  usually  in  a  sporadic  form  or  only  in  a  limited  enzootic 
extension  indicates  that  the  transmission  from  animal  to  ani- 
mal has  only  an  insignificant  part.  On  the  other  hand,  the  fact 
that  bacteria  which  correspond  with  the  true  swine  plague 
organism  in  all  their  characteristics,  are  present  in  the  soil  and 
accordingly  also  in  the  food  and  drinking  water  as  well  as  in 
the  air  passages  and  intestinal  canal  of  healthy  hogs  proves 
that  the  development  of  the  disease  is  associated  with  these 
facultative  pathogenic  bacteria.  It  may  be  accepted  as  highly 
probable  that,  in  a  similar  way  as  in  the  other  diseases  of 
the  hemorrhagic  septicemia  group,  the  usually  harmless  habi- 
tants of  the  hog  produce  a  pathogenic  action  under  certain 
conditions,  which  are  unknown  at  the  present  time.  It  is  possi- 
ble that  the  liacteria  attain  a  higher  virulence  before  entering 
the  animal  body  so  that  they  are  capable  of  attacking  the 
normal  tissues  of  the  animal.  However,  it  probably  happens 
more  frequently  that  the  normal  resistance  of  the  organism  is 
diminished  by  various  weakening  influences,  so  that  now  even 
the  less  virulent  bacteria  may  exert  a  pathogenic  action.    Lig- 


Natural    In  Icclion.  199 

nieres,  Uhlonlmth  and  Gniichtol  proved  the  prcdisposiiii;'  iiillu- 
eiice  of  colds  by  exporinioiit,  wliilo  Salmon  and  Katz  established 
the  fact  that  the  infection  is  facilitated  by  the  presence  of 
parasites  in  the  intestinal  canal  and  in  the  air  passages  ( Ascaris 
iunil)ricoides,  Echinorliynclms  gigas,  Sti-ongyhis  pai-adoxiis). 
In  the  presence  of  snch  parasites  tlie  bacteria  inay  more  readily 
])enetrate  the  affected  or  injnred  mucous  membrane.  There 
may  be  also  other  iiiHuenees,  such  as  poor  condition,  exhaustion 
during  transi)ortation,  etc.,  especially  in  young  animals  increas- 
ing the  susceptibility  to  the  pathogenic  action  of  these  ubicjui- 
tous  organisms,  which  is  usually  not  marked.  The  most  im})or- 
tant  part,  however,  in  the  infection  witli  the  swine  plague 
organisms  may  be  attrilmted  to  the  virus  of  hog  cholera  and  the 
primary  infection  caused  by  it,  and  as  a  matter  of  fact  in  hog 
cholera  outbreaks  there  are  very  frequently  found  changes  of 
organs  which  are  analogous  to  the  swine  plague  infection  (see 
hog  cholera). 

Ovoid  bacteria  which  closely  correspond  niorpliologically  and  in 
their  cultural  characteristics  with  the  swine  plague  organisms  were 
first  found  in  healthy  animals  by  Smith  then  hy  Moore,  Bang,  Jensen, 
Karlinski,  Kitt,  Klein  and  Haushalter.  Sometimes  they  were  only 
slightly  virulent,  or  not  at  all.  In  Jensen's  experiments,  however, 
various  strains  killed  mice  promptly  and  Bauermeister  found  that 
bacteria  which  he  grew  from  acinous  glands  were  very  pathogenic 
for  test  animals,  while,  on  the  other  hand,  Karlinski  as  "well  as  Beck 
&  Koske  succeeded  in  markedly  increasing  the  virulence  of  the  originally 
shghtly  virulent  strains. 

While  the  first  appearance  of  swine  plague  in  healthv  herds 
may  be  associated  with  soil  infection,  and  also  frequentlv  with 
weakening  influences  acting  upon  the  animals,  the  occasional 
direct  or  indirect  infection  from  the  first  affected  animals,  like 
in  the  other  diseases  of  the  hemorrhagic  septicemia  group, 
cannot  be  left  out  of  consideration.  Affected  hogs  pass  with 
their  excretions,  and  especially  with  the  mucus  which  thev 
cough  up,  great  numbers  of  very  virulent  bacilli  Avhich  then 
enter  the  bodies  of  healthy  hogs  and  may  by  their  great  numbers 
and  high  virulence  produce  inflammatory  processes  in  them.  In 
this  manner  an  infected  animal  which  has  been  purchased  and 
added  to  a  healthy  herd  may  produce  the  disease  among  the 
other  animals.  As  a  matter  of  fact,  however,  healthv  hogs  resist 
such  an  infection  in  most  instances.  The  fact  that  local  out- 
breaks usually  die  out  rapidly,  even  without  any  particular 
measures  of  eradication  may  be  attributed  to  a  rapid  diminu- 
tion of  the  virulence  of  the  infective  agent  outside  of  the  ani- 
mal body. 

As  the  ovoid  bacteria  occur  also  in  animals  affected  with 
other  diseases,  or  may  subsequeidly  ontei-  such  affected  bodies, 
tliey  may  exert  a  specific  pathogenic  action  in  already  affected 
organs.    In  this  manner  a  preexisting  catarrhal  pneumonia  may 


130  Swine  Plague. 

by  secondary  infection  pass  into  a  fibrinous  or  necrotic  pneu- 
monia (such  cases,  wliicli  are  observed  especially  after  long 
transportation,  have  been  taken  repeatedly  as  proof  for  the 
identity  of  the  primary  chronic  and  the  superimposed  acute 
processes). 

In  the  pneumonic  lungs  of  animals  affected  with  swine  plague  other 
bacteria  than  the  ovoid  bacilli  may  often  be  found  in  vaiying  numbers 
in  the  acute  cases,  but  more  so  in  the  chronic  cases.  Of  these  strepto- 
cocci, staphylococci,  colon  bacilli,  bac.  viscosus  (Preisz),  bac.  pyogenis 
suis,  bac.  necrophorous  and  others  are  frecjuently  present.  They  come 
into  consideration  only  as  secondary  invaders  which  produce  local 
changes  in  the  already  affected  tissues  (small  suppurative  centers,  etc.). 
The  presence  of  these  organisms  may  be  explained  by  the  fact  that 
they  are  also  frequent  inhabitants  of  the  air  passages,  and  may  occa- 
sionally multiply  under  abnormal  conditions.  Clearly  different  are 
conditions  in  the  enzootic  pneumonia  of  pigs,  this  disease  being  in  all 
probability  the  result  of  a  mixed  infection,  and  the  ovoid  bacteria  play 
here  probably  an  unimportant  role.  This  is  indicated  by  the  fact  that 
in  about  one-third  of  the  cases  the  demonstration  of  this  organism  from 
the  pneumonic  tissue  is  not  possible. 

The  susceptibility  of  hogs  for  this  disease  is  principally 
affected  by  their  condition  of  health  or  by  the  reduction  of 
their  natural  resistance  as  a  result  of  ^veakening  influences. 
Very  young  animals  rarely  become  affected,  otherwise  age  does 
not  seem  to  have  any  influence. 

Those  diseases  of  hogs  which  sometimes  develop  in  association  with 
hemorrhagic  septicemia  of  other  animals  are  identical  in  their  nature 
with  true  swine  plague.  Thus,  simultaneous  affection  in  hogs  may 
especially  be  observed  during  outbreaks  of  hemorrhagic  septicemia  in 
cattle  as  well  as  in  outbreaks  of  buffalo  disease  (see  the  latter).  Occa- 
sionally also  hogs  may  be  affected  while  influenza  of  horses  is  prevalent 
(Schindelka),  or  chicken  cholera  (Gorges).  On  the  other  hand,  in 
outbreaks  of  swine  plague  other  species  of  animals  may  become  affected. 
Thus  Galtier  observed  affections  in  sheep  which  were  kept  in  the  same 
stable  with  affected  hogs,  or  which  were  pastured  in  the  same  field 
where  carcasses  of  hogs  were  buried,  while  Keleti  saw  lambs  die  during 
outbreaks  of  swine  plague.  Both  authors  demonstrated  in  the  organs 
of  the  affected  sheep  bipolar  bacilli  (see  page  119).  Lastly  Goldstein 
as  well  as  Chamberland  &  Jouan  observed  the  death  of  all  the  chickens 
in  a  flock  with  manifestations  of  cholera-like  symptoms  after  they  had 
eaten  from  a  carcass  of  a  hog  which  died  from  swine  plague.  Gorges 
also  has  observed  geese  dying  after  ingestion  of  food  contaminated 
by  affected  hogs. 

Anatomical  Changes.  In  peracute  cases  the  autopsy  reveals 
lesions  of  typical  hemorrhagic  septicemia,  viz.,  numerous  small 
hemorrhages  in  the  skin  or  subcutaneous  fat,  in  the  serous  and 
mucous  membranes,  in  the  kidneys  and  under  the  endocardium, 
larger  hemorrhages  in  the  perirenal  connective  tissue,  in  the 
mucous  membrane  of  the  pelvis  of  the  kidney  and  the  bladder, 


Anatomical   ('liaiig:es. 


131 


as  well  as  in  tlio  nieniiiges.  There  is  also  acute  hemorrhagic 
swelling  of  the  lymph  ghnids  and  gelatinous  serous  inliltration 
of  the  subcutaneous  connective  tissue,  especially  in  the  region 
of  the  throat  and  neck. 

In  the  more  fre(|uent  acute  cases  lesions  in  the  thoracic 
organs  are  constantly  present.    The  lungs  contain  either  small 
or  larger  hepatized  areas,  of  which  the  cut  surface,  according 
to  the  duration  of  the  disease,  is  either  blackish-red  or  dark 
brownish-red    to 
light    gray,    and 
studded    with    mil- 
let   seed    to    hemp 
seed    sized    pale 
yellow    granules 
(croupous    hemor- 
rhagic or  multiple 
necrotic    pneu- 
monia;    Fig.     30). 
Some  of  the  hepa- 
tized areas  are  sur- 
rounded by  a  pale 
yellow     necrotic 
zone.      In    older 
cases,     however, 
larger  areas,  some- 
times   even    entire 
lobes  of  the  lungs, 
are  changed  into  a 
mass  of  cheesy  de- 
tritus.    The  inter- 
lobular   connective 
tissue  is  broadened 
and  shows  a  serous 
or  bloody  infiltra- 
tion as  a  result  of 
which  the  cut  sur- 
face has  a  mottled 
appearance.      The 
pleura  over  the  af- 
fected areas  of  the 
lungs     is     covered 
with  loose  or  more 
adhesive    fibrinous 
deposits      under 
which    the    pleura 
contains       small 
hemorrhages   or   shows   bloody   infiltration.      In    the   thoracic 
cavity  sero-fibrinous  exudate  may  be  present  in  varying  (juan- 
tities   (exceptionally  pleurisy  may  occur  without  pneumonia). 
A    similar    inflammatory    process    exists    frequently    on    the 


Fif,'.  30.  Multiple  necrotic  pneidnoniti  in  sn-ine  phiq\te. 
(ii)  Con<rosted  lunj,' tissue  still  containin-,' air  :  (h)  brown- 
ish-red hepatization;  (c)  yrayish-red  liepatization ;  (d) 
dilated  septum;  (c)  necrosis  of  a  lobule;  (f)  necrotic 
focus  (center  dark  red,  border  pale  yellow)  ;  (y)  bronchus. 


132  Swine  Plague. 

pericardium.  The  peribronchial  h^mph  glands  are  acutely 
swollen,  and  not  infrequently  studded  with  small  hemorrhages. 

The  mucous  membrane  of  the  stomach  and  intestines  shows 
a  catarrhal  swelling  and  frequently  also  numerous  hemorrhagic 
spots.  In  some  cases  the  surface  is  covered  with  fine  croupous 
pseudo-membranes,  or  it  may  appear  as  though  sprinkled  with 
bran  as  a  result  of  the  necrosis  of  the  epithelium.  These 
changes  are  especially  marked  in  the  posterior  part  of  the  small 
intestines  or  in  the  large  intestine.  The  solitary  follicles  and 
the  Peyer's  patches  are  swollen  or  contain  shallow  ulcers. 
The  spleen  usually  shows  no  changes  or  only  a  slight  swelling. 
Sometimes  it  contains  several  pale-red  firm  areas.  The  kidneys 
are  hyperemic,  and  some  wedge-shaped  portions  are  sometimes 
grayish  in  color. 

In  the  chronic  cases  the  lungs  of  the  greatly  emaciated 
carcass  show  extensive  necrotic  foci  without  any  signs  of  acute 
inflammation.  Exceptionally  there  may  be  sequestra  inclosed 
in  thickwalled  cavities  or  cavities  which  communicate  with 
the  bronchi.  In  other  cases  fairly  large  hepatized  areas  of  the 
lungs  are  studded  with  numerous  small  yellow  or  gray  necrotic 
foci. 

Caseous  foci  may  also  be  found  in  the  peril)roncliial  and 
mesenteric  glands,  in  the  tonsils,  in  some  joints,  in  bones  and 
in  the  subcutaneous  connective  tissue.  Possibly  also  so-called 
caseous  inflammation  of  the  intestines,  in  which  the  mucous 
membrane  of  the  large  intestines  is  broken  down  forming  a  dry 
mushy  mass,  belongs  to  the  anatomical  lesions  of  swine  plague 
(Schiitz,  Peters). 

In  the  peracute  cases  the  bipolar  bacteria  are  present 
usually  in  great  numbers  in  the  blood  and  in  all  organs.  In 
subacute  cases  they  may  be  found  in  the  affected  parts  of  the 
lungs,  the  bronchial  secretion  and  in  the  exudate  of  the  serous 
membranes,  sometimes  also  in  the  blood  and  likewise  in  great 
numbers.  On  the  other  hand,  in  the  chronic  cases  they  may  be 
demonstrated  only  in  the  necrotic  regions,  mostly  in  association 
with  other  bacteria  and  even  in  such  cases  they  may  be  detected 
only  with  great  difficulty. 

According  to  the  histological  examinations  of  Marek  the  hemor- 
rhages develop  either  as  a  result  of  bacterial  emboli  or  as  a  result  of 
a  toxic  affection  of  the  walls  of  the  blood  vessels  (the  latter  especially 
in  the  kidneys).  The  infarcts  of  the  lungs  and  kidneys  may  also 
result  from  thrombosis  of  blood  vessels.  The  pneumonia  is  rarely 
catarrhal  but  more  frequently  croupous,  developing  in  its  later  course 
a  coagulation  necrosis.  Coagulation  necrosis  may  also  be  observed 
in  small  foci  in  the  liver  and  in  the  adrenals.  The  nephritis,  which 
is  present  in  all  acute  cases,  leads  to  parenchymatous  degeneration  of 
the  epithelial  cells,  serous  infiltration  of  the  interstitial  tissue,  hemor- 
rhages and  necrotic  foci. 

Symptoms.  After  artificial  infections  by  subcutaneous  or 
intratracheal  injections  or  by  inhalation  of  virulent  material, 
the  time  of  incubation  is  usually  only  a  few  hours  or  one  to 


Syiiij)loiiis.  \'.V,\ 

two  clays.     Under  nahiral  conditions  also  it  is  probably  very 
short,  ])arti('iilarly  if  some  ])re(lis})osinj^'  i'aetoi"  exists. 

The  peraciite  cases  ol"  the  disease  nianit'est  the  typical 
symptoms  of  hemorrhagic  septicemia.  As  the  fever  rises  to 
40'^C  and  over,  the  animals  become  weak,  lose  their  appetite 
and  lie  motionless  on  the  gronnd.  In  the  pastnre  they  separate 
from  the  herd,  and  in  the  stal)le  they  nsnally  crawl  under 
the  straw.  If  urged  to  move  they  have  a  staggering  gait,  may 
move  in  a  circle  or  execute  other  forms  of  involuntary  move- 
nuMits.  Red  spots  develop  on  different  parts  of  the  body,  espe- 
cially under  the  ears,  on  the  neck  and  on  the  rumps  which  do 
not  disappear  on  pressure,  and  hemorrhages  may  occur  from 
the  nose,  the  intestines  and  urinary  organs.  In  some  animals 
s^^nptoms  of  a  severe  acute  pliaryngitis  may  l)e  observed.  The 
patients  usuall}'  die  in  12  to  24  hours  after  the  appearance  of 
the  first  spnptoms. 

In  the  acute  course  the  clinical  picture  corresponds  in  the 
majority  of  cases  with  that  of  acute  pneumonia.  The  fevered 
animals  have  a  short,  dry  and  spasmodic  cough,  assume  fre- 
quently squatting  position  like  dogs,  while  slimy  material  is 
expelled  from  their  mouths.  The  respiration  is  accelerated 
and  labored,  especially  during  expiration,  the  animal  frequently 
standing  with  legs  spread  apart  and  with  mouth  open.  The 
patient  manifests  pain  on  palpation  of  the  thorax.  The  nose 
discharges  a  sticky,  slimy  secretion.  Later  the  paroxysms  of 
coughing  become  more  frequent  and  more  severe;  the  respira- 
tion is  very  labored,  rattling,  the  temperature  remaining  con- 
stantly around  41°C.  The  animals  become  visibly  emaciated 
and  finally  they  can  hardly  rise  from  the  ground. 

The  mucous  membranes  are  cyanotic,  a  purulent  conjunc- 
tivitis may  sometimes  be  observed.  The  heart  action  is  accel- 
erated, later  throbbing.  There  is  at  first  constipation,  later 
diarrhea  sometimes  with  bloody  excrement.  Towards  the 
termination  of  the  disease  red  spots  may  also  be  observed  on 
the  skin. 

The  duration  of  the  acute  form  usually  extends  from  1  to 
2  weeks.  Complete  recovery  is  very  rare,  although  occasionally 
the  condition  temporarily  improves,  but  usually  it  passes  into 
the  chronic  form  of  the  disease. 

The  chronic  form  usually  follows  the  acute.  After  the 
subsidence  of  the  acute  s^nnptoms  indications  of  a  lung  affec- 
tion with  periodical  coughing  and  difficulty  in  respiration  will 
persist  for  a  long  time.  In  such  cases  the  animals  show  dis- 
turl)ed  appetite,  progressive  emaciation,  and  occasionally 
chronic  inflammation  develops  in  the  joints.  Towards  the  ter- 
mination of  these  cases  also  there  is  fetid  diarrhea,  and  the 
animals  die  in  from  3  to  6  weeks  from  complete  exhaustion. 
Not  infrequently,  however,  the  affection  in  the  lungs  remains 
stationary  and  the  animals  may  even  Ix'  fattenccl  in  spite  of 
the  encapsulated  foci  in  these  organs. 


134  Swine  Plague. 

In  the  swine  plague  observed  by  Borzoni  in  Sardinia  (see  page 
126)  one  form  of  the  disease  is  manifested  by  symptoms  of  a  general 
febrile  affection,  greenish  fetid  diarrhea  and  red  spots  on  various 
parts  of  the  body,  as  well  as  by  a  very  pronounced  acute  edematous 
swelling  of  the  throat  region.  The  other  form  commences  with  a  marked 
bloody  serous  infiltration  of  the  subcutis  on  the  extremities,  with  which 
an  inflammatory  swelling  of  the  neck  becomes  associated  in  the  course 
of  a  few  days.  The  autopsy  shows  bloody  serous  infiltration  of  the 
subcutaneous  and  intramuscular  connective  tissue  and  of  the  tongue, 
and  in  addition  to  this  only  an  acute  swelling  of  the  lymph  glands  and 
a  slight  intestinal  catarrh. 

Diagnosis.  The  peracute  septicemic  form  of  the  disease 
may  be  mistaken  for  acute  hog  cholera,  from  which  it  can  be 
distinguished  only  by  the  demonstration  of  the  bipolar  bacilli 
in  the  blood. 

The  recognition  of  the  lung  affection  in  process  of  devel- 
opment is  quite  easy  but  the  diagnosis  of  its  exact  nature  is 
much  more  difficult.  Verminous  bronchitis  is  very  similar  in 
its  manifestations.  This,  however,  has  a  much  slower  course 
and  attacks  usually  only  young  animals. 

The  greatest  difficulty  is  met  with  in  differentiating  swine 
plague  from  hog  cholera.  The  sporadic  appearance  of  the  dis- 
ease or  its  confinement  to  individual  premises,  with  sjTuptoms 
pointing  to  an  affection  of  the  lungs,  are  indicative  of  swine 
plague.  However,  if  there  exists  a  possibility  of  hog  cholera 
or  the  very  frequent  mixed  infection  its  differentiation  in  the 
living  animal  is  impossible. 

On  autopsy  pure  swine  plague  may  be  accepted  with  a 
certain  probability  when  in  addition  to  the  described  changes 
in  the  lungs  (acute  croupous-hemorrhagic  or  necrotic  pneu- 
monia), the  hemorrhages  and  acute  swelling  of  the  lymph 
glands,  there  are  no  diphtheritic  or  caseous  inflammatory  areas 
present.  The  differentiation  from  hog  cholera  even  in  such 
cases  is  absolutely  established  only  by  filtration  experiments, 
in  which  positive  results  are  indicative  of  the  presence  of  hog 
cholera.  On  the  other  hand  a  negative  finding  does  not  estab- 
lish the  absence  of  hog  cholera,  inasmuch  as  the  virus  of  the 
latter  disease  may  already  have  disappeared  from  the  body 
either  partly  or  entirely.  In  such  cases  the  sporadic  character 
of  the  disease  in  herds  which  otherwise  continue  to  remain 
healthy  speaks  for  pure  swine  plague.  The  epizootic  character 
should  therefore  be  given  a  weighty  consideration  in  the  estal)- 
lishment  of  a  diagnosis. 

Less  difficult  appears  the  differentiation  from  catarrhal 
pneumonia  of  pigs.  This  affection  occurs  only  in  very  young 
animals;  the  pneumonia  has  a  purely  catarrhal  form,  with  or 
without  fibrinous  exudate.  This  applies  also  to  those  cases 
in  Avhich  the  affection  proves  clinically  and  anatomically  to  have 
commenced  Avith  a  chronic  catarrhal  form  of  pneumonia,  and 
only  later  developed  into  an  acute  form.     In  such  cases,  the 


Diagnosis.     Treatment.     ImiiMiiiization.  135 

upper  ami  posterior  parts  of  the  lungs  usually  show  in  addition 
to  catarrhal  pneumonia  a  croupous-catarrhal  intlannnation. 

The  demonstration  of  hipolar  ovoid  baeilli  even  though  they  are 
highly  virulent  has  only  a  very  restricted  and  subordinate  diagnostic 
value.  Their  presence  is  of  itself  by  no  means  sufficient  to  estai)lish 
the  diagnosis  of  swine  plague,  as  these  l)acilli  may  be  present  ([uite 
accidentally  or  may  have  taken  only  a  secondary  part  in  the  development 
of  the  pathological  processes.  Only  if  they  are  present  in  great  num- 
bers and  exclusively,  or  almost  exclusively,  in  the  inflammatory  pro- 
ducts, may  they  be  accepted  as  the  direct  causative  agents  of  the 
disease  and  even  in  such  cases  the  possibility  must  be  considered  that 
the  disease  was  caused  primarily  by  the  much  more  vigorous  hog 
cholera  virus. 

Swine  erysipelas  usually  runs  a  more  rapid  course  and 
manifestations  of  pneumonia  are  absent.  On  autopsy  this 
disease  may  be  distinguished,  aside  from  the  different  bacterio- 
logical findings,  by  the  absence  of  post  mortem  lesions.  In 
chronic  cases  tuberculosis  comes  into  consideration  and  the 
positive  differentiation  is  only  possible  by  a  bacteriological 
examination.  The  pyobacillosis  of  pigs  or  its  complications  are 
characterized  by  purulent  catarrh  as  well  as  yellow  or  greenish 
suppurative  areas  in  the  lungs  and  in  other  organs,  by  which 
it  may  be  differentiated  from  swine  plague. 

Treatment  and  Prevention.  Medicinal  treatment  has  up  to 
date  proved  without  effect. 

Becker,  Spitzer  and  Szollos  reported  favorable  results  with  the 
proprietary  remedy  called  suptol  and  prepared  by  Burow  (according 
to  Andrejew  it  is  a  preparation  of  swine  plague  bacilli).  On  the  other 
hand  Tatray  employed  this  remedy  in  17  herds  on  several  thousand 
animals  with  varying  results,  which  agrees  with  the  findings  of  the 
Prussian  Official  Veterinarians.  Andrejew  and  Gellmann  deny  its 
protective  and  curative  action. 

Immediate  separation  of  the  afTected  animals,  effective 
disinfection  of  stable  and  feeding  trough,  destruction  of  the 
affected  organs  and  secretions  and  of  the  manure  appears  to 
be  advisable;  even  though  the  danger  of  infection  is  slight, 
nevertheless  it  should  be  considered.  From  a  standpoint  of 
veterinary  police  it  is  advisable  to  separate  swine  plague  from 
hog  cholera,  and  to  treat  it  in  the  same  manner  as  hemorrhagic 
septicemia  of  cattle. 

Immunization.  Since  the  etiology  of  hog  cholera  has  been 
studied  more  closely  the  former  attempts  of  elaborating  effec- 
tive methods  of  immunization  against  this  disease,  as  well  as 
against  swine  plague  which  is  frequently  associated  ^\ith  it, 
from  the  cultures  of  the  bacillus  suisepticus,  have  proven  of 
very  doubtful  practical  value.     Considering  that  an  immuniza- 


136  Swine  Plague. 

tion  against  pure  swine  plague  does  not  appear  necessary, 
because  of  its  rather  harmless  character,  vaccines  prepared 
from  this  organism  could  at  best  be  considered  as  a  probable 
protection  against  the  secondary  infections  of  hog  cholera,  and 
also  perhaps  to  a  certain  degree  as  protective  against  the  pneu- 
monia of  pigs  depending  on  a  mixed  infection  with  the  swine 
plague  organism.  Nevertheless  the  numerous  experiments  for 
the  establishment  of  a  method  of  vaccination  which  would  pro- 
tect against  the  infection  with  the  bacillus  suisepticus  have  a 
practical  importance  inasmuch  as  some  of  them,  especially  the 
inoculation  with  immune  sera  against  the  so-called  chronic 
swine  plague  of  pigs  (see  page  142),  are  extensively  employed 
in  Germany. 

1.  Active  Immunization.  In  rabbits  and  guinea  pigs  this  may  be 
attained  with  cultures  killed  at  58"'  C.  (Smith  &  JMoore),  as  well  as  with 
the  toxic  substances  isolated  from  the  cultures  (Suplagotoxin  and  Sapla- 
goalbumin  (see  page  128),  with  which  Schweinitz  succeeded  in  pro- 
tecting hogs  against  artificial  infection. 

More  recently  Veil  imnuuiized  hogs  with  an  exudate  (aggressin) 
obtained  from  infected  rabbits  and  hogs  of  which  10  cc.  injected  in 
two  parts  or  as  one  dose  into  the  blood  afforded  a  protection  against 
a  lethal  artificial  infection.  In  order  to  protect  the  animals  against 
natural  infection,  which  is  especially  dangerous  at  the  connnencemcnt 
of  the  treatment,  the  simultaneous  use  of  antiaggressive  imuume  serum 
is  recommended.  Similar  favorable  results  were  obtained  by  Citron 
in  rabbits  and  guinea  pigs  with  exudate  as  well  as  with  extracts  from 
cultures,  and  animals  immunized  by  his  method  withstood  a  hundred 
thousand  times  larger  dose  than  that  necessary  for  fatal  infection. 
Titze  employed  shake-extracts  of  tiltrates  made  from  cultures,  and 
recently  Miessner  &  Schern  used  pleural  exudate  and  heart  blood  from 
rabbits  containing  aggressins  and  sterilized  at  44*^0.  with  which 
they  produced  an  active  innnunity  in  guinea  pigs  against  virulent 
infection  with  swine  plague  bacteria. 

Beck  &  Koske  produced  an  active  immunity  in  pigs  by  in.iecting 
them  intraperitoneally  first  with  0.5  cc.  of  fresh  bouillon  culture  heated 
to  55°  C.  for  20  minutes,  and  seven  days  later  with  1  cc.  of  virulent 
culture  into  the  muscles  of  the  thigh.  Broil,  however,  found  that  the 
animals  occasionally  became  fatally  affected  with  peritonitis  and  enter- 
itis as  a  result  of  the  first  infection,  due  to  the  poisonous  toxic  action 
of  the  killed  bacilli,  and  further  that  the  vaccination  in  infected  herds 
favored  the  development  of  new  cases  before  immunity  had  been 
established. 

According  to  Broil's  experiments  the  administration  of  living  fowl 
cholera  bacteria,  or  of  such  killed  by  heating  for  20  hours  at  52'  to 
55°C.  does  not  produce  a  sufficient  resistance  against  swine  plague  infec- 
tion, whereas  swine  plague  bacteria  killed  in  a  similar  manner  produced 
in  pigs  a  high  grade  of  protection.  The  best  results  against  artificial 
infection  were  obtained  with  a  48-hour  shake-extract  prepared  by  the 
method  of  Wassermann  &  Citron.  The  extract  is  not  filtered,  and  is 
sterilized  by  the  addition  of  mustard  oil.  The  vaccination  of  new 
born  pigs  is  recommended  with  such  extract  and  immune  serum  (the 
serum  is  supposed  to  prevent  an  infection  during  the  negative  phase), 


liiiiiuuiizatidii.  137 

and  in  case  the  protection  is  not  sufficient  the  animals  may  l)e  re  vac- 
cinated shortly  before  weaning  with  the  bacterial  extract. 

2.  Serum  Immunization.  Blood  serum  from  animals  treated 
with  virulent  eulturcs  of  the  haeillus  sniseptieus  ])votects  test 
animals  for  a  short  time  against  a  subsequent  virulent  infection. 
As  a  result  of  these  experimental  findings  serum  of  horses 
hv])erimmunized  by  subcutaneous  and  intravenous  injection  of 
increasing  doses  of  virus  has  been  used  in  numerous  instances 
for  the  immunization  of  hogs  (see  also  page  141). 

Schweinitz  had  already  in  1890  immunized  horses,  mules  and  cattle 
with  either  living  or  dead"  cultures,  as  well  as  with  filtrates,  and  also 
with  toxic  substances  isolated  from  cultures,  lie  proved  that  the  serum 
of  such  imnmnized  animals  afforded  a  protective  action  aganist  an 
infection  with  the  bacillus  suisepticus  or  against  the  action  of  its 
toxins.  The  serum  was  usually  employed  together  with  the  hog  cholera 
serum  against  the  mixed  infection,  which  occurs  in  America,  hut  with 
doubtful  results. 

Later  Schreiber  obtained  an  immune  serum  from  horses  treated 
with  cultures,  which  was  placed  on  the  German  market  under  the  name 
"Septizidin."  According  to  his  views  his  product  possesses  both  a 
protective  and  also  a  curative  action,  and  is  often  used  against  the 
septic  pneumonia  of  calves. 

Polvvalent  immune  serum.  According  to  Wassermann  &  Ostertag 
blood  serum  of  artificially  immunized  animals  usually  protects  only 
against  the  variety  of  the  bacillus  suisepticus  which  had  ])een  used  for 
the  immunization.  On  the  other  hand  its  action  against  the  other 
varieties  of  this  organism  is  inefit'ective  in  spite  of  the  fact  that  morpho- 
logically and  in  their  cultural  characteristics  they  are  identical.  Ac- 
cording to  their  conception  the  protoplasm  of  the  bacterial  cell  consists 
of  different  components  which,  in  the  different  varieties  of  the  same 
bacterium,  are  to  some  extent  not  identical.  Besides  a  common  domi- 
mant  receptor  which  is  to  be  considered  as  the  carrier  of  the  special 
characteristics  of  the  species  of  bacteria,  the  different  varieties  may 
contain  individually  different  side-receptors.  Inasmuch  as  during  the 
process  of  immunization  the  various  components  produce  corresponding 
immune  bodies  (amboceptors)  by  binding  the  receptors  adapted  to  them 
(Ehrlich's  theory),  all  these  immune  bodies  bind  the  dominant  re- 
ceptor; but  the  side-receptors  of  the  variety  which  have  been  used 
for  the  immunization,  thereby  afford  a  protection  only  against  the 
latter,  and  are  ineffective  against  varieties  containing  other  side- 
receptors.  The  above  mentioned  authors  accordingly  treated  horses 
with  as  many  varieties  as  possil)le  of  th*^  bacillus  suisepticus  and  found 
that  the  serum  proved  effective  against  all  the  different  varieties.  This 
polyvalent  or  multipartial  serum  with  a  titre  of  not  less  than  0.01  cc. 
for  mice  against  a  dose  ten  times  the  fatal  dose  of  a  living  culture 
has  been  used  especially  against  the  pneumonia  of  pigs. 

IniiiiuTii?ation  with  chicken  cholera  senmi.  Klett  &  Braim  employ  serum  of 
horses  which  have  been  treated  for  a  lonjj  period  with  a  mxitnre  of  toxins  from 
killed  cultures  and  their  filtrates,  and  which  afterward  have  been  inoculated  with 
fidlv  virulent  chicken  cholera  bacteria.  These  authors  contend  that  the  bacilli  of 
fowl  cholera  produce  the  same  toxin,  only  in  larger  quantities,  as  the  bacilli  of 
swine  plaf,'ue.  Serum  from  horses  treated  in  the  above  manner  protects  gray  mice, 
in  quantities  of  0.0015-0.005  gm.,  against  a  fatal  infection  of  a  loopful  of  virulent 


138  Enzootic  Pneumonia  of  Pigs. 

swine  plague  culture,  while  if  the  serum  treatment  has  been  given  24  hours  pre- 
viously, it  also  has  projective  action  against  the  toxins  of  chicken  cholera  and 
swine  plague  bacteria.  The  passive  immunity  lasts  from  3  to  4  weeks,  while  active 
immunity  could  not  be  produced  even  in  mice  by  serum  and  culture  injections. 

Literature.  Loffler,  Arb.  d.  G.-A.,  1886,  1,  46.— Schutz,  A.  f.  Tk.,  1886, 
All,  210. — Salmon  &  Smith,  Bur.  of  Anim.  Ina.,  18S{)-1.S»4. — Smith,  Spec.  rep. 
of  the  cause  of  swine-plague,  Washington,  1891. — Preisz,  Z.  f.  Tm  1898  II  1 
u.  1907,  XI,  161.— Lignieres,  Bull.,  1900,  389  (Lit.).— Beck  &  Koske,  Arb.  d.  G.-A.' 
1905,  XXII,  181. — Joest,  Schweineseuche  u.  Schweinepest,  Jena  1906  (Complete 
Lit.).— Ostertag  &  Stadie,  Z.  f.  Infkr.,  1907,  II,  112,  u.  425.— Hutyra,  ibid.,  pp  281 
and  III,  235.— Citron,  Z.  f.  Hyg.,  1906,  XLI,  238.— Uhlenhuth,  Xylander,  Hiibener 
&  Bohtz,  Arb.  d.  G.-A.,  1908,  XXVII,  1  (Lit.).— Broil,  Z.  f.  Infkrkh,  1908,  V,  81 
(Lit.  on  immunization). — Gniiehtel,  Diss.  Leipzig  1909   (Lit.). 

Enzootic  Pneumonia  of  Pigs  (so-called  chronic  swine  plague  of 
pigs).  According  to  the  view  of  Ostertag,  which  is  also  accepted  by 
a  great  number  of  other  investigators,  the  classical  form  of  swine  plague 
described  above  has  changed  since  the  middle  of  the  nineties  of  the  last 
century  to  a  milder  form,  so  that  at  the  present  time  it  occurs  mostly 
as  a  chronic  pneumonia  affecting  only  very  young  pigs.  Among  these 
young  animals,  however,  it  occurs  widely  distributed.  According  to 
this  conception  the  disease  is  generally  known  as  "chronic  swine  plague 
of  pigs, ' '  but  in  some  localities  it  is  also  designated  as  pig  disease,  pig 
cough  and  cement  disease  (as  it  occurs  frequently  in  new  stables  with 
cement  floors). 

The  disease  causes  considerable  loss,  especially  among  the  improved  breeds, 
and  occurs  principally  in  Northern  Germany  (Eastern  and  Western  Prussia,  Silesia, 
Brandenburg,  Pommerania,  Schleswig-Holstein,  Hessen-Nassau,  etc.).  Thus  for 
instance  in  the  abbatoir  of  Hamburg  about  50,000  hogs  annually  show  the  ana- 
tomical lesions  of  the   disease. 

The  symptoms  of  the  disease  develop  sometimes  early  in  the 
first  days  of  life,  more  commonly,  however,  between  the  second  and 
fourth  week  after  birth.  The  animals  lose  their  sprightliness  and  appe- 
tite, sometimes  manifesting  also  a  perverted  appetite  (eating  of  manure, 
filth,  etc.).  A  catarrh  of  the  nose  (frequent  sneezing  and  blowing, 
especially  during  eating),  as  well  as  of  the  deeper  air  passages,  fre- 
quently develops.  The  young  animals  have  a  short,  sharp  spasmodic 
cough  M^hich  is  especially  brought  on  by  rising  and  eating.  The  cough 
sometimes  is  associated  with  rattling  and  choking.  At  the  same  time 
the  respiration  is  more  or  less  accelerated  and  labored,  the  animals  in 
the  more  severe  affections  lying  on  the  sternum  or  on  the  side,  or  they 
stand  with  arched  back  and  legs  spread  apart. 

Of  the  other  symptoms  conjunctivitis,  muco-purulent  nasal  dis- 
charge, and  frequently  a  peculiar  skin  eruption  may  be  observed.  This 
is  manifested  in  the  form  of  red  spots  on  the  head,  on  the  ears  and  on 
the  sides  of  the  body,  which  show  a  slight  exudation  and  soon  become 
covered  with  scabs  and  scales.  In  other  cases  vesicles  form  which 
after  bursting  also  become  covered  with  scabs,  so  that  finally  the  dry 
and  exfoliated  skin  appears  covered  to  a  great  extent  with  blackish-brown 
crust. 

With  the  advance  of  these  symptoms  the  affected  animals  are  re- 
tarded in  their  development,  the  appetite  being  changeable  or  con- 
tinually absent.  Subacute  inflammations  appear  in  the  different  joints, 
especially  in  the  knee  and  elbow  joints,  as  a  result  of  which  the  animals 
walk  with  evident  pain  and  stiffness,  and  after  the  appearance  of 
diarrhea  and  bloating  the  completely  exhausted  patients  usually  die 
in  the  course  of  the  second  or  third  month  of  their  lives. 


Syiiiptoiiis.      Analoiiiical    Cliaiijios.  130 

In  the  eases  Ifniiinatiii^'  in  recovery  the  animals  become  gradually 
brighter,  the  cough  hecoines  less  fre(|uent,  the  scabs  fall  ott",  the  skin 
regains  its  normal  color,  the  appetite  also  improves,  and  the  food  is 
utilized  in  the  normal  manner.  Such  animals  are  considered  as  re- 
covered; according  to  Foth,  however,  this  is  not  the  case  as  the  cough 
never  disappears  entirely.  On  the  other  hand,  animals  which  are 
still  sickly  may,  under  new  conditions,  become  again  att'ected  with  the 
acute  nmnifestation,  especially  if  exposed  to  cokl  in  the  presence  of 
digestive  disturbances  or  after  infections  with  virulent  pathogenic 
germs.  In  such  relapses  the  animals  usually  die  from  pleural  pneu- 
monia  or  pericarditis    (Ilinrichsen). 

In  pigs  about  4  weeks  old  the  course  of  the  disease  may  be  so 
unfavorable  that  50  to  80%  of  the  affected  aninuds  succuml).  On 
the  other  hand,  the  mortality  in  older  animals  hardly  ever  exceeds 
1  to  2%.  The  average  loss  is  a1)0Ut  10%,  while  an  additional  10% 
remain  runts.  The  majority,  however,  become  only  slightly  affected 
(Grips,  Glage  &  Nieberle), 

The  anatomical  changes  consist  principally  in  a  chronic  l)roncho- 
pneumonia,  fre({uently  associated  with  a  sero-fibrinous  inflammation 
of  the  serous  membranes.  The  autopsy  reveals  in  the  lower  anterior 
part  of  the  lungs,  either  in  a  large  portion  or  only  at  the  borders, 
wedge-shaped  sharply  circumscribed  hepatized  areas  which  have  a 
peculiar  semi-solid  consistency,  or  the  organ  may  be  similar  to  the 
normal  consistence  of  the  pancreas  (Joest).  On  the  cut  surface  the 
affected  lung  is  grayish-red,  smooth,  moist  or  somewhat  dry,  and  studded 
with  yellowish  spots.  At  the  same  time  the  pleura  over  the  correspond- 
ing areas  is  lusterless  and  rough  or  covered  with  fibrinous  membranes 
which  cause  adhesion  of  the  anterior  lobes,  and  also  wiih  the  costal 
pleura.  Between  the  pleural  layers  a  reddish-yellow  fluid  may  be 
present  in  small  ((uantities  which  may  also  contain  filn-in-coagulums. 
Similar  inflannnatory  changes  are  not  infre(iuently  found  also  on  the 
pericardium.  The  recovered  cases  often  show  only  adhesions  of  the 
serous  membranes,  some  atelectic  areas  on  the  borders  of  the  lungs 
and  hardening  of  the  thoracic  lymph  glands.  The  bronchi  are  usually 
filled  with  a  muco-purulent  secretion. 

In  some  of  the  cases  the  affected  areas  of  the  lungs  contain 
greenish  purulent  foci,  and  such  may  also  be  found  in  other  organs 
(see  pyobacillosis,  page  141 ) . 

According  to  the  histological  examinations  of  Liipke  and  Joest  the  changes 
in  the  lungs  are,  at  the  incipient  stages  of  the  disease,  those  of  a  typical  catarrhal 
pneumonia,  while  later  the  productive  granulating  character  becomes  more  and  more 
prominent  in  which  cell  forms  predominate  such  as  are  found  in  intiammatory 
granulation   tissue. 

The  bacteriological  examination  always  reveals  various  kinds  of 
bacteria  in  the  aft'ectt'd  i)arts  of  tiie  lungs.  The  bacillus  suisepticus  is 
present  in  about  two-thirds  of  all  cases.  Fre(|uently,  however,  they  are 
few  in  number  and  of  a  very  slight  virulence,  so  that  it  is  possil)le 
to  kill  test  animals  only  with  large  (piantities  of  suspected  material. 
Simultaneous  with  this  bacillus,  but  occasionally  without  it,  streptococci 
and  staphylococci,  coli  bacilli,  bacillus  pyocyaneus,  further  in  about 
60%  of  the  cases  the  bac.  pyogenes  suis  may  be  found. 

The  varying  bacteriological  findings  and  especially  the  frequent  absence  of 
the  bacillus  suisepticus  in  the  pneumonic  tissues  make  its  exclusive  primary 
etiolooical  importance  very  doubtful.     It  appears  more  probable  that  the  pneumonia 


140  Enzootic  Pneumonia  of  Pigs. 

of  pigs  commences  with  catarrhal  processes  of  the  air  passages  which  develop  in  a 
broncho-pueumonia  when  the  bacteria  which  are  normally  present  in  the  respiratory 
passages,  among  them  also  the  bac.  suisepticus,  will  subsequently  multiply  and 
aggravate  the  inllammatory  processes  j  that  the  bac.  suisepticus  is  not  the  true 
causative  agent  of  the  disease  is  further  substantiated  by  the  fact  that  this 
organism,  at  least  in  the  artificial  infections,  always  produces  acute  inflammatory 
and  later  necrotic  processes,  and  consequently  the  anatomical  lesions  of  the  pneu- 
monia of  pigs  do  not  correspond  with  the  pathogenic  characteristics  of  this  bacillus 
(see  also  chapter,  Enzootic  inflammations  of  the  Lungs  of  Young  Animals,  in 
Vol.  IJ.).  For  the  correctnes-s  of  the  conception  that  the  former  acute  swine 
plague  has  changed  in  Germany  to  a  chronic  catarrhal  pneumonia,  there  are  no 
convincing  proofs.  It  is  only  established  that  in  certain  localities  this  disease 
occurs  quite  extensively;  it  is,  however,  probable  that  the  disease  existed  there  in 
former  times.  The  occurrence  of  the  disease  is  in  the  first  place  influenced  by 
local  conditions  and  especially  by  exposure  of  the  delicate  young  animals  to  cold 
moist  stables,  and  possiljly  also  by  attempts  to  improve  the  breed  by  intensive 
breeding,  by  the  confinement  of  too  many  animals  in  close  quarters,  the  feeding 
of   creamery  products,   etc. 

Uhlenhuth  and  his  co-workers  have  proven  experimentally  the  correctness  of 
the  conception  that  the  catarrhal  affection  of  the  lungs  in  question  is  independent 
of  swine  plague,  and  that  the  disease  may  develop  without  the  cooperation  of  the 
bac.  suisepticus  in  animals  in  which  the  vitality  has  been  reduced.  They  placed 
pigs  in  enameled  troughs  or  in  sheds  in  which  the  floor  was  covered  with  cinders 
which  were  frequently  moistened.  These  animals  became  affected  with  a  typical 
catarrhal  pneumonia  and  the  lung  tissue  contained  only  streptococci  or  staphy- 
lococci. 

The  infection  from  animal  to  animal  may  also  play  an  important  part  in 
the  spread  of  the  disease.  The  animals  weakened  by  the  debilitating  influences 
above  mentioned  will  be  rendered  more  susceptible  to  infections,  if  they  ingest, 
with  the  expectoration  and  excrements  of  affected  animals,  various  kinds  of  faculta- 
tive pathogenic  bacteria  in  large  numbers.  Such  organisms  originating  from 
affected  organs  possei^s  usually  a  high  virulence  compared  with  the  organisms  of 
the  same  species  present  in  the  air  passages  of  healthy  animals.  An  infection  of 
adult   animals   through   affected   young   hogs   has   not   yet  been   established. 

The  recent  findings  of  Frosch  &  Broil  regarding  the  nature  of  the  enzootic 
pneumonia  of  pigs  cannot  yet  lie  accepted  as  conclusive.  They  succeeded  in  pro- 
ducing hog  cholera  in  pigs  with  filtered  and  unfiltered  material  of  affecteil  pigs 
from  4  to  6  weeks  old,  although  it  is  known  from  experience  that  animals  of  that 
age  very  rarely  become  affected  with  hog  cholera. 

The  medicinal  treatment  promises  no  results.  On  the  other  hand, 
improvement  of  the  hygienic  conditions  and  good  nutrition  have  a 
favorable  influence  on  the  course  of  the  disease. 

A  proprietary  remedy  which  is  marketed  in  Germany  under  the  name  of 
'  *  Wassermann  "s  Vaccine  for  the  Cure  of  Swine  Plague"  (aggressin  preparation?) 
gave  Mucha,  Eaebiger,  Willenberg  and  Dien  satisfactory  results. 

According  to  Ostertag  in  the  prevention  of  the  disease,  which 
should  extend  also  to  the  protection  of  the  healthy  animals  in  the  herd 
where  the  disease  has  already  appeared,  great  caution  should  be  exer- 
cised in  the  purchase  of  animals  in  limiting  to  some  extent  the  in- 
breeding, keeping  of  the  pigs  in  warm  and  dry  stables  with  access 
if  possible  to  outside  range.  For  parturition  the  animals  should  he 
placed  in  separate  stables  (cow  or  sheep  stables),  the  pigs  should  iiot 
be  weaned  too  soon,  those  pigs  stunted  in  growth  should  be  removed,  and 
lastly  the  stables  and  stable  utensils  should  be  regularly  disinfected 
with  a  2%  hot  soda  solution. 

Evers  considers  frequent  disinfection  as  a  very  difficult  procedure  in  practice, 
and  in  the  winter  time  not  without  danger;  on  the  other  hand,  he  lays  especial  stress 
on  the  proper  building  of  isolation  stables  as  well  as  the  destruction  of  all  runts. 

Immunization.  In  Germany  the  polyvalent  swine  splague  serum  of 
Wassermann  &  Ostertag  is  used  quite  extensively  (see  page  137).     The 


Pyobacillosis  of  Hogs.  141 

results  caiinot  be  estimated  satisfactorily,  but  it  appears  that  it  gives 
especially  good  results  in  the  places  where  proper  care  is  taken  in 
general  tor  the  welfare  of  the  pigs. 

According  to  Ostertag's  report  in  2 IS  herds  which  were  exclusively  atlectcl 
with  swine  i)lague  in  1902,  7,944  hogs  under  3  months  and  2,2:5S  older  aniuials  were 
inoculated.     Of   these,   633   young   i)igs    (7.9%)    and    11    (.5%)    old   hogs   (iie<l,_47 


her..„  -—    -  e  , 

ease  almost  entirely  ceased  after  the  vaccination,  and  in  nuuierous  tormerly 
infected  herds  lireed"ing  became  again  satisfactory  and  remunerative  after  the  vac- 
cination. According  to  ^\■asser7nann  17,7()9  pigs  were  vaccinated  in  the  years  ot 
1903  and  1904,  in  infected  herds  of  which  in  the  animals  up  to  3  months  of  age 
90.7%   remaine.i  healthy,  while  of  1,490  older  hogs  94.:!7o   also  remained  healthy. 

It  is  a.lvisable  to  vaccinate  the  pigs  on  the  first  day  of  their  lives  an<l  to 
repeat  it  shortly  before  weaning,  at  which  stage  the  animals  are  most  susceptible 
to  the  infection,  and  are  also  especially  exposed.  The  injection  may  be  repeated 
when  one  inoculation  fails  to  produce  a  sutlicient  ]uotectiou  and  the  <lisease  has 
newly  apj^eared.  The  inoculation  of  the  afCected  animals  is  unsatisfactory,  ihe 
dose  of  the  serum  is  from  3  to  •")  cc. 

Raebiger  as  well  as  Joest  and  Eipke  also  reported  favorable  results  from  tlie 
polyvalent  serum  (of  2,227  pigs  19..')%  remained  healthy).  The  reports  of  the 
Prussian  district  veterinarians  (1902-190G)  indicate  partly  favorable  and  partly 
less  favoralde   results. 

Immunization  with  extracts  of  swine  plague  bacteria  and  immune 
serum  (see  page  I'-M)  gave  Pfeil  and  Diem  favorable  results,  while 
Ma.iewski  and  Klipstein  "failed  to  olitain  such.  The  preparation  known 
as  Euman  appears  to  be  prepared  from  cultures  of  the  bac.  pyogenes 
suis. 

Literature.  Ostertag,  Z.  f.  Flhvg.,  1905,  XT,  266;  B.  t.  W.,  190r,,  20.^  u.  234; 
Z  f  Infkr..  19(17,  11,  113,  u.  4.25.— Grips,  Glage  &  Nieberle,  F.  d.  Vhyg.,  1904,  IF, 
5  (Lit.).— Hutvra,  Z.  f.  Infkr.,  1907,  II,  281  u.  Ill,  235.— Evers,  8chweinepest. 
Jena  1906  (Lit.). — Uhlenhuth,  Xylander,  Hiibener  &  Bohtz,  Arb.  d.  G.-A.,  1908, 
XVIII,   1    (Lit.). 


Pyobacillosis  of  Hogs.  (Pyemic  cachexia).  Grips  claimed  in  100:3 
that  the  cause  of  swine  plague  is  not  the  ovoid  septicemia  bacterium, 
described  by  Lotfler  &  Schiitz,  but  an  organism  which  he  found  in  the 
encapsulated  caseous  foci  of  the  lungs  and  named  bacillus  pyogenes 
suis.  Then  Grips,  Glage  &  Nieberle  attempted  also  to  prove  that  the 
enzootic  pneumonia  of  pigs  which  occurs  extensively  among  the  pigs 
of  Northern  and  Northwestern  Gernumy,  and  which  is  characterized 
by  catarrhal  suppuration  and  severe  inflammation,  hy  nervous  symp- 
toms, disturbances  of  nutrition  and  skin  eruptions  (see  page  188),  should 
be  considered  as  the  true  swine  plague,  and  that  it  is  caused  liy  the 
above  mentioned  organism,  whereas  Liiffler's  ovoid  bacteria  only  occa- 
sionally cause  acute  complications  in  the  normal  course  of  the  disease. 

This  view  stimulated  Olt,  Casper,  Ostertag,  Piitz  and  Preisz  to 
undertake  bacteriological  work  in  this  line,  and  they  proved  the  in- 
correctness of  the  above  conception.  They  have  proven  that  tlu^  bac. 
pyogenes  suis  produces  suppurative  processes  in  the  lung  tissue  only 
secondarily,  but  on  the  other  hand  th(^y  showed  that  the  new  bacillus 
may  also '  prod-uce  similar  processes  in  other  organs.  Its  biological 
characteristics  were  studied  more  extensively  by  Berger  and  Ilolth. 

In  most  of  the  cases  the  disease  represents  the  enzootic  pneumonia 
of  pigs,  known  also  as  chronic  swine  plague,  in  which  there  is  a  more 


142  Pyobacillosis  of  Hogs. 

profuse  muco-purulent  nasal  discharge,  a  complication  of  inflammations 
of  the  joints  and  abscesses  in  various  parts  of  the  body  as  a  result  of 
associated  infection  with  the  bac.  pyogenes. 

In  such  cases  the  autopsy  reveals  a  pronounced  purulent  bronchitis, 
and  numerous  small  greenish  suppurative  foci  which  are  in  the  lung 
tissue  enclosed  in  connective  tissue  capsules.  Sometimes  nodules  of 
the  size  of  a  hen 's  egg  may  be  present  which  consist  of  a  purulent  mass, 
at  times  dry  at  the  periphery,  softened  towards  the  center,  or  wiiich 
may  be  entirely  purulent.  The  contents  of  the  nodules  may  easily 
be  removed  from  the  connective  tissue  capsule. 

The  intestines,  especially  the  large  intestines,  frequently  manifest 
a  catarrhal  purulent  inflammation;  in  the  submucous  tissue  there  may 
frequently  be  found  nodules  in  size  from  a  hazel  to  a  walnut,  with 
dense  fibrous  walls  and  greenish  caseous  contents.  The  nodules  cause 
the  intestinal  wall  and  the  mucosa  to  bulge,  and  over  them  the  serous 
membrane  frecjuently  shows  inflammatory  changes. 

Occasionally  generalization  of  the  pathological  process  may  occur 
in  which  case  the  various  tissues  may  become  affected  more  or  less 
frequently  in  the  order  given;  muscles,  joints,  tendon  sheaths,  sub- 
cutaneous   fat,    liver,    spleen,    lymph    glands,    bones,    more    rarely    the 

kidneys  may  contain  greenish-yellow  sup- 
purative foci.  The  exudates  are  usually 
thin,  mucous,  of  whitish-yellow  or  reddish- 
gray  color,  frequently  with  a  greenish  hue. 
The  bac.  pyogenes  suis  which  is  recog- 
nized by  Grips,  Glage  &  Niel)erle  as  at 
least  the  principal  cause  of  these  suppura- 
tive processes,  is  present  in  the  bronchial 
secretion  (see  Fig.  31),  in  the  exudate  of 
the  serous  cavities  and  in  the  suppurative 
foci.  It  is  usually  associated  with  other 
bacteria  and  among  these  also  with  Loffler's 
bipolar  bacillus,  more  rarely  it  may  be 
present  in  great  quantities  in  pure  cultures 
Fig.  Zl.  Bacillus  pyogenes  su,s  (especially  in  greenish  pus).  It  is  also 
Grips.     Bronchial  mucus  from       j.     ^  -,    ■  -  i  •       ^i       •    t     4^-      i 

a  hog.    Carbol-fuchsin  staining;      f^^nd  m  great  numbers  in  the  mtestnial 
and   subsequent  washing  with      contents,  w^hile  in  older  suppurative  foci 
1%  acetic  acid.  the  bacilli  are  present  only  in  small  num- 

bers, or  may  be  entirely  absent. 

According  to  the  investigations  of  Glage,  Berger  and  Holth  the  bacillus  is 
identical  with  the  organism  described  by  Poels  (1897)  as  the  cause  of  arthritis  in 
calves  and  known  as  the  polyarthritis  liacillus  as  well  as  with  the  bac.  pyogenes 
bovis  which  was  found  by  Kiinnemann  in  abcesses  of  cattle  (see  page  144).  Dunkel 
considers  it  identical  with  the  bac.  pseudotuberculosis  ovis   (see  that  disease). 

In  hogs  Piitz  found  the  organism  in  inflamed  tissues  and  in  the  secretion  of 
the  bronchi  in  .36%  of  the  cases;  in  necrotic  foci  of  the  lungs  in  .')0%  ;  in  softened 
purulent  nodules  in  100%  of  the  cases.  Preisz  demonstrated  the  organism  in  16 
out  of  77  cases  of  acute  swine  plague  pneumonia.  Olt  on  the  other  hand  proved 
that  the  bacillus  is  present  in  great  numbers  in  the  pale  gray  mushy  plugs  in  the 
tonsils  of  healthy  hogs. 

The  bacillus  represents  delicate  non-motile  and  sporeless  rods, 
which  in  the  exudate  resemble  the  erysipelas  bacillus  (Fig.  31),  but 
in  cultures  appear  somewhat  sliorter  and  sometimes  club  shaped.  It 
stains  with  the  basic  anilin  dyes,  and  especially  well  with  carboi 
fuchsin  which  stains  it  uniformly  and  intensely,  after  a  sufficiently 
long  action  of  Lugol's  solution;  it  may  also  be  stained  by  Gram. 


Pyobacillosis  of  Hogs.  143 

The  cultivation,  although  somewhat  difficult,  succeeds  aerohically 
as  well  as  anacrohically,  hut  only  at  teinpcratures  of  between  24  and 
40"C.,  (the  best  growth  being  obtained  at  37°C.),  and  only  in  the 
presence  of  proteid.  As  nutritive  media  coagulated  horse,  cattle  or 
hog  blood  serum  is  most  suitable  on  the  surface  of  which  fine  bluish 
points,  and  corresponding  with  these  through  licjuefaction  of  the 
medium,  small  cup-shape  depressions  develop  in  from  2  to  7  days. 
Stab  cultures  in  coagulated  scrum  show  a  grayish  thread  consisting 
of  little  round  colonies  or  a  continuous  growth,  which,  after  li(iuefac- 
tion  of  the  serum,  soon  sink  down  and  form  a  flaky  gray  mass.  On 
serum  agar  small  transparent  drop-like  colonies  develop  in  the  stab 
which  confluate,  forming  a  lustrous  transparent  thin  layer.  On  serum 
agar  plates  the  colonies  form  small  thorn  apple-like  and  later  round 
colonies.  Luxuriant  growth  is  obtained  in  milk  which  commences  to 
coagulate  from  the  bottom  up  in  48  hours,  and  finally  turns  to  a 
uniform  whey  from  which  a  water-clear  serum  separates  later. 

The  resistance  of  the  l)ac.  pyogenes  is  very  slight.  In  cultures  it  docs  not  re- 
main active  longer  than  from  2  to  3  months.  A  temperature  of  57°C.,  drying,  for- 
malin vapors  or  sulphuric  acid  kill  it  rapidly.     (Piitz,  Berger). 

According  to  the  investigations  of  Grips,  Glage  &  Nieberle  the 
pathogenic  characteristics  of  the  organism  develop  in  small  test  animals 
only  after  the  injection  of  large  doses  of  cultures,  in  which  case  they 
produce  suppurative  processes.  In  sucking  pigs  the  feeding  of  pure 
cultures  produces  a  chronic  gastro-intestinal  catarrh,  which,  especially 
during  weaning  time,  results  in  fatal  diarrhea.  In  addition  atelectasis, 
exudative  pleurisy  and  peritonitis  as  well  as  nervous  attacks  may  de- 
velop not  infrecjuently.  The  animals  which  recover  from  the  disease 
remain  runts.  Intratracheal  injection  produces  suppurative  bronchitis. 
Subcutaneous  injection  causes  a  spontaneously  perforating  abscess  at 
the  point  of  inoculation.  In  older  weaned  pigs  the  action  of  the  inocula- 
tion is  manifested  in  similar  changes,  only  that  in  this  case  also  skin 
lesions  in  the  form  of  pox-like  eruptions  and  scabs  are  frequently 
observed.  Intrapulmonary  injections  result  in  catarrhal  pneumonia, 
exudative  pleuritis  or  abscess  formations  surrounded  by  a  hepatized 
area.  Metastatic  lesions  may  develop  in  the  joints.  Intrapleural  in- 
jections cause  a  specific  pleuritis  with  catarrhal  pneumonia  in  the  ad- 
joining lung  tissue,  as  well  as  chronic  pericarditis.  Intraperitoneal 
injections  produce  a  specific  peritonitis,  while  intravenous  injections 
result  in  a  fatal  pyemia.  Healthy  pigs  which  are  placed  in  contact 
with  experimentally  infected  animals  become  stunted  in  growth  as  a 
result  of  chronic  gastritis. 

The  later  experiments  of  Piitz,  Berger  &  Holth  gave  practically 
the  same  results,  as  they  have  proved  that  the  pyobacillus  pre  duces 
suppurative  inflammation  in  the  animal  tissues,  which  is  characterized 
by  its  chronic  and  slow  character.  A  marked  prolification  similar  to 
the  condition  occurring  in  actinomycosis,  precedes  the  breaking  down 
of  the  tissues  (Holth).  The  authors  mentioned  above  failed  in  pro- 
ducing catarrhal  pneumonia  in  hogs  by  inhalations  or  tracheal  in- 
jections of  cultures. 

According  to  these  experiments  the  diseased  condition  occurs  in 
hogs,  especially  in  young  pigs,  principally  asvsociated  with  suppurative 
processes.  They  are  caused  by  specific  bacilli  and  may  be  artificially 
produced  in  healthy  animals.     The  nature  of  the  anatomical  changes 


244  Pyobacillosis  of  Hogs. 

consists  in  a  specific  chronic  granular  suppurative  inflammation  which 
sometimes  is  confined  to  the  digestive  tract,  at  other  times  affecting 
also  the  mucous  membranes  of  the  air  passages  and  especially  the 
bronchi,  in  which  case  the  lungs  develop  a  catarrhal  suppurative  or 
a  purely  suppurative  inflammation.  With  the  affection  of  the  mucous 
membrane  an  exudative  inflammation  of  the  serous  membranes  be- 
comes associated  and  a  generalization  of  the  suppurative  processes 
may  also  take  place. 

The  changes,  however,  do  not  correspond  with  those  pathological 
processes  which  have  customarily  and  undoubtedly  with  justice  been 
considered  as  swine  plague  lesions.  Acute  catarrhal  croupous  or 
necrotic  pneumonia,  such  as  is  observed  in  acute  outbreaks  of  pure 
swine  plague,  as  well  as  in  a  more  frequent  mixed  infection  with  hog 
cholera,  has  in  no  case  been  produced  in  the  above  experiments.  These 
facts  have  been  pointed  out  by  Olt,  Casper  and  Ostertag  (the  changes 
which  were  indicated  as  such  were  always  atelectatic).  The  bacillus 
pyogenes  suis  exerts  in  all  cases  purely  pyogenic  properties. 

According  to  Olt  the  disease  caused  by  the  pyo-bacillus  and  desig- 
nated by  him  as  "pyemic  cachexia  of  hogs"  (the  name  pyobacillosis 
was  suggested  by  Llipge)  occurs  in  the  majority  of  cases  as  an  in- 
dependent affection,  but  also  in  association  with,  or  as  a  result  of 
other  infective  diseases.  Contrary  to  this  Ostertag  maintains,  without 
disputing  the  independent  occurrence  of  pyobacillosis,  that  most  cases 
of  the  affections  of  the  lungs  described  by  Grips  are  chronic  affections 
of  swine  plague  caused  by  ovoid  bacteria.  He  claims  that  in  the  course 
of  the  disease  the  Grips  bacillus  as  well  as  other  bacteria  may  localize 
especially  in  the  bronchial  mucous  membrane,  and  this  is  the  more 
possible  as  it  is  known  that  this  organism  occurs  as  a  saprophyte  in 
the  upper  air  passages  of  healthy  hogs.  The  primary  etiological  part, 
the  ovoid  bacterium,  in  pneumonia  of  pigs  has  been  authoritatively 
established  in  accordance  with  the  description  on  page  139.  Considering, 
however,  the  fact  that  the  pyo-bacillus  occurs  in  pure  cultures  only 
in  metastatic  abscesses,  while  in  the  pneumonic  lungs  it  is  always 
present  in  association  with  other  pathogenic  bacteria,  it  probably  takes 
only  a  secondary  part  in  the  lung  affections  of  hogs.  In  such  cases 
it  is  the  cause  of  severe  changes,  especially  of  extensive  suppurations. 

The  pyo-bacillus  exerts  a  similar  action  in  the  suppurative 
processes  of  ruminants.  According  to  the  investigations  of  Poels, 
Kiinnemann,  Roux,  Holth  and  Olt  it  occurs  in  inflammation  of  different 
organs  in  cattle  (Poels  found  the  organism  in  38  out  of  56  cases). 
However,  it  is  mostly  present  in  association  with  staphylococci, 
streptococci,  colon  bacilli,  necrophorous  bacilli  and  other  bacteria.  It 
occurs  especially  in  cases  of  peritonitis  caused  by  foreign  bodies,  in 
bacillary  pyelonephritis,  metritis,  to  which  inflammation  of  the  valves 
of  the  heart  may  be  added;  further  in  arthritis  in  calves,  various 
broncho-pneumonias  in  young  as  well  as  in  old  animals;  finally  in 
mastitis,  especially  in  those  cases  Avhich  are  associated  with  septic 
and  catarrhal  metritis  (according  to  Holth  the  presence  of  the  bacillus 
pyogenes  is  especially  indicated  by  a  thin  milk-like  secretion  of  the 
udder  with  dense  yellow  irregular  flakes;  further  by  a  purulent  fetid 
secretion).  As  a  causative  agent  of  mastitis  it  has  been  established 
in  goats  (Dammann  &  Freese,  Olt)  and  in  sheep  (Olt).  Olt  also  found 
the  organism  in  broncho-pneumonia  of  lambs  and  sheep  in  which 
especially  the  terminating  bronchi  were  in  parts  almost  entirely  ob- 
structed with  masses  of  bacilli. 


WliiU'   Scours  of   Snckliiifis.  145 

Literature.  (Jrips,  Diss.,  Ciios!-oii  11)(I2. — Kiiiuiciiiaiiii,  A.  f.  Tk.,  V.)i)'A,  XXIX, 
128.— Grips,  Cilajje  &  Isieberle,  F.  d.  Vhyjj.,  1!)()4,  il,  5  (Lit.).— Olt,  1).  t.  W., 
1904,  :5:2.");  liHis,  (il?  (Lit.).— Ostertaji,  il.i.l.,  l!)o:5,  185.— I'iitz,  Diss.,  (Jiossen 
1904.— Koske,  Arl>.  d.  Ci.-A.,  190(i,  XXIV,  ISL— Berger,  Z.  f.  Infkr.,  1907,  111, 
101.— Ilolth,    Ibiil.,  p.    I'jo    (Lit.).— Dunkei,  Z.    f.   liakt.,   1909,  Llll,  01. 

6.  Septicemic  Affections  of  New  Born  Animals.  The  acute 
septicemic  afi'ectioiis  of  the  newborn  may  clinically  l)e  collected 
into  two  groups.  In  the  first  group  all  those  affections  are 
considered  in  Avhich  manifestations  of  an  acute  gastro-intestinal 
catarrh  are  present,  and  its  most  conspicuous  s}^llptom  is 
diarrhea,  Avhile  the  affections  of  the  second  group  are  charac- 
terized l)y  sup])urative  inflannnatory  processes  in  various 
organs  and  about  the  l)od3',  especially  in  the  joints  and  extremi- 
ties. In  spite  of  the  variance  of  the  sjniptoms  the  more  recent 
investigations  indicate  with  great  probability  that  the  same 
bacteria  produce  the  diseases  belonging  to  both  these  groups. 
It  is  also  probable  that  several  species  are  concerned  in  the 
etiology  of  the  diseases  and  that  the  differences  in  the  course 
of  the  disease  depend  especially  on  the  mode  of  infection. 

While  the  two  forms  of  disease  are  apparently  very  closely 
related,  or  possibly  even  identical  in  their  etiological  relation, 
we  consider  that  the  question  has  not  been  completely  solved, 
especially  as  in  some  of  the  enzootics  frequently  only  one  or 
the  other  form  comes  under  observation.  Accordingly  from  a 
practical  standpoint  it  is  deemed  advisalile  in  discussing  the 
diseases  to  separate  the  forms  from  each  other. 


(a)  White  Scours  of  Sucklings:  Dysenteria  neonatorum 

{Diarrhea  neoiiatonou,  Diarrhce   dcs    nouveamics     [Frotch]; 
Buhr  der  Saufiliufie  [German'l.) 

White  scours  of  newly  born  is  an  acute,  contagious,  infec- 
tious disease  affecting  the  animals  in  the  first  days  of  their 
lives,  and  is  olisei'ved  usually  as  a  stable  affection  characterized 
by  profuse  diarrhea  and  by  rapid  exhaustion. 

History.  The  cause  of  this  dangerous  and  fatal  disease  has  ])een 
thought  until  recently  to  be  either  due  to  dietetic  errors,  especially 
as  a  result  of  feeding  niilk  of  improper  constitution  (Tolnay  1790), 
and  also  caused  by  improper  feeding  of  the  mother  animal,  or  else  as 
a  result  of  climatic  conditions.  Based  on  this  supposition  the  affection 
has  been  associated  with  the  gastro-intestinal  catarrh  of  adults  which 
results  from  similar  causes.  However,  Obich  (1805)  and  Roloff  (187;")) 
proved  that  the  disease  is  transmissible  from  stable  to  stable,  and 
further  investigations  proved  beyond  a  doubt  the  infectious  nature 
of  the  disease.  Frank  (1876)  concurred  in  these  findings,  and  at 
the  present  time  this  view  is  generally  accepted.  The  recent  investiga- 
tions of  Poels  (1899)  and  Joest  (1902),  and  especially  those  of  Jensen 
(1893  and  1905)  have  cleared  the  etiology  of  white  scours  in  most 
points. 


146 


White  Scours  t.f  Sucklings. 


Fig.  32.    BaciUits  coll  communis 
Agar  culture  ;  fuchsin  staining 


Occurrence.  The  disease  which  with  the  development  of 
intensive  agriculture  always  attains  greater  extension,  occurs 
especially  in  the  spring  and  in  the  fall,  while  in  winter  and 
summer  it  is  more  rarely  observed.  Calves  become  affected 
most  frequently.  Sometimes,  however,  the  disease  also  occurs 
among  foals,  lambs  and  pigs   (very  rarely  also  among  dogs 

and  cats).  It  causes 
considerable  loss  due 
to  its  contagious  na- 
ture as  well  as  by  its 
destructive  course  in 
the  affected  herds. 
Occasionally  all  the 
young  of  an  entire 
year  succumb  to  this 
malady,  wiiich  more- 
over frequently  reap- 
pears in  an  infected 
stable  during  the  con- 
secutive periods  of 
parturition. 
Etiology.  Up  to  the  present  time  white 
scours  has  been  studied  bacteriologically  very 
extensively,  and  according  to  the  uniform  results 
of  these  studies  the  disease  was  in  most  cases 
caused  by  the  bacillus  coli  communis,  or  by  one 
of  its  several  virulent  varieties  (Jensen,  Poels, 
Joest,  Bongert,  Titze  &  Weichel). 

The  bacillus  coli  communis  is  a  small  rela- 
tively thick  rod-shaped  or  slightly  oval  bac- 
terium (Fig.  32).  It  is  motile  (one,  two  or  more 
flagella),  does  not  form  spores,  and  stains  uni-  Fig.  33.  Gelatin 
formly  with  aqueous  anilin  dyes;  does  not  stain  ^b^I^^^^ 
by  Gram's  method.  communis. 


Cultivation.  The  bacillus  is  aerobic.  In  the  depth  of  gelatin  it 
produces  round  or  whetstone-shaped,  brownish  colonies  which  spread 
more  on  the  surface  of  the  media.  They  are  first  transparent,  later 
white,  veined  like  grape  leaves,  and  irregular.  Along  the  stab  the 
colonies  are  white  and  small,  the  medium  does  not  liquefy  (Fig.  33). 
On  agar  it  forms  gray  transparent,  later  white,  colonies.  The  bouillon 
becomes  uniformly  cloudy.  On  potatoes  a  grayish,  later  yellowish- 
brown,  thick  deposit  forms.  Milk  is  acidified  and  coagulated.  The 
bacillus  causes  the  formation  of  indol  and  hydrogen  sulphide  as  a 
result  of  which  the  cultures  have  a  disagreeable  odor.  In  media  con- 
taining sugar  the  organism  causes  an  alcoholic  fermentation,  but  colon 
bacilli  of  different  origin  show  in  this  respect  marked  differences, 
which  are  even  more  pronounced  relative  to  their  virulence. 

The  colon  bacillus  is  almost  a  constant  inhabitant  of  the  intestinal 
canal  of  most  animals  and  of  man.  In  guinea  pigs  and  chickens,  how- 
ever, it  is  usually  absent. 


Patli(ij;mi('ily.  147 

Pathogenicity.  Colon  bacilli  originating  from  the  bodies 
of  calves  which  die  from  wliite  scours  exert  a  severe  pathogenic 
action  on  newly  born  calves.  If  a  one-day-old  calf  is  given  5 
to  6  cc.  or  even  only  i/4  to  V2  cc.  of  the  bouillon  culture  mixed 
with  milk,  fever  and  diarrliea  set  in  tlie  following  day  and 
the  animal  dies  in  from  ly^  to  3  days.  Tlie  autopsy  reveals  a 
hemorrhagic  inHannnation  of  the  abomasum,  and  to  a  slight 
extent  also  of  the  intestines.  The  contents  of  the  intestines  are 
fetid  ajid  the  mesenteric  lymph  glands  show  hemorrhagic  swell- 
ing. The  injection  of  5  cc.  of  bouillon  culture  into  the  rectum 
of  a  new  born  calf  has  similar  results,  and  sometimes  the  sub- 
cutaneous injection  of  such  a  quantity  of  culture  is  fatal,  while 
1  cc.  of  culture  has  no  ill  effects  upon  the  animal  (Jensen)- 
A  fatal  infection  per  os  may  be  much  more  easily  produced 
in  calves  in  which  the  organs  have  not  yet  performed  their 
functions  than  in  those  in  which  the  stomach  and  intestines 
have  already  been  set  in  activity  by  the  ingestion  of  food 
(Joest).  Injection  of  culture  into  the  umbilical  vessels,  in  the 
amniotic  sac  or  into  a  vein  produces  in  some  cases  a  fatal 
septicemia  (Poels,  Joest).  Intraperitoneal  inoculation  of  rab- 
bits and  guinea  pigs  causes  a  fil)rinous  peritonitis  (Jensen, 
AVillerding),  and  sometimes  subcutaneous  injections  of  large 
quantities  of  culture  are  also  fatal  to  these  animals  as  well  as 
to  mice  (Mazzanti  &  Vigezzi,  Joest). 

The  colon  bacilli  which  are  found  in  calves  affected  with  diarrhea 
correspond  in  all  their  morphological  characteristics  with  the  colon 
bacilli  isolated  from  the  excrements  of  healthy  calves.  They  differ, 
however,  from  them  by  their  severe  pathogenic  action  on  calves.  Ac- 
cording to  Jensen  the  pathogenic  colon  bacilli  are  facultative  parasites 
which  enter  the  digestive  tract  soon  after  birth,  either  with  the  first 
milk  or  ^ith  other  material  swallowed  by  the  animals  (for  instance 
with  mucus  contaminated  with  straw).  Under  normal  condition  the 
bacteria  multiply  in  the  intestinal  canal  only  to  a  moderate  extent, 
and  are  harmless,  as  they  are  not  capable  of  attacking  the  mucous 
membrane  of  the  healthy  intestines.  If,  however,  the  resistance  of 
the  tissues  is  weakened  from  some  cause  (cold,  poor  nutrition,  etc.), 
the  bacteria  penetrate  into  the  intestinal  wall  and  later  also  into  the 
distant  organs  as  well  as  into  the  circulation  and  produce  in  this 
manner  an  affection  of  the  animal. 

The  great  susceptibility  of  calves  which  have  not  yet  taken  any 
food  may  be  explained  by  the  fact  that  the  colon  bacilli  which  enter 
the  stomach  before  the  ingestion  of  the  colostral  milk  pass  without 
interference  into  the  small  intestines  as  the  stomach  has  not  yet  pro- 
duced any  gastric  juice.  Owing  to  the  absence  of  the  intestinal  juices 
the  meconium  which  is  present  in  the  intestines  affords  a  favorable 
medium  for  the  multiplication  of  bacteria.  Their  penetration  into  the 
mucous  membrane  is  probably  also  facilitated  by  the  fact  that  the 
intestinal  epithelium  does  not  at  that  period  possess  a  mucous  covering, 
and  is  therefore  easily  penetrated   (Joest). 

Colon  bacilli  which  have  attained  a  higher  virulence  in  the  animal 
body  retain  it   for  that  respective  species   of  animals.     Leaving   the 


148  White  Scours  of  Sucklings. 

animal  body  they  may  again  be  taken  up  by  the  digestive  tract  of 
other  newborn  animals  and  produce  the  disease.  Repeated  transmission 
increases  the  relative  virulence  of  the  bacteria  which  then  retain  the 
severe  pathogenic  action  until  they  again  lose  their  virulence  through 
the  influence  of  certain  conditions. 

The  lowered  natural  resistance  of  the  animal  is  considered 
by  Jensen  to  be  of  great  importance,  as  he  succeeded  in  pro- 
ducing the  disease  by  feeding  material  which  has  a  weakening  influence 
only  on  the  intestinal  wall.  Thus  the  disease  developed  after  two 
administrations  of  5  gm.  doses  of  creolin,  and  after  repeated  doses 
of  pyoktannin  (in  all  0.75  gm.)  or  trichloride  of  iodine  (0.65  gm. 
given  inside  of  30  hours).  This  is  also  substantiated  by  the  fact 
that  the  disease  wall  appear  when  the  newborn  calves  are  fed  boiled 
milk  instead  of  colostral  milk. 

It  is  not  yet  positively  established  whether  the  causative  agent 
of  the  disease  represents  a  "pathogenic  variety"  of  the  colon  bacillus 
(Jensen,  Titze  &  Weichel)  or  is  a  "virulent  colon  bacillus"  (Pools) 
or  again  whether  it  is  "a  variety  of  the  bacillus  coli  communis  which 
is  pathogenic  only  for  calves"  (Joest  found  the  isolated  bacillus 
identical  with  the  organism  isolated  by  the  other  two  authors).  Of 
great  importance  is  the  fact  that  among  the  colon  bacilli  very  widely 
distributed  in  nature  there  are  such,  which  may  as  facultative  parasites 
sometimes  attain  a  high  virulence  for  calves  and  when  possessing  such 
properties  may  form  a  dangerous  virus. 

In  some  cases  other  bacteria  have  been  demonstrated  to  be 
the  cause  of  white  scours,  as  the  bacillus  aerogenes,  paracolon 
bacilli  (identical  with  Gaertner's  enteritidis  bacillus?)  as  well 
as  varieties  of  the  proteus.  These  are  found  as  a  rule  only  when 
the  disease  develops  somewhat  later  in  life  (Jensen),  Further 
the  bacillus  enteritidis  Gaertner  and  the  bacillus  pyocyaneus 
(Poels)  enter  into  the  etiology  of  this  disease.  According  to 
the  causative  agent  the  disease  may  show  marked  clinical  differ- 
ences (Jensen;  see  page  151). 

Title  &  Weichel  fomul  anions  210  strains  from  white  scours  from  different 
parts  of  Prussia  160  colon,  4  paracolon  and  16  psendoeolon  strains,  further  24 
strains  of  the  brvcillus  enteritidis  of  tiaertner  and  two  strains  each  of  bacillus  para- 
typhosus  B,  bacillus  lactis  aerogenes  and  of  the  bacillus  proteus  niirabilis.  (Para- 
colon bacilli  or  Caertner's  bacilli  and  bacillus  paratyphosus  B  can  be  only  dis- 
tinguished from  each  other  by  asg^lntination  tests ;  p^-eudocolon  liacilli  resemble 
colon  bacilli,  but  they  coagulate  milk).  In  cultures  of  colon  liacilli  the  presence  of 
toxins  could  not  be  demonstrated,  but  they  were  found  in  cultures  of  Gaertner's 
bacillus  that  were  at  least  ten  days  old,  and  also  in  cultures  of  paratyphosus  B 
liacilli  and  paracolon  bacilli.  The  toxic  action  was  somewhat  diminished  by  heat- 
ing the  filtrate  containing  the  toxins  for  a  half  hour  at  60°C.,  and  at  80°  the 
toxicity  was  entirely  destroyed.  The  administration  of  potent  toxins  per  os  caused 
diarrhea  in  test  animals.  Schmitt  repeatedly  found  also,  in  calves  affected  with 
scours,  bacilli  of  the  paraty]ihosus  B  group,  which  finding  deserves  especial  consid- 
eration, as  this  bpcterial  group  plays  an  important  part  in  meat  poisoning.  (Titze 
&  Weichel   could  never  demonstrate  such  bacilli  in  healthy  animals). 

Eecently  Krautstrunk  isolated  a  diplococcus  from  the  blood  and  organs  of 
calves  affected  with  scours  which  resembles  the  pneumococcus  of  man.  The  cultures 
of  this  organism  even  in  small  quantities  (few  loopfuls  of  agar  culture)  adminis- 
tered to  newborn  calves,  either  in  milk  or  by  intravenous  injections  within  a  few 
daj'S  produced  a  fatal  typical  white  scours  which  was  sometimes  accompanied  by 
swelling  of  the  joints.  The  diplococcus  which  is  Gram  positive  and  has  been  ob- 
tained in  pure  cultures,  in  9  out  of  7.3  cases,  and  in  16  cases  was  found  in  associa- 


Pntlmueiiicitv.      Xatuinl    In  tVct  ion.  140 

tioii  with  colon  lacilli,  appears  in  smear  preparations  to  le  surrovinded  by  a  l)roa<l 
capsule.  It  yrows  only  in  alkaline  nieijia,  especially  well  on  Mooil  a^ar,  an<l  also 
iu   serum   boiiillou. 

The  aflVetioii  of  the  newborn  of  other  species  of  domestic 
animals  is  ])r()l)ably  simihir  in  its  etioloi^ical  relation.  Thus 
accordini;-  to  llecker's  investigations  diarrhea  in  laml)s  is  pro- 
duced by  tlie  same  bacteria  as  in  calves,  while  Baldrey  demon- 
strated in  white  scours  of  a  foal  colon  l)acilli  as  the  cause. 

Natural  Infection.  Sometimes  the  disease  will  appear  in 
localities  which  have  previously  been  free  from  it,  without 
apparent  introduction  from  the  outside.  In  such  cases  it  may 
be  assumed  that  the  ordinary  colon  bacilli  which  have  been 
present  in  the  stable,  have  for  some  reason  attained  virulent 
])ro])erties  in  the  intestines  of  the  newly  born  animals  (for 
instance  as  a  result  of  dietetic  errors,  feeding'  of  boiled  milk 
innnediately  after  birth),  and  that  this  virulence  is  being 
retained  for  later  born  animals. 

In  affected  stables  the  virus  may  be  present  in  the  vagina 
of  the  mother,  on  the  floor  of  the  stable  or  in  the  litter,  from 
Avhich  the  external  genitals  and  the  udder  of  the  mother  become 
contaminated.  The  infection  results  usually  during  the  sucking 
of  the  contaminated  udder,  but  also  has  taken  place  during 
parturition,  and  later  through  contact  with  litter,  from  licking 
of  the  stable  walls,  etc.  Exceptionally  the  infection  may  also 
take  place  through  the  umbilieus  (Poels,  Jensen).  The  affected 
animals  may  then  infect  their  surroundings  with  their  excre- 
ments and  urine,  thus  increasing  the  possibilities  for  infection 
of  animals  born  later.  Newborn  animals  fed  artificially  with 
boiled  milk  may  become  infected  by  the  contaminated  hands 
of  the  attendants  as  well  as  by  the  use  of  dirty  feeding  vessels. 
In  many  instances  the  unfavorable  experiences,  gained  in  places 
M'here  animals  are  raised  artificially  (numerous  affections  wdth 
diarrhea)  may  he  attributed  to  a  large  extent  to  such  infections, 
l)ut  in  such  cases  consideration  should  also  be  given  to  the  fact 
that  by  heating'  the  milk  substances  are  destroyed  which  are 
valuable  for  the  digestion  (ferments),  which,  if  undisturbed, 
counteract  to  some  extent  the  development  of  diarrhea  by  stim- 
ulating the  function  of  tlie  digestive  glands,  thereby  preventing 
the  excessive  multiplication  of  the  normal  intestinal  bacteria. 

The  contagion  may  retain  its  virulence  in  infected  stables 
for  a  long  time,  which  may  explain  that  in  some  premises  where 
nothing  is  done  for  the  prevention  of  the  disease  it  reappears 
from  year  to  year  in  the  spring  and  in  the  fall.  On  the  other 
hand,  the  infective  agent  may  be  introduced  into  premises,  as 
yet  free  from  disease,  by  infected  sucklings  as  well  as  by  adult 
animals.  The  transmission  of  the  disease  by  breeding  animals 
is  especially  suggested  by  the  fact,  that,  where  cows  in  advanced 
pregnancy  are  taken  from  an  infected  stable  and  placed  on 
premises  free  from  the  disease,  the  calf  born  there  is  frequently 


150  While   Sccurs  (tf  Sucklins^s. 

affected  with  diarrhea  (D'.eckeihoff).  Besides  affected  animals 
may  spread  the  contagion  among  sucklings  of  other  species  of 
animals,  especially  lambs  may  become  affected  when  an  infected 
calf  is  placed  among  them  (Kotelmann). 

The  possibility  of  an  intrauterine  infection  was  proven  by 
Kitt  when  he  injected  3  cc.  of  a  washed  agar  culture  of  colon 
bacilli  intravenously  into  a  cow  in  advanced  pregnancy.  This 
immediately  caused  a  profuse  diarrhea  in  the  calf  which  w^as 
born  eight  days  later. 

Newborn  animals  are  more  susceptible  or  predisposed  to 
the  disease  immediately  after  birth,  while  later  the  suscepti- 
bility diminishes  rapidly.  As  a  matter  of  fact  the  animals 
become  affected  in  the  majority  of  cases  within  24  to  48  hours, 
much  more  rarely  from  3  to  8  days  after  birth,  whereas  older 
animals  usually  do  not  contract  the  disease.  Conditions  which 
predispose  the  body,  such  as  poor  nutrition,  congenital  weak- 
ness, etc.,  favor  the  development  of  the  disease,  particularly  as 
the  animals  have  not  a  great  resistance  in  the  first  days  of 
life.  Besides,  the  withholding  of  colostral  milk  from  the  calf 
and  the  immediate  feeding  of  boiled  milk  after  birth  results 
almost  always  in  the  appearance  of  the  disease. 

An  abnormal  composition  of  the  mother  milk,  high  fat  contents 
or  the  opposite  too  high  dihition,  as  well  as  indirectly  the  feeding 
of  the  mothers  with  oil  meal  cake  or  swill  (Kovacsy)  may  have  an 
influence  on  the  development  of  the  disease,  since  such  conditions 
favor  an  abnormal  uudtiplication  of  colon  bacilli  in  the  intestines  of 
sucklings. 

Pathogenesis.  Bacteria  which  accumulate  in  great  num- 
bers in  the  intestinal  tract  of  sucklings  enter  the  tissues  of  the 
intestinal  mucous  membrane,  the  lymph  spaces  and  the  lymph 
follicles.  The  penetration  of  these  organisms  in  the  first  days 
of  life  is  facilitated  by  the  absence  of  the  ''mucous  layer" 
(Disse)  from  the  intestinal  epithelium  which  at  a  later  age 
prevents  to  some  extent  the  penetration  of  the  bacteria.  From 
the  intestinal  walls  the  bacteria  enter  the  mesenteric  lymph 
glands  and  cause  acute  swelling.  Later  they  may  enter  the 
blood  circulation  and  flood  the  entire  body. 

According  to  Jensen  white  scours  is  not  a  simple  inflamma- 
tory condition  of  the  digestive  tract,  but  an  inflammatory 
process  complicated  with  a  septicemic  condition,  which  is  caused 
by  the  entrance  of  the  bacteria  into  the  blood  circulation.  It  is 
very  probable  that  the  manifestations  of  the  disease  are  to 
some  extent  caused  by  toxic  products  of  the  bacteria.  Although 
filtrates  free  of  bacteria  from  virulent  colon  cultures  have 
proven  harmless  (Jensen),  the  negative  results  do  not  exclude 
the  development  of  toxins  in  the  animal  body.  Bacilli  of  the 
paratyphus  group  B  produce  severely  acting  toxins  even  in 
artificial  culture  (see  page  148). 


Auatomieal  Changes.  151 

Anatomical  Changes.  The  carcasses  are  greatly  emaciated, 
anoiiiic,  tlie  parts  aioiind  the  amis  aro  soiUnl  and  the  mucous 
meinhrane  ])rotrudes.  The  mucous  uieuihi-auo  of  the  stouuu'h 
appears  lii^hly  reddened,  in  ruminants,  only  in  tlie  abomasum, 
and  in  tliis  especially  around  the  j)ylorus,  it  is  edematous, 
swollen,  covered  with  a  great  quantity  of  glary  mucus.  The 
i-idges  of  the  folds  are  sprinkled  with  punctiform  and  linear 
hemorrhages  and  erosions.  The  loosened  su})er(icial  layer  can 
be  easily  scraped  off  with  a  knife.  The  small  intestines  contain 
a  very  fetid,  yellowish  or  dirty  gray,  and  sometimes  reddish 
fluid  contents,  which  may  be  mixed  with  mucous  flakes,  and 
a  great  <|nantity  of  gas.  The  intestinal  mucous  membrane  is 
highly  reddened,  covered  with  sticky  mucus  and  may  be  studded 
with  hemorrhages.  Its  solitary  follicles  and  the  Peyer's  patches 
are  swollen,  the  submucosa  and  the  muscular  coats  are  edema- 
tous. Similar  changes,  although  not  to  the  same  extent,  are 
present  in  the  mucous  membrane  of  the  large  intestines.  The 
mesenteric  hmiph  glands  are  always  intensely  swollen  and  fre- 
quently contain  small  liemorrhages. 

The  parenchymatous  organs  are  conspicuously  pale,  the 
spleen  is  not  enlarged.  The  hings  show  acute  edema,  and  in 
exceptional  cases  catarrhal  pneumonic  foci.  The  serous  mem- 
branes, especially  the  pericardium  and  the  endocardium,  show 
liemorrhages.  The  umbilical  vessels  are  either  filled  with  nor- 
mal blood  coagula  or  are  empty. 

■  The  lesions  described  are  not  in  all  cases  distinct,  but  may  be 
only  slight  even  in  cases  where  the  pathogenic  bacteria  are  pres- 
ent in  all  organs  and  even  in  the  muscles  (Titze  and  Weichel). 

According  to  Jensen  the  following  forms  of  white  scours  in  calves 
may  be  distinguished,  depending  on  the  cause  of  the  disease : 

1.  roliliacillosis.  In  one  form  of  this  affection  which  usually 
occurs  shortly  after  l)irtli  and  runs  a  rapid  course,  the  lesions  consist 
in  a  pronounced  enteric  condition,  the  mesenteric  lymph  glands  are 
red  and  swollen,  the  spleen  is  in  most  cases  enlarged,  and  large  nuniliers 
of  bacteria  are  present  in  the  blood  and  in  the  organs.  The  other 
form  appears  from  3  to  5  days  after  birth  and  causes  death  of  the 
animal  in  8  to  5  days.  The  intestines  are  distended  by  gas  and  are 
pale,  the  mesenteric  lymph  glands  are  swollen,  but  mostly  pale;  swell- 
ing of  the  spleen  is  rare,  the  blood  and  the  organs  contain  no  bacteria, 
or  only  sparingly  so. 

2.  Aerogenes  hacillosis;  resembles  the  first  form  of  the  coli- 
bacillosis. 

3.  Paracolon  hacillosis  or  pseudocolon  hacillosis.  This  may  run 
a  course  of  hemorrhagic  enteritis;  frecjuently,  however,  the  enteric 
changes  are  not  very  marked  while  the  swelling  of  the  mesenteric  lymph 
glands,  the  enlargement  of  the  spleen  and  degeneration  of  the  internal 
organs  is  tery  pronounced.  Tn  rare  cases  the  serous  membranes  may 
contain  fibrinous  exudate,  the  blood  and  the  internal  organs  always 
contain  numerous  bacteria. 

4.  Pyocyaneus  hacillosis  (Poels).  It  is  manifested  as  a  severe 
diarrhea  and  the  autopsy  reveals  a  red  spotted  intestinal  mucous  mem- 


1o2  White  Scours  of  Sucklings. 

brane,  degeneration  of  the  liver,  hut  no  swelling  of  the  spleen.  In 
the  intestinal  contents  the  pyocj-aneus  is  found  in  almost  pure  cultures ; 
the  blood  on  the  other  hand  is  sterile. 

5.  Proteus  bacillosis.  This  usually  occurs  when  the  calf  is  several 
days  or  al)out  a  week  old  and  runs  a  slow  course.  Feces  are  fetid, 
never  mixed  with  blood.  On  the  autopsy  the  intestinal  tract  is  greatly 
distended,  pale,  the  mucous  membrane  becomes  macerated  shortly 
after  death.  The  spleen  is  normal,  the  mesenteric  lymph  glands  are 
slightly  swollen  but  not  hyperemic.  Proteus  organisms  are  present  in 
great  numbers  in  the  intestinal  contents,  but  are  not  found  in  the 
blood  or  in  the  organs. 

In  the  cases  which  are  caused  by  the  diplococcus  found  by  Krauts- 
trunk  the  autopsy  reveals  changes  similar  to  those  found  in  colon 
bacillosis,  the  intestinal  glands  being  always  markedly  swollen  and 
reddened. 

Symptoms.  In  animals  born  healthy  the  first  symptom 
nsually  appears  in  from  1  to  3  days,  exceptionally  in  a  few 
lionrs  after  birth;  in  rare  cases  in  from  4  to  8  days.  The 
newborn  cease  to  suck  and  stand  in  one  place  with  a  staring 
look.  They  are  depressed  and  lie  down  a  great  deal  of  the 
time. 

On  the  first  day,  or  not  later  than  on  the  second  day,  the 
diarrliea  appears ;  the  expelled  very  fluid  and  fetid  feces  is 
yellowish-brown  in  foals  and  pigs,  while  in  calves  and  sheep  it 
is  first  yellowish,  later  grayish-white,  frequently  foamy,  and 
contains  lumps  of  clotted  milk  as  well  as  blood  streaks  (white 
and  red  diarrhea).  The  parts  around  the  anus  are  soiled  and 
the  hair  or  the  wool  is  matted.  Tlie  consistency  is  at  first 
slightly  mucous,  later  watery;  the  odor  is  intensely  sweetish, 
later  penetrating,  putrid  (Hess).  The  feces  are  passed  at  first 
under  severe  straining,  later  it  is  painless  and  towards  the 
end  of  the  disease  involuntary  passing  of  the  feces  is  observed. 
Colts  suffer  severe  colicky  pains  before  and  after  the  passing 
of  the  feces,  they  show  restlessness,  paw  with  the  front  feet, 
look  towards  the  abdomen  or  they  draw  the  feet  under  the 
body.  Similar,  although  not  so  pronounced,  restlessness  is 
observed  in  calves.  At  the  same  time  there  is  bloating,  or  on 
the  contrary  the  abdomen  may  be  contracted,  the  flanks  are 
sunken  and  the  pressing  of  the  abdominal  walls  causes  pains. 
After  the  passages  the  animals  stand  in  one  place  with  feet 
drawn  together,  arched  back  and  lowered  head,  or  they  lie  for 
a  long  time  motionless  on  the  ground. 

The  weakness  increases  during  the  course  of  the  disease, 
the  eyes  sink  into  their  sockets,  the  cornea  loses  its  lustre, 
saliva  flows  from  the  mouth,  the  dry  tongue  is  covered  with  a 
viscid  mucus,  the  anus  is  continually  open,  the  hair  is  rough, 
the  skin  is  sticky  from  the  perspiration,  the  body  disseminates 
a  disagreeable  sweetish  odor,  and  finally  the  greatly  emaciated 
animals  enter  into  a  comatose  state  and  die. 

At  the  onset  of  the  disease  the  body  temperature  rises 
from    1    to    2°C. ;    later,    however,    with    the    appearance    of 


Symptoms.      Diagnosis.      Trt'atmciil.  153 

the  weakness,  it  returns  to  nornuil,  and  before  dcatli  it  may 
even  become  snbnoi'mal.  Tlie  resjtiration  is  supi'rlicial  and  later 
accelerated.  The  heart  action  becomes  more  t're(|U('iit  and 
weaker,  towards  the  termination  of  the  disease,  and  towards 
the  end  it  is  hardly  perceptible. 

In  the  more  protracted  cases  some  animals  develop  later 
indannnations  of  the  joints  as  well  as  manifestations  of  a 
pyosepticemia,  which  makes  the  close  relationship  of  the  two 
diseases  apparent. 

Course  and  Prognosis.  The  course  of  the  disease  is  in  most 
cases  unfavorable.  The  sooner  the  first  sjanptoms  appear  after 
birth  and  the  sooner  they  become  aggravated,  the  more  un- 
favorable is  the  prognosis.  Bloody  diarrhea  or  a  rapid  drop 
in  temperature  are  forerunners  of  death.  These  may  appear 
on  the  second  day  of  the  disease ;  mostly,  however,  between  two 
and  three  days,  exceptionally  even  after  ten  days. 

In  some  outbreaks  practically  all  the  affected  animals  die 
and  even  in  more  favorable  cases  the  losses  are  rarely  less 
than  80%.  The  high  mortality  is  partly  the  result  of  catarrhal 
pneumonia  which  frequently  develops  as  a  complication  in  cases 
of  less  severe  primary  infections.  (See  Vol.  II,  Enzootic 
Pneumonia  of  Young  Animals.) 

Diagnosis.  The  disease  is  differentiated  from  the  simple 
acute  gastro-enteritis  caused  by  dietetic  errors  by  its  appear- 
ance shortly  after  birth,  by  the  predominating  diarrhea  and  by 
the  enzootic  character  of  the  disease.  Acute  gastro-enteritis 
usually  affects  older  animals  and  is  characterized  by  less  severe 
symptoms.  In  calves  in  this  disease  the  intestinal  contents  are 
thick  to  mushy  in  consistence,  later  almost  constantly  of  a 
clay-yellow  color,  and  have  an  intensely  sourish  or  somewhat 
putrid  odor  (Hess). 

The  pyosepticemia  of  the  newborn  resulting  from  umbilical 
infection  is  characterized  by  an  early  afTection  of  the  umliilicus 
and  by  the  early  appearance  of  metastatic  inflammatory 
processes,  especially  in  the  joints. 

For  distino^uishing  the  different  forms  of  the  disease  in 
accordance  with  the  etiological  factors  the  descriptions  given 
on  page  151  offer  suflficient  points  of  differentiation. 

Treatment.  At  the  onset  of  the  disease  suitable  immune 
sera  (see  pase  156)  may  have  beneficial  effect  and  should  l)e 
employed  intravenously,  and  if  necessary  the  injection  should 
be  repeated  (5  to  20  cc),  but  even  in  such  cases  suitable  dietetic 
treatment  should  be  carried  out.  This  is  commenced  with  a 
mildly  actinii;  purgative  in  order  to  remove  the  fermenting 
intestinal  coiitents.  Especially  to  be  recommended  is  castor 
oil  (colts  and  calves  40  to  50  o;m.,  lambs  10  to  15  ,inn.),  or  calomel 
(colts  0.2  to  0.3  ,Q:m.).  After  the  appearance  of  the  pure:ative 
action  it  is  advisable  to  administer  various  slimy  gruels  (barley 


]^54  White  Scours  of  Sucklings. 

gruel,  lime  water,  decoctions  of  linseed,  barley  and  oats,  further 
of  althaea  or  senega  roots).  They  may  be  administered  with 
or  without  opium  (0.5  to  1  cc.  or  0.05  to  0.10  gm.)  to  which 
some  chalk  or  magnesia  (3  to  5  gm.)  may  be  added.  Hertwig's 
mixture  has  a  good  reputation  and  consists  of  Pulv.  Rad.  Rhei 
4,  Magn.  Carb.  1,  Opii  puri  0.3  in  100  gm.  cammomile  tea  or 
in  50  gm.  of  diluted  alcohol,  given  twice  daily  to  small  animals 
in  tablespoonful  doses.  Of  the  intestinal  disinfectants  salicylic 
acid  (0.2  to  0.5  gm.)  may  be  given  together  with  tannin;  further 
tannoform  (colts  0.2  to  0.5  gm.,  calves  1  to  2  gm.),  tannalbin 
(3  to  5  gm.),  napthalin  (1  to  2  gm.),  salol  (5  to  8  gm.),  etc., 
may  be  used  with  beneficial  results. 

Creolin  and  lysol  are  suitable  per  os  (1  to  2  gm.)  as  well 
as  in  a  1%  solution  of  enemas.  Boracic  acid  (3  to  4%)  may 
also  be  utilized  for  this  purpose.  In  the  presence  of  severe 
trismus  starch  flour  enemas  containing  tincture  of  opium  may 
be  given. 

Evers  recommends  the  intravenous  injection  of  collargol  as  an 
abortive  remedy  (0.05  gm.  collargol  in  5  gm.  of  1/2%  carbolic  solution). 
This  method  of  treatment  was  also  found  satisfactory  by  Stampel 
and  Trost.  Fumagalli  obtained  good  results  from  it  in  well  developed 
cases  (four  injections  daily  of  0.15  to  2  gm.).  Mobius  was  successful 
with  phosphoric  acid  (5%  solutions  in  teaspoonful  doses).  Schmidt 
recommends  the  administration  of  1  gm.  tannargentan  every  3  hours, 
to  be  given  in  a  tablespoonful  of  milk,  while  Eber  obtained  satisfactory 
results  in  mild  cases  from  tannothymol  (4  to  5  gm.  per  dose). 

In  addition  to  the  medicinal  treatment  attempts  should  be 
made  to  preserve  the  strength  of  the  animals.  For  this  purpose 
eggs  should  be  given  either  raw  with  a  small  quantity  of  alum, 
or  in  warm  wine  soup.  The  weakness  is  treated  advantageously 
with  wine  (port  wine),  further  with  black  coffee  or  with  sub- 
cutaneous injections  of  caffein.  Infusions  of  a  slightly  alkaline 
physiological  salt  solution  (0.8  of  1%  salt  and  0.25%  sodium 
carbonate)  into  the  subcutis  of  the  neck  or  into  the  rectum 
(2  liters,  repeated  if  necessary  in  from  2  to  5  hours)  have  often 
given  surprisingly  good  results  (Eber).  Further  rubbing  with 
alcohol  and  warm  blanketing  of  the  abdomen  is  indicated. 

As  the  infective  agent  is  contained  in  the  excrements  of 
the  animal  the  immediate  isolation  of  the  infected  animals  and 
the  destruction  of  the  feces  should  be  carried  out.  Besides  this 
a  thorough  disinfection  of  the  stables,  to  be  repeated  at  frequent 
intervals,  is  indicated. 

Prevention.  In  order  to  prevent  the  infection  of  the 
newborn  the  greatest  cleanliness  should  be  exercised  during 
births  (disinfection  of  the  stables  at  intervals  of  3  or  4  weeks, 
fresh  straw  under  the  parturient  animals,  clean  hands  of  the 
stable  attendants,  etc.).  If  the  disease  is  already  in  existence 
it  is  advisable  to  remove  the  highly  pregnant  breeding  animals 


Prevention.  155 

a  few  weeks  before  birth  into  suitable  clean  stalls  (Roloff, 
Franck),  and  innnediately  before  l)irth  to  pUuH;  them  in  a  1)0X 
stall  especially  used  for  that  purpose.  Sometimes  the  disease 
does  not  recur  in  infected  stables  if  the  stable  floor  and  the 
cribs  have  been  thoroughly  disinfected  and  if  the  newborn  calves 
are  not  placed  in  common  pens,  but  are  kept  tied  with  the 
mothers  for  two  weeks. 

Further  it  is  advisable  to  disinfect  the  litter  and  the  vagina 
of  the  mother  animal  before  as  well  as  after  birth,  and  to  care 
i'or  the  newborn  with  the  utmost  cleanliness.  In  order  that 
the  calves  may  pass  the  meconium  they  should,  as  soon  as 
possible,  suck  the  collostral  milk  from  the  previously  washed 
udder,  and  if  they  are  kept  in  special  pens  they  should  be 
allowed  to  feed  from  the  mothers  at  regular  intervals.  Further 
they  should  be  protected  against  taking  cold  and  therefore  kept 
in  a  moderately  warm,  clean  place,  free  from  draughts. 

In  places  where  the  calves  are  brought  up  artificially,  steri- 
lized milk  should  be  given  only  after  tlie  animal  has  partaken 
of  the  collostral  milk,  and  not  earlier  than  the  second  day,  and 
in  such  cases  a  painstaking  vigilance  should  be  maintained  as 
to  cleanliness,  especially  of  the  vessels  and  the  hands  of  the 
attendants.  The  milk  should  be  heated  shortly  before  feeding 
and  given  to  the  calves  cooled  to  40° C.  in  clean  sucking  pails. 
In  various  places  keeping  the  calves  in  single  stalls  for  the 
first  two  weeks  after  birth  has  given  splendid  results. 

Behring  recommended  the  feeding  of  raw  formalin  milk  (1  to 
10,000).  The  raw  milk  is  supposed  to  have  the  preference  over  the 
(Sterilized  milk  as  the  activity  of  the  glands  of  the  stomach  and  in- 
testinal mueons  membrane  are  stimulated  by  the  presence  of  ferments. 
The  addition  of  formalin  prevents  the  spoiling  of  the  milk,  and  exerts 
also  to  some  extent  a  slight  inhibiting  action  on  the  intestinal  bacteria 
(according  to  the  investigations  of  Kolles  the  addition  of  formalin  to 
milk  in  1  to  40,000  or  1  to  25,000,  inhibits  only  the  development  of 
the  lactic  acid  bacilli  but  not  the  peptonizing  bacteria).  Unfavorable 
results,  however,  were  observed  from  this  method  of  treatment 
(Raebiger),  and  it  will  probably  not  meet  with  favor  as  the 
formaldehyde  retards  or  inhibits  the  digestion  of  the  casein  by  the 
pepsin  and  the  trypsin,  and  besides  the  milk  containing  formaldehyde 
no  longer  acts  on  the  rennet  (Lowenstein). 

Poels  Method.  The  external  genitals  of  the  mother  as  well  as  the  tail  and 
the  iiilder  are  washed  with  a  .'^^  creolin  solution.  The  vagina  is  irrigated  with  a 
corrosive  sublimate  solution  of  1  to  .5,000,  or  with  a  liberal  quantity  of  hike  warm 
followed  by  cold  water.  The  calf  is  caught  in  a  clean  sheet,  the  umbilical  cord  is 
ligated  as  "close  as  possible  to  the  abdominal  wall,  severed  and  the  stump  is  painted 
with  a  o'^f  solution  of  potassium  permanganate.  Then  the  mouth  is  cleanoil  and  a 
tightly  woven  muzzle  applied.  The  calf  should  immediately  suck  out  the  collostral 
milk ;  however,  it  is  recommended  to  first  nulk  from  ea(di  teat  a  few  strokes  into  the 
straw,  as  the  first  few  strokes  may  be  infected.  The  milk  may  be  also  drawn  into 
clean  vessels  and  fed  to  the  calves  "(immediately  after  birth,  and  again  after  lA  to  1 
hour,  Vn  to  1  liter  each  time).  The  quantity  of  milk  required  by  newborn  calves  is 
on  the  first  day  3^  to  1  liter  collostral  milk,  on  the  second  day  IV2  liter  on  the  third 
day  214  liters,' and  later  up  to  the  sixth  day  it  increases  V-  liter  per  day.  Later  the 
milk  should  be  given  fresh  and  in  small  rations.  The  muzzle  is  removed  only  during 
sucking  or  feeding.     By  this  method,  which  of  course  can  be  also  applie<l  to  foals, 


156  Whiti)   Scours  of  Sucklings. 

the  (liseas^e  has  been  eradicated  in  many  small  farms  where  formerly  all  calves  die<i. 
Raehiger  recommends  washing  with  pure  water  and  drying  with  a  ch^an  cloth  for 
cleansing  the  udder.  Guillebeau  advises  to  follow  the  drying  by  the  application  of 
fat  to  the  udder  by  means  of  a  cloth  (for  the  treatment  of  the  umbilicus  see  also 
under  pyosepticemia.) 

Evers  obtained  very  good  results  from  placing  the  calves  in  a  transportable 
box  in  which  they  are  retained  for  4  to  5  days,  and  meanwhile  are  fed  with  milk 
freshly  obtained  from  their  mothers.  Inasmuch  as  the  box  is  thoroughly  cleaned  and 
disinfected  before  its  use,  infection  of  the  newborn  may  be  prevented,  and  should  it 
occur  the  dissemination  of  the  infection  is  limited. 

Immunization.  Jensen  treated  a  horse  partly  with  dead 
and  partly  with  living  cultures  of  the  colon  bacillus  and  pre- 
pared a  serum  which  had  a  decided  bactericidal  action  in  experi- 
ments on  guinea  pigs.  It  protected  the  animals  against  an 
otherwise  fatal  artificial  infection,  but  proved  only  effective 
against  the  particular  strain  of  the  colon  bacillus  with  which 
the  horse  had  been  treated,  while  against  other  strains  it 
afforded  only  slight  protection  or  none  whatever.  As  the  appli- 
cation of  the  monovalent  serum  proved  unsatisfactory  in  prac- 
tice he  produced  a  polyv^alent  serum  by  using  colon  strains  of 
different  origins  with  which  far  better  results  were  obtained. 
White  scours  also  being  caused  sometimes  by  paracolon  bacilli 
it  was  necessary  to  produce  also  a  paracolon  serum  which  in 
suitable  cases  exerted  a  protective  action. 

In  the  preparation  of  poly\'alent  colon  serums  carefully  selected  strains  of  the 
colon  bacillus  are  separately  cultivated  in  bouillon  at  37 "C,  then  the  cultures  are 
mixed  in  measuied  quantities  and  the  mixture  is  injected  intravenously  into  horses 
in  quantities  of  0.25  to  0.50  cc,  and  after  each  12  to  14  days  in  increased  doses  up 
to  10  and  20  ce.  If  after  a  certain  time  the  serum  of  the  horse  produces  precipita- 
tion in  a  bouillon  culture  of  a  certain  colon  strain  in  the  dilution  of  1  to  500  to 
2000  it  is  probable  that  the  protective  serum  may  be  utilized  with  satisfactory  re- 
sults against  infections  with  that  particular  strain. 

Bongert  and  Eaebiger  recommend  goats  and  sheep  for  the  serum  production. 
At  the  present  time,  however,  only  large  animals  are  used  for  the  production  of 
serum. 

The  preparation  of  the  paracolon  serum  is  more  difficult,  as  the  paracolon 
Vacilli  possess  higher  virulence,  so  that  an  injection  of  even  0.1  to  0.25  cc.  of  a 
bouillon  culture  may  cause  a  serious  infection. 

_  As  a  colon  serum  is  effective  only  against  colon  bacillosis  (the 
action  is  principally  bacteriolytic),  favorable  results  can  be  expected 
only  in  those  cases  in  Avhieh  the  disease  is  caused  by  colon  bacilli.  The 
results  obtained  in  practice  are  not  always  uniform  in  this  respect; 
thus  Jensen  succeeded  in  reducing  the  number  of  cases  and  the 
mortality  to  0%  in  numerous  i:>remises  where  the  disease  had  prevailed 
in  an  enzootic  and  malignant  form,  causing  sometimes  a  loss  of  1007f. 
These  results  were  obtained  without  the  inauguration  of  any  other 
protective  measures,  and  all  the  control  animals  died.  In  other 
premises  the  mortality  was  only  reduced  from  70  to  20%,  or  the  serum 
treatment  had  no  apparent  effect  on  the  disease. 

The  results  in  practice  have  since  revealed  the  favorable  action  of  the  serum 
treatment^  (Eaebiger,  Jans^on,  Ileurgren,  Schupp,  Piethrisen,  etc.).  The  colon 
serum  is  injected  subcutaneously  into  the  newborn  calves  as  soon  as  possible  after 
birth  in  20  cc.  doses.  If  the  animals  do  not  show  an  improvement  the  paracolon 
serum  may  then  be  used. 

Eaebiger  observed  only  one  death  among  62  injected  calves;  in  addition  he  also 
reports  278  inoculations  in  previously  infected  premises  in  which  none  of  the  new- 
born calves  have  become  affected  since  this  protective  measure  has  been  adopted. 


Active   liiuimnization    in    Advaiu-ed   l'iv<;iinuc\ .  157 

Active  Immunization  in  Advanced  Pregnancy.  Bast-d  on  the 
exporiuu'iital  obsci-vations  that  prutet-tivt'  Ixidics  lonncd  in  tlie  malernal 
organism  are  Iransniilled  l)y  way  ol"  the  loetal  eircuhition  to  the  foetus, 
and  tliat  these  protective  bodies  will  convey  a  speeiiic  protection  against 
a  later  infection  to  the  ottspring,  Sande  aimed  to  immuuize  calvi-s 
before  their  birth.  He  repeatedly  injected  pregnant  cows  sul)- 
eutaneously  with  sterile  extracts  obtained  from  white  scours  bacilli 
(shake-extract  from  colon  bacilli  cultures?),  and  the  calves  of  cows 
treated  in  this  manner  are  said  to  have  withstood  the  natural  infection 
in  infected  premises. 

Sande  reports  tlie  inoculation  of  21.5  cows  with  good  results  in  that  91.0%  ot 
the  calves  were  protected  from  white  scours,  t^ix  per  cent  became  affected  with  thb 
disea.se  and  tiled,  and  2.;? 7c  had  diarrhea  which,  however,  disappeared  soon  after  the 
administration  of  the  ^erum  treatment.  Favorable  results  are  also  reported  by 
Felirnuinn  in  22  cows  (only  2  calves  of  cows  which  had  not  been  vaccinated  became 
alfected),  by  Grajewski  in  8  and  by  Kronacher  in  16  cows  (only  3  control  calves 
became  att'ected).  tSchmitt  found,  however,  that  the  vaccines  for  mother  animals 
which  are  marketed  bear  no  relation  to  the  bacteria  of  the  colon  and  paratyphoid 
j,noup  nor  to  the  ovoid  bipolar  bacilli,  and  claims  that  this  form  of  vaccination  has 
not  proven  the  efficiency  of  the  treatment. 

The  vaccination  of  the  cows  is  carried  out  by  injecting  under  the  skin  of  the 
neck  10  cc.  of  extract  6  weeks  before  parturition,  and  ten  days  later  20  cc.  The 
animals  stand  the  inoculation  without  any  disturbance  in  their  health.  However, 
cows  should  not  be  vaccinated  in  the  last  n:onth  of  pregnancy  as  they  may  abort  or 
become  fatally  affected.     It  is  dangerous  also  to  employ  fully  virulent  cultures. 

Literature.  Oldch,  W.  f.  Tk.,  1865,  101.— Eoloff,  Tr7t.,  1876,  83.— Franck, 
D.  Z.  f.  Tm.,  1877,  376.— Hess,  Landw.  Jahrb.  d.  Schweiz,  1.S97.— Poels,  B.  t.  W., 
1901,  290.— Willerding,  A.  f.  Tk.,  1899,  XXV,  93  (Lit.).— Joest,  Z.  f.  Tm.  1903, 
YII,  377.— Jensen,  Monh.  1892,  lY,  97;  Hb.  f.  p.  M.  1903,  111,  761;  Z.  f.  Tm. 
190.5,  IX,  321  (Lit.  on  Etiologv  and  Vaccination). — Bugge  Kiilberruhr  u.  ihre 
Behdlg.,  195.— Schmitt,  D.  t.  W.,  1908,  673;  Z.  f.  Infkrkh.,  1909,  V,  435;  1910,  YII, 
71.— Sande,  B.  t.  W.,  1909.  261.— Titze  &  Weichel,  Arb.  d.  G.-A.,  1910,  XXXIII, 
516    (Lit.).— Krautstrunk,   Z.    f.   Infkrkh.,   1910,   VII,   256. 

Other  Colonbacilloses  in  Cattle.  Thomassen  (1897)  described  a 
new  septicemia  in  calves  which  causes  in  Holland  every  spring  great 
losses.  The  animals  become  aifected  at  the  age  of  from  4  to  5  weeks 
and  manifest  fever  of  40-41  "C,  great  debility,  depressed  appetite,  in 
some  calves  a  severe  dry  cough,  normal  action  of  the  bowels  and,  only 
in  very  exceptional  cases,  diarrhea.  The  urine  contains  great  quantities 
of  albumen  and  a  small  amount  of  blood  pigment  as  well  as  casts. 
In  some  severe  forms  epileptic  convulsions,  opisthotonus  and  trismus 
may  be  observed.  The  disease  usually  terminates  in  death  in  5  to  6 
days.  The  autopsy  reveals  small  hemorrhages  in  the  endocardium, 
on  the  peritoneum,  the  mucous  mem])rane  of  the  aliomasum  and 
})ladder.  Acute  hemorrhagic  swelling  of  the  mediastiiuil  glands,  marked 
acute  swelling  of  the  spleen  and  acute  nephritis. 

Bacilli  resembling  the  bac.  coli  communis,  l)ut  more  so  the  bacillus 
typhi  hominis  were  isolated  from  the  blood,  from  the  fluid  of  the 
abdominal  cavity,  from  the  liver,  kidneys  and  urine.  Bouillon  cultures 
of  these  organisms  when  inoculated  su])cutaneously  into  calves  in 
(|uantities  of  1  to  2  cc,  or  when  fed  in  larger  quantities,  caused  an 
attack  of  the  original  disease  fatal  in  3  to  7  days.  The  cultures  were 
also  pathogenic  for  rabbits,  guinea  pigs  and  fnice.  Oood  results  were 
obtained  in  treatment  of  some  of  the  cases  from  a  mixture  of  carbolic 
acid  (1  part),  alcohol  (30  parts),  milk  of  lime  (.300  parts),  and  oil 
menthae   (3  parts).     (A.  P.,  1907,  XLVT,  542.) 

Mohler    and    Bucklev    (1902)    observed    in    America    among    cows 


158  Pyo-Septiceniia  of  Sucklings 

a  similar  and  probably  etiologically  identical  disease.  In  the  acute 
cases  the  clinical  manifestations  as  well  as  the  anatomical  changes 
were  very  similar,  while  in  1  cow  which  died  only  after  26  days, 
necrotic  foci  were  found  in  the  liver  substance  in  addition  to  hemor- 
rhages of  the  serous  membranes.  As  the  cause  of  the  disease  an 
organism  of  the  paracolon  type  was  demonstrated  which  possessed 
pathogenic  properties  also  for  pigeons,  sheep  and  dogs.  (Bureau  Anim. 
Industry,  1902,  XIX,  297   [Lit.].) 


(b)  Pyo- Septicemia  of  Sucklings.    Pyo-septicaemia  neonatorum 

{Pyemic  and  septic  joint  disease  of  sucklings,  Joint  evil,  Navel 
ill;  Omphalophlebitis  septica,  Pasteur ellosis  neonatorum) 

Pyo-septicemia  of  sucklings  is  an  acute  contagious,  infec- 
tious disease  of  newborn  animals  occurring  in  the  first  days 
of  life  and  not  later  than  in  the  first  four  weeks.  It  is  charac- 
terized by  purulent  inflammation  of  the  joints  and  general 
pyemic  manifestations.  It  develops  as  a  result  of  umbilical 
infection,  exceptionally  as  a  result  of  an  intrauterine  infection 
of  the  foetus. 

History.  .  In  former  times  all  affections  of  newborn  animals  were 
combined  under  the  term  navel  ill  (joint-evil)  in  the  course  of  which 
lameness  and  disturbance  in  walking  was  present.  Fuerstenberg  (1864) 
recognized  the  fatty  degeneration  of  muscle  in  young  animals  as  an 
independent  disease,  and  Roloff  (1864)  indicated  that  rachitis  may 
also  manifest  symptoms  resembling  those  of  the  pyo-septicemia.  Later 
the  enzootical  acute  gastritis  and  white  scours  of  sucklings  was  sep- 
arated from  this  group  of  infection,  which  left  only  the  cases  in  which 
the  suppurating  processes  occurring  on  different  parts  of  the  body 
are  characteristic.  Bollinger  (1873  and  1875)  proved  that  one  part 
of  these  cases,  especially  the  so-called  "navel  ills"  and  "joint  evils," 
are  a  pyemia  resulting  from  septic  umbilical  infection,  more  rarely  a 
septicemia,  and  that  the  infection  of  the  umbilicus  occurs  immediately 
or  very  soon  after  birth.  This  conception  may  well  be  made  to  agree 
with  the  possi])ility  of  a  uterine  infection  in  spite  of  Bollinger's  ex- 
clusive view  point,  and  recently  Tatray,  Pfeiffer  and  especially  Sohnle 
confirmed  the  possibility  of  this  method  of  infection. 

The  etiology  of  the  disease  has  recently  been  more  extensively 
studied  in  calves  by  Gmelin,  Hess,  Lesage  &  Delmer,  in  colts  by  Casper, 
Sohnle  and  Ostertag. 

Occurrence.  The  disease  occurs  principally  in  sucking  colts 
and  sucking  calves,  less  frequently  in  sucklings  of  other  species. 
In  some  of  the  breeding  districts  it  attains  not  infrequently  an 
enzootic  character.  The  best  opportunity  for  the  spreading  of 
the  disease  is  present  in  the  studs  or  dairies  where  all  of  the 
newborn  animals  may  become  affected,  and  as  a  result  the 
breeding  industry  is  endangered  to  a  great  extent. 

TTp  to  the  year  1887  the  disease  caused  an  annual  loss  of  at  least  15%  in  the 
stud  of  Mezohegyes    (Hungary)  ;    sinee   that  time  disinfection  has  been  carried  out 


OccurreiR-e.      Etiology.  159 

systematically,  and  recently  the  disease  has  not  occurred.  In  Salzburg  out  of  336 
colts  172  became  affected  in  the  year  1884,  of  which  152  (92.4%-)  died.  In  the 
year  1885,  98,  iu  1886,  120  succumbed  to  the  disease. 

Etiology.  The  otioloiiy  of  ])yo-septicemia  lias  up  to  the 
l^rosout  time  l)een  only  elucidated  to  the  extent  that  the  investi- 
gations showed  as  the  causative  factor  of  the  disease  on  one 
side  a  variety  of  the  bacillus  (bipolaris)  septicns  (Pasteurella; 

see  pag-e  71)),  on  the  other  a  virulent  colon  bacillus. 

The  bacillus  bipolaris  septicus  isolated  from  the  body  of  affected 
animals  is  i)atliou:i'iii('  for  rabhits,  guinea  pigs,  mice,  and  in  larger 
(|uantities  also  for  pigeons.  Injections  of  3  to  5  cc.  of  fresh  virulent 
bouillon  culture  into  the  umbilicus  of  a  4  to  5-day  old  calf  cau.ses  an 
inflammation  of  the  um])ilicus  and  softening  and  thrombi  of  the  um- 
bilical vessels,  resulting  in  a  serofibrinous  inflammation  of  the  joints 
(Gmelin).  Intravenous  injections  of  3  cc.  of  culture  into  a  1-day  old 
calf  causes  a  slight  rise  in  temperature;  on  the  following  day  the 
animal  is  del)ilitated  and  at  the  same  time  the  temperature  drops 
bt'low  normal  (34.6).  The  animal  passes  white,  foamy,  later  bloody, 
fluid,  fetid  feces  with  much  straining,  and  succum])s  after  30  hours 
to  complete  exhaustion.  The  autopsy  reveals  manifestations  of  hemor- 
rhagic septicemia,  and  also  extensive  inflammation  of  the  large  in- 
testines. The  blood  and  the  exudate  of  the  serous  cavities  contain 
the  bipolar  bacillus  in  pure  cultures.  On  the  other  hand,  the  mesenteric 
glands  and  the  liver  contain  shortly  after  death  foreign  bacteria, 
principally  colon  and  paracolon  bacilli  in  great  quantities.  Animals 
recovering  from  the  disease  react  after  4  weeks  to  an  intravenous  in- 
jection of  10  cc.  of  culture  only  with  a  rise  in  temperature  which 
lasts  for  one  day  (Nocard). 

Bacteria  of  the  bacillus  coli  communis  type  (see  page  146)  were 
isolated  by  Zschokke  and  Wilhelmi  from  the  joints  of  calves  dead 
from  the  disease  either  in  pure  culture  or  mixed  with  some  other 
bacteria.  Wilhelmi  produced  in  8  cases  in  young  calves,  by  intravenous 
injections  of  pure  cultures,  a  sero-flbrinous  inflammation  of  the  joints, 
acute  endocarditis  and  diarrhea,  whereupon  the  animals  died  within 
a  short  time  or  after  longer  ailing.  In  one  case  Zschokke  produced  only 
a  passing  arthritis.  Poels  and  Joest  also  produced  fatal  infection 
iu  calves  by  injecting  colon  bacilli  into  the  umbilical  vessels.  The 
disease,  however,  corresponded  with  the  white  diarrhea  of  calves,  and 
inflammation  of  the  joints  was  absent. 

The  results  of  the  investigations  accordingly  appear  to  indi- 
cate that  the  disease  following  the  umbilical  infection  develops 
as  a  result  of  infection  with  various  micro-organisms.  The 
organisms  which  are  implicated  are  on  the  one  hand  the  bipolar 
bacillus  of  hemorrhagic  septicemia,  and  on  the  other  hand  a 
strong  virulent  variety  of  the  colon  bacillus.  According  to 
Lesage  &  Delmer  the  colon  bacillus  prepares  the  field  for  the 
pathogenic  action  of  the  bipolar  bacillus,  as  the  injection  of 
both  bacteria  under  the  skin  of  a  calf  produces  the  disease,  while 
the  bipolar  bacillus  alone  causes  only  a  local  inflammation  (in 
the  first  case  the  colon  bacillus  remains  at  the  point  of  inocula- 
tion, while  the  bipolar  bacillus  passes  into  the  blood). 


160  Pyo-SeiJtieeniia  of   Sucklings. 

Relative  to  aiToctions  of  sucklings  of  other  species  of  animals  tliere 
is  a  possibility  that  the  diseases  which  clinically  and  pathologic- 
anatoniically  are  practically  identical  in  various  species  of  animals, 
bear  a  very  close  relationship  etiologically.  As  a  matter  of  fact,  how- 
ever, the  investigators  of  pyo-septicemia  of  foals  have  not  proven  such 
relationship.  Casper  and  Ostertag  obtained  from  all  organs  of  atfected 
colts,  sometimes  only  from  the  heart  blood  or  from  the  joints  and 
bone  marrow,  the  streptococcus  pyogenes,  while  Solmle  obtained  from 
tlie  blood  and  the  joints  of  colts,  as  well  as  from  the  uterus  of  mares  a 
higlily  virulent  variety  of  the  staphylococcus  pyogenes  aureus.  Whether 
these  bacteria  are  the  original  causative  factors  of  the  disease  or 
whether  they  play  only  a  secondary  part  will  have  to  be  established 
by  further  investigation. 

The  natural  infection  results  mostly  through  the  torn  or 
not  yet  closed  mnbilical  vessels  immediately  after  birth,  excep- 
tionally also  during  birth.  The  stump  of  the  loose,  juicy 
umbilical  cord  which  is  no  longer  nourished,  as  well  as  the  blood 
present  on  the  torn  end  of  the  cord,  present  a  suitable  medium 
for  the  propagation  of  the  micro-organisms,  until  drying  of  the 
stump  has  taken  place.  Bacteria  which  reach  the  surface  of 
the  stump  find  favorable  development  in  the  thrombi  inside  of 
the  vessels.  Then  they  penetrate  along  the  thrombus,  pass  the 
navel  ring  and  finally  spread  even  in  the  abdominal  portion 
of  the  umbilical  vessels. 

The  extra  uterine  infection  which  causes  the  disease  in  the 
majority  of  cases  occurs  through  the  soiling  of  the  umbilical 
stump  with  the  contaminated  straw  immediately  after  birth, 
as  well  as  by  coming  in  contact  with  the  stalile  floor  containing 
pathogenic  bacteria  or  else  with  the  infected  hands  of  the 
attendants.  The  sucklings  which  have  first  become  infected 
in  the  course  of  the  disease  contaminate  the  straw  and  the  stable 
floor  A\dth  their  excrements,  especially  however  with  the  puru- 
lent exudate  of  the  umbilicus.  In  this  way  the  infection  accum- 
ulates in  the  stable,  and  as  a  result  of  this  the  animals  which 
are  born  later  are  more  exposed  to  the  infection.  In  this  way 
the  disease  which  was  at  first  sporadic  may  later  occur  with 
greater  frequency,  so  that  after  a  certain  time  almost  all  the 
newliorn  animals  become  victims  of  the  disease. 

The  cases  in  which  the  animals  are  affected  at  the  time  of 
birth,  or  in  which  autopsy  reveals  extensive  and  progressive 
changes  which  could  hardly  have  developed  since  the  time  of 
birth,  can  be  accepted  as  due  to  intra-uterine  infection.  This 
is  transmitted  by  the  placental  circulation  in  such  a  way  that 
the  bacteria  which  are  present  in  the  blood  of  the  mother  enter 
through  the  placenta  into  the  blood  circulation  of  the  foetus, 
where  they  then  multiply.  For  the  intra-uterine  infection  to 
occur  it  is  of  course  necessary  that  the  mother  suffer  from 
an  infectious  disease  as  a  result  of  which  pathogenic  bacteria 
circulate  periodically  in  the  blood.  This  form  of  infection  has 
been  observed  during  the  course  of  outbreaks  of  influenza,  when 


Aiiatoiiiiciil    Clinnsjcs.     Pathoiicticsis.  \Q\ 

tlie  foals  of  affected  mares  are  infected  at  the  time  of  l)irtli 
(Tatray,  Sohiile). 

Till'  possibility  that  the  infection  may  also  occur  from  the 
external  i^eiiital  organs  cannot  be  excluded.  Tiio  conta,e:ion 
which  may  enter  the  mucous  membrane  of  the  uterus  might 
localize  there  and  later  enter  the  vascular  system  of  the  devel- 
o])inii-  placenta,  and  in  tliis  manner  also  the  body  of  the  foetus. 
In  this  way  it  may  be  ex})laineil  that  some  animals  give  l)irth 
for  several  consecutive  years,  to  affected  offspring,  a  condition 
not  infrequently  observed,  especially  in  thoroughbred  mares. 
In  case  of  an  intrauterine  infection  the  infective  agent  remains 
lodged  only  in  the  finer  blood  vessels  of  the  intei'nal  organs 
and  causes  at  these  places  alone  inflammatory  processes,  while 
the  umbilical  vessels  remain  intact  (Peiffer  found  only  37%  of 
affected  foals  with  umbilical  vessels  diseased). 

The  infection  probal)ly  does  not  occur  tlirough  the  digestive 
and  air  passages;  at  least  up  to  the  present  time  the  disease 
could  not  ])e  produced  artificially  in  this  way  in  calves  (Nocard). 

The  greater  or  lesser  frequency  with  which  the  disease 
occurs  can  in  various  localities  be  referred  to  existing  local  con- 
ditions. The  fact  that  the  disease  is  only  rarely  observed  among 
common  bred  stock  which  is  kept  out  of  doors  most  of  the  time, 
as  well  as  in  stables  with  only  few  animals  can  be  readily 
explained  by  the  fact  that  under  such  conditions  the  animals 
are  not  confined  in  close  quarters  and  therefore  there  is  less 
chance  for  infection. 

Since  the  infective  agents,  the  bipolar  bacterium,  as  well 
as  the  colon  bacillus,  can  propogate  in  the  soil,  the  disease  may 
appear  without  introduction  from  outside,  as  a  result  of  direct 
infection  from  the  soil;  nevertheless  it  is  most  frequently  the 
result  of  an  introduction  from  adjoining  farms,  while  if  the 
disease  has  already  been  introduced  in  certain  premises  it  is 
])i"opagated  by  the  secretions  and  excrements  from  the  infected 
animals. 

Formerly  breeders  attributed  great  importance  to  heredity 
in  the  appearance  of  pyosepticemia.  However  except  for  the 
cases  of  intrauterine  infection,  in  Avhicli  the  infection  of  the 
foetus  is  directly  associated  with  the  infection  of  the  mother, 
the  disease  occurs  only  when  the  conditions  for  the  infection 
of  the  sucklings  are  favorable. 

Pathogenesis.    The  bacilli  which  enter  the  umbilical  veins 

commence  to  multiply  in  the  coagulated  blood  of  these  vessels, 

on  the  one  hand  cause  the  throm1)us  to  break  down,  and  on  the 

other  hand  produce  an  inflammation  of  the  intima  and  probably 

also  of  the  external   layer  of  the  walls   of  the  vessels.     The 

breaking  down  of  the  tliromlms  progresses  gradually  inward 

until  it  reaches  the  end,  when  the  infection  may  come  in  contact 

with  the  liquid  blood  contained  in  the  same  vessel,  or  in  the 

portal  vein,  coming  in  direct  contact  with  the  circulating  blood. 
u 


162  Pyo-Septiceiniu  of   Sucklings. 

Small  particles  of  the  softened  thrombus  may  be  carried  off 
by  the  circulating  blood,  and  with  these  the  bacteria  may  enter 
the  free  blood  circulation.  They  are  taken  either  into  the  liver 
or  with  the  blood  of  the  vena  cava  into  the  general  circulation. 

The  micro-organisms  which  enter  the  umbilical  vein  from 
without  do  not  necessarily  remain  confined  in  the  immediate 
surroundings  of  the  umbilical  ring.  While  the  circulation 
ceases  after  birth  in  this  blood  vessel,  the  passing  blood  stream 
of  the  portal  vein  or  of  the  ductus  Arantii,  as  well  as  the 
respiratory  movements,  produce  a  suction  on  the  fluid  which 
is  present  in  the  umbilical  vein,  by  which  the  blood  serum 
separates  from  the  blood  coagulum,  is  diverted  toward  the 
portal  vessel,  carrying  with  it  the  micro-organisms  w^hich  may 
be  contained  therein.  They  may  remain  attached  to  any  part 
of  the  intima  of  the  umbilical  vein,  where  they  produce  a  local 
inflammation  as  a  result  of  which  deposits  of  blood  coagulum 
occur,  or  a  softening  of  the  thrombus  wiiich  is  already  present. 
The  bacilli  may  even  penetrate  the  portal  vein  without  stopping, 
whence  the  blood  conveys  them  into  the  heart.  In  the  first 
case  that  section  of  the  umbilical  vein  which  is  nearest  to 
the  umbilical  ring  remains  healthy ;  in  the  other  case  the  entire 
umbilical  vein  will  be  intact  although  the  infection  has  passed 
through  it. 

In  ruminants  the  infective  agent  enters  wdth  the  blood 
either  through  the  ductus  Arantii  or  through  the  ramification 
of  the  portal  and  hepatic  veins  into  the  vena  cava,  and 
thence  into  the  general  circulation.  In  foals  all  septic  material 
enters  through  the  latter  channels.  In  these  animals,  however, 
breaking  down  of  the  blood  coagulum  is  also  frequently 
observed  in  the  umbilical  arteries  (Gmelin),  as  a  result  of  which 
the  infective  agent  may  pass  into  the  posterior  part  of  the 
abdominal  aorta,  and  with  the  blood  of  these  vessels  into  the 
peripheral  arterial  ramifications  of  the  posterior  extremities. 

Certain  organs  appear  to  have  a  special  predisposition  for 
attacks  by  the  micro-organisms  circulating  in  the  blood.  r)f 
these  the  lungs  and  the  liver  should  be  mentioned  first,  and  in 
addition  metastatic  inflammations  develop  frequently  on  the 
synovial  membranes  of  certain  joints. 

In  acute  cases  of  the  disease  the  flooding  of  the  blood  with 
pathogenic  bacteria,  as  well  as  the  inflammatory  processes  which 
develop  at  different  parts  of  the  body,  cause  the  death  of  the 
animal.  In  some  cases,  however,  the  acute  affection  is  suddenly 
checked,  and  the  disease  process  appears  to  turn  towards 
recovery.  After  several  weeks,  or  in  one  to  two  months,  how- 
ever, manifestations  of  the  chronic  affection,  especially  of  the 
lungs,  make  their  appearance.  These  manifestations  may  be 
associated  with  the  pre-existing  infection.  According  to  Nocard 
bacteria  of  hemorrhagic  septicemia  may  disappear  after  a  time 
from  the  blood ;  the  toxins,  however,  have  in  the  meantime 
exerted  a  paralytic  action  on  the  cells  by  which  the  resistance  of 


Pathogenesis.      Anatoinical   Changes.  1(53 

the  animal  has  been  reduced  to  such  an  extent  that  other  bac- 
teria, especially  the  Preisz-Xocard  l)acillus  of  pseudo-tuliercu- 
losis  (see  that  disease),  may  attack  the  tissues  of  the  body  and 
produce  an  inflannnation  of  the  lung  tissue. 

In  these  eases  which  have  become  chronic,  catarrhal  pneumonia 
k'ading  to  caseation  and  suppuration  can  usually  be  discovered. 
Bacilli  of  pseudo-tuberculosis  may  be  demonstrated  in  the  affected 
tissues  in  association  with  other  bacteria  (pus  cocci,  bacillus  necrophorus, 
streptothrix,  colon  and  paracolon  bacilli).  Their  occasional  pathogenic 
action  has  been  proven  by  Nocard  by  the  following  experiment :  A 
calf  three  weeks  old  was  injected  intra-peritoneally  with  100  cc.  of 
culture  of  the  ])ipolar  bacillus,  which  had  previously  been  heated  for 
one  hour  to  60° C,  and  after  six  hours  it  was  made  to  inhale  a  ])ouillon 
culture  of  the  bacillus  of  pseudo-tul)erculosis  for  five  minutes.  Tiie 
autopsy  which  was  performed  eight  days  later,  revealed  numerous 
catarrhal-pneumonic  areas  in  the  lungs.  In  a  second  calf,  which  was 
not  given  the  injection  of  the  killed  culture  of  the  bipolar  bacilli,  the 
inhalation  of  the  pseudo-tubercle  bacilli  caused  no  changes  in  the  lungs. 

According  to  ]\Ioussu  broncho-pneumonia  may  develop  in  sucking 
calves  also,  from  tlie  aspiration  of  the  amniotic  fluid  into  the  air  passages 
during  difficult  births.  The  infection  occurs  in  these  cases  while  the 
head  is  lodged  in  the  vagina,  and  with  the  commencing  respiratory 
movements  the  aspiration  of  the  fluid  takes  place. 

Anatomical  Changes.  In  some  of  the  acute  cases  the  um- 
bilicus is  swollen  and  dense.  The  borders  of  the  umbilical 
opening-  of  the  ring  which  has  not  closed  are  infiltrated;  some- 
times they  are  ulcerated,  and  a  purulent  ichorous  secretion  may 
be  pressed  out  of  the  same.  An  incision  frequently  reveals  an 
abscess  hing  in  the  abdominal  wall. 

The  umbilical  vein  in  colts,  also  one  or  both  umbilical 
arteries  (Gmelin),  are  greatly  thickened  and  of  a  firm  or  fluctu- 
ating consistence  in  their  entire  length,  or  only  in  parts.  In 
different  places  the  lumen  is  filled  with  blood  coagulum,  whicli 
in  various  parts  or  along  its  entire  length  appears  of  a  dirty 
red  color,  and  sometimes  liquefied  to  a  thick  fetid  mass.  The 
surface  of  the  intima  is  covered  with  fibrinous  shreds  or  with 
puriform  softened  masses  under  which  there  may  be  ulcerations. 
The  other  layers  of  the  wall  of  the  vessel,  as  well  as  the  sur- 
rounding connective  tissue,  are  sometimes  only  infiltrated  with 
the  serous  fluid,  in  other  cases  again  with  fibrinous  purulent 
exudate.  In  case  the  inflammation  has  extended  to  the  adjacent 
peritoneum  the  abdominal  organs  lying  close  to  the  affected 
areas  usually  show  adhesions  by  fibrinous  pseudo-membranes 
(intestines,  omentum,  liver,  in  colts  also  the  bladder).  All  these 
changes  may  be  present  without  an  affection  of  the  umbilicus. 
In  the  branches  of  the  portal  vein,  inside  of  the  liver  tissue, 
similar  thrombi  may  occur,  while  on  the  other  hand,  the  throm- 
bus of  the  vein  may  occasionally  extend  into  the  ductus  Arantii, 
and  may  even  penetrate  with  its  blunt  end  into  the  lumen  of 
the  vena  cava.    The  thrombi  of  the  umbilical  arteries  mav  reach 


164  Pyo-Septicemia  of  Sucklings. 

tlie  aorta.  The  internal  organs  present  indications  of  an  acute 
blood  infection  in  the  lungs,  sometimes  showing  areas  of  bron- 
cho-pneumonia. 

Metastatic  abscesses  occur  with  relative  frequency  in  the 
lungs,  where  they  are  always  associated  with  a  bronchial 
catarrh,  and  sometimes  also  with  a  fibrinous  or  purulent  pleu- 
risy. They  may  also  occur  in  the  liver  in  the  peribronchial, 
mediastinal  and  mesenteric  lymph  glands,  in  the  brain,  in  the 
kidneys,  etc.  Exudative  inflammations  of  the  jjeritoneum,  peri- 
cardium, and  of  the  meninges  of  the  brain,  are  also  frequently 
associated  with  the  disease.  Not  infrequently  ophthalmitis, 
with  an  accumulation  of  fibrinous  and  purulent  exudate  in  the 
anterior  chamber  of  the  eye,  is  present,  sometimes  also  a  lique- 
faction of  the  crystalline  lens. 

Purulent  inflammation  is  found  in  the  majority  of  cases  in 
the  joints  of  the  extremities,  most  frequently  in  the  hock  and 
knee  joints.  The  more  or  less  swollen  joints  contain  a  yellow 
or  reddish  semi-liquid,  pus-like  synovia.  The  synovial  sack 
appears  greatly  swollen,  bright  red  and  in  places  ulcerated ;  the 
surface  of  the  cartilage  is  uneven,  its  tissues  softened,  some- 
times covered  with  a  fiibrinous  or  purulent  exudate,  which  occa- 
sionally may  be  traced  even  into  the  spongy  substance  of  the 
bone  and  into  the  bone  marrow.  The  pariarticular  connective 
tissue  is  saturated  with  serous  fluid  or  with  a  sero-fibrinous  or 
sero-purulent  exudate  and  in  these  cases  abscesses  may  also 
be  found,  as  well  as  fistulous  tracts  communicating  with  the 
cavity  of  the  joint.  The  surrounding  tissue  is  always  edema- 
tously  infiltrated  and  the  muscles  frequently  show  a  fatty  degen- 
eration. The  tendon-sheaths  may  contain  a  sero-fibrinous  or 
purulent  exudate,  the  tissue  of  the  tendons  in  such  cases  show- 
ing serous  infiltration  and  loosening.  Purely  metastatic  ab- 
scesses may  be  present  in  the  subcutaneous  as  well  as  in  the 
intra-muscular  connective  tissue,  also  in  the  muscles  proper. 

In  the  peracute  cases  the  changes  are  less  conspicuous,  and 
usually  point  to  general  septic  infection.  The  lesions  consist 
of  a  cloudy  swelling  of  the  parenchymatous  organs,  acute 
catarrh  of  the  mucous  membranes,  hyperemia  of  the  spleen, 
small  hemorrhages  in  the  tissue  of  the  serous  and  mucous  mem- 
branes, sometimes  in  the  small  intestines  an  ulceration  of  the 
Peyer's  patches,  marked  acute  swelling  of  the  hnnph  glands,  etc. 

In  chronic  cases  (in  calves)  when  the  disease  has  not  pro- 
gressed to  an  advanced  stage,  the  lungs  show  signs  of  broncho- 
pneumonia, and  there  exist  frequently  fibrinous  or  sero-fibrinous 
pleurisy  and  pericarditis.  In  later  stages  the  broncho-pneu- 
monic areas  show  small  yellow^  caseous  foci,  and  still  later  the 
lungs  contain  large  firm  nodules,  which  inclose  small  cavities 
containing  a  white  or  greenish  caseous  substance.  The  medias- 
tinal and  peribronchial  lymph  glands  are  enlarged  and  some- 
times partially  caseated. 


Anatomical    ("liaiiges.      Syinptoms.  I(j5 

The  carcasses  of  animals  dead  from  tlic  disease  are  always 
greatly  emaciated,  and  show  manifestations  of  a  general  anemia 
and  cachexia. 

Symptoms.  The  symptoms  usually  appear  inside  of  24  to 
48  hours  after  birth;  e'xce])tionally  the  disease  may  also  occur 
somewhat  later,  and  in  rare  cases  the  animals  may  be  born 
affected  with  it. 

In  some  of  the  cases  symptoms  of  a  local  affection  of  the 
umbilicus  precede  the  general  aifection.  The  unil)ilicus  swells, 
becomes  sensitive  and  feels  warmer  than  normal  to  the  touch. 
The  stump  dries  more  slowly,  while  from  the  opening  of  the 
umbilical  ring  purulent  or  ichorous  secretion  may  be  pressed 
out.  In  the  median  line  between  the  swollen  umbilicus  and  the 
xyphoid  cartilage,  on  the  inner  surface  of  the  abdominal  wall, 
a  dense  cord  of  the  thickness  of  a  finger  may  be  felt.  The 
affected  animal  moves  but  little,  its  gait  is  laborious  and  stiff, 
the  desire  for  sucking  is  diminished,  the  body  temperature  is 
somewhat  elevated. 

The  symptoms  of  inflammation  of  the  umbilicus  may  sub- 
side after  a  few  days,  especially  when  appropriately  treated, 
and  the  patient  may  even  completely  recover.  In  the  majority 
of  cases,  however,  the  local  inflammatory  processes  increase 
in  severity,  and  sjanptoms  of  a  general  septic  infection  develop 
sometimes  rapidly,  in  other  cases  gradually.  In  rare  cases  the 
disease  may  develop  without  any  preliminary  inflammation 
of  the  umbilicus,  with  symptoms  of  a  general  infection. 

The  general  affection  is  indicated  by  symptoms  of  a  general 
febrile  condition.  The  animals  lose  their  desire  to  suck,  they 
will  not  look  for  the  udder  of  their  mother  on.  their  own  accord, 
and  if  led  to  it  they  suck  only  a  little  or  not  at  all.  At  the  same 
time  they  are  depressed  and  dull,  and  lie  continually  on  the 
ground.  When  stood  up  on  their  feet  they  remain  with  droop- 
ing head  in  one  place,  or  soon  collapse.  The  body  temperature 
is  elevated  and  unevenly  distributed  over  the  body  surface. 
The  pulse  and  respiration  are  accelerated.  This  condition  is 
soon  followed  by  symptoms  indicating  a  metastatic  inflamma- 
tion in  some  of  the  internal  organs. 

Inflannnations  of  the  joints  make  their  appearance  most 
frequently  and  earliest.  One  or  more  joints,  preferably  at  tlie 
extremities  (hock  and  knee  joints),  swell  simultaneously,  or  one 
after  the  otiier,  they  become  warm,  painful,  and  tense,  while 
the  surrounding  connective  tissue  is  edematous.  In  some  cases 
the  swelling  soon  disappears ;  more  frequently,  however,  a  fluc- 
tuation may  after  a  certain  time  be  noticed  in  different  parts 
of  the  swelling.  This  is  followed  by  a  breaking  at  one  or  more 
points,  and  from  the  resulting  opening  a  tenacious  purulent 
secretion  is  evacuated,  first  in  great  quantities,  later  more  spar- 
ingly. By  introducing  a  pro])e  into  the  opening,  a  rough  carti- 
laginous or  bony  surface  may  be  felt  at  different  places,  while 


3^55  Pyo-Septicemia  of  Sucklings. 

with  the  secretion  small  tissue  shreds  or  cartilaginous  and  bone 
particles  may  be  discharged.  The  motility  of  the  affected  joints 
is  interfered  with  by  the  pain  and  by  the  tense  and  swollen 
condition.  The  animal  does  not  support  the  body  with  the 
affected  extremity,  and  protects  it  from  touching  the  floor.  If 
several  joints  are  affected  at  the  same  time,  the  animal  no 
longer  moves  around,  but  lies  constantly  on  the  ground. 

The  affection  of  the  lungs  is  indicated  by  a  painful  cough 
and  rapidly  increasing  difficulty  in  respiration,  which  is  later 
associated  with  a  profuse  nasal  discharge,  as  an  indication  of 
a  developed  purulent  bronchitis.  Percussion  reveals  only  in 
circumscribed  areas  a  dull  or  tympanitic  sound ;  by  auscultation, 
however,  the  most  varied  catarrhal  sounds,  such  as  whistling, 
roaring,  moist  rales,  and  in  parts  also  bronchial  breathing,  may 
be  distinguished.  Sometimes  friction  sounds  may  also  be  heard 
over  some  parts  of  the  lungs  and  the  heart,  indicating  an  acute 
exudative  inflammation  of  the  corresponding  serous  memljranes. 
In  such  cases  the  patients  lie  much  on  the  chest  with  extremi- 
ties drawn  under  the  body,  or  with  legs  extended. 

In  the  presence  of  an  inflammation  of  the  brain  and  its 
membranes,  the  patients  are  much  depressed  and  apathetic. 
Sometimes  chronic  spasms  may  be  noticed  in  some  of  the  mus- 
cles or  groups  of  muscles,  or  the  animal  may  struggle  consid- 
erably. With  relative  frequency,  symptoms  of  meningitis  may 
be  present  as  the  result  of  the  extension  of  the  inflammation 
to  the  medulla ;  still  later  paralysis  may  appear  in  the  extremi- 
ties, or  in  the  territory  of  some  of  the  facial  nerves. 

Symptoms  showing  disturbances  of  the  digestive  organs 
are  hardly  ever  absent,  and  in  some  cases  they  may  even  be 
present  at  the  onset  of  the  disease.  Severe  colicky  symptoms 
may  appear  when  the  animals  lie  in  a  cramped  condition  on 
the  ground  with  the  head  turned  toward  the  abdomen ;  toucliing 
of  the  abdomen  causes  considerable  pain.  The  constipation 
which  is  at  first  present  is  followed  by  diarrhea,  the  animals 
passing  first  light,  later  dark  colored,  and  very  fetid,  fluid  feces. 
The  feces  soil  the  parts  around  the  anus,  and  later  the  excre- 
ments and  urine  are  passed  involuntarily. 

In  the  meantime  the  animals  become  greatly  emaciated, 
they  lose  their  strength,  the  eyes  are  sunken  deep  into  the 
orbits,  the  action  of  the  heart  becomes  accelerated  and  weak, 
the  body  temperature  drops  below  normal,  the  extremities,  the 
face  and  the  ears  become  cold,  the  body  is  covered  with  per- 
spiration, and  finally  the  patients  die,  with  symptoms  of  con- 
vulsions or  without  any  struggle.  Death  may  occur  before  tlie 
progress  of  the  disease  through  the  stages  described,  from 
asphyxiation  or  paralysis  of  the  brain. 

In  cases  of  pure  septicemia  only  high  fever  and  severe 
diarrhea,  sometimes  also  hematuria  are  observed;  in  such  cases 
the  patients  die  within  a  few  days  as  they  rapidly  lose  strength. 


Symptoms.      Course. 


1G7 


111   tlieso   instances   the   luuhilicns   manifests   no    inflanunatoiy 
cliani:(vs. 

Animals  wliicli  recover  from  tlie  acute  inflammation  may 
later  become  alTected  with  a  chronic  form  of  the  disease.  This 
form  may  develop  exceptionally  even  at  the  onset,  with  latent 
symptoms.  The  animals  fail  to  take  proper  nourishment,  and 
therefore  they  do  not  develop  well;  they  gradually  become 
emaciated,  and  toward  the  termination  a  rise  in  the  body  tem- 
perature and  diarrhea  a])poar.  Some  of  the  joints  become 
swollen,   painful,    and    hinder    the    patient    in    its   movements 


Fig.  34.     Chronic  pijo-scptwemia  of   a   colt.     Swelling  of   the   right  cari)al  and  left 

tarsal  joints. 

(Fig.  3-1-).  Ill  the  meantime,  symptoms  of  a  lung  affection  are 
manifested.  The  animals  cough,  there  is  a  muco-purulent  dis- 
charge from  the  nose,  over  the  lungs  numerous  rales  may  be 
heard.  Finally  the  animals  die  after  several  weeks,  from 
exhaustion. 

Course.  The  very  acute  septicemic  cases  result  in  death 
in  from  two  to  three  days.  In  some  less  acute  cases  the  disease 
mav  remain  confined  to  the  umbilicus  until  the  termination  of 


158  Pyo-Septiceniia  of   Sucklings. 

the  disease,  and  the  opening  of  the  umbilical  ring  may  perma- 
nently close  after  the  breaking  or  opening  of  the  abscess.  Such 
a  favorable  termination  is  principally  observed  in  cases  where 
the  disease  appears  somewhat  later  after  birth ;  that  is,  when  the 
thrombi  of  the  umbilical  vessels  are  already  more  solid,  the 
fluid  parts  have  been  absorbed,  and  the  penetration  of  the  micro- 
organisms has  thereby  been  rendered  more  difficult.  The  in- 
flammation of  the  joints  may  also  improve  after  a  time,  but 
the  recovery  is  only  exceptionally  complete,  as  usually  chronic 
changes,  such  as  shortening  of  the  ligaments  of  the  joints, 
deformities  of  the  cartilaginous  surface,  ankylosis,  etc.,  will 
remain  as  permanent  injuries. 

Severe  general  symptoms,  such  as  a  persisting  high  fever, 
severe  diarrhea,  grave  and  multiple  arthritis,  metastasis  in  the 
internal  organs,  etc.,  have  a  very  unfavorable  prognosis.  In 
such  cases  the  animals  usually  die  in  from  two  to  three  weeks 
(colts  on  an  average  in  26  days)    (Gmelin). 

The  chronic  form  of  the  disease  usually  leads  to  complete 
exhaustion  in  from  two  to  three  months ;  exceptionally,  however, 
recovery  takes  place,  when  only  a  thickening  of  the  pleura  is 
left  as  a  result  of  the  affection. 

The  percentage  of  mortalities  varies  with  the  different  out- 
breaks; as  a  rule,  however,  it  amounts  to  over  50%,  and  only 
in  calves  appears  somewhat  more  favorable  (according  to  Hess 
it  is  40,  and  according  to  Strebel  35%). 

Diagnosis .  The  inflammation  of  the  umbilicus  can  be  rec- 
ognized easily,  and  with  certainty.  An  affection  of  the  joints, 
or  of  internal  organs,  in  association  with  the  umbilical  affection, 
leaves  no  doubt  as  to  the  nature  of  the  disease.  In  cases  where 
the  urachus  remains  open,  there  may  be  also  intense  inflamma- 
tion and  swelling  of  the  umbilicus.  However,  in  such  instances 
the  dripping  of  the  urine  is  sufficient  to  reveal  the  nature  of 
such  an  abnormality  (Baillet  &  Seres  observed  as  a  result  of  a 
urachus  infection,  pyelo-nephritis,  with  septic  symptoms). 
Mistakes  in  diagnosis  may  only  occur  in  cases  when  the  local 
affection  of  the  umbilicus  is  absent,  or  present  only  to  such  a 
very  slight  degree  that  it  may  pass  unnoticed.  The  very  young 
age  of  the  patient,  and  the  purulent  consistency  of  the  exudates 
from  the  joints,  differentiate  the  disease  from  rachitis,  in  which 
moreover  the  synovial  capsule  is  not  distended  but  the  carti- 
laginous diaphyses  of  the  bones  are  thickened.  From  trau- 
matic inflammations  of  the  joints  it  is  differentiated  by  the 
absence  of  any  traces  of  traumatism,  and  by  the  presence  of 
symptoms  of  a  general  disease.  Internal  inflammation  of  the 
eye  occurs  in  such  an  early  age,  from  almost  no  other  cause  than 
from  a  pyemic  umbilical  infection. 

White  scours  of  sucklings  cannot  be  separated  from  the 
acute  septicemic  form  of  the  disease.  From  the  other  forms 
it  is  distinguished  by  the  absence  of  lesions  in  the  lungs  and 
in  the  joints.     (According  to  the  introductory  remarks  of  this 


DiaiiiKtsis.      Treafiuont.      Prcvciilioii.  Ki') 

chapter  tliore  exists  a  possibility   that  holli  diseases  have  an 
identical  etiological  basis.) 

Treatment.  The  inflammation  of  the  umbilicus  should  be 
treated  according  to  the  rules  of  surgery,  by  disinfection  of  the 
wounds,  and  if  necessary  by  opening  of  the  swellings.  The 
connnencing  inflanunation  of  the  joints  may  be  treated  in_  colts 
by  inunctions  with  gray  mercury  ointment.  However,  if  the 
joint  contains  a  great  (piantity  of  exudate,  this  should  be  re- 
moved by  i)uncturing  or  incising  the  joint,  and  by  subse(iuent 
disinfection  of  the  joint  cavity.  This  course  is  particularly 
indicated  when  the  inflamnuition  exists  only  at  one  place,  and 
the  internal  organs  are  not  affected.  If  the  contents  of  the 
joint  prove  to  i)e  serous  or  sero-librinous,  recovery  not  infre- 
quently takes  jjlace  in  from  one  to  two  weeks  after  a  single 
puncturing.  In  the  presence  of  a  general  infection  the  treat- 
ment can  only  consist  in  the  systematic  internal  administration 
of  stimulants;  further  in  controlling  the  gastro-intestinal 
catarrh  which  nuiy  be  present.  At  the  same  time  appropriate 
nutrition  should  be  provided  for  the  patient,  such  as  milk,  eggs, 
wine-soup,  or  nutritive  enemas.  The  affected  animals  should 
be  kept  in  a  moderately  warm,  clean,  and  airy  place.  Gott 
recommends  for  colts  intravenous  injections  of  collargol  (80  g. 
of  a  1/2%  solution,  for  three  days  successively),  while  Bernhardt 
recommends  ichthargan  (according  to  Ziirn  it  should  not  be 
used  in  stronger  solutions  than  1/10  to  1/5%,  on  account  of  the 
destructive  action  on  the  blood  corpuscles). 

Prevention.  The  infection  of  sucklings  may  be  successfully 
controlled  by  scrupulous  cleanliness  in  the  stables.  For  this 
purpose  disinfection  of  the  stables  at  intervals  of  one  to  two 
months  is  recommended ;  but  even  with  such  precautions  it  is 
advisable  to  place  the  highly  pregnant  animals  shortly  Ix'fore 
giving  birth,  in  a  stable  or  in  a  parturition  box  stall  kept  only 
for  such  purposes.  Such  places  should  be  thoroughly  disin- 
fected before  the  pregiiant  animal  is  installed  in  them,  and  at 
the  same  time  provision  should  be  made  that  the  newborn 
animal  may  be  received  on  fresh  straw  or  on  a  clean  sheet. 
Animals  affected  with  suppurating  wounds  should  be  kept  away 
from  the  places  used  for  partui'ition,  as  well  as  from  the  stalls 
of  the  sucking  animals.  Operations  (opening  of  abscesses) 
should  not  be  undertaken  in  these  quarters.  Satisfactory  ven- 
tilation and  dry  stable  air  also  deserve  especial  consideration. 
These  measures  should  of  course  be  carried  out  with  increased 
vigilance  when  the  disease  has  already  appeared,  that  is,  when 
the  stable  or  the  parturition  stand  are  y)roved  already  infected. 
Cleaning  of  the  external  genital  organs  of  the  mother  animals, 
as  well  as  irrigation  of  the  vagina  with  a  disinfecting  fluid, 
for  instance  with  2%  lysol  or  creolin  solution,  aid  also  in  the 
prevention  of  suckling  infection. 

In  places  where  the  veterinarian  is  present,  disinfecting 


IJQ  Pyo-Sepliceniia  of   Suckling's. 

treatment  of  the  umbilical  stump  is  very  desirable.     This  can 
also  be  executed  by  a  competent  attendant. 

Technique  of  the  Treatment  of  the  Umhilicus.  In  this  method  the  umbilical 
cord  is  washed  with  disiufectiug  fluid,  (3%  carbolic  acid,  1  to  1000  corrosive  sub- 
limate, 5%  creolin  solution.)  It  is  then  ligated  about  three  to  five  cm.  from  the 
navel  with  a  pieviously  disinfected  string.  The  ligation  should  be  carried  out  after 
the  pulsation  ceases.  The  cord  is  then  severed  with  scissors  below  the  ligature,  and 
the  cut  surface  is  moistened  either  with  the  same  fluid  or  with  a  more  concentrated 
disinfectant,  for  instance,  concentrated  carbolic  acid,  (Gmelin.)  On  the  following 
days  sponging  with  one  of  the  above-mentioned  fluids,  or  with  Burow  "s  solution  con- 
taining camphor  should  be  repeated  until  the  complete  drying  of  the  stump,  while 
the  cut  surface  may  be  sprinkled  with  disinfectant  and  drying  powders.  The  parch- 
ment-like dried  stump  may  be  cut  off  after  4  to  5  days,  and  the  navel  wound  should 
be  treated  daily  with  1%  corrosive  sublimate  gelatiu  until  cicatrization  is  complete. 
Nocard  washes  the  stump  of  calves  first  with  Lugol's  solution,  (2.5  parts  iodine,  4 
parts  iodide  of  potassium,  1000  parts  water,)  then  with  iodine-alcohol,  (2  parts 
iodine,  1000  methyl-alcohol,)  and  after  the  evaporation  of  the  alcohol  he  seals  the 
stump  and  the  navel  with  a  thick  layer  of  a  1%  iodine  colio<]ion,  Reindl  recom- 
mends for  washing  the  umbilicus  tincture  of  iodine  containing  carbolic  acid ;  for 
further  treatment,  linseed  oil  containing  5%  carbolic  acid.  Wilhelmi  cleans  int 
navel  and  the  undjilical  stump  with  a  1%  lysol  of  creolin  solution,  wheieupon  he 
opens  the  sheath  of  the  undiilical  cord,  paints  it  outside  and  in  with  a  liniment  con 
sisting  of  iodine,  tannin,  and  glycerine,  and  then  knots  the  lower  end  with  two 
fingers.  In  places  where  the  owner  is  poor,  repeated  painting  of  the  navel  region 
with  wood  tar  dissolved  in  oil  and  turpentine,  gives  good  service. 

The  disinfection  of  the  umbilicus,  if  carried  out  with  sufficient  thoroughness 
and  cleanliness,  gives  very  good  results,  and  in  this  manner  the  disease  has  been 
checked  among  colts  and  calves,  (Gmelin,  Nocard,  and  others.)  In  some  cases,  how- 
ever, an  aggravation  of  the  condition  has  been  observed  to  follow,  probably  becaiue 
the  persons  in  charge  of  the  treatment  have  directly  infected  the  umbilical  cord 
with  their  contaminated  hands  and  instruments. 

Immunization.  As  in  some  of  the  cases,  the  causative  agent  proved 
to  be  the  colon  bacillus,  and  owing  to  the  close  relation  between  pyo- 
septicemia,  and  white  scours  of  the  newly-borns,  the  immune  serum 
of  animals  treated  with  colon  bacilli  may  be  also  recommended  for 
this  disease  (see  page  ISfi).  Considering  that  the  bipolar  bacilli  have 
also  an  etiological  part  in  this  disease,  the  use  of  the  serum  which 
serves  against  this  bacterium  appears  to  have  at  least  an  experimental 
foundation. 

Literature.  Flirstenberg,  V.  A.,  1864,  XXIX,  152.— Eoloflf,  Ibid.,  1866, 
XXXVII,  434.— Bollinger,  Ibid.,  1873,  LVIII,  329;  D.  Z.  f.  Tm.,  1875,  I,  50.— 
Pfeiffer,  A.  f.  Tk.,  1891,  XYIL,  81.— Gmelin,  Monh.,  1891,  II,  196  (Lit.);  1897,  VIII, 
259. — Hess,  Landw,  Jahrb.  d.  Schweiz,  1897. — Casper,  D.  t.  W.,  1897,  159. — 8ohnle, 
Monh.,  1901,  XII,  337.— Ostertag,  Ibid.,  S.  385.- Krautstrunk,  Z.  f.  Infkr.,  1910,  VII, 
256. 

7.     Influenza  of  Horses.    Influenza  equorum. 

{Equiiw  iuf/uenza,  Pink  eye,  Typlioid  fever,  Stable  pneumonia. 

Influenza     catarrhalis    s.    erysipelatosa    ef    peetoraUs, 

Pleuro-pnenmonia  contagiosa  equorum;   Grippe, 

Fievre  typhoid e,  Pneumonie  infectieuse,  Pas- 

teurellose  du  clieval  [French];  Febbre 

tifosa  [Italian];  Pferdestaupe, 

Rotlaufseuche,  Brustseuche 

[German].) 

Influenza  is  an  acute  febrile,  contagious  infectious  disease 
of  horses,  which  occurs  frequently  in  stables  in  an  enzootic 
form.    It  is  characterized  either  by  acute  catarrh  of  the  mucous 


History.  171 

meiiibraiK's  or  by  severe  inllaiiiiiiatioii  of  llie  lungs  and  pleura. 
Accordingly  two  forms  of  tiie  disease  may  be  distinguished, 
namely:  the  catarrhal  influenza,  and  the  pectoral  influenza. 

History.  The  term  "influenza,"  taken  from  the  Italian  nomenela- 
ture  oi  human  medicine  (in  ItaHan  identical  with  "contagio"=uift"c- 
tion),  has  been  used  since  the  beginning  of  the  la.st  century  for  all 
acute  fehrile  affections  of  horses  which  spread  rapidly  and  have  a 
pronounced  miasmatic,  or  miasmatic-contagious  character.  Even  ni 
the  middle  of  the  century  various  diseases  have  been  collected  under 
this  term,  and  among  others  the  petechial  fever  has  also  been  con- 
sidered in  this  group.  Later  Falke  (1862)  applied  the  term  "Influenza" 
onlv  to  the  febrile  catarrhal  affections  of  the  nuicous  membranes,  wlnle 
to  the  cases  in  which  the  inflammation  extended  to  the  internal  organs, 
especiallv  to  the  respiratory  apparatus,  he  applied  the  name  of 
"Typhus."  At  the  same  time  he  considered  the  two  forms  to  be 
different  in  their  etiological  nature. 

Similar  to  this  was  the  conception  of  Dieckerhoff,  only  that  he 
designated  the  first  form  as  "horse  distemper,"  and  the  latter  as 
"contagious  pleuro-pneumonia."  At  the  same  time  he  separated  from 
these,  as  independent  affections,  the  "Skalma"  under  which  he  col- 
lected those  cases  in  which  a  moderate  fever,  a  diffuse  nifectious 
bronchitis,  with  a  subacute  course,  without  an  affection  of  the  con- 
junctiva, or  edematous  infiltration  of  the  subcutaneous  connective  tis- 
sues, were  the  characteristic  indications.  Further,  he  also  considered 
"infectious  lar^aigitis, "  "infectious  pharyngitis,"  and  "endemic 
cough"  as  independent  diseases.  Other  authors  have  not  recognized 
these  four  different  forms  of  disease,  other\^dse,  however,  the  majority 
of  German  authors,  as  well  as  many  French  writers,  have  accepted  the 
classification  of  Falke  and  Dieckerhoff. 

As  a  matter  of  fact,  even  at  the  present  time  there  are  no  experi- 
mental proofs  which  would  convincingly  establish  either  the  identity, 
or  the  difference  of  the  two  diseases.  Purely  practical  experiences, 
however,  speak  rather  for  their  close  relationship.  It  has  fre<iuently 
been  observed  in  outbreaks  in  large  stables,  that  while  some  of  the 
animals  become  affected  with  catarrhal  manifestations,  often  with 
serous  inflammation  of  the  tendons,  in  others  again,  severe  symptoms 
of  pleuro-pneumonia  develop,  the  characteristic  affection  of  the  eyes 
heinc'  fre(iuentlv  present  in  both  forms  of  the  disease.  As  a  result 
of  these  observations  the  relation  of  these  forms  appears  evident, 
particularlv  as  the  etiological  studies  of  their  nature,  by  which  the 
possible  difference  of  the  two  forms  of  the  disease  could  be  estahlished 
have  not  yet  been  completed.  In  spite  of  the  marked  differences  ot 
these  two  forms,  in  which,  however,  transitory  forms  are  treciuently 
observed,  it  appears  advisable  to  follow  the  view  of  Siedamgrotzsky,  and 
treat  the  disease  as  two  different  manifestations  of  the  same  affection ; 
namely    catarrhal  influenza  and  pectoral  influenza. 

Influenza  has  been  known  from  earliest  times  under  various  names 
(Febris  nervosa,  F.  maligna.  Typhus,  etc.),  and  its  infectious  nature 
has  been  recognized  since  the  second  half  of  last  century.  Scliutz 
(1887)  undertook  extensive  bacteriological  experiments  to  establish  the 
nature  of  the  disease,  and  indicated  a  diplococcus  as  the  causative 
factor  of  the  disease.  Hell,  Foth  and  more  recently  Lignieres,  however, 
proved  that  this  bacterium  is  really  a  streptococcus,  and  is  at  least 
closely  related  to  the  streptococcus  of  strangles.     On  the  other  hand, 


172  Influenza  of  Horses. 

Babes,  Starcovici  &  Calinescu  (1889),  as  well  as  Galtier  &  Violet  (1890), 
demonstrated  in  the  tissue  of  affected  lungs  bipolar  staining  bacteria, 
besides  the  diplococcus  of  Schiitz.  They  suggested  the  etiological 
relation  of  this  organism;  Lignieres  (1897  to  1900)  established  its 
identity  with  the  causative  organism  of  hemorrhagic  septicemia,  and 
expressed  his  view  that  influenza  is  caused  by  these  bacteria,  while 
the  diplococcus  of  Schiitz  plays  an  insignificant  part  in  the  etiology 
of  the  pathological  processes.  Exception  may  also  be  taken  to  this 
view,  the  same  as  against  those  of  Schiitz,  and  it  may  especially  be 
mentioned  that  with  neither  of  these  two  bacteria  may  a  typical  pneu- 
monia be  produced,  as  well  as  that  the  bipolar  bacilli  probably  exert  their 
pathogenic  action  only  secondarily  in  the  affected  animal ;  therefore  the 
question  of  the  true  cause  of  influenza,  or  of  its  two  forms,  must  be 
considered  at  the  present  time  as  unsolved. 

Occurrence.  The  disease  occurs  everywhere  either  sporad- 
ically, or  in  a  pronounced  enzootic  form,  and  in  the  latter  case 
it  spreads  rapidly  among  the  horses  of  large  territories.  With 
the  greatly  varying  character  of  the  disease  it  sometimes  causes 
only  slight  losses,  while  at  other  times  a  considerable  percentage 
of  the  affected  animals  succumb  to  the  disease,  principally  as 
a  result  of  pleuro-pneumonia  which  develops  in  its  course. 
Owing  to  the  latter  condition  the  disease  is  of  great  economic 
importance,  but  the  owners  also  sustain  considerable  loss 
in  the  milder  outbreaks  as  a  result  of  the  incapacity  of  the 
horses  for  work. 

Large  oxitbreaks  occurred  in  Europe  dnring  the  last  century  in  the  years  of 
ISlS-lSl.'j,  1825-1827,  1836,  1846,  1851,  1853,  1863,  1870-1873  (in  connection  with 
the  German  French  war),  and  finally  in  the  years  of  1881-1883,  at  which  time  the 
disease  spread  over  almost  the  entire  continent.  In  1872-1873,  the  disease  occurred 
extensively  in  America;  starting  in  the  eastern  parts  it  extended  all  over  the 
United   States.     It  was  introduced  in   South  Africa  by  the  English  troops  in   1899. 

In  1908  the  reports  from  the  German  Empire  show  in  Prussia  622  deaths  from 
the  disease;  in  Bavaria  and  Saxony  55  and  210  cases  resp.,  were  affected  with  the 
pleuro-pneumonic  form,  while  12  and  48  cases  respectively  were  affected  with  the 
catarrhal  form.  In  Wiirttemberg  88  eases  with  12  deaths  resulted  from  the  disease. 
However,  these  numbers  are  not  considered  as  complete. 

Among  the  horses  of  the  Prussian  armv,  in  the  years  between  1899  and  1908, 
861,  4,325,  1,066,  594,  2,223,  1,367,  487,  '  1,811,  8,058,  and  1,010  horses,  were 
affected  with  the  catarrlial  form,  while  the  pleuro-pneumonic  form  occurred  in  2,301, 
1,608,  1,078,   1,937,   1,268,   1,675,  3,877,  7,581,  3,502,  and  2,750  horses,  respectively. 

Etiology.  The  true  primary  cause  of  the  disease  has,  up 
to  the  present  time,  not  been  established.  Bacteriological  ex- 
aminations prove  only  the  fact  that  in  the  pectoral  form  (con- 
tagious pleuro-pneumonia)  two  bacteria  are  principally  pres- 
ent, the  streptococcus,  pyogenes  equi,  and  the  bacillus  equi- 
septicus. 

I.  The  streptococcus  pyogenus  equi,  which  has  been  de- 
scribed by  Schiitz  as  the  cause  of  contagious  pleuro-pneumonia, 
under  the  name  of  diplococcus  pneumoniae,  is  in  its  principal 
character  identical  with  the  streptococcus  of  strangles,  or  at 
least  is  closely  related  to  the  same.  In  the  affected  tissues 
it  is  present  in  the  form  of  mono  and  diplococci ;  in  the  exudates 
in  somewhat  longer  chains.     It   stains   readily  with  aqueous 


Etiology.  173 

aniline  dyes  as  well  as  by  Gram's  method.  On  artificial  media, 
it  grows  in  the  same  way  as  the  streptococcus  of  strangles 
(see  that  disease). 

Pathogenicity.  Cultures  kill  mice  in  two  to  three  days, 
while  rabhits  are  less  susceptible,  gaiinea  pigs  show  a  con- 
siderable resistance  against  tlie  infection.  In  the  experiments 
of  Schiitz  4  cc.  of  a  bouillon  culture  injected  in  various  parts 
of  the  lungs  of  a  horse  produced  a  gangrenous  pneumonia  and 
a  sero-fi))rinous  pleurisy  which  extended  from  the  point  of 
inoculation.  On  autopsy  great  numbers  of  cocci  identical  witii 
those  inoculated  were  found  in  the  gangrenous  areas  and  in 
the  tissues  surrounding  them,  as  well  as  in  the  pleural  exudate. 
They  were  present  in  smaller  numbers  in  the  spleen  and  in 
the  kidneys.  The  inhalation  of  a  sprayed  culture  produced 
in  the  horse  a  circumscribed,  chronic  inflammation  in  one  lobe 
of  the  lungs. 

According  to  Lignicres  the  streptococcus  in  question  is  identical  with  the  diplo- 
coccus  of  contagious  pneumonia  of  Schiitz,  with  the  streptococcus  of  Delamotte  & 
("hanteniessc,  as  well  as  with  the  streptococcus  of  Violet  &  Galtier,  and  is  closely 
related  to  the  streptococcus  of  strangles. 

IT.  The  bacillus  (bipolaris)  equisepticus  (Pasteurella  equi), 
which  is  considered  by  Lignieres  and  even  before  him  by  Babes, 
as  the  true  cause  of  the  disease,  represents  a  variety  of  the 
bacillus  bipolaris  septicus  of  the  hemorrhagic  septicemia.  In 
regard  to  its  staining  and  culture  characteristics  it  is  identical 
with  the  other  varieties  of  this  bacillus  (see  page  79). 

Pathogenicity.  Cultures  obtained  from  the  affected  body 
of  a  horse  produced  a  severe  pathogenic  action  on  rablnts  and 
.guinea  pigs.  The  former  succumbed  to  an  intravenous  in- 
fection in  18  to  24  hours,  while  the  latter  died  in  the  same 
length  of  time  from  an  intraperitoneal  infection.  Carnivorous 
animals  and  sheep  also  die  of  septicemia  following  an  intra- 
venous injection.  Subcutaneous  injection  of  0.25  cc.  of  culture 
produces  in  the  horse  fever  and  a  local  inflammatory  edema 
which  later  changes  to  suppuration.  Sometimes  however  such 
an  infection  causes  the  death  of  the  animal  inside  of  four  days. 
The  abdominal  exudate  of  guinea  pigs  which  die  as  the  result 
of  an  intraperitoneal  infection  acts  much  more  severely.  One- 
quarter  to  one-fifth  cc.  of  such  exudate,  when  injected  sub- 
cutaneously  into  a  horse  may  cause  the  death  of  the  animal 
in  24  to  48  hours,  while  1  to  2  cc.  injected  intravenously  kills 
the  animal  in  a  few  hours.  In  such  cases  the  horse  manifests 
high  fever,  great  debility,  accelerated  and  small  pulse,  throbbing 
heart  action,  muscular  trembling,  diarrhea,  injection  of  the 
conjunctiva,  and  lachr\Tnation.  T^ess  severe  infection  produces 
an  edematous  swelling  of  the  extremities,  and  in  some  of  the 
joints  a  sero-fibrinous  inflammation.  Subcutaneous  injections 
of  culture  are  sometimes  followed  by  sero-fibrinous  pleurisy, 


274  liiUueuza  uf  Horses. 

in  which  the  exudate  contains  streptococci  in  great  numbers 
in  addition  to  the  bipolar  bacilli. 

The  bipolar  bacilli  may  sometimes  be  demonstrated  in  the 
blood  at  the  beginning  of  the  febrile  stage,  they  are  very  fre- 
quently found  in  the  hepatized  tissue  of  the  affected  lungs,  and 
also  in  the  pleural  exudate.  In  the  exudate  they  are  usually 
present  in  association  with  streptococci,  and  also  with  other 
bacteria.  They  may  also  be  found  during  the  lung  affectior 
in  the  nasal  discharge. 

In  repeating  the  investigations  of  Lignieres,  Hiityra  found  the  bipolar  bacilli 
only  very  exceptionally  in  the  blood  and  in  the  nasal  discharge  of  att'ected  horses; 
on  the  other  hand  they  were  present  in  great  numbers  in  the  affected  lungs,  however, 
usually  associated  with  streptococci  and  also  with  other  bacteria  (colon  bacillus, 
bacillus  pyocyaneus,  and  others).  In  the  small  hemorrhagic,  or  reddish  brown, 
hepatized  areas  the  bipolar  bacilli  are  usually  present  in  great  numbers,  while  they 
lodge  in  the  gray  hepati2ed  or  gangrenous  areas,  and  in  the  pleural  exudate,  only 
sparingly,  or  their  presence  cannot  at  all  be  demonstrated.  The  bipolar  bacillus,  as 
well  as  the  streptococcus,  apparently  exert  their  pathogenic  action  through  toxins. 
Filtrate  of  a  bouillon  culture  of  the  bipolar  bacillus,  several  days  old,  injected  intra- 
peritoneally  into  a  horse  in  a  dose  of  500  g.,  produced  symptoms  of  severe  intoxica- 
tion (rapid  small  jsulse,  diarrhea,  profuse  sweating).  The  filtrate  of  streptococcus 
cultures  is  less  toxic,  nevertheless  350  cc.  of  the  same  injected  intravenously  may 
also  produce  symptoms  of  severe  poisoning  which  last  for  several  hours. 

The  presence  of  pyogenic  streptococci  in  the  nasal  discharge,  and  in  the 
thoracic  organs  has  also  been  established  by  other  authors  (Hell,  Foth,  tSven  Wall, 
Ostertag,  Tartakowsky  and  others).  Pfeiler  observed  aftei*  an  intravenous  injection 
of  bouillon  cultures  (35  to  120  cc.)  persistent  fever,  nasal  discharge,  yellowish-red 
discoloration  of  the  conjunctivae,  as  well  as  serous  or  fibrinous  infiammation  of  the 
pleura,  and  in  some  cases  also  pneumonia.  Tabusso  found  that  cultures  of  the 
bacillus  equisepticus  exert  a  severe  toxic  action,  and  that  the  intrapleural  injection 
may  produce  lobar  pneumonia.  Dreyer  is  of  the  opinion  that  the  dii-ease  may  be 
transmitted  with  the  fresh  blood  of  affected  horses.  However,  Ostertag  proved  in 
his  varied  experiments,  which  he  carried  out  for  many  years,  that  the  tj^pical  disease 
can  be  produced  with  neither  of  the  two  described  bacteria,  nor  with  the  diplo- 
bacillus,  which  he  found  in  the  nasal  discharge  and,  more  rarely,  in  the  blood  of 
affected  horses.  He  further  showed  that  the  disease  cannot  be  transmitted  to 
healthy  horses  by  means  of  the  nasal  discharge,  exhaled  air,  pleural  exudate,  urine 
and  blood  of  affected  animals. 

The  experiments  of  Hempel  &  Pfeiler  also  speak  against  the  streptococci  and 
bipolar  bacilli  as  being  the  primary  causes  of  the  disease,  as  they  failed  to 
demonstrate  complement  fixing  substances  for  these  respective  bacteria  in  the  blood 
of  horses  affected  with  the  disease. 

The  view  of  Lorenz,  according  to  which  the  cause  of  the  disease  is  a  pleomor- 
phous  micro-organism,  usually  present  on  the  surface  of  the  skin  of  the  pastern, 
is  a  priori  extremely  improbable  and  has  never  been  substantiated  by  others.  The 
claim  of  Baruchello  &  Pricolo  that  the  causative  agent  of  the  disease  is  a  blood 
spirochete,  and  the  more  recent  assertion  of  Baruchello  &  Mori  that  it  is  a  piro- 
plasma,  are  contradicted  by  the  fact  that  the  numerous  blood  examinations  of  other 
authors  failed  to  demonstrate  the  presence  of  these  organisms,  and  can  be  only 
explained  by  assuming  that  these  Italian  authors  studied  a  disease  of  horses  which 
differs  from  the  influenza  occurring  in  middle  Europe. 

The  etiological  action  of  the  bacteria  found  up  to  the  present 
in  influenza  cannot  as  yet  be  established  accurately.  For  none  of  these 
organisms  has  sufficient  proof  been  advanced  that  they  can  produce 
the  disease  primarily,  and  no  one  has  ever  succeeded  in  producing 
croupous  pneumonia  in  its  typical  course  artificially.  It  is  therefore 
possible  that  the  primary  cause  of  the  disease,  or  the  infective  agent 
which  transmits  the  disease  from  animal  to  animal,  is  a  micro-organism 
which  is  not  yet  known,  and  that  the  streptococci,  as  well  as  the  ovoid 
bacteria,  which  are  normal  habitants  of  the  healthy  air  passages,  exert 
their  pathogenic  action  only  after  the  specific  virus  has  already  affected 


ratlioi^t'iiicily.      Natural    In  IVctioii.  17'") 

tile  animal,  ami  thr.v  tlii'ii  subsLMiuciilly  produce  the  inflammatory 
changes  attrihutetl  to  them.  The  resistance  of  the  horse  may  be 
weakened  also  by  other  influences  such  as  colds  or  overexertion,  in 
which  condition  the  action  of  the  bacteria  mentioned  may  be  exerted 
and  lead  to  the  develoi)ment  of  the  inflammatory  i)rocesses  in  the 
lungs.  The  pleuro-pncumonia  -which  develops  in  such  cases  would 
anatomically  and  bacteriologically  miinifest  the  same  character,  inas- 
nuich  as  it  is  caused  by  these  same  bacteria,  but  it  would  differ  from 
influenza  by  the  absence  of  all  contagious  properties.  This  conception, 
which  is  based  only  on  theoretical  considerations,  tends  to  exi)lain  tli(! 
peculiarities  in  the  development  of  the  disease,  which  sometimes  appears 
as  an  enzo-otic,  at  other  times  only  in  a  sporadic  form,  while  the  clinical 
and  anatomical  manifestations,  especially  the  croupous  pneumonia,  are 
practically  the  same. 

Poels'  oliservation,  which  refers  to  a  stallion,  deserves  special  nientioii.  This 
animal  for  months  infected,  in  the  act  of  coitus,  the  mares  which  he  covered,  an<i 
its  semen,  fresh  as  well  as  filtered,  whea  injected  iidravenoiisly  in  healthy  uiiiinals, 
pro<luced  influenza  after  an  incubation  of  from  5  to  6  days.  The  blood  of  horses 
infected  in  this  manner  also  proved  virulent,  even  after  being  filtered  through  a 
Berkefeld  filter. 

The  natural  infection  is  evidently  transmitted  usually  by 
secretions  of  the  lungs,  and  by  the  feces  of  affected  animals, 
while  infectiousness  of  the  exhaled  air  is  very  improl)al)le. 

Tlie  secretions  and  excrements  are  especially  infectious 
during  the  development  and  at  the  heiglit  of  the  disease.  The 
convalescing  animals  may  also  infect,  and  even  apparently  re- 
covered animals  may  do  likewise,  in  cases  when  the  lungs  still 
contain  gangrenous  areas  after  the  disappearance  of  the  acute 
symptoms.  The  development  of  the  disease  among  horses,  by 
tiie  introduction  of  an  apparently  healthy  animal,  can  l)e  ex- 
plained by  such  a  mode  of  infection.  The  animal  introduced 
had  probably  been  affected  with  the  disease  but  a  short  time 
before.  This  may  also  explain  the  continued  existence  of  the 
disease  in  some  stables,  when  it  is  continuously  transmitted  to 
other  animals  from  one  which  has  not  completely  recovered 
from  the  disease.  Such  apparently  recovered  animals,  whose 
lungs  contain  necrotic  lesions,  which  are  uot  encapsulated,  may 
carry  the  infection  for  months  (Siedamgrotzky).  Usually,  how- 
ever, the  disease  is  introduced  by  animals  wdiich  are  in  the  in- 
cubation period  or  in  the  first  stages  of  the  disease,  and  in 
this  respect  animals  ])ought  in  horse  exchanges  are  especially 
dangerous,  while  among  army  horses  the  disease  frequently 
breaks  out  after  the  introduction  of  remounts. 

According  to  some  English  authors  fPottie,  J.  Clark,  Eieks),  as  well  as  the 
observations  of  Jensen,  stallions  which  recover  from  influenza  may  transmit  the 
disease  to  mares  in  the  act  of  coitus  months  later  and  even  after  one  to  two  years. 
Grimme  reports  a  case  in  which  apparently  14  out  of  22  mares  were  said  to  have 
been  infecte<I  by  a  stallion,  which,  besides  a  slight  reddening  of  the  conjunctivae, 
manifested  no  other  imlications  of  the  disease.  (See  also  the  observation  of  Poels, 
al  lOve. ) 

Indirect  infection  is  transmitted  by  the  most  varied  objects 
which  may  be  contaminated.     Such  are  the  secretions  and  ex- 


IJQ  Influenza  of  Horses. 

crements  of  affected  horses,  contaminated  food,  straw,  manure, 
stable  utensils,  cribs,  pails;  people  who  are  employed  in  hand- 
ling sick  animals,  their  clothing,  etc.  The  virus  may  retain  its 
virulence  for  a  long  time  in  poorly  ventilated,  musty  and  damp 
stables,  while  in  pure,  dry  air  and  under  the  influence  of  sun- 
light it  loses  its  virulence  within  a  short  time.  These  condi- 
tions may  explain  the  fact  that  out])reaks  usually  remain  con- 
fined to  individual  stal)les  or  townships,  or  to  limited  localities, 
and  that  a  wide  extension  of  the  disease,  such  as  is  the  case, 
for  instance,  in  foot-and-mouth  disease,  is  rarely  observed. 

The  possibility  of  the  infection  being  transmitted  V)y  flies,  as  interme<liate 
carriers  of  the  virus  (Giesecke),  is  not  at  all  probable  in  consideration  of  the  mode 
of  appearance  and  extension  of  the  disease,  and  especially  in  view  of  the  frequent 
localization  of  the  affection  in  individual  stables. 

The  infective  agent,  as  a  rule,  enters  the  animal  body 
vrilli  the  feed  or  drinking  water,  and  very  probably  through 
the  intestines  or  through  the  l^Tuphatic  pharyngeal  ring 
(Walther) ;  however  the  possibility  of  infection  through  the 
air  passages  should  not  at  the  present  time  be  disregarded. 

Pecus  reports  on  observations  of  outbreaks  in  which  the  infection  could  only 
have  occurred  through  the  digestive  tract;  in  several  stables  only  those  horses  became 
affected  which  drank  from  a  common  trough,  whereas  the  hort-es  which  were  watered 
with  individual  pails  escaped  the  disease.  One  particular  horse  drank  from  a  pail 
the  contents  of  which  was  contaminated  by  the  discharge  of  an  animal  affected  with 
influenza,  and  this  horse   developed  the  disease  in   six  days. 

Of  the  predisposing  causes  of  the  disease  colds  should 
come  first  in  consideration.  Experience  also  points  to  this 
fact,  that  the  beginning,  and  the  greatest  extension  of  the  dis- 
ease, is  frequently  associated  with  northern  or  eastern  winds, 
and  the  frequent  occurrence  of  the  disease  in  the  cold,  damp 
periods  of  the  year  can  be  traced  to  this.  Catarrhal  affection 
of  the  mucous  membranes  is  another  predisposing  cause  for 
the  disease,  and  owing  to  this  fact  the  mortality  among  horses 
which  are  kept  in  badly  ventilated  stables  is  usually  greater 
than  under  more  favorable  hygienic  conditions. 

The  age  of  the  animals  has  an  influence  on  their  suscep- 
tibility, inasmuch  as  horses  over  one  year  of  age  are  most 
readily  affected  with  the  disease,  while  it  occurs  less  frequently 
among  very  old  animals.  The  disease  occurs  with  greater 
frequency  and  in  a  more  severe  form  among  horses  of  high 
breeding,  as  well  as  among  the  heavier  breeds.  All  solipeds 
are  susceptible  to  the  disease. 

One  attack  of  the  disease  diminishes  the  susceptibility  to 
infection  for  only  a  short  time.  We  have  observed  horses  at- 
tached to  the  medical  (army)  service  which  passed  almost  every 
year  through  a  slight  attack  of  influenzal  pneumonia. 

Pathogenesis.  As  the  primary  cause  of  the  disease  is  at 
present  unknown,  only  suppositions  are  admissible  relative  to 
its  method  of  action.  The  infective  agent  produces  a  general 
blood   infection   which   is   manifested  in   general   febrile   and 


Pathofrenesis.  177 

catarrhal  SMiiptoms.  The  disease  which  develops  in  tliis 
iiiaiiiier  may,  after  the  disappearance  of  the  infective  a,i>ent 
from  the  bodv,  terminate  in  recovery  within  a  short  time.  Most 
cases  of  the'  catarrhal  form  of  influenza  follow  this  course, 
while  an  unusually  severe  infection  may  result  in  a  very  severe 
septic  manifestation,  and  cause  the  death  of  the  animal  witlnn 
a  few  days.  The  autopsy  findings  in  such  cases  are  similar 
to  those  of  hemorrha.i'ic  septicemia,  with  hemorrlia,i!:es  m  the 
serous  and  mucous  membranes,  hyperemia,  and  small  hemor- 
rhages in  the  parenchjanatous  organs,  especially  m  the  lungs 
and  kidneys,  but  as  in  such  cases  the  bacteriological  examina- 
tion not  infrequently  shows  the  presence  of  the  bipolar  bacilli 
in  the  organs  as  well  as  in  the  blood,  there  exists  a  possd)ility 
that  they  have  taken  part  in  the  fatal  termination  of  the  disease. 
These  organisms  enter  the  blood  in  an  early  stage  of  the  dis- 
ease, multiplv  in  the  same  very  rapidly,  and  are  frequently 
the  direct  cause  of  death,  or  at  least  they  hasten  death. 

The  primary  infection,  that  is,  the  general  febrile  condi- 
tion, may  weaken  the  body  to  such  an  extent  that  the  facultative 
pathogenic  bacteria,  especially  the  ovoid  bacteria  and  strepto- 
cocci, can  exert  their  specific  infective  action.  As  a  result  of 
their  invasion  inflammatory  processes  develop,  especially  in 
the  lungs,  in  the  form  of  pneumonia  or  pleuro-pneumonia,  while 
the  primary  infective  agent  has  possibly  in  tlie  meantime  dis- 
appeared from  the  body. 

The  bipolar  bacillus,  as  w^ell  as  streptococci,  may  produce 
such  inflammation;  usually,  however,  in  the  cases  wheie  pleuro- 
pneumonia caused  the  early  death  of  the  animal,  under  mani- 
festations of  a  violent  septicemic  character,  the  pleural  exudate 
and  the  affected  lung  tissue  contain  the  ovoid  bacteria  ex- 
clusively, while  the  streptococci  appear  to  multiply  more  rapidly 
only  later  in  exudates  which  have  already  developed  as  the  re- 
sult of  the  disease.  These  latter  are  present  in  predominating 
numbers  or  sometimes  even  exclusively  in  the  hepatized  and 
necrosed  lung  tissue,  while  in  the  pleural  exudate  they  are 
usually  found  exclusively  (the  pleurisy  apparently  being  caused 
only  by  the  streptococci  which  pass  from  the  lungs  into  the 
pleura).  Streptococci  may  also  enter  the  blood,  and  in  this 
way  they  may  reach  the  parenchymatous  organs  when  they  may 
be  found  on  autopsy  in  the  spleen,  the  kidneys,  and  in  the 
lymph  gland.:. 

Other  bacteria  may  in  some  cases  cause  a  secondary  infection ; 
thus,  in  one  of  our  cases,  besides  the  bipolar  bacillus,  the  diplococcus 
laneeolatus  (recently  also  demonstrated  by  Meyer),  in  another  case 
the  bacillus  pyocyanens,  were  present  in  great  nnmlicrs.  Besides  these 
the  colon  bacillus  may  often  be  found  in  the  inflamed  lung  tissue. 
The  eventual  necrosis  of  the  inflamed  lun^  tissue  may  be  due  to  the 
bipolar  bacillus  or  to  the  streptococcus.  Tn  several  cases  the  gan- 
grenous lesions  have  contained  the  bacillus  necropliorus.  which  indi- 
cates that   in   this   process,    at  least   under   suitable   conditions,   this 

12 


178  Inriuenza  of  Horses. 

bacillus  probably .  has  an  active  part.  Bourget  &  Prevost  finally  found 
a  virulent  form  of  proteus  in  the  pleural  exudate  of  several  horses. 

Anatomical  Changes.     In  the  catarrhal  form  of  influenza 

an  acute  hyperaemia  of  the  mucous  membranes  develops  in 
the  digestive  tract  or  in  the  air  passages,  or  possibly  in  all 
the  mucous  membranes.  This  condition  is  associated  with  an 
edematous  infiltration  of  the  submucous  connective  tissue,  as 
a  result  of  which  the  mucous  membrane,  especially  in  the  laryux 
and  in  the  pyloric  portion  of  the  stomach,  and  in  the  small 
intestines,  forms  thick  gelatinous  folds.  In  the  small  intestine 
the  solitary  follicles,  and  the  Peyer's  patches  are  swollen,  and 
moreover  the  reddened  mucous  membrane  contains  in  places 
superficial  erosions  or  even  deep  ulcers  (Rips).  The  mesen- 
teric lymph  glands  are  greatly  swollen,  their  tissue  is  reddish- 
gray  and  moist. 

\^ery  frequently  the  subcutanous  connective  tissue  is  in- 
filtrated with  a  clear,  or  somewhat  cloudy,  readily  coagulating 
serous  fluid.  These  infiltrations  may  occur  at  different  parts 
of  tbe  body,  especially  in  the  parts  surrounding  some  of  the 
tendons  of  the  extremities.  A  similar  fluid  may  be  contained 
in  the  tendinous  sheaths  in  considerable  quantities.  The  yellow, 
gelatinous  tissue  is  in  such  cases  studded  with  small  hemor- 
rhages, and  similar  changes  are  sometimes  present  in  the  sub- 
and  retroperitoneal  connective  tissue,  especially  in  the  imme- 
diate vicinity  of  the  kidneys.  The  body  cavities  may  also 
contain  various  quantities  of  a  pure  or  slightly  cloudy,  reddish 
exudate. 

The  other  internal  organs  are  not  much  changed.  A  mod- 
erate, acute  swelling  of  the  spleen  may  be  present,  also 
hyperaemia  or  acute  edema  of  the  lungs,  cloudy  swelling  of 
the  heart  muscles,  of  the  liver,  and  of  the  kidneys.  Hyperemia 
of  the  meninges,  and  even  a  slight  acute  hydrocephalus  internus 
may  l)e  found. 

In  the  pectoral  form  of  influenza,  necrotic  pneumonia,  in 
association  with  sero-fibrinous  pleurisy,  represents  the  most 
important  and  common  anatomical  change.  The  pneumonia 
sometimes  occurs  in  the  form  of  lobular  broncho-pneumonia, 
or  the  inflammatory  process  extends  in  the  form  of  a  lobular 
pneumonia,  affecting  at  the  same  time,  large  contiguous  areas 
of  one  or  both  lungs.  In  the  first  case  the  lung  contains  only 
a  few  dense  hepatized  catarrhal  or  hemorrhagic  areas;  the 
tissue  in  immediate  surroundings  of  these  areas  is  serously 
infiltrated;  while  in  the  second  case,  the  lower  sections  of  the 
lungs  are  uniformly  hepatized  throughout  large  areas.  The 
affected  lung  tissue  lireaks  readily,  the  cut  surface  is  granular, 
and  depending  on  the  stage  of  formation,  it  is  either  gra^dsh- 
brown,  grayish-red,  or  yellowish-gray.  In  the  parts  still  con- 
taining air,  besides  the  hyperemia  or  acute  edema,  the  con- 
nective tissue  walls  are  gelatinously  infiltrated. 


Syiiiptoins.  "179 

In  the  liepatized  tissue  uimieious  necrotic  areas  may  fre- 
quently he  disseminated,  which  vary  in  size  from  that  of  a 
poppy  seed  to  a  hazehiut.  They  are  of  a  dirty,  grayish-l)rown 
or  greenish  color,  and  of  a  mushy  consistency.  In  some  cases 
a.  cireumscrihed  ])orlion  of  the  affected  lung  is  clianged  into 
a  necrotic  mass  which  may  attain  the  size  of  a  fist  or  a  child's 
head,  and  may  sometimes  be  surrounded  by  a  layer  of  pus. 

The  mucous  membrane  of  the  bronchi  and  trachea  is  bright 
red,  swollen,  not  infrequently  sprinkled  with  hemorrhages,  and 
profusely  covered  with  sero-pnrulent  secretion. 

Inflannnation  of  the  superficial  layers  of  the  lung  is  always 
associated  with  pleurisy.  The  pleura  loses  its  luster  as  a 
result  of  a  desquamation  of  the  epithelial  layer,  is  dull,  rough, 
and  covered  by  loose,  moist,  smeary  pseudo-membrane.  This 
peels  off  readily,  and  is  of  icteric  yellow  color,  and  somewhat 
resembles  pudding.  Between  the  two  layers  of  the  pleura  there 
is  a  yellowish  fluid  Miiicli  contains  flakes  of  the  fibrinous  mem- 
brane. This  exudate  is  cloudy,  and  is  sometimes  present  in 
considerable  quantities,  exerting  more  or  less  pressure  on  that 
portion  of  the  lung  which  is  not  hepatized.  In  less  acute  cases 
there  is  a  thick,  wide  connective  tissue  layer  under  the  loose 
false  membrane.  If  the  pleurisy  develops  in  connection  with 
superficial  necrotic  fields,  or  as  a  result  of  the  rupture  of  such 
an  area,  the  exudate  is  always  of  a  purulent  or  ichorous  char- 
acter. In  case  the  gangrenous  area  which,  opened  into  the 
pleural  cavity  communicates  Adth  the  bronchi,  pneumothorax 
or  pyo-pneumothorax  will  develop. 

In  other  respects  the  autopsy  reveals  conditions  similar 
to  those  present  in  the  catarrhal  form  of  influenza,  only  the 
changes  are  usually  somewhat  more  pronounced.  On  the 
mucous  membranes  not  infrequently  superficial  ulcerations  inay 
be  found  besides  the  catarrhal  reddening  and  swelling.  The 
parenchymatous  degeneration  of  the  heart  muscles,  the  liver 
and  in  the  kidneys,  frequently  passes  into  a  fatty  degeneration. 
Small  hemorrhages  or  even  extensive  suffusions  are  often 
present  in  the  tissue  of  the  serous  membranes  as  well  as  in 
the  endocardium.  The  lymph  glands,  especially  those  of  the 
thoracic  cavity  are  greatly  swollen.  Suppurative  areas  may 
exceptionally  be  found  in  various  organs,  and  purulent  inflam- 
mation of  the  joints. 

Symptoms.  The  time  of  incubation  in  influenza  extends 
in  the  majority  of  cases  from  .S  to  7  days;  less  frequently,  es- 
pecially after  the  animal  has  contracted  a  cold,  the  first  s\nnp- 
toms  may  appear  after  24  to  48  hours,  while  in  other  cases  the 
disease  may  remain  latent  for  8  to  9  days.  In  some  cases 
the  animals  are  affected  for  a  time  only  with  a  slight  bronchial 
and  stomach  catarrh,  while  the  manifestations  of  the  pectoral 
form  of  influenza  gradually  develop  later.  In  these  cases  the 
time  of  incubation  appears  to  be  considerably  longer,  although 


180  Influenza  of  Horses. 

the  preexisting  catarrhal  manifestations  were  really  indica- 
tions of  infection  with  influenza. 

According  to  Siedamgrotzky  the  time  of  incubation  in  influenza  is  from  4  to 
5  days,  while  Dieckerhoflf  claims  that  the  first  manifestations  appear  in  from  12  to 
24  hours.  On  the  other  hand,  even  14  days  may  in  exceptional  cases  elapse  before 
the  onset  of  the  disease.  In  infections  which  are  transmitted  by  coitus  the  disease 
usually  develops  in  from  6  to  9  days  (Clark,  Jensen,  Grimme). 

The  disease  commences  almost  invariably  with  marked  de- 
pression, dullness  of  the  sensibility,  and  capricious  appetite. 
The  animals  stand  with  eyes  half  closed,  ears  drooped,  support- 
ing the  head  to  the  crib  or  the  strap  of  the  halter,  sometimes 
standing  in  the  stall,  apathetic  and  in  abnormal  positions. 
They  take  the  food  offered  them  with  hesitation,  masticate  it 
slowly,  and  with  frequent  interruptions.  They  frequently  do 
not  swallow  the  bolus,  but  it  lies  in  the  mouth  on  the  outside 
of  the  molars  apparently  forgotten.  If  urged  to  move  they 
walk  lazily  and  with  some  difficulty;  frequently  the  gait  is 
staggering. 

The  body  temperature  is  first  elevated,  and  reaches  on  the 
first  day  of  the  affection  40  to  40.5° C.  At  this  point  the  temper- 
ature remains  for  two  or  three  days  with  only  slight  variations, 
whereupon  in  the  catarrhal  form,  after  one  to  two  days  more 
it  drops  rapidly  to  normal  (Fig.  35  on  page  181). 

In  the  case  of  pure  or  predominating  pneumonia  the  tem- 
perature continues  to  remain  high,  with  slight  variations,  and 
returns  to  normal  only  after  the  regeneration  of  the  changes 
in  the  lungs  (Fig.  36  on  page  183).  In  severe  cases  the  fever 
persists  continuously  or  remittently  until  death.  In  slowly 
progressing  cases  however  the  fever  is  interrupted  periodically 
by  afebrile  intervals  (Fig.  37  on  page  186).  During  the  period 
of  high  fever  the  heat  over  the  surface  of  the  body  is  unevenly 
distributed,  the  coat  is  rough;  muscular  trembling  may  be  also 
observed  in  some  parts  of  the  body.  The  skin  sometimes  mani- 
fests nodular  eruptions  or  urticara.  The  heart's  action  is  from 
the  beginning  more  or  less  excited,  in  severe  cases  it  is  greatly 
accelerated  and  weak,  as  a  result  of  the  developing  parenchy- 
matous degeneration  of  the  heart  muscle.  The  pulse  is  usually 
from  50  to  60  per  minute ;  in  severe  cases,  however,  the  number 
may  increase  to  from  80  to  100,  with  throbbing  heart  and  small, 
wiry  pulse. 

Special  Symptoms  of  the  Catarrhal  Form  of  Influenza. 

In  this  form  of  the  disease  catarrhal  manifestations  of  the 
mucous  membranes  develop  in  association  with  the  above  de- 
scribed febrile  symptoms. 

In  the  eyes  the  conjunctivae  appear  reddened  (mahogany 
or  brick  red),  frequently  with  a  yellowish  tint,  the  submucous 
connective  tissue  containing  a  serous  infiltration.  There  is 
always  photophobia  as  well  as  lachrymation  present.  The 
eyelids  swell,  and  the  opening  of  the  eye  is  thereby  narrowed. 


Syinj)t(iiiis. 


181 


If  it  is  forced  open,  tears  escape  profusely,  or  in  the  later  stages 
a  secretion  which  is  mixed  with  mucus  or  pus.  The  swelling 
may  extend  to  the  sclerotic  conjunctiva,  as  a  result  of  which 
the' cornea  is  surrounded  by  a  yellowish-red,  somewhat  elevated 
ring.  The  cornea  proper  is  often  cloudy,  and  the  epithelium  is 
desquanuited  from  the  anterior  portions.  In  some  cases  an 
iritis  may  also  develop,  Avith  a  contraction  of  the  pupil,  and 
the  deposit  of  a  yellow 
fil)rinous  exudate  in 
the  anterior  chamber 
of  the  eye. 

The  catarrh  of 
air  passages  is  first 
manifested  by  a  rough 
and  dry,  later  by  a 
moist  but  always 
strong  and  sometimes 
painful  cough,  wiiich 
comes  on  spasmodi- 
cally. From  the  red- 
dened mucous  mem- 
brane of  the  nose  first 
a  small  quantity  of  a 
serous,  later  more  pro- 
fuse muco-purulent 
discharge  escapes, 
which  during  spells  of 
coughing  is  also  ex- 
pelled through  the 
mouth  and  nose.  If  the  nasal  catarrh  is  severe  the  sub- 
maxillary hTuph  glands  are  usually  swollen  and  sensitive. 
Respiration  is  more  or  less  accelerated  and  superficial.  Per- 
cussion reveals  normal  conditions  over  the  thorax,  wiiereas 
on  ascultation,  raw,  vesicular  breathing,  dry  and  moist  rales 
of  varj-ing  intensity  and  numbers,  may  be  heard.  Sometimes 
an  increased  sensitiveness  of  the  thorax  may  also  be  present. 
The  appetite  is  at  first  depressed,  while  the  animals  willingly 
take  water,  although  only  in  small  quantities.  The  mucous 
membrane  of  the  mouth  is  warm  and  dry,  the  tongue  is  also 
dry  and  coated.  Not  infrequently  difficulty  in  swallowing  may 
be  observed  as  an  indication  of  the  coexisting  pharyngitis. 

Gastric  catarrh  is  indicated  by  the  distribution  or  entire 
disappearance  of  the  appetite,  also  by  frequent  yawn  and  a  de- 
sire to  lick  cold  objects.  At  first  there  is  constipation,  during 
which  the  feces  are  dry,  forming  small  balls,  covered  with 
mucous  shreds.  The  abdomen  is  sometimes  moderately  bloated. 
Later  the  feces  become  softer,  or  even  fluid,  and  towards  the 
third  or  fourth  day  frequently  fetid.  Sometimes  they  are  of 
a  dirty  reddish  color,  and  expelled  with  straining.  Peristalsis 
is  at  first  depressed,  later  lively,  and  in  some  instances  may 


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182  Influenza  of  Horses. 

be  uninterrupted.  Not  infrequently  mild  colicky  symptoms  may 
be  observed.  The  persistent  diarrhea  and  the  absence  of  ap- 
petite weakens  some  of  tlie  patients  considerably. 

During  the  entire  existence  of  the  febrile  condition  urine 
is  passed  in  only  small  quantities.  It  is  of  a  high  specific 
gravity,  and  dark  yellow  in  color,  containing  a  small  quantity 
of  albumen,  and  sometimes  bile  pigments.  The  chemical  re- 
action in  the  later  stages,  and  in  the  presence  of  continuous 
bad  appetite  turns  acid.  If  allowed  to  stand  a  great  amount 
of  sediment  precipitates,  which  may  contain  epithelial  cells 
from  the  bladder  and  the  pelvis  of  the  kidneys,  exceptionally 
also  casts  may  be  noted.  In  the  presence  of  catarrh  of  the 
bladder  and  urethra  the  animals  urinate  frequently  and  strain 
during  each  passage.  A  transient  polyuria  may  develop  after 
the  subsidence  of  the  other  sjanptoms.  In  females  the  mucous 
membrane  of  the  vagina  may  show  catarrhal  inflammation,  and 
in  such  cases  a  muco-purulent  discharge  escapes. 

In  some  cases  edematous  swellings  develop  in  the  subcutis, 
especially  on  the  chest  and  lower  abdomen,  or  on  the  lower 
extremity  of  the  sheath.  Occasionally  urticaria-like  eruptions 
may  occur  on  the  rump ;  these  present  the  form  of  round,  beet- 
like elevations.  Such  subcutaneous  and  cutaneous  edema  may 
be  observed  in  some  outbreaks  on  practically  every  patient. 
In  other  instances  it  may  be  observed  only  in  isolated  cases. 
In  some  outbreaks  there  may  be  found  an  inflammation  of 
the  flexor  tendons  and  tendinous  sheaths  of  the  extremities, 
Avith  an  accumulation  of  serous  exudate  in  the  latter.  As  a 
result  of  the  pain  which  is  associated  with  this  form  of  affec- 
tion the  patients  rest  the  legs  intermittently  and  keep  them 
flexed  as  much  as  possible. 

The  symptoms  described  may  reach  various  degrees  in  the 
different  cases.  In  mild  forms  they  may  disappear  in  one  to 
two  days,  whereas  severe  symptoms  develop  only  in  very  few 
instances. 

Kramell  reports  a  peculiar  form  of  influenza  in  39  out  of  72 
army  horses.  The  fever,  lasting  from  one  to  six  days,  varied  between 
38.6  and  41  °C.,  at  the  same  time  the  frequency  of  pulse  dropped 
to  80  and  28  beats.  In  about  one  third  of  the  cases  a  disturbance  in 
the  gait  of  the  animals  was  observed,  which  was  evinced  by  stiffness 
of  gait,  resembling  a  rooster 's  step,  or  lameness  in  the  different  extremi- 
ties. Respiration  was  not  affected,  the  conjunctivae  were  usually  nor- 
mal, and  the  appetite  was  capricious. 

Special  Symptoms  of  the  Pectoral  Form  of  Influenza.  This 
form  is  also  inaugurated  by  febrile  and  catarrhal  symptoms, 
as  is  the  case  in  the  catarrhal  form,  only  they  are  more  intense 
in  character.  In  the  meantime  s^niiptoms  arise  which  point 
to  an  affection  of  the  respiratory  organs,  and  this  develops 
in  a  short  wdiile  into  characteristic  acute  pneumonia  or  pleuro- 
pneumonia.   The  affection  of  the  lungs  represents  either  lobar 


Syinptdins. 


183 


croupous  pneumonia,  or  lobular  broncho-pneumonia,  but  tlu' 
del'niite  dill'erentiation  of  these  forms  is  only  in  rare  eases 
possible  because  the  latter  also  has  a  very  acute  development 
and  a  rapid  extension. 

In  some  cases  the  pneumonia  develops  in  a  manner  similar 
to  genuine  croupous  pneumonia  (see  Fig.  36).  Accordingly 
the  symptoms  consist  of  difficult,  costal-abdominal  breathing; 
first  a  tym])anic,  later  a  dull  sound  on  percussion  over  the  lower 
parts  of  one  or  both  sides  of  the  thorax,  which  later  changes 
into  a  t>^npanic  and  finally  into  a  normal  sound.  On  asculta- 
tion  rales  may  be  heard,  later  bronchial  breathing  or  the  ab- 
sence of  any  respiratory  sound.     This  may  be  again  followed 


Fig.  36.     Fever   curve    in  pectoral    influenza.      Type   of    the    croupous    pneumonia : 

recovery. 


by  moist  rales.  In  numerous  cases  there  is  a  saffron,  or  rust- 
colored  nasal  discharge  (for  detailed  information  see  Vol.  2, 
Chapter  IV).  On  the  other  hand,  if  the  affection  of  the  lungs 
develops  as  a  lol)ular  pneumonia  the  symptoms  of  hepatization 
(dullness,  bronchial  breathing),  may  be  entirely  absent,  or  they 
may  be  established  only  over  small  irregular  areas,  so  that 
the  existence  of  pneumonia  is  suggested  only  by  the  marked 
respiratory  difficulties,  the  high  fever  and  possibly  the  rust- 
colored  nasal  discharge. 

The  pleurisy  which  frequently  develops  in  association  with 
the  pneumonia  is  manifested  by  a  sensitiveness  of  the  thorax, 
and  also  by  superficial  abdominal  breathing,  later  by  double 


184  Influenza  ol'  Horses. 

breathing,  friction  sounds,  and  if  a  pleuritic  exudate  forms  also 
by  dullness  below  a  horizontal  line  (see  Vol.  2,  chapter  on  Pleu- 
ritis.) 

Ill  the  Prussian  army,  in  the  years  of  1899  to  1908,  out  of  9462  cases  in  which 
3198  were  affected  with  pleuro-pneiunonia,  in  1817  cases  pneumonia  on  the  right, 
and  in  1780  pueiiinonia  on  the  left  side,  in  1336  double  pneumonia,  and  in  100 
cases  pleurisy  only  was  present.  In  the  clinics  of  Budapest,  in  the  years  of  1904 
and  1906,  in  169  cases  the  pneumonia  was  unilateral,  in  195  cases  it  was  bilateral, 
while  in  106  eases  pleuropneumonia  was  established. 

In  association  with  the  pneumonia  gangrene  of  the  lungs 
develops  subsequently  with  relative  frequency,  and  to  a  certain 
degree  this  is  characteristic  of  the  lung  affections  in  influenza. 
In  such  cases  the  symptoms  consist  of  a  disagreeable  odor  of 
the  exhaled  air,  cavity  formations  in  the  hepatized  lung  tissue, 
high  fever,  weak  heart  action,  etc.,  which  usually  develop  in 
the  course  of  the  second  week  of  the  affection.  A  nasal  dis- 
charge is  observed  in  almost  every  case.  The  secretion  con- 
sists first  of  only  yellowish  drops,  later  it  becomes  more  profuse 
and  purulent,  or  rust-colored,  and  tenacious,  in  exceptional 
cases  it  may  also  be  bloody.  After  the  appearance  of  gangrene 
the  discharge  becomes  of  a  greenish-brown  color,  and  has  an 
intensely  disagreeable  odor. 

The  urine  invarial)ly  contains  albumen,  sometimes  also 
blood.  During  the  incipient  stage  of  the  pleuro-pneumonia  the 
quantity  of  chlorine  salts  is  diminished,  but  it  increases  again 
at  the  convalescing  period  as  a  result  of  the  absorption  of 
the  exudate.  The  appetite  is  entirely  absent,  the  chemical  re- 
action of  the  urine  is  acid.  Microscopically  the  sediment  shows 
epithelial  cells  from  the  urinary  passages,  sometimes  hyaline 
or  granular  casts,  and  even  red  blood  corpuscles. 

The  number  of  lymphocytes  in  the  lilood  increases  from  the 
beginning  of  the  disease,  and  by  the  fifth  to  seventh  day  may 
exceed  the  normal  number  by  40%.  After  recovery  has  taken 
place,  normal  relation  is  not  established  until  a  long  time  after 
the  disappearance  of  the  clinical  symptoms  (Sturhan). 

The  patients  become  emaciated  in  the  course  of  the  dis- 
ease as  a  result  of  the  fever  and  inappetence.  They  usually 
do  not  lie  down,  or  in  the  presence  of  a  painless  pure  pneumonia 
they  lie  only  on  the  affected  side,  and  in  the  unfavorably  ter- 
minating cases  they  succumb  as  a  result  of  septicemia  or 
asphyxiation. 

Complications  occur  quite  frequently  in  the  course  of  the 
disease,  and  may  lead  the  otherwise  mild  affection  to  a  fatal 
termination.  Of  relatively  small  importance  are  the  inflam- 
mations of  the  tendons  and  tendon  sheaths  of  the  extremities; 
especially  of  the  flexor  tendons,  also  inflammations  of  the  sensi- 
tive lamina  of  the  hoof;  this  applies  also  to  the  edematous 
swellings  of  the  skin,  which  may  appear  as  long  as  the  heart's 
action  is  sufficiently  strong,  as  these  processes  soon  disappear 
after  the  improvement  of  the  inflammation  of  the  respiratory 
organs    (Frohner  observed  in  the  later  stages  of  contagious 


SymptDiiis.  185 

pleuro-pnoimionia  tho  dovolopinoiit  over  night  of  a  weeping 
exzenia  around  the  ankles  of  the  iiind  legs  and  over  the  iioofs 
which  later  extended  also  to  the  front  legs,  causing  supi)uration 
and  seal)  formations).  The  paralysis  of  certain  nerves,  which 
develops  in  the  course  of  the  first  or  second  week  of  the  dis- 
ease is  likewise  usually  only  temporary;  the  nerves  most  fre- 
(piently  affected  are  the  N.  recurrens  vagi,  N.  facialis,  N. 
trigeminus  or  the  N.  ischiadicus.  In  some  cases,  however,  the 
paralvsis  subsides  only  after  a  longer  period. 

A  more  dangerous  and  quite  frequent  complication  is  the 
parenchjnnatous  or  fatty  degeneration  of  the  heart  muscle, 
and  the  paralysis  of  the  heart  which  develops  as  a  result  of 
it,  or  owHng  to  a  pericarditis  which  develops  at  the  same  time. 
Tlie  parenchymatous  degeneration  of  the  kidneys  which  is 
almost  constantly  present  may  later  pass  into  an  acute  nephritis, 
manifested  by  a  diminution  of  the  quantity  of  urine,  niarked 
albuminuria,  and  the  presence  of  numerous  other  constituents. 

The  manifestations  of  intestinal  catarrh  may  increase  in 
severity  and  a  profuse  diarrhea  develop.  If  this  does  not  per- 
sist for  a  long  time  recovery  may  follo^v.  Severe  intestinal 
s^-mptoms  however  which  indicate  deep-seated  inflammatory 
ciianges  of  the  intestinal  mucous  membranes,  always  aggravate 
the  course  of  the  disease,  inasmuch  as  it  causes  in  the  weakened 
patient  an  almost  complete  exhaustion;  and  besides  the  diarrhea 
is  not  infrequently  a  s^anptom  of  developing  septicemia. 

Septicemia,  exceptionally  pyemia,  usually  terminates  the 
course  of  the  disease,  especially  wdien  the  grangrenous  processes 
in  the  lungs  have  reached  great  extent.  Persistent  high  fever, 
chills,  very  weak  and  frequent  pulse,  as  well  as  diarrhea,  indi- 
cate the  development  of  the  disease  in  this  direction. 

As  further  complications  may  be  mentioned  pronounced 
icterus,  hemorrhages  in  the  lungs  (into  cavities  and  thence  into 
the  communicating  bronchi),  or  betw^een  the  layers  of  the 
pleura,  marked  nervous  irritation,  sometimes  associated  with 
spasms  and  trismus  (Wohlmuth;  AVilden  observed  in  a  case 
the  development  of  general  tetanus  8  days  after  the  onset  of 
the  disease,  which  lasted  for  four  days  and  suddenly  disap- 
peared on  the  fifth  day).  Inflammation  of  the  cerebral  and 
spinal  meninges,  paralysis  of  the  sphincter  muscles  of  the 
rectum  and  bladder,  as  \vell  as  of  the  tail  (Friedberger),  oc- 
casionally develop  during  the  course  of  the  disease.  Further, 
inflammation  of  the  eye,  sometimes  with  hemorrhages  into  the 
interior  of  the  eyeball,  serous  and  sero-fibrinous  inflanunations 
of  the  joints,  verrucose  and  ulcerative  endocarditis,  necrosis 
of  the  skin  over  the  edematous  sw^ellings,  phlegmonous  inflam- 
mation of  the  subcutaneous  connective  tissue,  breaking  through 
of  a  cavity  in  the  lung  under  the  skin  of  the  thorax,  falling  of 
the  hair  from  mane  and  tail,  may  also  result  during  the  disease. 
Pregnant  mares  may  abort  in  the  course  of  the  affection. 


186 


Influenza  of  Horses. 


In  the  Prnssian  army  in  the  years  of  1899  to  1908,  among  9,925  affected 
animals  tendonitis  and  tendo-vaginitis  (724  cases),  roaring  (330),  internal  opthalmia 
(189),  purpura  hemorrhagica  (53),  skin  eruptions  (62),  inflammation  of  joints  (32), 
etc.,  occurred  as  the  most  frequent  complications,  or  sequelae  of  contagious  pleuro- 
pneumonia. 

Course.  The  catarrhal  form  of  influenza  lasts  in  the  great 
majority  of  cases  about  one  week,  sometimes,  however,  only 
two  to  three  days,  in  which  cases  the  fever  rapidly  subsides, 

and  the  animals  soon 
recover.  In  other 
cases  the  course  may 
extend  to  two  weeks, 
and  then  it  requires 
considerable  time  un- 
til the  animals  regain 
their  health.  Fatal 
terminations  are  ex- 
ceptional, and  only 
occur  when  severe 
complications  become 
associated  with  mild 
forms  of  the  affec- 
tion (pneumonia,  hy- 
peremia or  acute  in- 
flammation of  the 
brain,  enteritis,  de- 
generation of  the 
heart  muscle,  etc.). 

Much  more  va- 
ried is  the  course  of 
the  pectoral  form  of 
influenza.  In  the 
typical  cases  in  which 
tlie  different  stages 
of  lobar  pneumonia 
follow  each  other 
with  regularity,  and 
the  resolution  is  also 
undisturbed,  the 
pleurisy  being  pres- 
ent in  a  mild  form  or 
not  demonstrable  at 
all,  the  fever  may 
subside  at  the  end  of 
the  first  or  at  the  be- 
ginning of  the  second  week.  Here,  however,  complications  and 
sequelae  which  develop  frequently  in  association  with  the  dis- 
ease, more  often  cause  a  deviation  of  its  regular  course. 
Especially  in  cases  of  pleurisy  in  which  a  great  quantity  of 
exudate  develops,  the  affection  may  extend  for  weeks  (Fig.  37), 
and  even  for  months,  the  patients  manifesting  temporary  im- 


Symptoms.  187 

provenicnt  ami  repeated  relai)se.s,  until  linally  the  animal  dies 
from  exhaustion,  or  remains  broken-winded  for  the  rest  of 
its  life.  Death  may  result  however  even  earlier  at  the  heift'ht 
of  the  pneumonia,  usually  followin*^-  paralysis  of  the  heart. 
Convalescence  in  this  forin  of  influenza  takes  a  considerably 
lon.irer  time,  and  as  a  rule  extends  over  a  period  of  more  than 
two  weeks. 

The  termination  of  the  disease  is  natui-ally  also  influenced 
by  the  existiui^-  hyi>ienic  conditions,  and  especially  the  continued 
workinj?  of  animals  already  ill  will  usually  render  the  course 
of  the  disease,  which  otherwise  might  have  been  only  mild,  an 
unfavorable  one. 

After  the  termination  of  the  acute  disease,  chronic  processes 
sometimes  develop  as  sequelaoea  After  a  severe  pneumonia, 
and  especially  Avlien  the  tissues  in  different  parts  have 
become  gangrenous,  chronic  granulating  inflammatory  proc- 
esses, with  shrinkage  of  the  lung  tissue,  may  develop.  This 
condition  may  also  result  in  the  formation  of  bronchiectasis, 
while  after  an  exudative  pleuritis,  adhesions  of  the  pleural 
lavers  may  follow,  as  a  result  of  wdiich  the  animal  may  suffer 
from  dyspne.  until  its  death.  A  frequent  result  of  pleurisy 
is  the  paralysis  of  the  N.  recurrens  vagi,  which  causes  roaring 
in  the  animal.  The  acute  catarrh  of  the  intestines  may  develop 
into  a  chronic  form,  which  results  in  the  gradual  emaciation 
of  the  animal.  Other  after  affects  that  may  occur  are  paralysis 
of  the  hind  parts,  shortening  and  even  necrosis  of  some  of  the 
tendons,  chronic  inflammation  of  the  joints,  exostoses,  hemo- 
globinemia,  and  as  a  result  of  the  inflammation  of  the  eye, 
amaurosis.  Finally,  horses  recovering  from  influenza  may  later 
become  affected  with  purpura  hemorrha.gica,  and  the  internal 
inflammation  of  the  eye  may  also  develop  only  two  to  three 
weeks  after  the  passing  of  the  disease  (Hell). 

The  character  of  the  disease  varies  greatly  in  the  different 
outbreaks.  While  in  some  periods  the  course  of  the  disease  is 
very  mild,  so  that  the  great  majority  of  the  animals  are  only 
slightly  affected  with  the  catarrhal  s^nuptoms,  and  while  also 
the  infrequent  pneumonia  almost  invariably  terminates  in  re- 
covery, there  are  outbreaks  in  which  the  disease  is  of  a  re- 
markably malignant  character.  This  form  is  characterized 
especially  by  frequent  hemorrhages,  as  well  as  by  pneumonias 
which  frequently  assume  gangrenous  forms.  The  character  of 
the  disease  may  also  change  in  one  and  the  same  outbreak; 
thus  in  some  instances  it  may  occur  that  at  the  beginning  of 
the  outbreak  only  cases  of  the  catarrhal  form  of  influenza 
are  observed,  while  later  the  pleuro-pneumonic  form  becomes 
more  frequent,  and  towards  the  termination  of  the  epidemic 
the  affections  return  again  to  the  milder  form. 

Diagnosis.  The  catarrhal  form  of  influenza  may  ])e  easily 
mistaken   for   catarrhal   manifestations   of   the   mucous   mem- 


^^(S  Inllueiiza  of  Horses. 

braiie  from  other  causes,  while  pectoral  influenza  may  easily 
be  confounded  with  sporadic  croupous  pneumonia.  Althoui^li 
the  edematous  infiltrations  of  the  subcutis,  as  well  as  the 
tendonitis  and  the  tendo-vaginitis,  also  the  icteric  discolora- 
tion and  chemotic  infiltrations  developing  in  association  with 
the  conjunctivitis,  are  quite  characteristic  of  influenza,  these 
symptoms  are  not  infrequently  absent,  especially  in  the  early 
cases  of  an  outbreak.  In  such  cases  the  infectious  character 
of  the  disease,  and  its  rapid  spread  among  horses,  reveals  the 
nature  of  the  affection.  In  practice  it  is  advisable  therefore 
to  suspend  diagnosis  in  the  first  cases,  until  the  appearance 
of  new  cases,  or  dependable  data  disclose  the  infectious  nature 
of  the  disease,  or  until  characteristic  symptoms  develop,  or 
on  the  other  hand,  until  the  infectiousness  of  the  affection  may 
be  excluded.  In  consideration  of  these  diagnostic  difficulties 
every  suddenly  appearing  catarrhal  affection,  and  particularly 
every  croupous  pneumonia,  should  be  considered  as  if  it  were 
an  attack  of  influenza,  that  is,  as  an  infectious  disease.  Ac- 
cordingly an  immediate  isolation  of  the  affected  animal  is  in- 
dicated in  all  such  cases.  Influenza  is  distinguished  from 
the  non-infectious  catarrhs,  principally  hj  the  fact  that  in  the 
former  the  catarrhal  manifestations  are  preceded  by  high  fever 
of  sudden  development,  while  in  the  latter  the  catarrhal  symp- 
toms are  rather  latent  and  develop  only  ^\dth  slight  rises  in 
temperature. 

If  influenza  has  been  established  in  a  stable,  or  if  the  dis- 
ease is  present  in  nearby  localities,  all  febrile  affections  should 
be  considered  as  suspicious  of  the  disease.  Further,  as  the 
feljrile  rise  of  the  temperature  represents  the  first  sjniiptoms 
of  influenza,  it  is  advisable  in  order  to  separate  immediately 
the  newly  affected  animals,  to  take  the  temperatures  of  the 
horses  in  the  infected  or  endangered  stables  systematically 
twice  a  day.  A  rise  in  the  temperature  of  two  degrees  or  over 
is  sufficient  to  indicate  the  probable  presence  of  the  disease. 

Infectious  anemia  may  possibly  be  mistaken  for  the 
catarrhal  form  of  influenza,  especially  when  it  is  associated 
with  severe  intestinal  disturbances.  The  condition  of  the  blood 
affords  a  means  of  differentiation  since  in  anemia  it  coagulates 
incompletely,  at  the  same  time  the  serum  frequently  appears 
opalescent  and  of  a  more  reddish  color  (Vallee).  The  appear- 
ance of  pneumonia,  or  pleuro-pneumonia,  or  the  development 
of  similar  symptoms  in  other  horses  of  the  stable  would  be 
indications  of  influenza ;  on  the  other  hand,  rapid  emaciation 
and  cachexia,  without  organic  afTection,  as  well  as  the  pres- 
ence at  autopsy  of  a  greatly  enlarged  spleen,  would  suggest 
the  presence  of  infectious  anemia.  Strangles  may  also  be 
considered  in  the  beginning  of  the  affection,  from  the  standpoint 
of  a  differential  diagnosis;  in  this,  however,  the  swelling  and 
suppuration  of  the  lymph  glands  reveals  the  nature  of  the 
affection. 


Prognosis.  189 

Prognosis.  The  prognosis  of  the  catarrhal  form  of  in- 
fluenza is  usually  favorable,  as  deaths  seldom  occur  except  as 
a  result  of  complications,  the  api)earance  of  which  are  com- 
monly associated  with  unfavoral)le  hygienic  conditions.  Under 
favorable  conditions  the  loss  hardly  ever  exceeds  0.5  to  1%  ;  it 
may  however  reach  4%  and  even  more.  Accordingly  in  the  prog- 
nosis all  existing  circumstances,  as  well  as  the  benign  or  the 
malignant  character  of  the  disease  should  be  taken  into  con- 
sideration. 

The  ])rognosis  of  the  pectoral  form  of  influenza  is  much 
more  unfavorable.  In  this  form  the  losses  are  never  less  than 
4  to  5%,  and  frequently  considerably  higher  (according  to 
Dieckerhoff  the  average  is  167o).  Besides  it  should  l)e  also 
considered  that  in  addition  to  the  losses  resulting  from  death 
some  of  the  animals  do  not  completely  recover,  and  that  their 
protracted  convalescence  may  greatly  diminish  the  value  of  the 
animals  through  the  lessening  of  their  al)ility  to  work. 

The  life  of  the  affected  animal  is  imperiled  in  the  first 
place  by  danger  of  paralysis  of  the  heart.  Indications  of  a 
weak  heart  always  render  the  prognosis  unfavorable,  and  in 
the  presence  of  a  soft  empty  pulse  of  over  80  beats,  as  well 
as  when  a  venous  pulse  can  be  detected,  the  chances  of  recovery 
are  very  slight. 

The  termination  of  the  disease  depends  also  on  the  extent 
of  the  pneumonia  and  pleurisy.  A  unilateral  pneumonia  with 
only  slight  pleuritis  usually  terminates  favorably;  on  the  other 
hand  a  bilateral  affection,  and  especially  the  formation  of 
great  quantity  of  pleural  exudate  is  always  grave.  In  such 
cases,  even  at  the  best,  the  course  of  the  disease  is  very  pro- 
longed, and  chronic  changes  of  the  respiratory  organs  usually 
remain  as  a  sequel  to  the  disease. 

Moderate  fever,  and  at  least  a  fair  appetite,  are  favorable 
prognostic  signs.  The  more  regularly  the  different  stages  of 
the  disease  follow  each  other,  the  more  favorable  is  the  prog- 
nosis, while  a  rapid  change  for  the  worse  in  the  respiration, 
with  very  high  fever,  without  a  distinctly  demonstrable  dullness 
(pneumonia  centralis!),  usually  results  in  death  after  a  few 
days.  The  dangers  from  cases  of  a  hemorrhagic  character 
are  in  most  instances  great  (bloody  nasal  discharge,  similar 
pleural  exudate!). 

According  to  Frohner,  prognostic  conohisions  can  he  ma«lo  in  every  case  of 
contagions  pleuropneumonia,  from  the  consistence  of  the  exudate  which  may  be 
obtained  by  asj)iration.  If  the  exudate  contains  no  bacteria  the  prognosis  is  always 
favorable:  on  the  other  hand,  in  the  presence  of  bacteria  (streptococci)  the  disease 
as  a  rule  has  a  fatal  termination. 

^  The  course  of  the  fever  is  of  great  importance  in  the  prog- 
nosis, especially  in  the  pectoral  form  of  influenza.  If  the  tem- 
perature, after  rising  rapidly,  remains  for  several  days  ap- 
proximately at  the  same  height,  and  if  it  falls  towards  the 
end  of  the  first  week  just  as  rapidly,  or  even  gradually,  the 
prospect  of  a   favorable  termination  is  excellent.     If,  on  the 


190  Influenza  of  Horses. 

other  hand,  the  fever  curve  shows  a  remittent  character,  and 
if  the  febrile  condition  lasts  over  a  week,  and  also  if  a  new 
rise  in  temperature  takes  place  after  the  appearance  of  the 
apyrexia,  an  unfavorable  prognosis  is  indicated.  In  the  latter 
instance  a  rise  in  the  temperature  lasting  only  for  one  day 
(perturbatio  critica),  has  no  special  importance;  continuous 
fever  is,  however,  always  grave,  as  it  either  points  to  an  ex- 
tension of  the  pleurisy,  or  to  the  development  of  some  other 
complication. 

Unfavorable  terminations  are  also  indicated  by  the  pres- 
ence of  severe  inflammations  of  the  tendons,  which  interfere 
with  the  standing  of  the  animal ;  also  persistent  diarrhea,  hem- 
orrhages in  the  lungs  or  other  organs,  the  appearance  of 
pulmonary  gangrene,  or  an  affection  of  the  brain,  etc.  A 
rapid  reaccumulation  of  the  pleural  exudate  after  aspiration 
is  also  an  unfavorable  sign,  although  in  exceptional  cases,  even 
after  repeated  aspirations  recovery  may  finally  take  place, 
which,  however,  is  usually  incomplete.  In  all  of  these  cases 
the  dietetic  conditions,  the  care  and  nursing  of  the  patients, 
as  well  as  the  general  strength  of  the  animals  should  be  given 
relative  consideration.  The  more  favorable  the  conditions  are 
in  this  respect  the  milder  a  course  of  the  disease  may  be  ex- 
pected. 

In  the  Prussian  army,  during  the  period  of  lo  years  (1894  to  1908),  out  of 
26,678  horses  affected  with  the  catarrhal  form  of  influenza,  40  died  (or  0.15%), 
in  most  instances  as  a  result  of  subsequent  plenro-pneunionia ;  while  in  the  same 
period  38,671  horses  were  affected  with  the  pectoral  form  of  influenza,  of  which 
1,527  succumbed  (3.94%).  Among  the  horses  of  private  stables  in  which  the 
hygienic  conditions  are  usually  more  unfavorable,  the  losses  are  correspondingly 
higher. 

Treatment.  This  consists  in  the  first  place,  in  a  suitable 
regulation  of  the  dietetic  conditions.  It  is  of  particular  im- 
portance that  the  animal  should  immediately  be  taken  from 
work  and  placed  in  a  clean,  quiet  and  moderately  cool  stable. 
If  the  weather  is  favorable  it  should  be  allowed  to  remain 
outdoors,  although  protected  against  wind  or  rain.  The  diet 
should  consist  of  easily  digestible,  palatable,  and  if  possible, 
of  fresh  green  food,  and  the  animal  should  be  given  fresh 
drinking  water  in  sufficient  quantity  (when  the  disease  ap- 
peared among  army  horses  the  bivouacking  of  all  the  animals 
in  the  open  air  has  repeatedly  proved  beneficial).  As  long 
as  the  course  of  the  disease  is  normal,  and  there  are  no  alarm- 
ing symptoms,  the  expectant  method  of  treatment  may  he  fol- 
lowed. In  such  cases  medicinal  treatment  may  be  omitted,  with 
perhaps  the  exception  of  alcohol  rubs  which  are  always  favor- 
able, and  the  regulation  of  the  bowels.  In  the  presence  of  an 
extensive  bronchial  catarrh,  inhalations  of  turpentine  or  tar 
vapors  are  advantageous  (Lugano  recommends  also  intra- 
tracheal injections  of  10  to  12  cc.  of  a  4%  formalin  solution). 

The  fever  does  not  require  special  treatment^  as  it  usually 


Treatment.  191 

subsides,  without  interference,  after  several  days.  Cold  water 
ill  the  form  of  douches,  once  or  twice  a  day,  or  as  rectal  enemas, 
gives  favorable  results,  especially  during  warm  summer 
weather.  Its  beneficial  action,  however,  is  due  rather  to  the 
stimulation  of  the  nervous  system  and  the  heart's  action,  than 
to  its  antipyretic  action,  although  continued  application  of  cold 
water  douches  does  reduce  the  temperature  from  one  to  two 
degrees.  Direct  antipyretic  treatment  appears  to  be  indicated, 
when  the  body  temperature  remains  abnormally  high,  even  in 
the  later  stages  (over  40.5  to  41  °C.).  In  such  instances  the 
internal  administration  of  antipyrin  and  of  anti-febrin  (15  to 
30  g.)  is  advised. 

If  pneumonia  or  pleuro-pneumonia  develops  in  association 
with  catarrh  of  the  air  passages,  or  if  the  affection  develops 
in  this  form  from  the  beginning  the  application  of  Priessnitz 
l)andages,  as  well  as  rubbing  with  camphor  and  spirits  of  tur- 
pentine, act  favorably.  During  the  sunmier  weather,  cold 
douches  once  or  twice  daily  may  be  applied  advantageously. 
The  heart's  action  requires  special  watching,  and  in  case  it 
is  accelerated,  while  still  strong,  the  administration  of  alcohol 
ill  drinking  water  (25  to  50  g.  alcohol,  i/.  to  1  liter  of  wine) 
will  give  beneficial  results.  In  case  the  heart's  action  is  greatly 
accelerated,  and  the  pulse  is  weak,  heart  stimulants  are  in- 
dicated, such  as  digitalis  leaves  (2  to  5  g.),  tincture  of  strophan- 
thus  (10  to  25  g.),  caffeine  (1  to  2  g.),  camphor  (2  to  5  g. 
subcutaneously  every  3  to  4  hours),  or  barium  chloride  (2  g.). 
Strophantine  may  be  given  subcutaneously  (0.003  g.  in  10  g. 
of  water,  injected  at  2  places). 

Frohner  recommends  instead  of  the  natural  camphor,  the  cheaper 
preparation  made  artificially  from  oil  of  turpentine,  for  the  treatment 
of  contagions  pleuro-pneumonia.  The  horses  should  receive  daily  100 
to  200  g.  of  oleum  camphoratum  (syntheticum)  forte,  or  as  a  "single 
dose  50  to  100  g.  injected  on  both  sides  of  the  thorax. 

Recently  Eberlein  &  Toepper  obtained  very  favorable  results  in  the 
treatment  of  influenza  l)y  oxygen  inhalations.  The  animals  were  given 
the  oxygen  inhalations  twice  daily  for  10  to  15  minutes.  According 
to  observations  in  the  German  army,  liowever,  the  effect  of  this  treat- 
ment consists  only  in  a  general  improvement  for  15  to  30  minutes, 
as  well  as  a  diminution  of  the  rate  of  respiration  and  pulse,  while 
the  treatment  has  no  influence  on  the  pneumonic  process,  and  even  if 
inaugurated  at  the  onset  of  the  disease  does  not  prevent  an  unfavorable 
course  (Fiichsel).  Hermann  observed  rapid  absorption  of  the  exudate 
and  recovery  in  a  severe  case  from  two  sul)cutaneous  injections  of  a 
25%  iodipin  solution  (50  g.  for  each  injection)  ;  such  an  effect,  however, 
was  not  observed  in  the  Budapest  clinic.  The  German  army  veterin- 
arians had  variable  results  from  the  intravenous  injections  of  tallianin 
(10  g.  doses).  (Eichhorn  found  this  remedy  effective  in  the  beginning 
of  the  disease.) 

If  the  exhaled  air  indicates  by  its  fetid  odor  that  decompo- 
sition of  the  secretion   in   the   air   passages,   or  gangrene   of 


192  InHuenza  of  Horses. 

of  the  lung  tissue  is  progressing,  the  inhalation  of  finely 
atomized  disinfecting  fluids  is  advisable.  For  this  purpose  a 
solution  of  corrosive  sublimate  is  recommended  (1  to  2000-4000). 
If  this  treatment  is  applied  sufficiently  early  the  fetid  odor 
frequently  disappears;  extensive  gangrene  of  the  lungs  how- 
ever is  not  checked  l)y  this  method  of  treatment,  likewise  has 
it  no  influence  on  the  development  of  a  general  infection  as 
the  result  of  absorption  of  septic  substances. 

Masson  &  Vazeux  recommend  for  the  treatment  of  pulmonary 
gangrene,  daily  intratracheal  injections  of  creosote  (20  cc.  of  a  solution 
of  1  g.  of  creosote  in  each  40  g.  of  alcohol  and  water),  while  Gotti 
recommends  formalin  (10-20  cc.  of  a  4%  solution). 

The  pleurisy  should  be  treated  in  the  beginning  with  cold 
applications  or  cold  douches ;  however  after  the  subsidence  of 
the  symptoms  of  irritation  these  should  be  changed  to  warm, 
moist  compresses.  The  accumulation  of  fluid  pleural  exudate 
should  be  relieved  by  an  early  aspiration  of  the  thoracic  cavity. 
Eepeated  aspirations  result  sometimes,  even  in  severe  cases, 
in  recovery,  but  in  such  cases  the  chances  are  not  very  promis- 
ing, as  the  pleurisy  frequently  develops  in  conjunction  with 
gangrenous  processes  of  the  lungs.  The  absorption  of  the 
exudate  may  also  be  promoted  with  diuretics,  such  as  potas- 
sium acetate  (100  to  180  g.),  oil  of  turpentine  (10  to  15  g.), 
juniper  berries  (15  to  25  cc),  etc.,  as  well  as  by  rubbing  with 
irritating  liniments  (6  to  10%  mustard,  or  chloroform  liniment 
10  to  40),  followed  by  the  application  of  moist,  warm  com- 
presses. 

The  aspiration  of  the  fluid  shouhl  be  stopped  as  soon  as  the  patient  manifests 
uneasiness,  accelerated  respiration,  or  coughing  spells.  The  subsequent  irrigation  of 
the  pleural  cavity  with  a  physiological  i^alt  solution,  or  a  mild  disinfecting  solution 
does  not  appear  to  act  favoralily.  Strictly  aseptic  technique  is  naturally  the  most 
essential  requirement  for  satisfactory  results.  Boucheriou,  after  aspiration,  recom- 
mends a  subcutaneous,  while  Almy,  an  intravenous  injection,  of  2  to  3  liters  of  a 
physiological  salt  solution.  Fairise  advises  an  intrapleural  injection  of  1.5  to  4 
liters  of  a  1  to  1.5%  gelatin  solution  in  order  to  prevent  a  possible  hemorrhage, 
as  well  as  the  rapid  re-accumulation  of  the  exudate,  the  injections  to  be  made 
immediately  after  the  aspiration  of  the  fluid. 

In  the  presence  of  sjTnptoms  of  a  gastro-intestinal  catarrh 
laxative  salts  should  be  given  daily  to  the  patients,  or  Karlsbad 
salts  (40  to  60  g.),  with  bitter  remedies  (rheum,  gentiana,  oak- 
bark,  etc.).  In  consideration  of  the  infectious  character  of 
the  catarrh,  especially  in  the  presence  of  fetid  excrements,  in- 
testinal disinfectants  are  indicated,  such  as  resorcin  (10  to 
15  g.),  creolin  or  lysol  (10  to  20  g.),  creosote  (5  to  10  g.), 
naphthalin  (10  to  15  g.),  etc.  If  diarrhea  exists  astringents 
(oak-bark,  bismuth  sub-nitrate,  etc.),  with  opiates,  as  well  as 
enemas  containing  powdered  starch  are  beneficial.  If,  however, 
the  diarrhea  is  profuse,  which  usually  is  an  indication  of  a 
general  septic  infection,  the  results  from  such  treatment  are 
not  favorable. 


Prevoiiti.)ii.  193 

The  coiijiiiictivitis  may  be  treated  with  washes  ol"  niikl 
collyriums,  such  as  boracic  acid  or  creoiin  soliitioii,  hiter  astrin- 
gent washes  may  be  api)lied  (0.5  to  1%  tannin,  or  sulphate  of 
zinc  sohition,  collyriuni  adstringens  hiteum).  In  the  i)resence 
of  a  chemotic  swelHng  of  the  conjunctiva,  and  keratitis,  moist 
■warm  appUcations  are  advantageous.  If  the  iris  is  also  affected 
a  lYo  atropine  solution  may  be  dropped  into  the  eye. 

Swellings  of  the  skin  are  benelited  by  rubbing  with  alcohol 
containing  oil  of  turi)entine.  Acetate  of  lead  (5%)  or  Bui'ow's 
solution,  with  the  addition  of  camphor,  may  also  be  applied 
to  this  form  of  affection. 

In  the  convalescing  stage  the  animals  require  good  nourish- 
ment and  rest,  although  moderate  exercise  in  favorable  weather 
is  rather  protitable  than  injurious.  Animals  should  be  used 
for  work  only  when  all  S5^llptoms  of  the  disease  have  disap- 
peared, and  after  they  regain  their  former  strength. 

The  syniptoiiiatic  treatment  is  similar  to  that  followed  in  the  pneumonia  or 
pleurisy  and  euteritis  resulting  from  other  causes;  see  accordingly  their  respective 
chapters  in  the  second  volume. 

Serum  Treatment.  Lignieres  recommends  his  polyvalent  Pas- 
teurella  serum  for  the  treatment  of  influenza  (see  page  86),  In  acute 
cases  of  the  catarrhal  form  of  influenza,  in  the  presence  of  a  fever 
(40.5  to  41°),  he  injects  40  to  60  cc.  of  the  serum  intravenously,  where- 
upon the  fever  is  reduced,  tlie  patient  becomes  brighter,  and  recovers 
inside  of  a  few  days.  In  subacute  cases  (39  to  39.5°),  the  temperature 
usually  rises  somewhat  after  the  injection,  but  drops  after  10  to  12 
hours,  to  normal.  He  also  observed  improvement  in  the  presence  of 
pneumonia,  when  the  serum  was  administered  within  the  first  24  to 
36  hours,  while  later  treatment  promises  little  result,  because  of  the 
associated  streptococcus  infection.  Believing  that  the  inflammatory 
processes  may  also  be  caused  or  aggravated  by  streptococci,  Joly  recom- 
mends the  subcutaneous  injection  of  anti-streptococcus  serum  (25  to  30 
cc.  daily). 

Prevention.  Healthy  horses  should  be  separated  from 
affected  animals,  as  well  as  from  attendants  and  utensils  that 
come  in  contact  with  diseased  animals  or  w^tli  their  secretions. 
It  is  advisable  to  isolate  a  newly  acquii'ed  horse  for  two  wrecks 
for  observation,  and  it  should  be  placed  among  the  other  horses 
only  after  that  period.  This  applies  particularly  to  regions 
in  which  the  disease  is  prevalent. 

If  the  disease  has  already  appeared  the  affected  animals 
should  first  of  all  be  separated,  and  their  stalls,  as  well  as  the 
neighboring  stalls,  should  be  thoroughly  disinfected.  As  in 
the  first  place  the  immediate  neighboring  animals  are  under 
suspicion  of  becoming  affected,  they,  as  well  as  all  animals 
showing  an  elevated  temperature  or  catarrhal  symptoms, 
should  be  segregated  in  different  isolated  places.  At  the  same 
time  the  healthy  animals  which  have  no  fever  should  be  kept 
out  of  doors,  as  far  as  place  and  w^eather  conditions  permit, 
or  in  places  which  are  free  from  the  infection.  They  should 
be  divided  in  groups,  and  onlv  animals  which  are  entirelv  free 

13 


]^94  Influenza  of  Horses. 

from  fever  should  be  used  for  work.  The  infected  stable  should 
be  thoroughly  disinfected,  and  scrupulous  cleanliness,  as  well 
as  free  ventilation  of  the  stable,  should  be  carried  out. 

As  the  development  of  the  disease  is  favored  by  influences 
which  have  a  weakening  effect  on  the  animals,  the  protection 
of  the  horses  from  such  influences,  and  especially  from  taking 
colds,  should  be  given  due  consideration. 

Animals  which  have  passed  through  the  disease  may,  in 
the  majority  of  cases,  and  usually  in  the  catarrhal  form  of 
influenza,  be  considered  as  recovered  and  free  from  the  in- 
fection tw^o  weeks  after  cessation  of  the  fever,  and  the  dis- 
appearance of  all  the  symptoms.  Convalescent  patients  from 
the  pectoral  form  of  influenza  if  the  changes  in  the  lungs  have 
not  entirely  disappeared,  and  especially  if  in  the  meanwhile 
relapses  have  occurred,  are  for  a  much  longer  time  capable 
of  infecting  other  animals. 

Immunization.  Shortly  after  the  discovery  of  Schiitz'  diplo- 
coccus,  Hell  undertook  the  inoculation  of  over  1000  animals,  with 
bouillon  cultures  of  this  bacterium.  Healthy  animals  were  injected 
8  or  4  times  with  40  cc.  of  the  culture  into  the  trachea,  and  some  of 
the  animals  were  given  in  addition  subcutaneous  injections  of  5  to 
10  cc.  The  injection  was  followed  by  a  fever  lasting  from  one  to  two 
days,  whether  the  animals  had  had  the  disease  or  not.  The  subcutaneous 
inoculation  was  also  followed  by  abscess  formation.  Further  observa- 
tion showed  that  animals  immunized  against  the  Schiitz  diplococcus 
did  not  withstand  the  influenza  infection,  and  therefore  this  method 
of  immunization  was  later  entirely  abandoned. 

Immunizations  with  blood  serum  from  horses  which  had  shortly 
before  recovered  from  the  pectoral  form  of  influenza  have  not  given 
uniform  results.  Although  Hell,  at  first,  reported  favorable  results, 
the  continued  experiments  among  the  horses  of  the  German  army 
showed  that  the  serum  treatment  of  affected  animals  was  entirely 
unsuccessful  and  moreover  produced  such  contradictory  and  even 
unfavorable  results,  that  this  method  has  also  been  gradually  aban- 
doned. According  to  the  tabulation  of  Christiani,  in  the  years  of 
1892  to  1898  the  results  of  17  inoculation  tests  showed  that  in  9  cases 
they  were  favorable,  and  in  8  they  were  unfavorable.  In  opposition 
to  the  advocates  of  immunization  (Eichhorn,  Toepper,  Garrey,  Giancola 
and  especially  Friis,  Jensen  &  Nielsen),  others  (Pilz,  Neusse,  Wittich, 
Zschokke,  Troester,  Mieckley)  found  it  ineffective.  The  contradictory 
results  may  be  explained  to  some  extent  by  the  fact  that  the  effective- 
ness of  the  serum  varies  in  accordance  with  the  intensity  of  the  disease, 
and  also  with  the  time  which  has  elapsed  since  the  recovery  of  the 
animal. 

At  best  serum  inoculation  affords  the  animals  a  passive  immunity 
which  lasts  but  a  few  weeks.  Such  results  do  not  meet  the  require- 
ments of  practice,  even  when  the  serious  difficulties  encountered  during 
the  execution  of  the  inoculations  are  not  taken  into  consideration. 
It  would  therefore  be  indicated  only  when  it  appears  desirable  to  protect 
the  animals,  even  for  a  short  time,  against  a  threatening  infection,  such 
as  immediately  before  or  during  cavalry  maneuvers. 

Vaccination  Technique.  For  the  senim  inoculations  blood  is  taken  under 
strictly  aseptic  precautions  ^oni  a  horse  which  has  recovered  from  the  pectoral  form 
of   influenza   not   more   than   six   weeks   previously.     The   quantity   of   blood    drawn 


(^ 


Iiiiiminizaf  ion.  195 

is  usually  between  three  and  four  liters,  collected  in  sterilized  high  test  tubes,  and 
stored  in  a  dark,  cool  place.  The  serum  which  separates  on  the  following  day  from 
the  blood  clot,  may  be  utilized  for  the  inoculations  immediately,  or  several  days 
later.     Until  its  use  it  should  be  kept  in  a  cool  place. 

The  serum  is  injected  subcutaneously  in  iloses  of  40  to  100  cc,  and  the 
procedure  is  repeated  four  to  six  times  during  the  following  days  (Krueger  recom- 
mends the  intravenous,  Delia  Noce  the  intratracheal  injection).  To  the  serum 
several  drops  of  chloroform  may  be  added  (Friis,  Jensen,  Nielsen),  or  0.8%  of 
o-\alic  acid,  in  the  proportion  of  1  to  10  (Prussian  army).  The  inoculation  causes 
in  most  instances  only  a  transitory  indisposition,  but  in  one  Prussian  regiment, 
among  VJo  horses,  extensive  swellings  and  abscess  formations  were  also  observed 
(evidently  the  serum  was  contaminated).  Eecently  vario'.is  serum  prcjiarations  have 
been  recommended,  for  the  purpose  of  immunization,  which  however  have  not  proved 
satisfactory  in  practice;  thus  the  results  which  were  ol>taine«l  by  Bues  with  Ueutsidi- 
n.ann's  yeast  serum  (and  with  polyvalent  hog  serum),  gave  absolutely  negative 
results  in  contagious  pleuro-pneumonia.  Thomann  experienced  similar  unsatisfactory 
results  with  the  vaccines  prepared  by  Loreuz  from  cultures  of  his  pleomorphic 
bacterium.  The  same  probably  also  applies  to  the  serum  of  Willerding,  prepareil 
from  the  cultures  of  a  diploccocus  which  he  isolated  from  the  secretions  of  the 
nose  and  eye,  as  Lorenz  found  it  equivalent  to  his  own  in  his  laboratory  experiments. 

Immunization  with  Killed  Cultures.  Vallee  &  Carre  used  a  vaccine 
prepared  from  killed  (.•ultiii-cs  of  six  varieties  of  "Pasteurella"  for  the 
iijimunizatiou  of  horses.  The  administration  of  this  vaccine  to  the 
horses  of  an  infected  stable  was  followed  in  several  animals  by  severe 
symptoms  of  depression  and  dullness,  some  became  affected  with  the 
tyi)ic'al  form  of  contagious  pleuro-pneumonia,  and  three  of  thern  died 
as  a  result  of  the  infection  (latent  infection?). 

Veterinary  Police.  In  tlie  German  Empire  compulsory 
notitieatiun  of  inliueuza  in  horses  was  inaugurated  in  the  year 
of  -1908.  The  official  measures  require  the  separation  of  the 
affected  and  suspected  animals,  quarantine  and  disinfection  of 
the  infected  stables.  The  observation  period  extends  over  five 
weeks. 

Literature.  Falke,  Die  Influenza  des  Pferdes  usw.,  Jena  1862. — Dieckerhoff, 
Die  Pferdestaujie.  Berlin.  1^82. — Sieilamgrot;kv,  Sachs.  Jhb.,  1-91-1893. — Schiitz,  A. 
f.  Tk..  1SS7,  XIII,  27.— Hell.  Z.  f.  Vk.,  is9n."ll,  97;  1S92,  IV,  4o2 ;  1906,  XVIII, 
159.— Jensen,  Monh.,  1891,  II,  196.— Foth,  Ibid.,  1S91,  III,  192.— Leclainche,  Eev. 
vet.,  1892,  78  (Lit.).— Lignieres,  Bull.,  1897,  35.5  u.  437;  1900,  524  (Lit.);  Eev.  gen., 
1907,  IX,  599.— Jensen  &  Nielsen,  Maanedsskr.,  1897,  YIII,  401. — Sturhan,  Z.  f.  Vk., 
1905,  XVII,  248.— Drever,  Z.  f.  Vk.,  1908,  XX,  307. — Ostertag,  Z.  f.  Infkr.,  1909, 
V,  ISO.— Pfeiler  &  Her^ipel,  Ibid.,  1909,  VI,  28. 

Influenza  in  Man.  In  human  medicine  influenza  represents  an  acute, 
contagious,  infectious  disease,  which  at  times  spreads  \\ith  extra- 
ordinary rapidity.  The  symptoms  consist  in  pain  in  the  joints  and 
muscles,  occasional  muscular  tremors  in  different  parts  of  the  body, 
sudden  and  intense  fever  \\'ith  severe  headache.  There  is  also  marked 
debility,  and  a  progressive  acute  catarrh  of  the  air  passages,  conjunc- 
tivitis, and  frequently  gastro-intestinal  catarrh.  The  disease  usually 
terminates  in  from  two  to  six  days  in  recovery,  however  it  may  extend 
to  two  weeks.  In  older,  and  exceptionally  among  younger  persons, 
severe  disease  processes  may  develop  in  a.ssociation  with  catarrh  of 
the  mucous  membrane,  such  as  pharyngitis,  catarrhal  and  croupous 
pneuiDonia.  occasionally  also  pleurisy  and  pericarditis,  as  well  as 
inflammation  of  the  middle  ear.  In  the  latter  eases  the  course  is  usually 
protracted  and  not  rarely  fatal. 

The  disease,  which  has  no  association  with  influenza  of  horses, 
is  caused  bv  the  verv  small  influenza  bacillus,  which  has  been  discov- 
ered by  Pfeiffer  (Beck,  Ergebn.  d.  allg.  Atiol.,  1896,  I,  742). 


196  Dengue  Fever. 

Dengue  Fever.  This  disease  of  man  occurs  in  the  tropics,  espe- 
cially iu  America,  East  Indies  and  on  the  coast  of  the  Mediterranean. 
It  sometimes  is  very  widely  distributed,  and  is  characterized  by  suddenly 
appearing  chills,  pains  in  the  joints  and  muscles  (dengue-dandy,  so  called 
from  the  peculiar  stiff  gait  as  the  result  of  pain  in  the  knee  joints), 
further  iu  a  polymorphous,  exanthema  of  the  skin.  According  to  some 
observers  (DeBrun,  Cubillas,  Martialis),  the  disease  also  occurs  among 
domestic  animals.  Piot-Bey  observed  iu  1895,  in  Egypt,  enzootic 
affection  of  cattle  which  he  identified  with  dengue  fever.  The  animals 
suddenly  became  affected  with  a  striking  muscular  weakness,  which 
was  so  marked  that  they  staggered  and  trem])led  in  walking,  or  becom- 
ing exhausted  they  lay  down  on  the  chest.  The  body  temperature  was 
moderately  elevated  (39.5  to  39.6*^0.),  respiration  and  pulse  accel- 
erated (25  to  30,  and  60  to  90  per  min.).  At  the  same  time  there  was 
complete  inappetence  and  constipation.  Usually  after  three  to  four 
days  diarrhea  appeared,  which  was  soon  followed  in  all  cases  by 
complete  recovery.  (Fievre  dengue  sur  I'espece  bovine,  Extrait  du 
Bull,  de  rinst.  Egyptien,  Le  Caire,  with  literature). 

Three  Days'  Sickness,  Stiff  Sickness,  Ephemeral  Fever.  In  South 
Africa  there  occurs  a  disease  among  cattle  which  Schweiufurth  observed 
in  1867,  but  to  which  the  attention  of  the  experts  has  only  in  recent 
years  been  directed,  when  it  spread  extensively  in  Rhodesia,  in  the 
Transvaal,  Natal  and  in  the  Cape  Colonies.  It  was  first  demonstrated 
in  November,  1906,  by  Edmonds,  and  later  described  by  Bevan,  Theiler 
and  Freer  (it  is  possibly  identical  wdth  dengue  fever). 

The  symptoms  in  the  majority  of  eases  develop  and  disappear 
within  three  days,  or  the  disease  may  terminate  in  death.  IManifesta- 
tions  are,  stiffness  of  the  muscles  of  one  or  all  extremities,  extending 
to  the  neck,  or  even  over  the  entire  body.  As  a  result  of  this  condition 
the  animals  are  lame,  and  later  they  are  hardly  able  to  move  and  seeui 
obliged  to  lie  helplessly  on  the  ground.  Development  of  this  condition 
is  preceded  by  diminishing  appetite  and  rumination,  and  also  by  an 
elevation  of  the  body  temperature,  while  later  on  there  appears  a 
conjunctivitis,  with  swelling  of  the  parts  surrounding  the  eyes,  frequent 
respiration,  very  weak  pulse,  distinct  veinous  pulse  and  constipation. 
The  termination  is  usually  favorable,  as  not  more  than  3%  of  the 
affected  animals  succumb,  and  part  of  these  as  a  result  of  inhalation 
pneumonia. 

The  cause  of  the  disease  is  unknown  at  the  present  time,  but 
Robertson  and  Theiler  showed  that  it  may  be  transmitted  with  the 
blood  of  affected  animals,  in  which  case  the  symptoms  develop  after 
an  incubation  of  from  2  to  3  days.  It  is  possible  that  the  infection  is 
communicated  by  insects  ( mosquitoes  ? ) .  Animals  which  have  recovered 
from  the  disease  ac(iuire  an  immunity  which  only  lasts  about  six  weeks 
(Robertson),  reinfections  being  therefore  not  infrequently  observed 
(Freer). 

Literature.  Bevan,  J.  of  comp.  Path.,  1907,  XX,  104.— Theiler,  Eep.  of 
the  Transvaal  Gov.  Bact.,  1907.— Freer,  V.  J.,  1910,  19. 

Malta  Fever.  (]\Iediterranean  Fever.)  Malta  fever  is  a  febrile 
disease  of  man,  which  most  fre(|uently  occurs  on  the  Island  of  Malta, 
then  in  the  countries  around  the  Mediterranean  Sea,  and  probal)ly 
also  in  other  tropical  countries.  The  disease  is  very  protracted,  remit- 
tent in  its  course,  and  associated  with  anemia,  headaches,  rheumatic 
difficulties,  constipation,  and  swelling  of  the  joints.    A  fatal  termination 


Malta  Fever.      Disleiiipci'  oL'   Doj^s.  197 

occurs  only  in  al)ont  .V/o  of  the  cases.  Bruce  (1887)  established  as 
its  cause  a  very  small,  motile,  Gram-negative,  oval  coccus  (micrococcus 
melitensis).  The  organism  can  l)e  cultivated  on  the  ordiiuiry  media, 
and  shows  consideral)le  resistance  against  drying.  In  ati'ected  persons 
the  coccus  is  usually  i)resent  in  the  blood,  from  which  it  is  fre(|uently 
eliminated  with  the  urine. 

Natural  infection  occurs  in  most  cases  through  the  ingestion 
of  raw  goat  milk.  Zannnit  (1905)  proved  that  al)0ut  10"/o  of  the  goats 
at  Malta  eliminate  the  causative  agent  of  INIalta  fever  with  their  milk, 
and  that  many  of  these  animals  harbor  the  organism  in  their  blood. 
He  further  found  that  the  serum  of  about  50%  of  all  goats  gives  a 
positive  agglutination  reaction.  As  it  has  been  proved  that  the  infec- 
tion may  be  readily  transmitted  through  ingestion  of  infected  milk, 
the  drinking  of  raw  goat  milk  was  prohibited  in  the  army,  whereupon 
the  morbidity  innnediately  dropped  to  one  tenth  of  its  former  rate. 

Goats  wliich  pass  the  microccocus  melitensis  with  the  milk,  and 
also  with  the  urine,  usually  show  no,  or  only  slightly  marked  symptoms, 
but  if  they  are  killed,  hy])eremia  and  acute  swelling  of  the  spleen, 
together  with  swelling  of  the  lymph  glands,  especially  of  the  mesen- 
teric and  inguinal  Avill  fre(iuently  be  found.  Exceptionally  nephritis 
and  lobular  pneumonia  are  present.  The  causative  factor  may  be 
isolated  by  culture  procedures  from  the  lesions  in  the  organs,  as  well 
as  from  the  blood  and  from  the  udder  (in  chronic  cases  only  from 
the  latter). 

Goats  are  easily  infected  per  os,  and  it  appears  that  the  natural 
infection  occurs  by  this  method,  especially  by  the  ingestion  of  feed 
contaminated  by  urine  of  alfeeted  animals.  The  virus  then  becomes 
localized  in  the  internal  organs  and  in  the  udder,  where  it  produces 
inflammatory  changes,  from  which  the  bacteria  pass  into  the  milk. 
Intravenous  or  subcutaneous  injections  of  cultures  produce,  sometimes, 
a  severe  affection,  with  symptoms  of  septicemia.  It  is  also  possible 
to  produce  a  mild  form  of  the  disease  in  monkeys. 

The  infectious  properties  of  the  goat  milk  may  in  some  cases  be 
established  by  the  presence  of  the  virus;  it  may  also  be  considered 
infectious  if  the  blood  serum  of  the  suspected  animals  agglutinates 
cultures  of  the  organisms  in  dilutions  of  at  least  1  to  30.  The  aggluti- 
nation test  may  be  also  made  with  milk  (Zammit),  or  with  milk  serum 
(Pulvirenti),  and  Wright's  opsonic  test  also  gives  good  results. 

Literature.  Babes,  Hb.  d.  p.  M.,  1903,  ITT,  43S,  Report  of  the  English  Com- 
mission, London,  19()o-1907,  Vol.  I-VII. — Mohler  &  Hart,  Bureau  Anini.  Industry, 
1908,  279. 

9.     Distemper  of  Dogs.     Febris  catarrhalis  et  nervosa  canum 

{Dog  ill,- Pasteur ellosis  canum,  Maladie  des  ch'ieus,  Maladie  du 

jeune  age  [Frencli];  Staupe  der  Hioide  iGerman]  ; 

Cimnrro,  Moccio  canino  [Ifalia)!]. 

Distemper  is  an  acute,  contagious  infectious  disease  of  * 
young  carnivorous  animals,  and  is  characterized  by  febrile 
manifestations,  and  an  acute  catarrli  of  the  mnoous  membranes, 
which  is  frequently  followed  by  catarrhal  pneumonia,  and  in 
some  cases  by  the  development  of  nervous  sjTuptoms.  The 
disease  is  caused  bv  a  filtrable  virus. 


198  Distemper  of  Dogs. 

History.  The  frequency  of  the  disease  among  dogs,  and  its  im- 
portance, is  well  illustrated  by  the  fact  that  it  is  known  in  almost  all 
languages  as  the  "dog  disease."  In  Europe  it  is  supposed  to  have 
occurred  since  the  second  half  of  the  eighteenth  century,  having  been 
introduced  from  Asia  (Spiuola)  or  from  Peru  (Heusinger).  The 
infectious  nature  of  the  disease  was  proved  in  the  middle  of  the  last 
century,  by  successful  experiments  of  transmission,  with  the  nasal  dis- 
charge (Renner  &  Karle,  Weisz,  Laosson,  Krajewsky),  with  saliva 
(Venuta),  and  with  the  contents  of  the  skin  pustules  (Trasbot),  from 
affected  animals  to  young  dogs.  Its  etiology,  however,  was  first 
cleared  up  by  the  investigations  of  Carre  (1905),  which  established  that 
the  disease  is  caused  by  a  filtrable  virus. 

Occurrence.  Distemper  is  a  remarkably  frequent  disease 
of  young  carnivora,  especially  of  young  dogs,  so  much  so  that 
the  great  majority  of  the  latter  become  affected  before  reaching 
the  age  of  one  year.  In  kennels  young  animals  usually  become 
affected  in  great  numbers,  but  not  infrequently  the  disease 
occurs  in  an  epizootic  form  affecting  entire  townships  or  even 
large  territories.  It  is  more  prevalent  during  warm  weather, 
but  is  also  quite  frequent  during  the  winter. 

Etiology.  According  to  the  investigations  of  Carre  which 
have  since  been  confirmed  by  Lignieres,  distemper  is  caused 
by  a  filtrable  virus  which  in  the  beginning  of  the  disease  is 
contained  in  the  nasal  discharge. 

Subcutaneous  injections  of  two  drops  of  the  serous  dis- 
charge from  the  nose  kills  young  animals  within  6  or  7  days 
with  symptoms  of  coma  and  a  fall  of  the  temperature  at  the 
termination  of  the  disease.  The  autopsy  shows  only  an  accumu- 
lation of  clear,  yellow  serous  fluid  in  tlie  pericardium.  Injec- 
tion of  a  filtered  nasal  discharge,  or  of  filtered  pericardial 
fluid  produces  a  rapid  rise  in  temperature  after  3  or  4  days, 
catarrh  of  the  conjunctivae  and  the  nasal  mucous  membrane, 
cough,  and  after  8  to  10  days  a  pustular  exanthema  on  the 
parts  which  are  thinly  covered  with  hair.  The  nasal  discharge 
becomes  more  profuse  and  purulent,  whereupon  death  results 
in  from  2  to  3  weeks.  The  autopsy  reveals  catarrhal  pneu- 
monia, the  heart  muscle  appears  to  be  sprinkled  with  small 
hemorrhages  and  yellow  spots,  while  the  pericardium,  some- 
times also  the  pleural  and  the  abdominal  cavity,  contains  a 
serous  fluid  in  varying  quantities.  The  exudate  is  only  ex- 
ceptionally virulent,  unlike  that  of  acute  cases.  The  blood  is 
only  virulent  at  the  beginning  of  the  fever,  while  later,  even 
in  an  unfilterod  condition,  it  will  not  produce  the  disease;  this 
applies  also  to  the  nasal  discharge  which  has  become  purulent, 
and  to  material  from  the  hepatized  lungs.  Healthy  dogs  may 
be  artificially  infected  by  cohabitation. 

In  view  of  the  results  of  the  investigations,  the  different  bacteria 
which  have  been  found  by  various  investigators  in  the  tissues  of  dogs 
affected  with  distemper  must  be  considered  as  secondary  participants 


Etiology.  199 

in  producing  tho  disoaso  proposscs.  Tho  l)Odj'  Avhieh  is  attacked  by 
the  filtrable  virus  prepares  the  tield  of  action  for  the  other  organisms 
which  produce  intianimatory  local  changes.  Thus  Jensen  found  strepto- 
cocci, staphylococci  and  a  slender  bacillus,  Mathis  isolated  a  diplo- 
coccus  from  pustules  on  the  skin,  the  cultures  of  which  resembled  the 
ordinary  staphylococcus,  Schantyr  obtained  a  motile  bacillus  resem])liug 
the  organism  of  abdominal  typhus,  Perez  incriminated  the  cocco-bacillus 
ozoenae  foetidus,  while  Galli-Vallerio  found  a  bacillus  resembling 
the  colon  bacillus,  which,  however,  stains  ])y  Gram.  Lignieres,  Ceramicolu 
and  Wunschheim  attri])uted  the  disease  to  an  ovoid  bacterium,  and  Pior- 
kowski  obtained  a  slender,  delicate  capsulated  bacillus,  etc. 

All  of  these  organisms  appear  to  be  normal  inhabitants  of  the 
dog  organism.  In  different  cases  one  or  the  other,  or  several  of  these 
organisms  commence  to  multiply  more  rapidly  in  the  affected  dog, 
and  then  exert  their  pathogenic  action.  This  applies  especially  to 
the  ])acilhis  ])ipolaris  septicus,  which  was  considered  by  Lignieres  as 
the  true  cause  of  the  disease.  Cultures  of  this  organism  (they  can 
only  exceptionally  ])e  isolated)  produce  severe  septic  symptoms  in  dogs 
after  intravenous  injections,  and  frequently  also  secondary  inflamma- 
tions in  various  organs.  Whether  there  exists  an  independent  pas- 
teurellosis  of  dogs,  as  claimed  by  Lignieres,  in  addition  to  the  distem- 
per caused  by  the  filtrable  virus,  is  not  established  at  the  present  time. 

Contrary  to  the  described  etiological  findings,  Kregenow  succeeded  in  producing 
the  disease  with  filtrable  virus  in  only  two  instances  out  of  10  inoculations,  and 
even  the  two  positive  cases  he  attributes  to  natural  infection.  Accordingly  he  is 
of  the  opinion  that  the  virus  is  not  filtrable,  and  must  be  one  of  the  numerous 
visible  organisms.  However,  the  experiments,  as  indicated  by  his  notes,  were  not 
carried  out  as  suggested  by  Carre,  with  the  serous  nasal  discharge,  but  with  a  puru- 
lent discharge  and  material  obtained  from  pneumonic  lungs.  It  is  possible,  therefore, 
that  the  filtrable  virus  contained  therein  was  retained  during  filtration. 

Natural  infection  occurs  through  direct  or  indirect  contact 
with  affected  animals.  The  virus  is  present  in  the  catarrhal 
secretion  of  the  mucous  membranes  and  is  evidently  in  most 
instances  taken  into  the  digestive  canal  with  the  food  and  water. 
The  infection  is  probably  favored  by  influences  which  reduce 
the  resistance  of  the  body,  such  as  colds,  insufficient  or  im- 
proper food,  such  as  bread,  kitchen  refuse,  etc.  The  disturb- 
ances of  digestion  caused  by  these,  together  with  loss  of  blood, 
exhaustion,  weak  constitution,  etc.,  favor  the  development  of 
the  disease. 

Young  animals  are  most  susceptible.  They  may  excep- 
tionally become  affected  when  only  2  to  3  weeks  old  (Fried- 
berger  &  Frohner),  but  usually  dogs  several  months  old  up  to 
one  year  suffer  most  frequently  from  the  disease  (this  is  prob- 
ably due  to  the  fact  that  the  animals  at  that  age  move  around 
more  freely  and  are  more  exposed  to  the  infection).  Tlie 
susceptibility  diminishes  with  advancing  age,  so  that  animals 
over  three  years  old  are  but  rarely  aifected.  The  great  re- 
sistance of  older  animals  is  in  all  probability  due  to  the  fact 
that  the  great  majority  have  been  affected  with  the  disease 
at  a  younger  age  and  have  thereby  become  immune  to  it. 

Pampered  and  weakly  dogs,  as  well  as  animals  recently 


200  Distemijer  of  Dogs. 

imported,  especially  those  of  the  finer  breeds,  are  more  sus- 
ceptible and  usually  become  more  severely  affected  than  do 
dogs  which  are  kept  in  the  country  and  are  hardened. 

Pathogenesis.  The  action  of  the  specific  virus  produces  a 
febrile  condition,  and  in  direct  association  with  it  catarrh  of 
the  mucous  membranes,  as  well  as  inflammation  of  the  serous 
membranes,  especially  of  the  pericardium.  If  the  animal  lives 
through  the  acute  attack,  its  weakened  resistance  favors  the 
development  of  secondary  processes  by  other  micro-organisms. 
These  are  usually  facultative  pathogenic  bacteria,  which  are 
mostly,  or  probably  invariably,  frequent  habitants  of  the  healthy 
dog.  Of  the  secondary  inflammations  the  most^  frequent  are 
pneumonia,  purulent  inflammations  of  the  conjunctivae,  the 
mucous  membranes  of  the  air  passages  and  of  the  intestinal 
canal,  pustules  on  the  skin,  and  also  inflammatory  changes 
in  various  parts  of  the  nervous  system  as  a  result  of  metastasis. 
The  later  course  of  the  disease  depends  on  these  secondary 
diseases,  while  the  filtrable  virus  usually  disappears  before, 
or  not  later  than  at  the  beginning  of  their  development. 

Anatomical  Changes.  In  the  rare  peracute  cases  a  large 
quantity  of  serous  fluid  is  present  in  the  pericardium,  and 
possibly  there  are  small  hemorrhages  in  the  heart  muscles. 

In  the  great  majority  of  cases  the  respiratory  organs,  es- 
pecially show  severe  changes.  The  mucous  meinbranes  of  the 
air  passages  are  bright  red,  swollen,  and  profusely  covered 
with  sero-purulent  secretion.  If  the  smallest  bronchi  are  af- 
fected simultaneously  numerous  small  purulent  plugs  may  be 
squeezed  out  of  the  cut  surface  of  the  lungs  (bronchitis 
capillaris).  In  most  cases  there  is  also  a  catarrhal  pneumonia. 
Sometimes  small  broncho-pneumonic  areas  may  be  disseminated 
throughout  the  lungs,  or  larger  lung  portions,  especially  near 
the  anterior  and  lower  borders  are  found  dense,  hepatized,  and 
according  to  the  duration  of  the  inflammation  either  dark 
brown-red  or  grayish-red.  The  cut  surface  is  smooth  or  finely 
granulated,  and  sometimes  studded  with  small  purulent  foci. 
The  borders  of  the  unaffected  lobes  of  the  lungs  show  bluish-red, 
depressed,  club-shaped  atelectatic  areas.  The  pleura  covering 
the  affected  parts  of  the  lungs  is  either  smooth  and  lustrous, 
or  dull  and  covered  with  fine  filirinous  membranes. 

The  mucosa  of  the  stomach  and  intestines  show  frequently 
manifestations  of  acute  catarrh;  the  solitary  follicles,  as  well 
as  Peyer's  patches  are  swollen.  Exceptionally  there  may  also 
be  superficial  erosions  and  catarrhal  ulcerations  present. 

The  lymph  glands  of  the  thoracic  cavity,  and  of  the 
mesentery  show  inflammatory  swellings;  the  pericardium  con- 
tains sometimes  a  great  quantity  of  a  clear  serous  fluid.  The 
heart  muscles  may  be  interspersed  with  small  hemorrhages  and 
yellow  fatty  degenerated  areas.  The  liver  and  the  cortical 
jDortions   of  the"  kidneys   show   parenchymatous   or   fatty   de- 


Syiuptonis.  LOI 

generation.  The  spleen  is  only  sliglitly,  or  not  at  all  onlaigcd. 
The  eyes  are  nsually  aTfected  with  a  iiiuio  or  less  intense  catarrh 
of  the  conjunctivae  sometimes  an  ulcerative  keratitis,  and  oc- 
casionallv  bv  a  panophthalmitis. 

The 'central  nervous  system  may  in  some  cases  show 
changes  corresponding  to  a  myelitis  disseminata  (Mazulewitsch, 
Bohl,  Dexler). 

AccordinK  to  Dexler 's  investigations  the  changes  of  the  central  nervous  system 
show  a  pronoimce.l  ilisseniinated  myelitis  and  poliomyelitis,  in  whu-h  the  inllam- 
n.atory  foci  are  not  confined  to  the  gray  anterior  lobes  alone,  but  are  always 
present  iu  the  entire  nervous  system  without  any  regular  arrangement.  Virulent 
streptococci  are  frequently  found  iu  the  affected  areas. 

(.•oufirming  similar  reports  of  Standfuss,  Leutz  describes  small  roundish  or 
oval  formations  which  he  calls  distemper  corpuscles  and  which  are  suiiposed  to 
develop  from  the  action  of  the  distemper  virus  on  the  plastin  substaiice  ot  the 
nerve  cells  which  is  destroved,  and  causes  the  chromatin  substance  to  roll  together 
iu  peculiar  granules.  These  formations  which  have  been  found  in  dogs  dying  lioui 
a  severe  nervous  form  of  distemper  are  distinguished  from  the  somewhat  similar 
Negri's  rabies  bodies,  iu  that  they  occur  outside  of  the  nerve  cells,  or  m  the  greatly 
degenerated  cells,  and  possess  no  inner  structure. 

Symptoms.  The  time  of  incubation  after  an  artificial  in- 
fection is  usually  from  3  to  4,  and  at  least  2  days  (Carre) ; 
although  it  is  probably  somewhat  longer  under  natural  con- 
ditions   (according  to  ^Krajewszki   it  may  extend   up   to   21/2 

weeks). 

The  peracute  form  of  the  disease  is  manifested  m  a  sud- 
denlv  appearing  inappetence,  depression,  groaning,  fatigue,  as 
welfas  high  fever.  After  2  or  3  days  the  temperature  rapidly 
drops  below  normal  (to  35-33^ C  ),  whereupon  death  soon  ap- 
pears under  comatous  sjanptoms  (Carre). 

The  acute  form  also  is  inaug-urated  by  high  fever  (Fig.  35), 
the  temperature  rising  rapidly  to  40°  C.  or  over,  and  remains 
at  this  height  for  1  to  2  weeks  or  it  falls  slightly  in  1  to  2  days, 
and  then  there  exists  only  moderate  fever,  of  a  continuing  or 
remittent  character  in  the  further  progress  of  the  disease. 
In  severe  cases  the  temperature  rises  again  owing  to  the  de- 
velopment of  pneumonia,  but  towards  the  termination  of  the 
disease  it  falls  gradually  or  rapidly  below  normal  (to  32°) 

The  beginning  of  the  disease  is  usually  indicated  by  a 
change  in  the  disposition  of  the  animal.  The  animals,  or- 
dinarilv  bright  and  playful,  become  capricious  and  less  lively; 
they  obey  the  call  only  with  hesitation  and  unwillingly,  pre- 
ferring to  find  secluded  places  where  they  remain  lying  for 
long  periods.  Meanwhile  they  tremble  over  the  entire  body, 
or  at  times  appear  suddenly  startled.  The  hair  is  roughened, 
the  appetite  diminished  and  capricious.  x\fter  1  or  2  days  the 
more  characteristic  symptoms  of  the  disease  develop. 

In  most  cases  an  acute  catarrh  of  the  air  passages  appears. , 
The  animals  feel  an  itching  in  the  nose  because  of  which  they 
frequently  sneeze  and  puff,  wiping  the  nose  with  their  paws 
or  on  tlie*^  forelegs.     There  is  at  first  a  serous  or  mucous,  later 
a  purulent  secretion  from  the  nose,  which  soils  the  surrounding 


202 


Distemijer  of  Dogs. 


parts  and  dries  around  the  nasal  openings  in  brown  crusts. 
The  secretions  may  also  contain  streaks  of  blood,  or  become 
ichorous,  and  irritate  the  skin  of  the  upper  lip  and  of  the 
nasal  wings,  which  then  become  raw.  If  the  swelling  of  the 
nasal  mucous  membrane  is  pronounced  the  respiration  becomes 

sniffling  (this  is  an 
especially  frequent 
manifestation  in 
breeds  of  dogs  with 
short  heads). 

The  catarrh  of 
the  larynx  and  the 
bronchi  is  indicated 
by  a  cough  which  at 
first  is  short  and  dry, 
later  more  prolonged 
and  moist.  It  some- 
times appears  spas- 
modically, and  in 
such  cases  it  tortures 
the  animals  greatly, 
and  also  causes  vom- 
iting. Respiration  is 
accelerated  and  lab- 
ored. Auscultation  of 
the  thorax  reveals 
rough  vesicular 
breathing,  and  dry 
or  moist  rales,  as  well 
as  other  catarrhal 
sounds.  If  in  the  fur- 
ther course  of  the 
disease  capillary 
bronchitis  or  ca- 
tarrhal pneumonia 
develops,  the  number 
of  respirations  in- 
creases to  60-80  and 
even  more  per  min- 
ute. The  accessory 
respiratory  muscles 
are  utilized  to  a 
great  extent,  and  at  each  expiration  the  cheeks  become  dis- 
tended. In  such  cases  percussion  shows  dullness,  or  a  tym- 
panitic sound  in  phices,  while  on  auscultation,  extensive 
catarrhal  murmurs  are  heard,  in  other  places  bronchial  breathing 
or  no  respiratory  sounds  at  all  are  observed.  The  cough  now 
becomes  very  weak  and  feeble. 

The  affection  of  the  eyes  mostly  develops  simultaneously 
with  the  catarrh  of  the  respiratory  organs.    It  commences  with 


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Synii)t()ius.  203 

conjunctivitis,  to  which  are  addotl  photophobia,  pain  and  swell- 
ing- of  the  eyehds.  The  conjunctiva  is  bright  red,  has  a  moist 
luster,  and  at  times  is  raised  above  the  cornea.  The  hiclirymal 
secretion  is  increased  from  the  onset,  but  hiter  the  tears 
are  mixed  with  a  mucous  and  puruk'ut  secretion,  winch, 
to  some  extent  accumulates  in  the  inner  canthus,  sticking  the 
eyelids  together,  especially  at  night.  Ulcerative  keratitis 
develops  with  relative  frequency  in  association  with  the  con- 
junctivitis, small  depressions  appearing  in  diiferent  jjarts  of 
the  cornea,  which  nuiy  later  heal  entirely.  Sometimes,  however, 
these  lesions  extend  rapidly  in  size,  so  much  so  that  even  on 
the  first  day  loss  of  substance  may  result  which  reaches  the 
extent  of  a  lentil,  and  penetrates  to  Descemet's  meml)rane,  or 
in  some  instances  the  entire  cornea  may  be  destroyed.  The 
borders  of  the  depressions,  as  well  as  the  entire  cornea  may  at 
the  same  time  be  clear,  or  pus  rhay  be  present  only  at  the  base 
of  the  depressions.  Descemet's  membrane  thus  exposed  is 
then  forced  out  as  a  result  of  the  internal  pressure  from  the 
eye,  and  in  this  manner  a  staphyloma  may  develop,  the  rupture 
of  which  may  result  in  the  prolapse  of  the  iris,  followed  by 
the  well-known  severe  results.  In  other  cases  a  parenchymatous 
keratitis  develops,  associated  with  a  uniform  cloudiness  and  a 
marked  ciliary  injection  of  the  cornea,  which  retains  its  char- 
acter until  the  termination  of  the  disease,  is  not  followed  by 
ulceration,  and  gradually  disappears  or  results  in  a  permanent 
white  cloudiness.  The  pupil  usually  becomes  constricted,  while 
severe  iritis  with  accumulation  of  a  plastic  or  a  purulent 
exudate  in  the  anterior  chamber  occurs  only  rarely  except  in 
cases  in  which  there  is  a  perforation  of  the  cornea. 

The  involvement  of  the  digestive  organs  is  shown  early 
by  diminished  appetite.  At  the  onset  of  the  disease  an  increased 
thirst,  as  well  as  vomiting  is  observed,  which  is  an  indication 
of  acute  gastritis.  The  patients  vomit  mostly  slimy,  yellowish 
material  mixed  with  bile.  At  the  same  time  the  buccal  mucous 
membrane  is  dry  and  warm,  the  tongue  is  coated,  and  the  region 
of  tlie  stomach  sensitive.  As  a  result  of  the  intestinal  catarrh 
which  IS  usually  present  together  with  the  gastritis,  there  is 
at  first  constipation;  which  soon  changes  to  diarrhea.  The 
excrements  which  are  often  passed  under  severe  straining  are 
in  a  fluid  state  and  nuiy  contain  mucous  flakes  or  blood.  The 
feces  are  very  fetid.  The  abdomen  is  at  first  somewhat  1)loated, 
later  however  it  becomes  drawn  up  and  painful. 

In  some  cases  the  urine  contains  albumen,  and  occasionally 
bile  pigments  as  well  as  hyaline  and  cellular  casts. 

Nervous  s>anptoms  are  hardly  ever  absent  even  in  the 
cases  which  are  not  very  severe,  and  sometimes  they  may  reach 
such  a  degree  that  they  practically  control  the  entire  disease. 
Besides  the  dullness  and  the  change  in  the  disposition  of  the 
animals  already  mentioned,  the  patients  sometimes  manifest 
considerable  excitement  which,  however,  usually  lasts  only  a 


OQj.  Distemper  of  Dogs. 

few  liours.  In  many  cases  muscular  tremors  or  clonic  spasms 
develop,  and  are  either  coniined  to  certain  groups  of  muscles, 
or  extend  over  the  entire  body.  Local  spasms  are  usually 
observed  in  the  face,  especially  on  the  lips,  nasal  wings,  cheeks, 
and  in  the  muscles  of  mastication  (chattering  teeth  and  foaming 
lips).  In  other  cases  spasms  occur  in  the  muscles  of  the  neck 
or  extremities  so  that  the  affected  portion  of  the  body,  in  the 
former  case  the  head  and  the  neck,  trembles  sometimes  con- 
stantly or  only  at  certain  periods,  or  again  it  may  l)e  moved 
regularly  in  a  certain  direction. 

The  spasms  of  the  entire  body  muscles  which  frequently 
develop  from  the  above  condition  are  manifested  either  by  con- 
tinuous trembling  or  by  periodical  epileptiform  fits.  In  the 
latter  case  the  animal  becomes  restless,  then  suddenly  collapses 
unconscious,  while  chronic  spasms  occur  over  the  entire  body, 
and  the  rapid  movements  of  the  jaws  churn  the  saliva  to  a  foam. 
The  expression  of  the  face  is  distorted,  and  the  head  is  forcibly 
extended  forward  or  turned  sidewise.  During  the  attack  feces 
and  urine  may  be  passed  involuntarily.  These  attacks  exhaust 
the  animals  greatly,  and  sometimes  occur  several  times  within 
an  hour,  whereupon  a  deep  coma  develops  which  soon  is  fol- 
lowed by  deatli.  As  the  reflex  irritability  is  greatly  increased 
the  local,  as  well  as  the  general  spasms  may  be  brought  on  by 
slight  external  irritations,  such  as  loud  calling,  irritation  of  the 
skin,  sudden  exposure  to  light,  etc.  Occasionally  involuntary 
movements  may  be  also  observed. 

The  convulsions  may  gradually  become  less  frequent  and 
finally  disappear;  m  some  cases,  however,  they  terminate  in 
paralysis,  which  may  appear  in  certain  parts  of  the  body,  while 
others  are  still  irritable.  The  paralysis  is  most  frequent  in 
the  hind  parts,  and  is  associated  with  movements  of  incoordina- 
tion, and  not  infrequently  by  paralysis  of  the  sphincter  muscles 
of  both  bladder  and  rectum.  Paralysis  of  a  facial  nerve 
results  in  a  distortion  of  one-half  of  the  face;  paralysis  of  an 
oculo^notor  nerve  causes  an  abnormal  position  of  the  eye, 
strabismus  and  inequality  of  pupils.  Simultaneously  with  the 
paralysis  contractions  may  develop  in  some  of  the  extremities. 

According  to  Dexler  the  virus  of  distemper  may  produce  three 
great  groups  of  nervous  disturbances :  1,  local  clonic-tonic  continued 
spasms  of  different  parts  of  the  body,  and  chorea-like  movements;  2, 
flaccid  paralysis  of  the  extremities  and  sphincters;  3,  clonic-tonic  epi- 
leptiform fits  occurring  during  attacks  of  unconsciousness.  All  these 
symptoms  are  brought  on  l)y  isolated  or  general  inflammatory  changes 
which  can  be  demonstrated  histologically  (see  p.  201).  and  since  th(^ 
motor  disturbances  differ  from  those  of  chorea  of  man,  Dexler  appears 
to  be  justified  in  his  conception  that  the  convulsions  of  distemper  do 
not  represent  a  neurosis,  and  accordingly  should  not  ])e  designated  as 
chorea,  but  that  the  affection  should  be  considered  as  an  independent 
condition,  and  for  the  present  should  be  named  "distemper-Tic,"  or 
rhythmical  post-infectious  convulsions. 


Coiusc.  205 

In  about  oiu'-lialf  of  all  cases  a  poculiai-  pusliilar  exautliema 
((listtMni)er  exaiitlicnia)  is  ohservi'd  on  tlic  skin.  Small  red 
s])ots  may  appear  on  the  inner  surface  of  tlie  ♦liigli,  on  the 
conti^'uoiis  alxlominal  wall,  or  more  rarely  on  the  parts  snr- 
ronndinii'  the  nose  and  the  eyes,  in  the  external  ear,  on  the 
conjunctiva,  and  exce])tionally  on  the  entire  surface  of  the  l)ody. 
At  these  ])laces  small  nodules  soon  develo[),  which  change  to 
lentil-sized  i)urulent  vesicles.  They  dry  to  brown  crusts,  or 
burst,  leaving  reddened  moist  places  which  later  become  also 
covered  with  scabs.  If  the  eruptions  become  extensive  the 
animals  at  this  stage  diffuse  an  nn])leasant  sweetish  odor. 
Finally  the  scabs  drop  oiT,  and  in  their  ])lace  reddish  spots 
covered  with  ei)ithelium  are  left,  which  gradually  l)ecome  paler, 
and  linally  disappear  entirely.  In  rare  cases  the  pustular 
exanthema  may  also  develo])  on  the  borders  of  the  lips,  whence 
it  may  even  extend  to  the  buccal  mucous  membranes,  and  there 
produce  a  severe  ulcerative  condition  which  may  even  lead  to 
a  general  septic  infection.  (Semmer,  Arnous,  Jliirlimann;  see 
also  typhus  of  dogs,  p.  213.) 

Trasliot  considered  the  ])ustiiles  of  the  skin  as  tnie  ])0X  ernptions,  and  this 
conception  appeared  to  be  strenj^thened  by  successful  exjierinients  of  transmission, 
ilowever,  their  rapid  development,  as  well  as  i:he  lack  of  the  characteristic  structure 
of  the  true  i)ox  vesicles,  further  the  fact  that  the  artificial  ])roduction  of  such 
vesicdes  does  not  influence  the  susceptilility  of  the  do^s  for  distemper  infections, 
contradicts  this  supposition.  Moreover,  Carre  succeeded  in  producing  the  exanthema 
even  with  the  viru.>  of  foot-and-mouth  disease. 

The  action  of  the  heart  is  more  or  less  disturbed  according 
to  the  severity  of  the  different  cases.  In  severe  cases  the  heart 
beat  is  greatly  accelerated,  irregidar,  throbbing,  and  the  pulse 
-wiry,  owing  to  the  parenchymatous  degeneration  of  the  heart's 
muscles. 

Lange  observed  in  al)ont  50%  of  animals  affected  with  <listeinper, 
a  painless  external  otitis,  with  a  thin  fluid  secretion  and  moist  eczema 
of  the  external  ear  passage.  Sabrazes  &  ]\Iuratet  found  in  the  ])lood 
of  dogs  atfected  witli  distemper  a  neutrophilic  polynuclearcytosis  and 
hypoeosinophilia,  as  well  as  an  iodophilia. 

The  animals  usually  become  greatly  emaciated  in  the  course 
of  the  disease.  At  the  approach  of  death  they  lie  in  a  deep 
stupor,  trembling  on  the  ground,  until  they  finally  die  of  the 
convulsions. 

Course.  The  disease  shows  a  most  varied  course.  Fre- 
quently, especially  in  benign  cases,  only  a  certain  group  of  the 
symptoms  described  are  present,  and  even  these  may  be 
developed  in  different  cases  with  varying  intensity.  Thus 
in  some  cases  catarrhal  s^nnptoms  are  present  exclusively,  while 
in  others  only  nervous  manifestations  are  seen.  Sometimes  the 
disease  is  manifested  by  pustular  exanthemata  of  the  skin  only. 

Taking  the  etiological  identity  of  these  cases  into  consid- 


206  Distemper  of  Dogs. 

eration,  a  catarrhal,  a  nervous  and  an  exantliematons  form  of 
distemper  may  be  distinguished.  Such  sharp  characteristic 
forms  of  the  disease,  however,  are  only  rarely  observed,  as  in 
most  instances  the  symptoms  of  two  or  even  of  all  three  forms 
are  present  simultaneously,  although  in  such  a  way  that  the 
sjanptom  complex  of  one  of  the  forms  usually  predominates. 
Most  frequently  the  catarrhal  or  nervous  form  occurs  separ- 
ately, while  the  skin  exanthema  usually  occurs  conjointly  with 
one  or  the  other.  Besides  the  character  of  the  disease  may 
not  infrequently  change  during  its  course,  as  it  is  often  noted 
that  nervous  manifestations  associate  with  the  catarrhal  symp- 
toms, and  later  these  may  even  predominate. 

Just  as  there  are  great  variations  in  the  clinical  appearance 
of  the  disease,  so  its  duration  varies  greatly  from  case  to  case ; 
very  mild  cases  may  thus  terminate  in  recovery  inside  of  a 
week,  whereas  severe  cases  may  extend  over  several  months. 
The  average  duration,  however,  is  from  three  to  four  weeks. 
The  recovery  is  not  infrequently  incomplete,  or  it  may  become 
complete  only  after  a  long  time.  The  symptoms  of  paralysis 
are  most  prone  to  persist,  or  may  improve  only  after  several 
weeks.  Incuralile  degenerations  may  be  present  in  some  of  the 
nerves  of  the  brain,  leading  sometimes  to  blindness,  deafness, 
loss  of  the  sense  of  smell,  etc. 

Occasionally  after  the  acute  stage  of  the  disease  has  passed 
a  certain  predisposition  of  the  mucous  membranes  for  catarrhal 
affections  becomes  noticeable  wdiich  leads  for  months  after- 
wards to  repeated  catarrhs.  The  catarrhal  pneumonia  may 
develop  into  a  chronic  inflammatory  condition  leading  to  casea- 
tion of  the  exudate  and  an  increase  of  the  connective  tissue, 
which  considerably  interfere  ^^^th  the  later  development  of 
the  young  animals. 

Permanent  changes  sometimes  develop  in  the  eyes,  suchas 
white  cicatrices  at  the  sites  of  the  cornea  ulcerations,  synechiae 
after  a  perforation  of  the  iris,  and  occlusion  of  the  pupil  or 
atrophy  of  the  eyeball  after  a  severe  iritis. 

Diagnosis.  Distemper  may  be  readily  distinguished  from 
other  catarrhal  affections  whenever  nervous  or  pustular  exan- 
thema are  present  in  addition  to  catarrhal  s^anptoms.  This 
also  applies  to  older  animals,  in  which  the  diagnosis  is  other- 
wise more  difficult.  In  the  presence  of  purely  catarrhal  s^nnp- 
toms,  the  high  fever  which  occurs  in  the  beginning  of  the 
disease,  the  pustular  exanthema,  the  early  age  of  the  animals, 
and  frequently  also  the  possibility  of  tracing  the  infection, 
may  reveal  the  nature  of  the  disease.  Gastro-intestinal  catarrhs 
originating  from  other  sources,  such  as  for  instance  from 
dietetic  errors  or  from  poisoning,  are  differentiated  from  dis- 
temper by  the  absence  of  the  catarrh  of  the  air  passages  and 
conjunctivae.     The  change  in  the  disposition  of  the  animals, 


Prognosis.     Treatment.  207 

especially  the  occasionally  noticeable  excitement  and  also  the 
convulsive  mastication  with  the  formation  of  foam  at  the 
mouth,  may  create  a  suspicion  of  rabies.  However,  tins  condi- 
tion exists  in  distemper  only  for  a  very  short  time,  and  is  soon 
followed  by  a  period  of  depression,  then  by  muscular  spasms, 
while  the  paralysis  of  the  muscles  of  the  pharynx  and  of  the 
muscles  of  mastication  wliich  are  characteristic  of  rabies,  are 
absent.  The  severe  convulsive  attacks  are  distinguished  prin- 
cipally from  those  of  epilepsy  by  the  fact  that  in  distemper 
they  occur  at  frequent  intervals,  are  preceded  by  local  muscular 
spasms,  and  that  these  spasms  are  present  even  between  the 
attacks. 

Prognosis.  The  average  mortality  in  tlie  disease  amounts 
to  about  50%.  The  cases  in  wliich  the  purely  exanthematous 
and  catarrhal  sjanptoms  are  present  are  the  most  favorable  with 
about  70%  recoveries.  Least  unfavorable  are  the  cases  in  which 
the  nervous  manifestations  predominate,  as  in  these  the  recov- 
eries sometimes  do  not  reach  10  to  15%.  The  more  rapidly 
the  sjmiptoms  increase  in  severity  and  the  higher  the  degree 
they  attain,  the  more  unfavorable  becomes  the  prognosis.  The 
convulsions  which  affect  the  entire  l)ody,  as  well  as  the  appear- 
ance of  catarrhal  pneumonia,  and  a  severe  persistent  diarrhea 
are  unfavorable  prognostic  indications.  Continuous  high  fever 
indicates  a  severe  infection  as  a  result  of  which  grave  changes 
in  the  myocardium  may  be  expected.  A  still  more  unfavorable 
sign  is  the  rapid  fall  in  the  temperature  below  normal,  as  it 
usually  indicates  the  approach  of  death. 

Pampered,  very  young  or  improperly  nourished  dogs  usu- 
ally become  more  severely  affected  than  older  and  hardened 
animals  of  ordinary  breeds.  The  existing  hygienic  conditions 
should  also  be  given  consideration  in  the  prognosis. 

According  to  statistics  of  Wirth,  which  include  2855  cases,  an  average  of 
35  8%  succumb  to  the  disease.  In  these  cases  the  mortality  was  the  lowest  among 
fox  terriers,  and  highest  in  hounds.  Nervous  symptoms  were  observed  in  15.1% 
of  the  cases,  females  appearing  to  be  more  predisposed  to  this  form  of  affection ; 
in  some  outbreaks  the  exanthema  was  entirely  absent. 

In  localities  m  which  the  disease  occurs  only  periodically  as  a  result  of  intro- 
duction troni  the  outside,  it  rages  with  peculiarly  destructive  force,  and  it  has 
been  observed,  for  instance  in  Greenland,  that  sometimes  such  outbreaks  destroy 
about  one-third  of  the  entire  number  of  dogs   (Hjortlund). 

Treatment.  First  of  all  the  hygienic  condition,  and  espe- 
cially the  diet,  should  be  suitably  regulated.  The  affected 
animals  should  be  placed  iui  a  clean,  uniformly  warm  place, 
they  should  be  protected  from  draughts,  and  if  possible  should 
be  furnished  concentrated  nourishment.  For  this  purpose  milk 
and  good  strong  meat  broth,  with  the  yolk  of  an  es!;Q;  beaten 
into  it,  is  most  suitable.  Several  daily  feedings  with  chopped, 
salted  meat  cooked  in  steam,  is  very  beneficial  (Gerstner).  In 
the  presence  of  gastro-intestinal  catarrh,  gruel  may  be  given 
to  advantage. 


208  Disleiiijier  of  Doys. 

A.S  an  abortive  treatment  subcutaneous  injections  of  tri- 
ciiloride  of  iodine  (3  times  daily,  3-5  g  of  a  solution  of  1  to 
1000-500),  as  recommended  by  De  Bruin,  are  indicated.  This 
method  of  treatment  when  applied  in  the  early  stages  of  the 
disease  is  very  beneficial,  as  the  animals  after  a  few  days 
become  much  brighter,  their  temperature  returns  to  normal, 
and  the  catarrhal  manifestations  diminish.  In  some  of  the  ani- 
mals, however,  in  spite  of  the  greatest  care,  a  necrosis  of  the 
skin  at  the  point  of  injection  develops.  Bass  recommends  for 
the  early  treatment,  Ichthargan  (Ichthargan,  gummi  arab  aa. 
5.0,  aqu.  100.0,  3  times  daily  in  teaspoonful  to  tablespoonful 
doses),  while  Liebert  &  Schmidt  recommend  tannargentan  (1 
g.  2  or  3  times  daily). 

For  the  depression  and  weakness  nervous  stimulants  are 
recommended,  such  as  alcohol  (wine,  cognac)  in  proper  dilu- 
tions, and  in  small  but  frequently  repeated  doses  In  severe 
cases  coffee  or  caffeine,  liquor  ammonii  anisatus  in  any  desired 
infusion,  also  subcutaneous  injections  of  30  cc.  of  a  physiological 
salt  solution  (Parent)  are  indicated.  To  the  salt  solution  it 
is  advisable  to  add  10-20  eg.  caffeine  (Cuny). 

The  fever  does  not  require  any  special  treatment,  unless 
very  severe  (over  40°),  when  the  administration  of  antipyretics 
(phenacetin,  antipyrin,  in  doses  of  0.25-0.50  g.)  is  recommended. 

The  catarrh  of  the  respiratory  organs  is  treated  to  the 
best  advantage  with  inhalations  of  warm  vapors,  containing 
expectorants  (1  to  3%  solution  of  carbonate  or  bicarbonate  of 
soda).  If  the  secretion  is  very  profuse  inhalations  of  disinfec- 
tant fluids  (creolin  2-3%,  creosote  015%,  turpentine,  aqua-picis, 
septoform)  may  be  given  three  or  four  times  daily  with  Siegel's 
or  Bulling 's  apparatus.  In  painful  dry  cough  antispasmodics 
such  as  Morpheum  salts  (morphii  muriat  0.10,  aqua,  amygd. 
amar.  12.0,  10  to  15  drops  every  2-3  hours),  or  codein  (cod. 
phosph.  0.30,  aqu.  150.0,  1  to  2  teaspoonfuls  every  2-3  hours) 
give  beneficial  results.  In  the  presence  of  profuse  secretions, 
however,  suppression  of  the  cough  is  rather  harmful.  In  such 
cases  ipecacuanha  infusions  and  senega  decoctions,  given  either 
with  apomorphine  (1  to  2  mg.  per  dose)  or  with  ammonium 
chlorate  (0.1-0.5  g.)  may  be  used  to  better  advantage.  If  pneu- 
monia has  appeared  inhalations  of  oxygen  may  be  tried 
(Kantorowicz). 

The  gastro-intestinal  catarrh  should  be  treated  first  by 
regulating  the  diet  as  already  described,  and  in  the  first  days 
of  the  affection  a  cathartic  such  as  castor  oil  or  calomel  (0.02- 
0.05  g.  2-3  times  daily),  as  well  as  salol,  should  be  given.  If 
vomiting  is  present  this  may  be  controlled  by  the  administration 
of  ice,  water  containing  soda,  salicylate  of  bismuth  (0.5  g.), 
in  emergency  ^\ath  opium  (0.05  to  0.10  g.).  For  the  stimulation 
of  the  digestion  hydrochloric  acid  (0.2  to  0.5  g.)  in  the  drinking 
water,  or  pepsin  (0.1  to  0,5  g.)  alone  or  with  the  hydrochloric 
acid,  is  advisable.    Besides  the  various  bitter  tinctures  (Tinct. 


Tiratiii(.'iit.  209 

rlioi  a(|nosa  and  vinosa,  Tinet.  geiitianao,  Tinet.  chiiiao  coni- 
posita  .')-]()  i;-.  per  dose)  are  often  used.  If  diarrhea  has  ai)])eared 
it  is  advisahk'  to  achninister  opiates  (U.l  to  0.2  opium  or  5 
times  that  amount  of  the  o])ium  tincture  every  3-4  hours)  ;  tliis 
may  be  given  together  with  tannin  (0.1  to  0.5  g.),  bisnmth  sub- 
nitrate  (0.2  to  0.5  g.),  tannoform,  tannalbin,  tannopin  (0.5  to 
]  g.  of  each),  or  with  red  wine  (in  teaspoonful  doses). 

Kalei^h  olitaiiicd  recoveries  in  60^{  of  his  cases  by  treatinjf  the  afl'ected  animals 
first  with  (1.25  to  0.40  jj.  of  calomel,  ami  followeil  four  times  daily  with  o.iio  g. 
sotiium  hyi>osnli>hite,  while  Liebert  tic  Schmidt  obtained  splendid  results  from  the 
administration  of  tannargentan    (2-3  times  daily  1  g.  doses). 

In  the  presence  of  nervous  symptoms  anodynes  and  anti- 
spasmodics are  recommended.  However  a  l)eneficial  action 
from  tlieir  use  on  tlie  neuritic  or  myelitic  affection,  can  hardly 
be  hoi)ed  for.  Of  these  may  especially  be  mentioned  bromide 
of  potassium  and  bromide  of  sodium  (1:250  4  or  5  times  daily 
in  tablespoonful  doses),  chloral  hydrate  (0.5  to  2  g.),  sulfonal 
(1  to  2  g.),  or  morpliium  in  larger  doses  (0.05  to  0.1  g.)  sub- 
eutaneously.  Paralysis  may  be  treated  with  massage,  alcohol 
rubs,  or  by  the  application  of  electricity,  as  well  as  by  sub- 
cutaneous injections  of  veratrin  (1  to  5  mg.)  or  strychnia 
(0.5  mg.). 

The  conjunctivitis,  while  the  sjmiptoms  of  irritation  last, 
should  l)e  treated  with  warm  applications  2-3  times  daily,  and 
washing  with  a  1%  creolin  and  boracic  acid  solution,  while 
astringents  are  indicated  only  after  the  subsidence  of  the  acute 
s}iiiptoms.  Of  such  astringents  may  Ije  mentioned  0.5  to  1% 
solutions  of  sulphate  of  zinc,  alum,  or  tannin,  as  well  as  the 
"collyrium  adstringens  luteum"  (diluted  1-3  to  1-2).  If  the 
catarrh  has  become  chronic,  or  if  there  exists  a  continuous 
purulent  secretion,  the  painting  of  the  eye  with  a  1%  silver 
nitrate  solution  may  be  tried.  It  should  he  applied  with  very 
great  care,  and  the  superfluous  portion  should  be  neutralized 
with  a  1%  salt  solution.  For  the  keratitis,  as  well  as  for  the 
internal  inflammations  of  the  eye,  warm  applications  and  the 
dropping  of  a  1%  atropin  solution  into  the  eye  are  recommended. 
For  clearing  away  the  cloudiness  in  the  cornea,  the  blowing 
of  powdered  calomel  or  rubbing  of  a  iodide  mercury  salve 
(1-20),  with  subsequent  massage  of  the  eye,  is  often  beneficial; 
this,  however,  should  he  only  undertaken  after  the  disappear- 
ance of  the  acute  symptoms.  For  threatening  blindness  as  a 
result  of  paralysis  of  the  optic  nerve,  injections  of  strychnia 
into  the  temporal  region  might  be  favorable. 

The  exenthema  of  the  skin  does  not  require  a  special  treat- 
ment, hut  the  sprinkling  of  the  moist  surfaces  with  a  drying 
powder,  or  the  application  of  a  salve,  may  assist  in  the  healing 
of  these  lesions. 

Prevention.  Since  the  affected  animals  easily  infect  others, 
thev  should  be  kept  from  healthv  voung  dogs  and  cats,  and  the 

14 


210  Distemper  of  Cats. 

place  wliere  tliey  are  kept  should  be  disinfected.  Young  animals 
should  be  kept  from  contact  with  sick  ones,  and  by  this  the 
advantage  will  at  least  be  gained  that  the  animals  may  not 
become  affected  until  an  older  age,  when,  according  to  observa- 
tions the  chances  for  recovery  are  much  better. 

Immunization.  The  various  sera  for  distemper  are  not  very  prom- 
ising, as  they  are  prepared  with  the  aid  of  bacteria,  which  at  best  are 
of  importance  only  in  the  secondary  organic  lesions. 

I/ignieres  uses  for  this  purpose  partly  attenuated  cultures  of  bipolar  bacilli 
obtajued  from  affected  dogs,  partly  his  polyvalent  vaccine  and  his  polyvalent  serum 
(see  pp.  85  and  86).  Physalix  uses  cultures  of  the  same  organism  grown  in  glycerin 
bouillon,  while  Piorkowski  prefers  a  serum  prepared  with  the  aid  of  his  ' '  distemper 
bacillus. ' '  But  with  none  of  these  preparations  was  it  possible  to  obtain  satisfac- 
tory results  in  practice.  Eichter  proved  that  the  vaccines  of  Physalix  and  Piorkowski 
are  valueless  for  the  treatment  of  the  disease,  and  Boden  also  found  that  Piorkowski 's 
serum  at  the  best  only  produced  an  improvement  in  the  first  stages  of  the  purely 
catarrhal  form  of  distemper. 

Bissauge  &  Naudin  recommend  the  antistreptococcus  sera  of  the  Pasteur  Insti- 
tute, and  of  Dassonville  &  Wissoeq  (twice  daily  2-4  doses  of  4  ec.  each) ;  and  at  the 
same  time  the  administration  of  Pury  's  Swiss  yeast  in  warm  milk. 

The  yeast  serum  (antistreptococcus  serum),  obtained  by  Deutschmann  by 
treatment  with  increasing  amounts  of  yeast,  is  according  to  Lamche  absolutely 
useless  as  a  prophylactic  agent,  and  as  a  curative  it  has  only  a  moderately  beneficial 
action  in  those  cases  which  show  no  complicating  intestinal  affections.  Blanck  and 
Wolff,  however,  report  favorable  results  from  this  method  of  treatment. 

The  distemper-antigourmin  (Furoneuline),  which  has  been  highly  recommended 
by  Difline  and  is  prepared  from  equal  parts  of  yeast  and  starch,  proved  unreliable 
in  the  experiments  of  Meltzer,  Hochstein,  Meckelburg  and  Lamche  both  as  a 
curative  and  prophylactic. 

Literature.  Bollinger,  A.  f.  Tk.,  1878,  IV,  214.— Krajewski,  Eev.  f.  Tk., 
1881,  177  (Lit.);  D.  Z.  f.  Tm.,  1887,  XIII,  324.— Laosson,  Diss.  Dorpat,  1882 
(Lit.).— Dexler,  Arb.  d.  Wiener  Inst.  f.  Nervenanat.,  1892;  D.  t.  W.,  1909,  313 
(Lit.).— Jensen,  Maanedsskr.,  1895  and  1896.— Jess,  Zbl.  f.  Bakt.,  1899,  XXV,  541.— 
Lignieres,  Bull.,  1900,  469  (Lit.)  ;  1906,  622.— Physalix,  Bull.,  1901,  131.— Carre, 
Bull.,  1905,  335;  Eev.  gen.,  1906,  VII,  649;  C.  E.,  1906,  962.— Piorkowski,  B.  t.  W., 
1905,  830;  1906,  377.— Wirth,  T.  Zbl.,  1908,  200.— Eichter,  Die  Hundestaupe,  Diss. 
Bern,  1908  (Lit.).— Kregenow,  Zbl.  f.  Bakt.,  1909,  L,  326  (Lit.).— Lamche,  Diss. 
Zurich,   1909    (Lit.  on  yeast  treatment). 

Distemper  of  Cats.  Although  young  cats  are  also  suscep- 
tible to  the  virus  of  distemper  (Krajewski,  Laosson),  the  dis- 
ease occurs  in  these  animals  much  less  frequently  than  in  dogs. 
The  sjanptoms  and  the  anatomical  changes  correspond  with 
those  of  dogs  affected  with  distemper,  but  according  to  Fried- 
berger  &  Frohner  nervous  symptoms  are  less  common  and  the 
exenthema  of  distemper  is  usually  absent.  In  the  treatment 
the  above-described  principles  should  be  followed.  (Literature 
same  as  in  dog  distemper.) 

A  new  disease  of  cats  was  described  by  Gaertner,  in  which  the 
symptoms  consisted  of  depression,  conjunctivitis,  muco-pnrulent  dis- 
charge from  the  nose,  and  marked  difficulty  in  respiration.  The  disease 
usually  terminated  in  death  in  from  three  to  six  days ;  exceptionally, 
however,  it  lasted  for  several  weeks.  The  autopsy  revealed  a  multiple 
necrotic  pneumonia,  principally  of  the  posterior  lobes  of  the  lungs, 
and  as  the  causative  agent  a  bipolar  ovoid  bacillus  (Bact.  pneumoniae 
felis)  was  established  (Cbl.  f.  Bakt.,  1909,  LI,  232). 


Typhus  of  Dogs.  211 

An  ovoid  bacterium  (Bac.  felisepticns)  was  also  I'ouiid  by  Boucek 
in  young  cats,  wbich  died  in  an  enzootic.  These  animals  sutfered 
from  disturbed  a])petite,  vomiting  and  convulsions,  while  the  autopsy 
revealed  a  mild  intt'stinal  catarrh,  moderate  swelling  of  the  spleen  ami 
of  the  mesentery  lymiih  glands,  as  well  as  punctiform  hemorrhages 
in  the  pericardium  nud  in  the  heart  muscles  (Cbl.  f.  Bakt.,  1909, 
Llll,  279). 

II.    Typhus  of  Dogs.    Typhus  canum. 

{IIini(h'tijp}iu^,     Stuttgarter     Hmuleseuche;     Gastro-enteritis 

haemorrhaglca.) 

Typhus  of  dogs  is  an  acute  infections  disease  which 
periodically  occurs  in  an  epizootic  form,  in  the  course  of  whicli 
severe  symptoms  of  a  gastro-intestinal  inilannnation  are  ob- 
served frequently  complicated  by  ulcerative  stomatitis  and 
severe  nervous  symptoms.  The  etiology  of  the  disease  has  not 
been  determined  up  to  the  present  time. 

History.  Hofer  dt'sci-ilxni  the  disease  under  the  name  of  "typhus" 
in  IS.IO;  however,  it  did  not  create  a  general  interest  until  it  appeared 
in  Germany  in  1898,  and  in  the  following  years  also  in  other  countries, 
as  a  severe  plague.  In  this  outbreak  the  disease  was  first  described 
clinically  by  Klett,  who  observed  it  in  the  fall  of  the  year  in  and 
around  Stuttgart  (hence  the  name  "Stuttgart  dog  disease").  Other 
outbreaks  of  the  affection,  and  also  deviations  from  the  usual  mani- 
festations were  described  by  Seheibel  of  Frankfort,  Albrecht  of 
IMunich,  Zschokke  of  Switzerland,  Trevisan  &  Gambarotte  of  Italy,  Binies 
&  Seres  and  others  of  France,  Hebrant  of  Belgium,  Nemo  of  Edin- 
burgh. Mattel  &  Tremmel  of  Vienna  and  vicinity.  A  similar  disease 
was  observed  in  1903  at  Budapest,  when  several  cases  came  under 
observation. 

Occurrence.  According  to  the  above  mentioned  writers  the 
disease  existed  in  the  years  of  1898-1900  in  Middle  Europe  in 
the  form  of  a  wide  spread,  epizootic  extension;  since  that  time 
however  it  has  again  disappeared.  In  the  period  mentioned 
the  disease  caused  great  losses  especially  among  older  dogs 
of  tlie  affected  localities. 

Etiology.  The  epizootic  occurrence  of  the  disease  in 
various  localities  which  are  not  far  apart,  appears  to  indicate 
its  infectious  nature.  On  the  other  hand  various  investigators 
have  observed  almost  uniformly  that  direct  transmission  has 
no,  or  only  an  insignificant,  importance,  in  its  appearance  and 
spread.  Frequently  dogs  became  affected  which  had  not  pre- 
viously come  in  contact  with  affected  animals,  while  on  the 
other  hand  among  dogs  kept  in  kennels,  not  infrequently  only 
isolated  cases  were  ol)served.  Test  inoculations  have  not  given 
uniform  results  up  to  the  present  time. 

In  the  outbreaks  whicli  have  occurred  usually  the  older 
dogs   and  not  infrequentlv  those   over   10   years   old  became 


212  Typhus   of   Dogs. 

affected.  Some  of  the  animals  contracted  the  disease  in  spite 
of  the  fact  that  they  had  passed  through  an  attack  of  distemper. 
The  condition,  sex  and  breed  of  the  animals  appeared  to  have 
no  noticeable  influence  on  their  susceptilnlity. 

Attempts  at  artificial  transmission  have  so  far  given  variable 
results.  Pirl  observed  after  subcutaneous  injection  of  the  bile  of  a 
severely  affected  animal  (5.0  or  2.0  crn.)  into  two  healthy  dogs,  that 
an  inflammatory  edema  developed  at  the  point  of  inoculation,  followed 
by  fever,  salivation,  vomiting,  bloody  diarrhea  and  convulsions.  One 
of  the  dogs  died  after  three  days,  the  other  recovered  after  six  days. 
The  subcutaneous  injection  of  blood,  fluid  from  the  lungs,  or  an  emul- 
sion prepared  from  the  walls  of  the  stomach  or  intestines,  produced 
only  a  local  suppuration  (Albrecht,  Scheibel),  while  the  feeding  of 
organs  and  of  the  contents  of  the  stomach  of  animals  dead  from  the 
disease  proved  harmless.  Scheibel  observed  in  only  one  instance  the 
development  of  a  gastro-intestinal  inflammation,  after  he  had  previously 
neutralized  the  gastric  juice  in  the  animal  which  was  fed  with  the 
infected  material.  Scheibel  &  Zschokke  found  a  bacterium  in  the  blood 
resembling  the  organism  of  foAvl  cholera  or  swine  plague,  while 
Leclainche  &  Vallee  demonstrated  in  the  pathologic  secretions  and 
tissues  the  presence  of  a  "Pasteurella. "  Based  on  these  findings  Bimes 
&  Seres  identified  the  disease  with  dog  distemper  (?). 

In  the  winter  of  1903  to  1904  several  cases  were  observed  at  the 
Budapest  clinic  which  in  their  manifestations,  except  for  the  absence 
of  the  ulcerations  in  the  mouth,  were  similar  to  the  cases  observed 
in  Germany.  From  the  contents  of  the  severely  inflamed  and  hemor- 
rhagic intestines,  also  from  the  intestinal  mucous  membrane  and  the 
mesenteric  lymph  glands,  a  colon  bacillus  and  a  virulent  type  of  proteus 
has  been  isolated  in  every  instance.  An  intravenous  injection  of  1  g. 
bouillon  culture  of  these  bacilli  per  1  kg.  of  body  weight,  produced 
in  dogs  a  very  intense  hemorrhagic  gastro-enteritis,  which  produced 
death  inside  of  six  hours,  while  the  subcutaneous  injection  of  the  colon 
bacillus  caused  extensive  but  painless  suppuration,  and  necrosis  of  the 
skin.  It  was  impossible  to  produce  the  disease  by  feeding  the  bouillon 
or  meat  cultures,  not  even  after  a  previous  neutralization  of  the  hydro- 
chloric acid  of  the  stomach  (Hutyra). 

Anatomical  Changes.  The  autopsy  establishes  in  all  cases 
severe  inflammatory  changes  in  the  digestive  tract.  The  mucous 
meml)rane  in  the  entire  stomach  and  in  the  duodenum,  is  greatly 
swollen,  corrugated,  and  of  a  blackish-red  color.  Its  surface 
shows  numerous  hemorrhages  varying  in  size  from  that  of  a 
lentil  to  a  pea,  and  is  covered  profusely  with  mucous  or  with 
a  chocolate  brown,  semi-liquid  mass  which  has  an  alkaline  reac- 
tion (exceptionally  fresh  blood  may  be  also  present  in  the 
stomach).  Similar,  but  less  plainly  marked  inflammatory 
changes,  are  present  in  the  intestinal  canal,  especially  in  the 
small  intestines  and  in  the  ciecum.  The  peritoneum  over  the 
stomach  and  the  intestines  is  markedly  injected,  the  mesenteric 
lymph  glands,  and  to  a  greater  or  lesser  extent  the  spleen  also 
show  acute  swelling.  The  liver  and  the  kidneys  are  hyperemic, 
the    latter   also    contain    small    hemorrhages;    the   bladder   is 


Symptoms.  213 

usually  distended,  its  mucous  uieinbi'juic  is  usually  smoolli  and 
pale  red.  The  lungs  show  only  hyperaiiuia  and  acute  edema. 
The  muscle  of  the  heart  often  tears  easily,  and  on  the  cut  surface 
it  is  sj)rinkled  with  butler-yellow  streaks.  The  l)rain  and  its 
meninges  are  hyperemic.  The  buccal  cavity  frequently  con- 
tains iiiflanmiatory  as  well  as  ncci-otic  changes  (see  symptoms). 

Symptoms.  Tlie  disease  ahnost  invariably  comnieiiccs  with 
sudden  vomiting,  which  usually  attacks  the  animal  wiiile  eating 
or  drinking,  and  which  may  re-appear  very  frequently.  The 
vomited  nuiteriai  consists  of  remains  of  the  ingested  food  or 
water  stained  yellow  by  the  bile,  but  may  later  become  bloody. 
From  this  stage  on,  the  animals  refuse  to  eat,  or  they  acce})t 
food  unwillingly;  on  the  other  hand  they  drink  water  very  fre- 
quently and  feverishly.  There  is  first  constipation,  but  later 
diarrhea  appears. 

The  aninuils  are  greatly  depressed  from  the  beginning  of 
the  disease,  and  are  unwilling  to  move  about,  and  in  doing  so 
they  manifest  a  staggering  gait.  They  show  indifference  to 
their  surroundings,  which  condition  later  develops  into  great 
dullness  and  sleepiness.  The  animals  become  greatly  emaciated 
as  a  result  of  the  frequent  vomiting,  and  persistent  inappe- 
tence,  and  the  disease  develops  in  its  characteristic  form  in 
from  3  to  5  days. 

The  conjunctivae  show  a  brownish-red  discoloration,  are 
greatly  injected,  the  eyeballs  are  sunken  in  their  sockets,  the 
pupils  are  dilated.  The  nasal  mucous  membrane  is  of  a  similar 
color  and  dry. 

,  The  mouth  emits  a  very  unpleasant,  penetrating  odor,  wdiicli 
sometimes  may  be  noticeable  at  a  great  distance.  The  buccal 
mucous  membrane  is  dry,  dark  brownish-red,  and  covered  with 
a  tenacious  coating  which  is  at  first  gray,  later  thick  and 
chocolate  brown;  this  coating  is  especially  noticeable  on  tlie 
tongue.  Later  the  mucous  membrane  loses  its  luster  in  spots, 
these  areas  soon  changing  into  erosions,  and  beconung  covered 
with  pale  yellow  or  dirty  browm,  tinder-like  scabs;  sometimes 
they  are  surrounded  by  bright  red  inflammatory  tissue.  These 
lesions  are  principally  observed  on  the  inner  surface  of  the 
cheeks  opposite  the  rows  of  teeth,  on  the  gums,  in  the  corners 
of  the  mouth,  on  the  inner  surface  of  the  lips,  especially  in 
the  region  of  the  corner  teeth,  and  on  the  borders  of  the  loAver 
surface  of  the  tongue.  Later  the  scabs  drop  off  and  in  their 
place  dark  red  ulcerations  appear,  which  are  covered  witli  tissue 
shreds  or  with  a  dirty  brown  debris.  In  severe  cases  the  ulcers 
may  confluate  forming  large  ulcerative  areas,  while  the  tongue 
may  change  into  a  dry,  chapped,  frequently  entirely  insensitive, 
shrunken  l)ody. 

The  abdomen  is  very  sensitive,  especially  over  the  region 
of  the  stomach,  and  it  is  either  bloated  or  drawm  up;  loud 
peristaltic  sounds  may  be  heard  when  close  to  the  animal.    The 


214  Typhus  of  Dogs. 

movement  of  the  bowels  is  at  first  retarded,  sometimes  the 
animals  after  severe  straining,  pass  balls  of  feces  covered  with 
mucous  or  blood,  which  may  also  contain  blood;  in  other  cases 
again  severe  diarrhea  may  appear,  the  feces  being  fluid,  bloody 
and  very  fetid.  The  mucous  membrane  of  the  rectum  is  occa- 
sionally greatly  inflamed,  very  painful,  and  exceptionally  also 
ulcerated.  The  body  temperature  is  usually  normal,  only  to- 
w^ards  the  end  of  the  disease  it  sometimes  drops  below  normal. 
The  heart's  action  becomes  accelerated  in  the  later  stages  of 
the  disease,  being  w^eak  and  beating  arhythmically.  The  respira- 
tion is  quiet,  and  deep,  exceptionally  however  in  the  presence 
of  pneumonia  it  becomes  accelerated.  The  urine  which  fre- 
quently can  be  passed  only  on  pressing  the  greatly  distended 
bladder,  contains  in  severe  cases  a  great  amount  of  albumen, 
and  more  or  less  bile  pigment.  In  some  cases  chronic  spasms 
of  the  muscles  of  the  head,  or  over  the  entire  body,  may  be 
present. 

From  the  described  clinical  appearance  of  the  disease,  which  was 
observed  by  Klett  at  the  time  of  the  outbreak  at  Stuttgart,  various 
deviations  are  observed  in  the  different  outbreaks,  especially  in  the 
extension  and  intensity  of  the  ulcerative  and  necrotic  processes  on  the 
buccal  mucous  membranes,  which  may  even  be  entirely  absent  in  fatal 
cases  (Albrecht).  In  other  cases  there  occurs  considerable  swelling 
of  cheeks  and  lips,  without  ulcerations,  a  livid  discoloration  of  the 
buccal  mucous  membrane,  profuse  salivation,  and  an  acute  swelling 
of  the  cervical  lymph  glands  (in  Scheibel's  cases  the  disease  was  always 
introduced  by  high  fever).  In  some  of  the  outbreaks  nervous  symp- 
toms predominated  over  the  clinical  manifestations   (Bimes  &  Seres). 

Among  other  symptoms  may  also  be  mentioned  rigidity  and  ten- 
derness of  the  muscles,  similar  to  those  occurring  in  rheumatism ;  total 
paralysis  of  the  hind  quarters,  hematuria  (Mattel)  ;  in  some  of  the 
otherwise  typical  eases  the  body  temperature  may  be  high  at  the 
beginning  of  the  disease,  and  may  be  associated  with  severe  chills 
(Mattel,  Tremmel).  There  may  be  hemorrhages  into  the  anterior 
chamber  of  the  eye  (Richter)  with  which  keratitis  may  become  asso- 
ciated (Pirl).  Some  patients  may  become  hard  of  hearing,  and  later 
deaf  (according  to  Richter  probably  as  a  result  of  the  extension  of 
the  inflammatory  process  from  the  pharynx  to  the  internal  and 
middle  ear). 

Course  and  Prognosis.  The  average  duration  of  the  disease 
is  usually  from  8  to  10  days ;  in  most  severe  cases  the  animals 
usually  die  in  from  4  to  6  days,  exceptionally  however  death 
ensues  towards  the  end  of  the  second  day.  The  rate  of  mortality 
fluctuates  between  wide  limits  in  different  epizootics.  In  the 
beginning  of  an  outbreak  sometimes  almost  every  animal  dies, 
while  later  the  course  of  the  disease  becomes  less  and  less 
severe.  A  very  rapid  development  of  the  disease,  complete 
inappetitence,  profuse  diarrhea  and  great  debility  indicate  un- 
favorable terminations,  whereas  a  slow  course  and  mild  symp- 
toms warrant  hopes  for  recovery.  Young  animals  are  more 
apt  to  withstand  the  disease  than  older  ones. 


Diagnosis.      Treatment.  215 

In  the  favorable  cases  tlie  animals  sometimes  recover  en- 
tirely within  a  short  time,  even  the  ulcers  in  the  mouth  iieal 
with  renuirkable  rapidity;  as  a  rule  it  requires  from  1^  to  ii 
weeks  for  the  animals  to  regain  their  former  appetite  and  dis- 
position. The  recovery  is  usually  com])lete ;  permanent  s<Hiuelae 
develop  only  in  exceptional  cases  (paralysis  of  a  posterior  ex- 
tremity, deafness). 

Diagnosis.  The  sudden  vomiting,  the  inappetence  and 
great  depression,  the  ulcerations  on  the  mucous  membrane  of 
the  buccal  cavity,  the  striking  injection  of  the  sclerotic  conjunc- 
tiva, in  connection  with  the  infectious  character  of  the  disease, 
usually  afford  sufficient  grounds  for  a  diagnosis.  Distemper  is 
distinguished  from  this  disease  by  the  almost  invariably  present 
catarrh  of  the  conjunctivae  and  air  passages,  as  well  as  b}'  the 
fact  that  in  distemper  usually  young  animals  ])ecome  affected. 
In  cases  of  gastro-enteritis  resulting  from  dietetic  errors  or 
poisonings  (meat  poisoning),  the  ulcerative  condition  in  the 
mouth  is  absent,  besides  the  more  uniform  development  of  the 
clinical  manifestations,  the  appearance  of  the  disease  in  numer- 
ous localities,  as  well  as  the  exclusive  affection  of  dogs,  are 
indications  against  poisoning.  Ulcerative  stomatitis  and  scor- 
butus develop  more  slowly,  furthermore  the  violent  vomiting 
and  great  depression  seen  at  the  beginning  of  this  disease 
are  absent. 

Treatment.  For  the  violent  vomiting  washing  of  the  stom- 
ach appears  to  be  indicated;  besides  this  Klett  recommends  sul)- 
cutaneous  injections  of  morphine,  swallowing  of  ice,  and  the 
placing  of  ice  bags  over  the  region  of  the  stomach.  Mattel 
advises  the  administration  of  mild  Russian  or  bitter  tea,  Wohl- 
muth  prefers  a  tablespoonful  of  black  coffee  every  hour,  and 
tincture  of  valerian,  15  drops  3  times  daily,  later  warm  or 
Priesznitz  bandages  applied  to  the  abdoinen  may  diminish  the 
pains.  In  o))stipation  or  diarrhea,  enemas  (4%  boracic  acid, 
1%  alum  solution)  may  be  used.  Bass  administers  internally 
ichthargan  (ichthargan,  gummi  arab.  aa  15.0,  aqua  50.0,  tea- 
spoonful  doses  every  2  hours),  and  ichthargan  ointment  exter- 
nally to  the  inner  surface  of  the  thighs.  It  is  advisable  to 
wash  the  buccal  cavity  carefully  several  times  daily  with  fresh 
water  or  a  mild  disinfectant  (potassium  hypermang.  in  a  1% 
solution).  The  animals  should  ))e  kept  in  a  (juiet  place,  and  if 
they  evince  great  weakness  or  lose  considerable  blood,  sul)cu- 
taneous  infusions  of  hike  warm  salt  solution  (0.8%)  are  indi- 
cated (Klett). 

After  the  vomiting  subsides  it  is  advisable  to  give  the 
animals  water  acidified  with  hydrochloric  or  citric  acid,  while 
in  the  period  of  convalescence  the  animals  should  l)e  given 
highly  nutritious  food  (gruels,  milk,  eggs,  and  later  meat). 


216  Purpura  Hemorrhagica. 

Literature.  Hofer,  Bepert.,  1852,  XIII,  201.— Hiirlimann,  Schw.  A.,  1896, 
120.— Klett,  D.  t.  W.,  1899,  43.— Scheibel,  B.  t.  W.,  1899,  73.— Albrecht,  D.  t.  W., 
1899,  189.— Zschokke,  Schw.  A.,  1900,  241.— Mattel,  O.  M.,  1900,  491.— Tremmel, 
T.   Zbl.,   1900,  454.— Wohlnmth,   T.   Zbl.,   1905,   113. 


9.    Purpura  Hemorrhagica.    Morbus  maculosus  equorum 

{Petecliial    fever,    Acute     liaemorrhaglc-anasarcous     toxemia, 

Typhus   eqiioruni,  Afiasarque   essentielle   ou   idiopathique, 

[French];  Blutfleckenhrankheit  der  Pferde,  [German]; 

Fehbre    petechiale,    Morbo    maculosa,    [Italian].) 

Purpura  hemorrhagica  represents  an  acute,  non-infectious 
disease  or  process,  probably  caused  by  a  septic  bacterial  intoxi- 
cation, as  a  sequel  to  a  specific  infection.  It  is  principally 
characterized  by  extensive  edematous  inliltrations  of  the  sub- 
cutaneous connective  tissue,  and  by  hemorrhages  in  the  swell- 
ings as  well  as  in  the  mucous  membranes,  and  in  the  internal 
organs. 

History.  In  olden  times  the  disease  was  grouped  among  the 
putrid  fevers  (Febris  putrida)  or  with  the  typhus  affections  (horse 
typhus),  and  it  was  thought  to  be  essentially  a  primary  decomposition 
of  the  blood.  Later  it  was  considered  by  some  to  be  a  form  of  anthrax 
(Roell),  by  others  aii  affection  related  to  scarlet  fever  of  man  (Perci- 
vall,  Zschokke).  Hering  (1841-1850)  recognized  its  non-infectious 
nature  and  at  the  same  time  separated  the  disease  as  an  independent  af- 
fection (petechial  fever)  from  other  similar  ailments.  Recently  the  idea 
became  generally  accepted  that  the  disease  is  to  be  taken  as  an  intoxi- 
cation caused  by  bacterial  toxins  (Dieckerhoff,  Lignieres  and  others). 

The  names  given  at  the  present  time  to  the  disease  (petechial 
fever,  Hering,  purpura  hemorrhagica)  are  based  upon  important 
symptoms,  particularly  the  hemorrhages  into  the  mucous  membranes. 
The  designation  of  horse  typhus  which  was  used  in  former  times  does 
not  appear  to  be  appropriate,  as  the  disease  differs  decidedly  from 
typhus  affections  of  man,  and  especially  from  the  abdominal  typhus. 

Occurrence.  The  disease  usually  occurs  sporadically,  but 
many  cases  may  appear  within  a  short  time,  especially  in  stables 
where  influenza  and  strangles  have  existed.  The  disease  is 
of  importance  on  one  hand  because  of  its  frequently  fatal  ter- 
mination, and  on  the  other  hand  by  the  very  slow  course  and 
the  loss  sustained  by  the  continued  disability  of  the  patient 
for  work. 

According  to  Javorsky  in  1892-1901,  544  cases  occurred  in  Moscow;  the  mor- 
tality among  the  animals  received  in  the  city  hospital  was  as  high  as  0.3  to  0.8%, 
the  average  being  0.42%. 

Etiology.  Purpura  hemorrhagica  with  rare  exceptions 
develops  as  a  secondary  affection,  as  a  sequel  to  diseases  in 
which  suppuration  or  necrosis  of  tissue  have  occurred  in  any 
part  of  the  body.    Such  diseases  are  especially  strangles,  pneu- 


Etiology.  ^ly 

iiionia,  pharj^n^atis,  influenza,  in  rare  cases  catarrli  of  the  upper 
air  passa^i^cs  or  of  tlio  intcstinos,  and  pyemia  of  tlie  siiuises  of 
tlie  head,  caries  of  bone,  exanthenui  of  the  skin,  abscesses  from 
any  cause,  and  gangrenous  areas  in  the  subcutaneous  connective 
tissue,  or  in  the  internal  organs.  As  all  of  these  diseases  are 
associated  with  the  presence  of  micro-organisms,  and  as  the 
l)urpura  hemorrhagica  sometimes  occurs  in  the  form  of  an  en- 
zootic, it  nu\y  be  accepted  that  micro-organisms  are  either 
directly  or  indirectly  incriminated  in  the  development  of  the 
disease.  The  indirect  influence  of  the  microbes,  and  the  appear- 
ance of  the  disease,  is  substantiated  by  the  fact  that  the  affec- 
tion is  not  transmitted  from  infected  to  healthy  animals,  and 
cannot  be  transmitted  artificially  either  by  inoculation  of  secre- 
tions from  the  affected  animals,  or  with  blood  (Ilaubner,  Iler- 
ing),  nor  by  direct  transfusions  of  blood  (Arloing). 

The  characteristic  hemorrhages  and  serous  exudations  in 
tlie  disease  indicate  a  severe  affection  of  the  vessel  walls  whicli 
in  all  probability  may  be  explained  by  the  fact  that  chemical 
substances  whicli  circulate  in  the  blood  reduce  the  normal  elas- 
ticity and  resistance  of  the  vessel  walls.  While  this  may  be 
the  result  of  a  change  in  the  blood,  through  which  the  nutrition 
of  the  walls  of  the  vessel  becomes  diminished,  and  the  watery 
consistency  of  the  blood  in  itself  facilitates  the  transudation  of 
the  blood  plasma,  a  direct  toxic  action  appears  much,  more 
probable  in  consideration  of  the  quick,  sometimes  very  abrupt 
hemorrhages  and  serous  infiltrations.  Since,  according  to 
observations,  pathogenic  bacteria  produce  toxic  sul)stances, 
poison  of  similar  origin  may  be  suspected  as  the  etiological  fac- 
tor of  this  disease. 

According  to  Dieckerhoff's  conception  these  toxins  form  in 
necrotic  or  suppurative  lesions  which  develop  in  any  part  of  the 
body  through  the  action  of  the  micro-organisms  during  the 
course  of  the  primary  disease.  This  supposition  is  very  prob- 
able, as  the  diseases  preceding  petechial  fever  as  a  rule  are 
those  in  which  the  abscesses  or  gangrenous  areas  which  develop 
in  the  course  of  the  disease  communicate  eitlier  originally  or 
later  with  the  outside  world,  whereby  micro-organisms  may 
readily  gain  entrance  into  the  body.  These  organisms  may  then 
multiply  in  the  exudates  or  the  necrotic  tissues,  and  produce 
chemical  poisons  which  are  later  absorbed  by  the  circulation. 
In  rare  cases  petechial  fever  apparently  develops  independently 
of  other  diseases,  or  in  connection  ^nth  fresh  injuries  (castra- 
tion), but  even  in  such  cases  local  necrotic  processes  cannot  be 
excluded  with  certainty.  Accordingly  purpura  hemorrhagica 
should  ])e  considered  as  an  infectious  disease  in  which,  however, 
the  incriminated  virus  (probably  the  pyogenic  streptococcus 
which  because  of  its  ul)iquity  easily  gains  entrance  into  the 
necrotic  tissue),  exerts  its  pathogenic  action  indirectly  with 
its  specific  toxic  products. 


218  Purpura  Hemorrhagica. 

According  to  the  bacteriological  examinations  of  Lignieres  (1895- 
1898),  the  internal  organs  and  the  blood  of  animals  dead  from  purpura 
hemorrhagica  contain,  as  a  rule,  besides  other  bacteria,  streptococci, 
principally  pyogenic,  and  more  rarely  streptococci  of  distemper.  The 
bacillus  equisepticus  is  also  met  with  relative  frequency  (among  26 
cases  this  organism  was  found  in  9  instances),  and  this  seems  to  indicate 
that  both  diseases  are  closely  related.  This  may  be  also  substantiated 
by  observations  in  Argentine  Avhere  influenza  occurs  mostly  in  a  very 
acute  form  without  inflammation  of  the  thoracic  organs  and  purpura 
hemorrhagica  very  frequently  develops  as  a  sequel  (similar  observa- 
tions were  made  by  Theiler  in  Transvaal).  Accordingly  both  bacteria 
play  a  part  in  the  etiology  of  purpura  hemorrhagica,  the  severe  symp- 
toms, however,  are  caused  by  the  streptococci  or  their  toxins. 

Lignieres  failed  to  produce  the  disease  even  in  a  single  instance 
in  its  characteristic  form,  in  spite  of  the  fact  that  he  injected  horses 
intravenousl}^  with  quantities  up  to  8000  g.  of  streptococci  culture,  and 
subsequently  exposed  the  animals  to  cold  rains.  He  considers  the  im- 
portance of  the  streptococci  proven,  however,  from  the  observations 
made  by  Frasey,  who  has  seen  a  disease  corresponding  clinically  with 
purpura  hemorrhagica  develop  in  two  horses,  which  had  been  injected 
with  highly  virulent  cultures  of  streptococci  for  the  preparation  of  anti- 
streptococcic serum.  The  fact  that  purpura  hemorrhagica  develops 
quite  freciuently  as  a  se<iuel  to  strangles  and  influenza,  appears  to 
indicate  the  indirect  association  of  streptococci  with  the  disease  (Bruin 
observed  the  development  of  purpura  hemorrhagica  in  its  severe  form 
m  two  cases  after  the  accidental  injury  of  a  vein  in  puncturing  an 
abscess  in  strangles) 

Cadeac  also  consider?  purpura  hemorrhagica  as  an  intoxication,  which, 
according  to  his  view  develops  as  the  result  of  vasodilatatory  toxins  of  various 
bacteria,  especially  of  different  pyogenic  cocci,  in  animals  which  have  been  weak- 
ened by  another  disease.  Mouilleron  &  Eossignol,  as  well  as  Cormier,  also  attribute 
the  greatest  importance  to  the  stieptococci,  especially  on  the  ground  of  the  favorable 
results  which  they  have  obtained  in  the  treatment  of  the  disase  with  antistrepto 
coccus  serum,  although  they  do  not  deny  the  possible  action  of  other  micro-organisms. 
Coquot  considers  the  disease  as  a  Pasteurellosis. 

Contrary  to  other  observers  Javorsky  succeeded  in  only  7  cases  out  of  148, 
in  demonstrating  the  occurrence  of  purpura  hemorrhagica  as  a  sequel  to  other 
affections  (twice  strangles,  5  times  pleuro-pneumonia).  Wohlmuth  also  believes 
that  the  dii-ease  may  develop  independently,  and  therefore  he  distinguishes  an 
idiopathic  and  symptomatic  form,  in  which  the  vascular  system,  especially  the  intima 
of  the  capillaries,  is  always  the  point  of  attack  for  the  toxins  which  produce  the 
disease. 

Eecently  Baruchello  &  Nori,  and  later  also  Perrucci  expressed  the  improbable 
view  that  purpura  hemorrhagica  represents  a  piroplasmosis,  as  they  found  protozoa 
resembling  piroplasma  in  the  red  blood  corpuscles  ot  four  affected  horses.  However, 
the  severe  initial  STOiptoms  (high  fever),  which  were  observed  ir  these  cases  indicate 
that  these  affections  were  not  true  cases  of  purpura  hemorrhagica. 

The  mode  as  well  as  the  determining  factors  of  natural 
infections  are  not  yet  sufficiently  clear.  It  has  been  observed 
that  the  disease  occurs  principally  in  badly  ventilated  stables, 
with  dirty  floors,  but  it  also  occurs  in  well  groomed  horses  kept 
under  favoral)le  conditions.  The  disease  is  most  frequent  in  the 
spring  and  in  the  beginning  of  summer. 

The  age  of  the  animals  appears  to  have  no  influence  except 
that  colts  under  two  years  of  age  do  not  become  affected  (Dieck- 
erhoff) ;  otherwise  there  appears  to  be  no  factor  which  affects 


Anatoiuifal   Changes.  0^9 

the  susceptibility  of  the  annual,  nor  does  the  care  the  horses 
receive  or  the  work  they  do  exert  any  inHuence. 

Anatomical  Changes.  The  characteristic  lesions  of  the  dis- 
ease are  the  hemorrhages  in  the  skin  and  in  the  mucous  mem- 
brane, as  well  as  in  the  subcutaneous  and  sul)niucous  connective 
tissue,  in  association  with  extensive,  very  marked,  edematous 
swellings.  InMannnation  and  tissue  necrosis  may  develop  as 
secondary  processes  with  swelling  of  the  affected* parts  of  the 
body. 

Upon  the  cut  surface  of  the  edematous  swelling  the  subcu- 
taneous connective  tissue  forms  a  yellow,  gelatinous  layer  of 
several  centimeters  thickness,  which  shows  dark  red  hemor- 
rhages and  in  some  cases  contains  cavities  filled  with  purulent 
ichorous  fluid,  or  with  necrotic  tissue.  The  gelatinous  infiltra- 
tion extends  also  between  the  nmscles  while  the  muscle  sub- 
stance itself  appears  pale  gra\ish-brown  or  clay  color,  and 
friable,  as  a  result  of  parencliymatous  and  fatty  degenerations 
of  the  muscle  fibers.  The  affected  muscles  feel  greasy  to  the 
touch,  and  are  sprinkled  with  small  hemorrhages.  In  different 
places  small  areas  of  the  muscles  are  necrotic  and  changed  to 
a  clay-like  detritus,  which  sometimes  appears  dirty  brown-red 
from  admixture  of  blood.  Hemorrhages  may  also  occur  in  the 
tendons  and  tendon  sheaths,  under  the  periosteum,  or  in  the 
joints;  in  the  latter  the  cartilaginous  tissue  may  even  become 
necrotic  (Prevost). 

Of  the  mucous  membranes  those  of  the  nose,  pharynx  and 
larynx  become  affected  in  the  first  place,  then  those  of  the  stom- 
ach and  the  small  intestines.  The  mucous  membrane  is  affected 
less  frequently  in  the  deeper  air  passages  and  in  the  other  parts 
of  the  digestive  tract,  as  well  as  in  the  genital  organs.  In  addi- 
tion to  catarrhal  injection  and  swelling,  the  mucous  membrane, 
as  well  as  the  submucous  connective  tissue  of  the  intestinal 
canal,  also  in  the  muscular  layer  and  under  the  serosa,  small 
punctiform  or  streak-like  or  even  larger  hemorrhages  may  be 
present.  The  loose  connective  tissue  surrounding  them  is  always 
more  or  less  gelatinously  infiltrated.  Over  the  larger  extravaza- 
tions  the  mucous  memlirane  is  often  necrotic,  or  after  the  pale 
yellow  necrotic  parts  have  been  thrown  off",  irregularly  formed 
ulcerations  develop  which  are  covered  with  dirty  tissue  shreds. 
In  the  intestines  they  may  extend  to  the  peritoneum,  or  the 
intestinal  wall  may  be  perforated  and  lead  to  purulent  or 
ichorous  peritonitis,  while  in  the  nose  the  ulcerative  process  may 
cause  a  destruction  ot  the  nasal  septum. 

Hemorrhages  are  as  a  rule  present  also  in  some  internal 
organs,  especially  in  the  lungs  and  the  spleen,  and  also  under 
the  capsule  of  liver  and  kidneys.  The  lungs  may  contain  hemor 
rhagic  areas  the  size  of  a  fist,  the  cut  surface  may  show  spots 
like  those  of  a  tiger's  skin,  which  are  the  result  of  l)lood 
aspirated  into  the  bronchi.    The  spleen  is  sometimes  consider- 


220  Purinira  Hemorrhagica. 

ably  enlarged  due  to  liemorrliages  in  its  tissue  and  under  its 
capsule,  and  sometimes  a  rupture  of  the  spleen  and  a  fatal 
internal  hemorrhage  may  be  observed.  Far  less  often  are 
instances  of  fatal  bleeding  into  the  retroperitoneal  or  into  the 
perirenal  connective  tissue,  into  the  digestive  tract,  or  into  the 
air  passages;  finally  hemorrhages  may  also  be  found  in  some 
cases  in  the  inside  of  the  eyes,  in  the  bone  marrow,  in  the 
heart  muscles,  and  under  the  pericardium. 

The  immediate  cause  of  death  usually  is  septicemia,  pyemia 
or  gangrenous  pneumonia,  less  frequently  asphyxiation  may 
be  observed.  Autopsy  may  reveal  the  mode  of  origin  of  the 
disease  by  disclosing  the  presence  of  older  organic  changes. 

Symptoms.  The  disease  usually  commences  with  the 
appearance  of  small  punctiform  or  linear  hemorrhages  in  the 
nasal  mucous  membrane.  In  some  instances  the  animals  do  not 
manifest  any  indications  of  disturbed  health  while  in  other 
cases  the  appetite  becomes  somewhat  diminished  in  the  earlier 
stages,  and  the  patient  manifests  slight  dullness  and  depression. 

Later  the  hemorrhages  in  the  mucous  membranes  become 
more  numerous,  and  those  lying  close  together  confluate,  so  that 
extensive  blood  extravasations  result.  At  the  same  time  there 
is  a  yellowish  mucous  discharge  from  the  mucous  membrane, 
which  dries  on  the  surface  first  to  yellow,  later  to  dirty  brown 
crusts.  In  severe  cases  the  mucous  membrane  covering  the 
hemorrhages  becomes  necrotic,  and  ulcerations  develop.  In  this 
condition  the  discharge  which  at  first  is  scanty  becomes  more 
profuse,  discolored,  mixed  with  shreds  of  necrotic  tissue,  and 
not  infrequently  also  with  blood  The  discharge  emits  a  fetid 
odor.  In  the  meantime  swelling  of  the  eyelids  is  frequently 
observed  and  if  they  are  forcibly  spread  apart  a  reddisli  fluid 
or  even  pure  blood  flows  out  of  the  slit ;  in  such  cases  the  bulbar 
as  well  as  the  tarsal  conjunctiva,  shows  shallow  hemorrhages 
(exceptionally  necrosis  of  the  conjunctiva  and  hemorrhages  into 
the  inside  of  the  eyes  [Roell]  may  be  observed,  also  atrophy 
of  the  optic  nerve  [Schindelka] ). 

Tn  all  of  the  148  cases  ol)serve<l  1iy  Javorsky  hemorrhages  were  present  on 
the  nasal  nnieous  membrane  On  the  other  hand  they  were  found  in  only  58  cases 
in  the  mouth  and  m  only  38  cases  on  thj  conjunctiva. 

Immediately  after  the  appearance  of  the  hemorrhages  in 
the  nasal  mucous  membrane,  swelling  of  the  skin  and  the  subcu- 
taneous connective  tissue  make  their  appearance.  In  some 
cases  numerous  urticaria-like  vesicles  develop  over  the  entire 
body,  which  disappear  after  a  certain  time,  or  confluate  form- 
ing dollar-sized  flat  roundish  swellings  (Figure  39;  Kleinpaul 
observed  simultaneous  shedding  of  the  hair).  In  most  instances, 
however,  diffuse  swelling  developed,  especially  on  the  extremi- 
ties, on  the  chest  and  abdomen,  especially  on  the  sheath  and 
udder,  and  sometimes  on  the  front  part  of  the  head  (Figure 


Syni])t<iiiis. 


221 


40).  Tlio  swolliii^-s  often  o-row  rapidly  assuming  groat  dimen- 
sions, so  tliat  tlic  outline  of  the  affected  part  of  the  body  wliich 
is  nuK'h  deformed,  becomes  lost.  In  severe  eases  tlie  circum- 
ference of  tlie  extremities  becomes  enormous,  so  much  so  that 
sometimes  the  k'gs  from  the  coronary  l)an(l  to  tlie  ell)0w  or 
to  tlie  knee  swell  to  2  or  .'>  times  their  normal  size,  and  they 
appear  like  posts  on  which  some  transverse  furrows  are  the 
only  indications  of  the  joints.  On  the  head  the  swelling  iirst 
affects  the  alae  of  the  nose  and  the  lips,  soon  however  the  lower 
part  of  the  face  becomes  affected,  and  the  fore  part  of  the  head 


Fin:.  39.     Purpura  ItciiturrluKjivu.     Eruptions  resembling  urticaria  at  the  beginning  of 

the  disease. 


may  become  so  broad  that  the  transverse  diameter  greatly  ex- 
ceeds that  of  the  upper  portion  of  the  head,  the  nose  piece  of 
the  halter  making  a  deep  impression,  and  the  head  in  such  cases 
resembles  somewliat  the  head  of  a  rhinoceros  (Figure  40).  The 
swellings  are  characterized  by  being  always  sharply  defined 
from  tiie  healthy  surrounding  parts.  They  are  firm,  almost  of 
the  hardness  of  a  board,  so  that  the  surface  may  be  pitted  only 
with  difficulty,  the  resulting  depressions  disappearing  but  slowly. 
The  skin  over  the  swelling  becomes  stretched,  and  from 
its  surface  a  yellowish  tenacious  serous  fluid  oozes  out  which 
later  dries,  forming  brown  crusts.     In  the  flexor  side  of  the 


222 


Purpura  Hemorrhagica. 


joints  the  skin  sliows  cracks  wliicli  expose  a  moist  reddened 
wound.  In  places  where  the  stretching  of  the  skin  is  the  great- 
est, therefore,  especially  over  the  bony  protuberances,  as  well 
as  in  the  places  where  it  is  exposed  to  outside  pressure,  excep- 


Fig.  40.     Purpura  Jiemorrhagica.     Swelling  of  the  forehead  and  of  the  lower  chest. 

tionally  also  in  other  parts  of  the  body,  for  instance  on  the 
upper  lip  (Figure  41),  the  skin  becomes  insensitive  in  circum- 
scribed areas,  cold  and  dry,  and  takes  on  a  darker  color.  Soon 
dry,  round  portions  of  skin  as  large  as  a  dollar  or  even  larger, 
dark  brown  and  parchment-like  are  separated  and  fall  off.   The 


Symptoms. 


223 


gangrenous  process  may  extend  deeper,  affecting  the  muscles, 
while  on  the  back  of  the  nose  and  l)elo\v  tiie  carpal  and  tarsal 
joints  it  may  extend  to  the  l)one,  leading  to  ugly  ulcerations, 
which  continually  discharge  a  purulent,  ichorous,  fetid  secretion 
containing  necrotic  tissue  shreds. 

Aeeortliiig  to  Javorsky's  statistics  swellings  on  tlio  alxlomen  are  observed  in 
47.3%,  on  the  posterior  extremities  in  74..'}%,  and  on  ail  4  extremities  in  4;"). 5% 
of  the  cases. 

The  swelling  impairs  the  ])hysiological  functions  and  the 
mobility  of  the  affected  ])art  of  the  body.  AVitli  the  increase  of 
the  swelling  of 
the  nasal  mucous 
membrane  the  res- 
])iration  becomes 
snuffling,  and  is 
especially  difticult 
during  the  act  of 
inspiration.  The 
labored  respira- 
tion is  still  more 
severe  when  the 
swelling  extends  to 
the  folds  of  the 
mucous  membrane 
in  front  of  the 
larynx,  or  to  the 
mucous  membrane 
of  the  larynx  itself. 
In  such  cases  the 
animals  show"  all 
the  indications  of 
an  inspiratory 
dyspnoea  (anxious 
look,  whistling  or 
rattling  respira- 
tion, spreading  of 
the  legs,  forced  ex- 
tension  of  the 
thorax,    with    the 

intercostal  spaces  sunken  in)  and  with  further  progress  of  the 
stenosis  asphyxiation  may  result. 

The  great  swelling  of  the  forehead  renders  the  motion  of 
the  jaws  and  with  it  mastication  more  difficult,  wdule  the  infiltra- 
tion of  the  pharyngeal  mucous  meml)rane  and  of  its  underlying 
connective  tissue  interferes  with  deglutition,  so  that  in  severe 
cases  the  animals  are  unable  to  take  nourishment,  although  their 
appetite  is  not  impaired,  or  they  succeed  only  with  great  effort 
in  swallow^ing  small  quantities  of  food  or  a  little  water. 

The  sw^elling  of  the  extremities  interferes  more  or  less  with 
the  gait  of  the  animals.    At  first  and  even  later  in  mild  cases. 


Fiff.  41. 


Pitrpura  hemorrhnf/ica.     Commencing  necrosis 
of  the  skin  on  the  swollen  iip])er  lij)s. 


224  Purpura  Hemorrhagica. 

the  disturbance  is  manifested  only  by  stiffness  and  clumsiness 
in  gait  and  inability  to  lie  down,  or  if  tliey  succeed  in  this,  in 
their  inability  to  rise.  In  the  presence  of  large  swellings  they 
remain  motionless  in  one  place,  and  it  is  impossible  to  make 
them  move  (the  inability  to  move  may  be  partly  due  to  involve- 
ment of  the  muscles).  The  swelling  of  the  sheath  hinders  the 
animal  from  protruding  the  penis,  so  that  the  urine  trickles 
out  of  the  narrow  opening  of  the  sheath,  and  its  borders  as  well 
as  the  surrounding  parts  of  the  skin  become  irritated  by  it. 

The  nutrition  of  the  animals,  except  in  the  very  mild  cases, 
is  always  insufficient,  through  the  difficulty  in  mastication  and 
deglutition  which  was  already  mentioned.  Although  the  appe- 
tite remains  unimpaired  for  a  considerable  length  of  time,  and 
in  mild  cases  even  during  the  entire  course  of  the  disease  and 
the  thirst  is  even  increased;  in  severe  cases  disturbances  in 
the  appetite  are  noticeable  which  are  due  to  the  involvement 
of  the  gastric  mucous  membrane.  Symptoms  of  colic  some- 
times follow  the  severe  changes,  and  these  indicate  hemorrhages 
and  inflammatory  edematous  infiltrations  of  the  gastric  and 
intestinal  wall.  The  colic  may  occur  either  in  severe  attacks 
or  less  severely  but  more  continuously.  In  some  cases  they 
are  followed  by  manifestations  of  a  rapidly  progressing  anemia 
and  by  collapse,  which  is  an  indication  of  an  internal  bleeding 
into  the  abdominal  cavity,  while  in  other  cases  paralysis  or 
perforation  of  the  intestine  lead  to  sudden  death.  Feces  are 
passed  in  moderate  quantities,  a  bloody  consistency  pointing 
towards  intestinal  bleeding,  while  frequent  movements  of  the 
bowels  and  a  covering  of  the  feces  with  a  muco-purulent  ma- 
terial points  to  inflammation  of  the  rectum.  In  the  presence 
of  a  severe  inflammation  of  the  intestines  profuse  diarrhea 
appears.  In  severe  cases  the  urine  contains  albumen  and  also 
blood. 

In  mild  cases  the  body  temperature  remains  through  the 
entire  course  of  the  disease  at  normal  height,  or  is  only  very 
slightly  elevated.  In  the  presence  of  necrosis  and  ulceration 
of  the  skin,  and  of  the  mucous  membrane,  the  fever  may  rise 
high  from  absorption  of  septic  substances.  The  character  of 
the  fever  in  such  cases  indicates  a  septic  form.  The  tempera- 
ture may  also  change  in  those  cases  in  which  the  affection  devel- 
oped immediately  after  a  febrile  atfeetion  (Fig.  42),  or  if  com- 
plications arise  during  the  course  of  the  disease. 

In  the  beginning  the  heart's  action  is  somewhat  accelerated 
but  sufficiently  strong.  Later  it  becomes  excited,  and  because 
of  the  difficult  respiration  the  changes  in  blood  pressure  due  to 
hemorrhage  and  to  pyemia  or  septicemia,  the  heart's  action 
becomes  very  rapid  and  throbbing,  while  the  pulse  steadily 
diminishes  in  volume. 

A  microscopical  examination  of  the  blood  shows  nothing 
characteristic,  with  the  exception  of  an  occasional  hyperleuco- 
cytosis   (according  to  Smith  the  quantity  of  albuminous  sub- 


Fever  Course. 


_:l'.) 


R'  l)loo(l  is  iiicreast'd,  that  ot*  libriii,  water 
d). 


stances  and  fats  in  tl 
and  iron  is  diniinishe 

Modification 
of  the  Course. 
Tlie  clinical 
picture  de- 
scribed  may 
she  w  marked 
modiiications. 
The  disease 
may  become 
checked  in  any 
stage  of  its  de- 
velopment, and 
pass  on  to  re- 
covery. On  the 
other  hand  in 
some  cases  in 
the  early  stages 
the  original 
disease,  to 
which  purpnra 
hemorrhagica 
forms  a  sequel, 
may  yet  per- 
sist; but  in  a 
still  greater 
n  u  m  b  e  r  of 
c  .a  s  e  s  the 
disease  itself 
may  be  changed 
by  the  appear- 
ance of  compli- 
cations arising 
during  its  de- 
velopment. 

One  of  the 
most  frequent 
complications 
i  s  pneumonia, 
which  usually 
is  lobular  in 
character,  and 
develops  in 
connection  with 
h  e  morrhages 
into  the  lung 
tissue ;  and  may 

be,  less  frequently,  the  result  of  the  aspiration  of  necrotic  parts 
of  mucous  membrane,  assuming  then  often  a  gangrenous  form. 


226  Puri)ura  Hemorrhagica. 

Rapid  and  labored  respiration,  especially  in  cases  when  the 
upper  air  passages  are  not  markedly  constricted,  in  associa- 
tion with  a  rise  in  temperature,  are  indicative  of  pneumonia, 
and  renders  a  careful  examination  of  the  thoracic  organs 
necessary. 

A  severe  and  not  infrequently  ulcerative  inflammation  of 
the  stomach  and  intestinal  mucous  membrane  also  develops  with 
relative  frequency,  and  causes  a  putrid  diarrhea,  which  greatly 
weakens  the  animal. 

In  the  cases  with  unfavorable  termination  the  clinical 
symptoms  are  almost  invariably  terminated  by  manifestations 
of  pyemia  or  septicemia.  They  usually  develop  either  from  the 
above  cited  causes,  or  from  the  sores  which  develop  on  the  body 
of  the  animals  when  they  persistently  lie  down. 

According  to  Payrou  petechial  fever  as  it  is  observed  as  a  sequel  to  distemper, 
may  be  manifested  either  as  a  toxemic  (lymphatic)  form,  brought  on  by  the 
absorption  of  toxins  into  the  blood,  or  in  a  septicemic  form  caused  by  a  strepto- 
coccus infection  of  the  blood.  The  former  develops  in  the  second  week  after  the 
beginning  of  strangles,  when,  in  the  presence  of  a  moderate  fever,  the  extremities 
slowly  swell  from  below  upwards,  and  the  nasal  mucous  membrane  manifests  only 
small  petechiae.  The  course  is  frequently  mild.  The  second  form  develops  with 
high  fever,  and  extensive  petechiae,  running  a  peracute  course,  causing  swellings 
everywhere,  especially  on  the  head  and  on  the  conjunctivae,  which  have  a  great 
tendency  to  necrosis.  In  these  cases  the  disease  usually  terminates  fatally  in  from 
8  to  10  days.  As  a  result  of  the  great  frequency  of  intermeiliate  forms  the  sepa- 
ration of  these  two  types  might  often  be  very  difficult,  and  it  is  doubtful  whether 
such   a   classification   is  justified. 

Course.  The  course  of  purpura  hemorrhagica  varies  from 
case  to  case.  From  the  very  mild  forms  wliich  manifest  only 
petechiae  of  the  nasal  mucous  membrane,  and  a  slight  simulta- 
neous swelling  of  the  skin  and  the  symptoms  of  which  may  dis- 
appear inside  of  two  or  three  days,  to  the  cases  of  extreme 
distortion  of  the  body  and  resulting  in  death  from  asphyxiation 
or  sepsis,  all  the  possible  degrees  may  be  observed.  In  the 
successive  development  of  the  symptoms  the  affection  of  the 
nasal  mucous  meml)rane  usually  appears  first,  and  it  is  hardly 
ever  absent.  This  is  followed  in  one  or  two  days  by  a  swelling 
of  the  skin,  and  only  later  by  the  affection  of  the  phar;^Tix, 
whereas  the  involvement  of  the  intestinal  canal  is  usually  ob- 
served only  in  advanced  stages  of  the  disease.  However,  there 
are  rare  cases  where  the  sequence  of  s^nnptoms  differs ;  thus  the 
edema  of  the  skin  may  proceed  to  development  of  petechiae  in 
the  nose,  or  severe  colicky  symptoms  may  develop  in  the  begin- 
ning of  the  disease. 

The  evolution  and  course  of  the  disease  depends  especially 
on  the  localization  and  the  more  or  less  rapid  development  of 
the  hemorrhages  and  of  the  edematous  swellings.  Apparently 
severe  cases,  in  which  however  the  changes  are  exclusively  con- 
fined to  the  nasal  mucous  membrane,  the  skin  and  the  su])cu- 
taneous  connective  tissue  may  terminate  in  complete  recovery 
even  when  the  skin  becomes  iiecrotic  over  a  considerable  area ; 
on  the  other  hand  affections  of  the  internal  organs,  as  well  as 
hemorrhages  and  inflanimations,  exert  an  unfavorable  influence 


Course.     Diagnosis.  227 

Oil  the  course  of  the  disease,  and  such  cases  usually  terminate 
fatally. 

In  the  favorable  cases  the  swellings  after  reaching-  a  certain 
degree  retrogress  either  rapidly  or  gradually.  Frequently, 
however,  the  iiiiproveiiient  is  only  temporary,  as  the  condition 
later  becomes  aggravated  again,  and  with  such  variations  the 
disease  may  run  for  several  weeks  until  linally  the  animal  recov- 
ers. The  average  duration  of  the  mild  cases  may  be  placed  at 
about  two  weeks,  although  it  may  occasionally  extend  over  a 
period  of  6  to  8  weeks.  In  cases  where  large  areas  of  the  skin 
l)ecome  necrotic  it  may  require  several  months  until  a  definite 
recovery  takes  place,  and  even  in  such  cases  the  recovery  is  not 
complete,  as  in  place  of  the  extensive  wounds  contracted  scars 
remain  which  interfere  with  the  function  of  the  extremities,  and 
thereby  reduce  the  value  of  the  horse  for  work. 

In  fatal  cases  the  duration  of  the  disease  also  varies.  There 
are  cases  in  which  the  swellings  form  with  such  rapidity  and 
become  so  extensive  that  death  ensues  in  from  5  to  5  days  (Dern- 
])acli  saw  a  liorse  in  wiiich  death  occurred  after  7  hours  as  a 
result  of  a  hemorrhage  in  the  neighborhood  of  the  medulla 
oblongata).  Complications  (gangrenous  pneumonia,  enteritis, 
pyemia,  septicemia)  usually  develop  only  after  the  swellings 
have  progressed  extensively  and  have  produced  functional  dis- 
turbances as  well  as  necrotic  processes;  up  to  that  time,  how- 
ever, usually  1  or  2  weeks  have  elapsed.  If  any  of  these  com- 
plications have  appeared  death  always  ensues  after  several 
days. 

Diagnosis.  Recognition  of  the  disease  is  difficult  as  a  rule 
only  when  it  is  associated  from  the  beginning  with  fever,  or 
when  edematous  swellings  and  hemorrhages  appear  in  the 
course  of  a  preceding  febrile  affection.  Edematous  infiltrations 
may  develop  from  local  causes  (phlegmons,  lymphangioitis) 
as  well  as  in  general  infectious  diseases  (anthrax,  malignant 
edema) ;  they  may,  however,  be  distinguished  from  the  swellings 
of  purpura  hemorrhagica  by  the  diffused  borders  and  by  the 
localization  of  the  inflammatory  processes.  Besides  this  the 
swellings  in  purpura  hemorrhagica  are  usuall}^  sharply  circum- 
scribed and  occur  in  most  instances  symmetrically  on  both  sides 
of  the  body;  they  also  appear  after  or  simultaneously  with  the 
development  of  petechiae  on  the  nasal  mucous  membrane.  In 
the  early  stages  of  the  disease  urticaria  may  also  come  under 
consideration,  as  it  is  sometimes  manifested  by  extensive  and 
sharply  circumscribed  swellings  of  the  skin;  however,  in  this 
affection  the  petechiae  are  absent  on  the  nasal  mucous  mem- 
brane, and  the  eruptions  disappear  entirely  after  a  short  time. 
Acute  glanders  may  likewise  resemble  purpura  hemorrhagica 
to  some  extent,  especially  in  cases  in  which  the  swelling  of  the 
nasal  mucous  membrane  and  its  surrounding  tissue,  as  well  as 
of  the  extremities  and  abdomen  develops  rapidly;  however,  in 


228  Purpura  Heniorrliagica. 

such  cases  there  are  no  petechiae  on  the  nasal  mucous  mem- 
brane, but  nodules  and  ulceration,  and  at  the  same  time  there 
is  also  a  swelling  of  the  submaxillary  lymph  glands.  In  addi- 
tion to  this,  the  rapid  development  of  the  swellings  on  other 
parts  of  the  body  is  always  accompanied  by  fever  and  by  symp- 
toms of  a  general  infection  (it  must  be  remembered  that  pur- 
pura hemorrhagica  may  develop  in  the  presence  of  glanders). 

Prognosis.  This  is  very  uncertain  in  consideration  of  the 
varied  course  of  the  disease,  and  therefore  should  be  made  with 
especial  care.  Although  with  proper  treatment  on  an  average 
40-50%  (according  to  Javorsky  60-65%)  of  the  affected  animals 
recover,  the  mortality  fluctuates  between  wide  limits.  The  slow 
development  of  the  hemorrhages  and  swellings,  and  their  pres- 
ence in  small  numbers,  are  indications  of  a  favorable  course, 
whereas  their  rapid  increase  and  extension  point  toward  an 
unfavorable  prognosis.  There  are  cases,  however,  which  show 
a  very  severe  affection  from  the  onset,  and  in  which  after  a 
certain  time  sudden  improvement  is  noticeable,  the  animals 
finally  recovering.  This  is  especially  the  case  when  by  proper 
treatment  the  development  of  threatening  complications  is  pre- 
vented. A  recovery  may  be  expected  as  long  as  the  patients 
are  without  fever  or  have  only  a  slight  fever,  and  take  nour- 
ishment at  least  in  moderate  quantities.  High  fever  renders  the 
situation  usually  grave,  as  it  points  to  septic  infection  or  to 
inflammation  of  internal  organs.  Other  unfavorable  indications 
are  pronounced  cyanosis  or  yellow  discoloration  of  the  mucous 
membranes,  the  jjresence  of  albumen  or  blood  in  large  quan- 
tities in  the  urine,  continuous  lying  down,  frequent  and  weak 
heart  action,  further  the  excessively  rapid  disappearance  of  the 
swelling.  The  latter  apparently  favorable  sjanptom  indicates 
in  most  instances  a  rapid  breaking  down  of  the  tissues,  or  that 
great  quantities  of  blood  or  blood  plasma  have,  under  the  influ- 
ence of  the  high  fever,  transuded  into  the  internal  organs.  The 
development  of  after  affections  should  also  be  taken  into  con- 
sideration in  forming  a  prognosis,  as  they  are  of  a  decided 
influence  in  determining  whether  treatment  extending  over  a 
long  period  of  time  is  justified,  in  view  of  the  inability  of  the 
animals  to  work  and  the  expense  of  such  prolonged  treatment. 

At  the  clinic  at  Budapest  between  1887-1908,  out  of  296  affected  horses 
167  (56.4%)  recovered;  the  numbers  of  maximum  and  minimum  recoveries  in  these 
years  was  20  and  95%.  In  the  Prussian  army  in  the  years  of  1895-1903,  149  horses 
became  affected,  of  whict  110  (79%)  recovered  (the  maximum  and  minimum  recov- 
eries in  these  years  were  56.2  and  85%). 

Treatment.  Symptomatic  treatment  has  a  great  influence 
on  the  further  development  of  symptoms  and  on  the  termina- 
tion of  the  disease,  especially  as  it  is  not  infrequently  possible 
to  avert  the  danger  of  asphyxiation,  and  to  prevent  the  appear- 
ance of  complications. 

Above  all  it  is  necessary  to  assure  suitable  feeding  of  the 


Treat  iiK'iit. 


229 


affected  annuals,  and  to  provide  a  snl'licient  supply  of  I'resli 
water.  Hydrochloric  or  sulpluiric  acid  (8-10  g.  to  a* pail)  may 
))e  added  to  the  water  and  in  the  presence  of  fever  wine  or  alco- 
hol (IVl.-l  liter  to  a  i)ail).  If  the  animals  show  difficulty  in 
mastication  and  swallowing  they  should  he  oiven  orecn  food 
and  hran— or  Hour— gruels.  If  this  condition  becomes  aggra- 
vated the  animals  may  be  fed  artificially  per  rectum,  and  in 
this  manner  they  may  retain  their  strength  for  a  considerable 
tmie.  Pure  fresh  air  is  likewise  an  important  reciuirement  for 
a  favorable  course,  and  it  is  advisable  to  keep  the  animals  out 
of  doors  in  the  summer  time  and  in  bad  weather  in  roomy  box 
stalls.  The  halter  should  be  removed  as  it  may  have  a  harmful 
effect  by  its  pressure  on  the  swollen  cheeks  and  nose. 

AVounds,  ulcers  and  a])scesses  require  antiseptic  surgical 
treatment.  In  the  presence  of  a  considerable  swelling  of  the 
nasal  mucous  membrane  the  nasal  cavities  should  be  carefully 
syringed  2  to  3  times  daily  with  a  non-irritating  disinfecting" 
solution  {3-4%  boracic  acid,  2-3%  creolin  or  Ivsol  solutioir, 
VL.-1%  alum  solution).  The  swellings  of  the  skin  are  in  many 
cases  fayora])ly  influenced  by  rubbing  with  spirits  of  turpentine 
2  to  3  tnnes  daily,  since  under  this  treatment  gangrene  of  the 
skin  occurs  more  rarely.  Various  other  fluids  mav  be  used  for 
the  same  purpose,  especially  Burow's  solution  with  camphor 
which  IS  highly  recommended  by  Dieckerhoff  (Camphorae  50  o' 
Plumbi  acet.  200.0,  Alum.  100,  which  is  used  in  the  proportion 
of  1  tablespoonful  to  1  liter  of  water),  Goulard's  extract,  sub- 
acetate  of  lead  or  alum  solution  (5%),  spirits  of  camphor,  etc. 
Counterirritants  should  positively  be  avoided  as  the  stimula- 
tion of  an  inflammation  enhances  the  development  of  necrosis 
of  the  susceptible  skin. 

If  in  spite  of  this  treatment  gangrenous  abscesses  develop 
over  the  swellings  of  the  skin,  such  defect  as  well  as  tears 
should  be  treated  after  the  removal  of  the  necrotic  tissue  shreds, 
by  washing  with  one  of  the  above  mentioned  solutions,  or  still 
better  they  may  be  dusted  with  a  drying  powder.    For  this  pur- 
pose charcoal  powder  containing  corrosive  sublimate  (charcoal 
mixed  with  a  1%  corrosive  sublimate  solution  and  then  dried) 
further  Dermatol,  Alumnol,  Iodoform,  Thioform,  Tannoform] 
etc.,  may  be  used  to  good  advantage.    A  5-7%  creolin  liniment 
(smeared  on  wool  and  placed  on  the  wound)  mav  also  act  bene 
ficially  whereas  tinctures  (tincture  of  myrrh,  tincture  of  aloes) 
are  less  effective.    This  treatment  should  be  continued  until  the 
wound  has  filled  up  and  healed  over,  but  in  the  meantime  pro- 
tuberant granulations  which  may  develop  should  l)e  controlled 
by  cauterization  (nitrate  of  silver  or  with  fuming  nitric  acid) 
Soi-es  of  decul)itus  should  l)e  treated  in  like  manner.    The  con- 
junctivitis may  be  controlled  by  blowing  sodium  borate  into  the 
eye,  while  m  gangrene  of  the  conjunctiva  washing  with  a  2% 
creolin  solution  is  advised. 

If  the  patient  is  threatened  with  asphyxiation  as  the  result 


230  Purpura  Hemorrhagica. 

of  marked  constriction  of  the  upper  air  passages,  the  perform- 
ance of  tracheotomy  is  advisable.  The  stenosis  of  the  nose  may 
be  relieved  by  elevating  the  median  alae  of  the  nostrils  passing- 
threads  through  them  and  tying  them  together  over  the 
back  of  the  nose,  or  according  to  Johne's  suggestion,  by  the 
introduction  of  tin  tubes  into  the  nostrils.  These  methods,  how- 
ever, are  not  to  be  recommended  as  the  threads  and  even  more 
the  tin  tubes  may  produce  necrosis  of  the  skin  and  of  the 
mucous  membrane.  The  wounds  caused  by  tracheotomy  should 
be  cleaned  2  or  3  times  daily,  and  in  order  to  prevent  a  harmful 
pressure  between  the  outer  plate  of  the  tube  and  the  skin  a 
ring  of  cotton  should  be  inserted.  The  operation  may  even  be 
undertaken  before  asphyxiation  threatens,  especially  in  cases 
when  a  rapid  development  of  the  swellings  indicates  the  ap- 
proach of  a  dangerous  nasal  stenosis. 

In  consideration  of  the  difficulty  in  swallowing  which  is 
present  in  most  instances  only  such  remedies  should  be  used 
in  the  treatment  of  gastro-enteritis  as  may  be  administered  in 
the  drinking  water  or  in  soft  food.  Calomel  is  to  be  mentioned 
as  a  remedy,  as  it  not  only  has  a  disinfecting  action,  but  also 
facilitates  the  absorption  of  the  transudated  serous  fluid  as  a 
result  of  its  uniting  with  the  blood  albumen  ( Jendrassik)  (3-4.0 
g.  daily,  divided  in  several  doses),  then  boracic  acid,  tannin, 
sugar  of  lead,  also  ichthyol  (sodium  or  ammonium,  sulfo-ichtliy- 
olicuni,  20-30  g.  pro  die),  cinchona  bark,  etc.,  may  be  given.  In 
cases  where  the  rectum  is  severely  affected  enemas  of  astrin- 
gents and  disinfecting  fluids  (for  instance  2-4%  lukewarm 
boracic  acid)  are  indicated. 

If  improvement  becomes  apparent  the  convalescing  animals 
should  be  exercised  out  of  doors  for  a  short  time  2  or  3  times 
a  day,  as  soon  as  the  fever  disappears,  and  the  loss  of  the  body 
fluids  should  be  restored  through  profuse,  rich  nourishing. 

Various  remedies  were  recommended  for  the  purpose  of  an 
abortive  treatment,  but  none  of  these  can  be  considered  as  specific. 

Thus  Azary  recommended  the  fluid  extract  of  hydrastis  canadensis 
(5-8.0  g-.  subcutaneously).  Payrou  advised  adrenalin  (15-25  drops  in 
14  1-  of  water)  early  in  the  disease,  because  of  its  vasoconstrictor  action; 
while  recently  iodine  and  silver  preparations  are  used  very  extensively. 

Dieckerhoff  employed  intratracheal  injections  of  Lugol's  solution 
(iodi  puri  1.0,  potass,  iodati  5.0,  aquae  dest.  100-200.0;  30-40  g.  for 
one  dose ;  at  the  same  time  1 0-20  g.  of  iodide  of  potassium  may  be  added 
to  the  drinking  water).  This  treatment  has  been  given  extensive  trial 
in  practice,  but  without  any  remarkable  results.  The  literature  sliows 
that  out  of  96  cases  treated  in  this  manner  only  61  horses  (63.5%) 
recovered  (in  the  Prussian  army  inside  of  three  years  out  of  41  horses 
81  recoveries,  75%)  and  some  of  the  authors  (Zschokke,  Cadeac,  Lemke, 
Johne)  have  even  observed  bad  effects  from  this  treatment  (gangrene 
of  the  mucous  membrane  of  the  trachea,  symptoms  of  poisoning). 

Jodvasogen,  which  has  been  introduced  into  veterinary  practice 
by  Jess,  has  also  been  tried  (intratracheal  injections  of  15-20  g.  of  a 
6-10%  solution,  or  50-80  g.  per  os  daily).     The  results,  however,  have 


Treat  iiieiil. 


231 


been  doubtful,  as  alongside  of  Ww  favorable  msulls  reported  bv  Straubc 
Thomas,  Clausen,  Kieliter  &  Feuerhack,  there  are  those  of  Zerler  & 
Giesenselilag  as  well  as  Gutzeit,  whieh  are  unfavorable.  The  value  of 
the  lodipin  treatment  as  recommended  by  Franz,  Thomas  and  Tantos 
(10  g.  of  a  2o7o  solution  of  iodipin  injected  dailv  snbcutaneouslv  and 
on  every  second  day  50  g.  of  a  10%  iodipin  solution  per  os),  ctlnnot 
be  judged  at   the   present   time. 

Of  the  silver  preparations  Dieekerhoff  recommended  Crede's  colloid 
sdver  or  Collargol  (50  g.  of  a  freshly  prei)ared  1%  solution  intra- 
venously 2-4  times  a  day  at  the  beginning  of  the  disease)  ;  the  results 
from  tins  method  of  treatment  varied.  While  Thomassen,  Zimmermann, 
Roder,  Dresdow,  :\rollerau  and  others  obtained  satisfactory  results,  the 
experiences  with  this  method  in  the  Prussian  army  were  not  so  encour- 
aging; in  the  years  1899-11)02,  51  animals  were  treated,  with  Collargol, 
of  which  40  (78.57c)  recovered,  while  of  35  animals  which  were  treated 
by  other  methods  or  were  not  given  any  treatment  26  (74.3%)  recov- 
ered. At  the  liudapest  clinic  in  the  years  of  1898-1902  25  animals 
received  the  silver  treatment,  and  14  (56%)  recovered,  while  16  other 
cases  were  treated  otherwise,  of  which  8  (507o)  recovered.  It  was 
observed  that  even  when  this  remedy  was  employed  at  the  earliest 
stages  of  the  disease  it  did  not  intluence  its  normal  course  (Fettick). 
Payrou  declared  this  remedy  to  be  Avorthless,  and  Brohle  observed  a 
fatal  termination  in  three  cases  as  a  result  of  embolism  of  the  pulmonary 
arteries  following  an  intravenous  injection  of  0.4:40.0  g.  Collargol. 

Conditions  are  similar  in  the  case  of  Ichthargan  (50  g.  of  a  17o 
solution  intravenously),  as  recommended  by  Lange  and  Jost.  The 
results  obtained  with  this  jn-eparation  in  the  Prussian  army  in  the  years 
of  1904-1905  were  not  uniform.  Ziirn  calls  attention  to  the  hemolytic 
and  strongly  irritating  action  of  this  remedy,  and  therefore  recommends 
only  0.1  to  0.2%  solutions  for  intravenous  injections.  (Lovy  saw  after 
an  injection  of  0.5  g.  of  a  17o  solution,  the  development  of  severe 
toxic  symptoms  in  a  horse  of  advanced  age). 

Bertelotti  employed  spirits  of  turpentine  (5.0  g.  intravenously), 
Howe  oil  of  turpentine  (per  os),  Pelz,  Thomas  and  Feuerhack  talliaiiin 
(10-30  cc.  Ultra venously),  Gorjaew  corrosive  sulilimate  (10  cc.  of  a  1% 
solution  intravenously),  Beck  lastate  of  silver  or  Actol  (40  cc.  of  a  1% 
solution  3  times  daily  intravenously),  apparently  with  good  results. 

Serum  Treatment.  Stimulated  l)y  the  good  results  obtained  in 
human  medicine  with  ^Marmorek's  anti-streptococcus  serum  in  strepto- 
coccus infections,  various  authors  used  the  serum  for  the  treatment  of 
purpura  hemorrhagica  in  horses,  according  to  the  prevailing  idea  that  the 
disease  is  also  caused  by  a  streptococcus  infection.  This  appeared  justi- 
fied in  view  of  Lignieres'  assertion  that  the  streptococci  associated  Avith 
purpura  hemorrhagica  was  identical  Avith  the  pyogenic  streptococci  of 
man,  and  in  view  of  his  good  results  with  Marmorek's  serum  in  tiiice. 
The  treatment  consists  of  subcutaneous  injections  of  10-40  g.  serum, 
3  to  6  times  daily,  or  repeated  even  every  hour.  (Sommermeyer 
injects  first  10  g.  of  immune  serum  subcutaneously  and  later  20  g. 
normal  serum  intravenously). 

The  reports  published  so  far  on  the  use  of  ^larmorck's  serum  are 
favorable  (Lignieres,  ]\Iouilleron  &  Rossignol,  Peuch,  Pecus,  Maier  Avho 
used  in  one  case  190  and  in  another  440  g.  serum  inside  of  two  weeks!), 
as  well  as  about  the  Jess-Piorkowski  serum  prepared  in  a  similar  wav 
(Sommermeyer,    Bolz).      Lignieres'   results   show  only   two   deaths   in 


232  Purpura  Hemorrhagica. 

15  patients,  the  tabulation  of  Mouilleron  and  Rossignol  only  11  deaths 
with  62  patients,  while  of  209  cases  treated  by  other  methods  126  suc- 
cumbed to  the  disease.  The  Pasteur  Institute  of  Paris  has  recently 
prepared  a  polyvalent  serum  with  the  aid  of  streptococci  of  man  and  of 
the  horse,  and  with  this  serum  Payrou  obtained  favorable  results  in 
army  horses  (of  45  cases  only  7  died,  15.5%).  However,  as  in  the 
etiology  of  purpura  hemorrhagica  other  bacteria  appear  to  have  also 
a  part  and  Cadiot  obtained  equally  good  results  with  normal  blood 
serum  (100-125  g.),  the  value  of  the  rather  expensive  serum  treatment 
cannot  be  definitely  judged  at  the  present  time. 

Literature.  Percivall,  The  Yet.,  1844.— Hering,  Spe7.  Path.,  1858,  371  (Lit.).— 
Dieekerhoff,  Spez.  Path.,  1892,  417;  B.  t.  W.,  1898,  541.— Mouilleron  &  Eossignol, 
Bull.,  1898,  168.— Lange,  Z.  f.  A^k.,  1903,  XV,  117.— Jost,  B.  t.  W.,  1904.— Lignieres, 
Bull.,  1895,  587;  1898,  722;  1903,  363.— Javorskv,  A.  f.  Tk.,  1905,  XXXI,  601.— 
Payrou,  Bull.,  1905,  491.— Mollerau,  Eec,  1905,  24.— Drouin,  Eev.  gen.,  1906,  VII, 
289.— Barthel,  Z.  f.  A^k.,  1906,  XVIII,  430   (Lit.).— Franz,  D.  t.  W.,  1906,  38. 

Purpura  Hemorrhagica  of  Cattle.  Recent  literature  contains 
several  reports  (Schleg,  Eichhorn,  Frank,  Roder,  Plate,  Ehrhardt,  Kop- 
pitz,  Reinhardt  and  others),  which  render  the  occurrence  of  purpura 
hemorrhagica  among  cattle,  especially  younger  animals,  and  perhaps 
also  in  buffalo  (De  Does)  probable.  In  the  respective  cases  there  w^as 
a  diminished  appetite  and  cessation  of  rumination,  as  well  as  great 
depression  and  weakness.  At  first  small,  later  more  extensive  hemor- 
rhages occurred  in  the  skin,  and  in  the  subcutaneous  connective  tissue, 
in  the  conjunctivae,  in  the  mucous  membranes  of  nose  and  lips,  and 
in  the  udder ;  while  in  some  cases  edematous  swellings,  although  usually 
only  in  a  moderate  development,  were  observed  on  the  extremities,  and 
on  the  abdomen.  From  the  surface  of  these  swellings  a  bloody  serous 
fluid  oozed  out.  At  the  same  time  a  bloody  discharge  from  the  nose  and 
the  vagina  was  occasionally  observed,  and  the  mash-like  excrements 
were  also  mixed  wdth  blood.  In  exceptional  cases  there  appeared  a 
necrosis  over  the  hemorrhages  in  the  buccal  mucous  membrane,  and  in 
the  conjunctivae,  as  well  as  in  the  skin.  In  some  of  the  cases  the 
temperature  remained  normal,  in  others,  however,  the  disease  was  inau- 
gurated with  high  fever.  In  the  cases  where  the  animals  were  not 
slaughtered  during  the  disease,  recovery  usually  followed  in  from  six 
to  ten  days,  but  in  some  instances  not  for  three  weeks,  Avhile  some  of 
the  animals  died  from  intestinal  hemorrhage  or  septicemia.  Autopsy 
usually  revealed  more  or  less  extensive  hemorrhages  in  the  muscles,  in 
the  serous  and  mucous  membranes,  in  the  suliserous  and  su])mucous 
connective  tissues,  as  well  as  in  the  internal  organs.  In  some  cases  there 
was  also  yellowish-gray  or  grayish-brown  discoloration  of  the  liver.  The 
spleen  usually  appeared  normal. 

In  the  majority  of  cases  the  healthy  animals  became  affected  with- 
out any  apparent  cause ;  exceptionally  the  disease  developed  in  connec- 
tion with  a  local  inflammatory  process,  especially  mastitis  (Robert), 
puerperal  inflammation  of  the  uterus  (Augstein),  or  rheumatism  of  the 
joints  (Zehl).  The  disease  w'as  also  observed  as  a  stable  infection, 
although  a  transmission  from  animal  to  animal  could  not  be  established 
in  these  cases. 

Before  establishing  a  diagnosis  of  purpura  hemorrhagica  it  should 
be  differentiated  from  other  diseases  in  which  hemorrhages  occur,  espe- 
cially the  various  kinds  of  septicemias  (anthrax,  malignant  edema, 
hemorrhagic  septicemia,  etc.).  The  disease  is  mainly  distinguished 
from  these  affections  by  the  absence  of  fever  in  the  early  stages. 


Ill   Doo-s.     Ill  Man,  233 

In  tlie  treatment  tlie  same  jirineiples  apply  as  given  in  pnrpui-a 
hemorrhagiea  of  the  liorse.  Jn  the  etises  where  in  one  stable  several 
animals  became  atfeeted  consecutively,  the  disease  was  checked  by 
changing  the  feed  and  the  drinking  water  (Minder)  as  well  as  by  dis- 
infecting the  stable   (Eichhorn). 

Literature.     See  Reinhar.lt,  ^rollh.,  1900,  XXI,  221.— Zelil,  B.  t.  W.,  19(i9,  715. 

Purpura  Hemorrhagica  of  Dogs.  Lellmann  observed  in  a  6-year 
old  dog  symptoms  which  indicated  an  affection  of  purpura  hemorrhagica. 
The  emaciated  animal,  which  had  no  fever,  showed  weakness  and  a 
weak  heart  action,  also  swelling  of  the  hind  parts,  ascites,  epistaxis, 
hematuria,  and  bloody  excrement.  The  autopsy  revealed  hemorrhages 
in  the  spleen,  liver,  kidneys,  in  the  serous  membranes,  in  the  skin,  in 
the  subcutaneous  connective  tissue,  and  in  the  muscles.  In  another 
case  there  was  anemia  (pale  mucous  memlirane,  small  pulse,  anemic 
heart  nuirmurs)  bloody  vomiting  and  diarrhea,  also  numerous  hemor- 
rhages in  the  skin  which  comprised  tiie  principal  manifestations. 
The  autopsy  findings  in  this  case  resembled  those  of  the  first.  Lellmann 
considers  both  cases  identical  Avith  purpura  hemorrhagica  of  the  horse. 
(B.  t.  W.,  1897,  509;  1902,  266.) 

Raitsits  observed  in  a  dog  bluish-red,  later  confluating  spots 
on  the  abdomen  and  on  the  inside  of  the  thighs,  petechiae  on  the  con- 
junctivae, swellings  of  the  gums,  hazel-nut  sized  abscesses  on  the  phre- 
num  of  the  tongue,  albuminuria  and  hematuria.  The  autopsy  revealed 
hemorrhages  under  the  skin,  also  in  the  conjunctivae,  and  a  hemorrhagic 
inflammation  of  the  rectum.     (A.  L.,  1906,  421.) 

Purpura  Hemorrhagica  of  Man.  This  disease  (morbus  maculosus 
Werlhofii,  purpura  hemorrhagica),  is  caused  according  to  Kolb,  by  a 
small  Gram-positive  bacillus,  the  bacillus  haemorrhagicus,  while  accord- 
ing to  Letzerich  it  is  caused  by  the  bacillus  purpurae  haemorrhagicae. 
The  hemorrhages  which  appear  in  different  parts  of  the  body  in  asso- 
ciation with  the  disease  cause  it  to  somewhat  resemble  purpura  hemor- 
rhagica of  animals;  however,  the  possible  relations  of  the  two  diseases 
have  not  yet  been  established.  It  should  be  mentioned  that  in  a  case 
reported  by  Bock  a  stable  attendant  became  affected  with  Werlhof's 
disease  several  days  after  the  death  of  a  horse  with  purpura  hem- 
orrhagica. 

Literature.  Kolb,  Arb.  d.  G.-A.,  1891  YII,  Cn.— Bock,  Z.  f.  Yk.,  1902, 
XIV,   117. 

Scarlatinoid  of  Horses.  Under  this  name  Champetier  described  a 
disease  of  young  horses  which  resembled  scarlet  fever  of  man.  In  a 
mild  form  of  the  affection  there  is  a  fever  reaching  10.3-104'^F.,  inappe- 
tence,  frequent  pulse  and  cough,  injection  and  petechiae  of  the  mucous 
membranes,  further  a  peculiar  pustular  exanthema  of  the  skin,  and 
edenmtous  swellings  of  the  extremities.  In  the  more  severe  form  the 
enumerated  symptoms  are  more  intense  and  bronchial  catarrh,  catarrhal 
pneumonia,  and  nephritis  may  also  develop.  (Les  maladies  du  jeune 
eheval.     Paris,  1892.) 

The  latter  of  these  forms  has  also  been  observed  by  Marek  in 
an  8-year  old  mare.  Simultaneously  with  a  marked  swelling  of  the 
nasal  mucous  membrane  diffuse  edematous  swellings  appeared  on  the 
abdomen  and  on  the  hind  extremities;  nodules  developed  on  the  skin 
of  the  rump,  the  head  and  neck,  and  later  round  ulcerations  appeared 


234  Scarlatinoid.     Rinderpest. 

in  their  places.  The  autopsy  on  the  animal,  which  died  sixteen  days 
after  the  appearance  of  the  disease,  revealed  a  partial  necrosis  of  the 
nasal  niucons  membrane,  fresh  ulcerations  on  the  tracheal  mucous 
membrane,  and  a  hemorrhagic  nephritis.  There  was  also  present  a 
striking  inflammation  of  the  lymph  vessels,  and  a  pronounced  acute 
congestion  of  the  lymph  glands  of  the  mesentery.  (Monh.,  1896,  VII, 
346.) 

Scarlatinoid  of  Cattle.  Hetzel  observed  in  a  ly^-year  old  steer 
an  affection  resembling  the  clinical  appearance  of  the  preceding  disease 
of  the  horse.  The  symptoms  consisted  in  a  high  fever  with  sudden 
onset,  great  depression,  catarrh  of  the  pharynx  and  larynx.  Two  to  four 
days  later  petechiae  appeared  on  the  nasal  mucous  membrane,  and 
various  kinds  of  erythematous  spots  on  the  skin.  At  these  places  nodules 
developed  in  the  later  course  some  of  which  disappeared,  while  others 
developed  into  pea-sized  vesicles  containing  clear  serous  fluid.  Later 
the  contents  of  these  vesicles  became  purulent,  and  finally  they  turned 
into  thick  scabs,  the  animals  manifesting  severe  itching.  Purulent  con- 
junctivitis and  bronchitis  had  also  developed,  and  diarrhea  exhausted 
the  animals  to  a  great  degree.  The  fever  subsided  after  a  duration 
of  six  to  twelve  days,  the  catarrhal  symptoms  became  milder,  and  after 
a  desquamation  of  the  scabs  complete  recovery  took  place.  (A.  L., 
1903,  33.) 

10.    Rinderpest.    Pestis  Bovina 

{Cattle  plague,  Typhus  hovum  contagiosus,  Peste  bovine;  Ty- 
phus contagieux    [French^;  OrientaUsclie  Rinderpest 
[German^;  Peste  hovilla  [Italian].) 

The  oriental  rinderpest  represents  an  acnte  febrile,  con- 
tagions, infections  disease  of  cattle,  caused  by  an  nltra-micro- 
scopical  micro-organism,  and  wliicli  aside  from  its  typical 
course  is  characterized  by  a  croupous  diphtheritic  inflammation 
of  the  mucous  membrane.  Exceptionally  the  disease  passes 
from  cattle  to  other  ruminants. 

History,  The  attention  of  experts  has  been  directed  to  rinderpest 
from  earliest  times,  because  of  its  destructive  character,  and  tlie  most 
varied  theories  have  been  formulated  regarding  its  nature.  At  times 
the  affection  was  considered  identical  with  human  pox  (Ramazzini,  Vicq 
D'Azyr,  F.  Miiller),  and  again  with  typhus  (Veith,  Spinola)  and  dysen- 
tery of  man  (Lorinser).  Its  infectious  nature  was  recognized  early, 
and  was  established  by  successful  inoculations  (Dodson,  1744;  Camper, 
1770),  and  veterinary  police  measures  were  inaugurated  against  the 
spread  of  the  disease  (in  Prussia  in  the  year  of  1711,  in  France  in 
1714).  Since  the  beginning  of  the  last  century  the  belief  of  a  spon- 
taneous origin  of  the  disease  has  been  more  and  more  abandoned,  but 
the  causative  agent  remained  unknown  up  to  the  most  recent  times  in 
spite  of  the  numerous  investigations  conducted  along  this  line  (Semmer, 
Gamaleia,  Nencki  and  others),  until  Nicolle  &  Adil-Bey  (1902)  estab- 
lished its  filterability  through  porcelain  filters.  Deliberate  experiments 
conducted  by  Semmer  &  Raupch,  more  recently  by  Nencki  and  his 
co-workers   in  Russia,   Koch,    Danysz   &   Bordet,   Edington,    Koller   & 


Occuneiice.  235 

Turner  in  Soulli  Africa,  Xit-ollc  &  Adil-licy  in  Turkey,  led  to  the 
elaboration  of  several  methods  of  immunization  adapted  for  practical 
re(iuireiaents. 

Occurrence.  Riiidorpost  causes  enoniions  losses  in  the 
infected  ln'rds  of  cattle,  and  may  even  result  in  the  almost  com- 
plete extinction  of  animals  in  large  territories.  Sometimes  it 
may  also  cause  considerable  losses  among  flocks  of  sheep  and 
goats.  At  the  present  time  it  prevails  in  Europe  only  in  the 
southern  part  of  tlie  Balkan  peninsula,  but  in  Asia  it  is  con- 
tinually present,  and  recently  it  has  become  prevalent  in  Africa. 

Rinderpest  M-as  proba])]y  known  in  the  early  ages,  and  not  only 
in  its  original  home,  Asia,  hut  also  in  Europe.  With  the  gi-eat  migra- 
tions of  i)eople  it  was  introduced  from  tlie  l^lack  Sea  over  the  entire 
continent  westward,  where  it  has  raged  almost  continuously  since  that 
time  until  the  70 's  of  the  last  century.  Extensive  outbreaks  u.sually 
appeared  associated  with  great  wars,  inasmuch  as  the  cattle  wiiich  were 
driven  after  the  troops  di.sseminated  the  disease  over  distant  territories. 
Such  invasions  occurred  in  Germany  during  the  period  of  Charles  the 
Great  in  connection  with  his  wars ;  in  France  and  Italy  at  the  same 
time;  in  the  thirteenth  century  after  the  intrusion  of  the  Mongolians; 
at  the  time  of  tlie  thirty-years'  war,  etc. 

Tn  the  first  two  decades  of  the  eighteenth  century  the  disease  existed 
throughout  Europe  with  such  vehemence  that  for  instance  in  the  years 
1711-17U,  one  and  a  half  million  of  cattle  fell  victims  to  it  (Paulet). 
Later  Holland  lost  almost  its  entire  stock  of  cattle  as  a  result  of  the 
disease.  Through  the  great  Napoleonic  wars  the  disease  attained  again 
a  great  extension  especially  in  Germany  and  in  France  (the  first  French 
veterinary  schools  were  established  as  a  result  of  the  great  losses  caused 
by  rinderpest  at  that  time). 

Since  the  middle  of  last  century  it  has  generally  been  accepted  that 
the  disease  spreads  only  by  infection  through  which  knowledge  the  only 
rational  way  of  control  and  eradication  of  the  disease  has  been  estab- 
lished. The  complete  eradication  of  the  disea.se.  which  in  some  coun- 
tries caused  severe  losses,  appeared  as  a  very  urgent  necessity,  and 
consequently  the  European  governments  adopted  measures  by\vhich 
they  succeeded  in  pressing  it  back  to  the  far  East.  The  plague  attained 
considerable  extension  in  middle  Europe  for  the  last  time  during  the 
Franco-Prussian  war,  but  in  the  course  of  the  following  decade  it  was 
completely  sui)pressed,  so  that  since  1881  it  is  contined  to  Russia  and 
Turkey  and  more  recently  has  apparently  disappeared  even  from  Euro- 
pean Russia. 

The  losses  in  Germany  during  the  eighteenth  century  are  estiniatei]  at  ."^O 
million  cattle.  The  disease  was  distributed  most  extensively  in  the  beginning  of 
the  last  century  during  the  Napoleonic  wars,  in  the  '30 's  through  the  Polish  Revo- 
lution, an<l  later  through  the  Franco-Prussian  war.  During  the  latter.  1,3.000 
cattle  and  4000  sheep  died  in  Alsace-Lorraine,  while  in  Germany  81.51  cattle  suc- 
cumbed or  were  killeil  (the  disease  was  also  brought  to  Switzerland  by  the  eastern 
army  which  entered  that  country).  Tn  1877  the  disease  was  spread  from  Poland 
to  Posen  and  from  Austria  to  Wiesbaden  and  caused  a  loss  of  1591  cattle,  and  in 
the  following  year  2.349  cattle  die<l  in  Prussia  from  the  disease.  It  ajtj^eared  for 
the  last  time  in  188 1  in  the  province  Schlesien,  and  since  its  eradication  from  this 
territory  the  German  Empire  has  remained  free  from  the  plague  (DieckerhoflP 'l. 

In  France  the  disease  raged  to  an  alarming  extent  during  the  great  Revolu- 
tion and  the  Napoleonic  wars,  especially  after  the  unsuccessful  Russian  expedition. 


236  Rinderpest. 

It  appeared   for   the   last   time   after   the   Franco-Prussian   war,   and   caused   in  the 
course  of  two  years,  in  43  districts,  a  loss  of  56,533  cattle  valued  at  15,000,000  francs. 

Great  Britain  was  free  of  the  disease  from  the  middle  of  the  eighteenth 
century  for  a  period  of  120  years.  In  1865  the  disease  was  brought  to  the  London 
stock  market,  and  at  the  same  time  to  different  provincial  cities  by  a  cattle  boat 
from  Finland,  and  towards  the  end  of  that  year  85  counties  were  infected.  During 
the  IV2  years  of  its  prevalence  500,000  cattle  died,  valued  at  100,000,000  francs. 
The  last  outbreak  occurred  in  1877  as  a  result  of  its  introduction  from  Hamburg, 
and  caused  a  loss  of  1198  cattle. 

In  the  middle  of  the  year  1866  the  disease  spread  from  England  to  Holland, 
where  it  extended  rapidly  and  in  barely  a  year's  time  had  affected  156,594  cattle, 
of  which  7S,110  died  and  36,919  were  slaughtered,  while  41,565  recovered. 

The  disease  was  introduced  into  Italy  toward  the  end  of  the  eighteenth  century 
by  Austrian  troops,  and  spread  southwards  with  such  rapidity  that  inside  of  three 
years  over  3,000,000  cattle  became  its  victims.  Later  in  the  years  1862-1868,  the 
disease  was  widely  distributed,  having  been  introduced  from  Dalmatia,  in  which 
time  the  kingdom  of  Naples  alone  sustained  a  loss  of  50,000  cattle.  Rinderpest 
occurred  in  Italy  for  the  last  time  in  1878  in  the  province  of  Naples. 

In  Austria,  Galicia  and  Bukowina  sustained  great  losses  in  the  middle  of  the 
last  century.  In  both  of  these  crown  possessions  about  54,000  cattle  succumbed  in 
the  years  of  1848-1864,  and  about  35,000  head  in  the  years  1868-1877.  In  the  first 
period  Moravia  suffered  a  loss  of  12,000,  while  southern  Austria  lost  4,500  head. 
The  plague  invaded  Dalmatia  for  the  last  time  during  the  Bosnian  War,  in  the 
year  of  1878,  and  towards  the  end  of  the  following  year  Slavonia,  Styria  and  the 
Krain  experienced  a  visitation.  During  this  outbreak,  in  a  period  of  three  months 
1785  cattle  died  of  the  disease.  Since  the  year  1880  Austria  has  been  free  of 
the  disease. 

Hungary  suffered  most  severely  after  the  invasion  of  the  Mongolians,  and 
during  the  time  of  the  Turkish  wars,  but  the  disease  appeared  repeatedly  in  that 
country  in  later  years.  During  the  time  of  the  Eussian-Turkish  war,  in  the  years 
1827-1828,  the  disease  was  introduced  from  Moldau  and  from  Eoumania,  and 
prevailed  continuously  until  1842,  the  losses  in  the  first  two  years  amounting  to 
30,000  head  of  cattle.  After  the  conclusion  of  the  wars  of  1848-1849  the  disease 
was  almost  entirely  eradicated  from  the  western  part  of  Europe,  but  was  Ijrought 
to  Hungary  in  1849  by  the  Eussian  army,  where  it  raged  continuously  until  1861. 
(The  loss  in  this  period  amounted  to  over  350,000  cattle.)  After  the  war  between 
Austria  and  Prussia  the  plague  again  increased,  and  lasted  up  to  1874.  From 
the  middle  of  the  year  of  1861  until  the  end  of  1873  the  total  loss  was  165,732 
cattle,  valued  at  over  8,000,000  florins;  while  the  execution  of  the  veterinary  police 
measures  required  an  expenditure  of  over  half  a  million  of  florins  (Eoll).  The 
creation  of  the  Einderpest  law  in  1874  finally  resulted  in  a  complete  eradication 
of  the  disease  in  the  year  of  1881. 

In  Eussia  during  some  of  the  outbreaks  more  than  a  million  cattle,  in  some 
localities  even  3  to  5%  of  the  total  stock,  were  annihilated  by  the  disease  (Jewta- 
chiew).  In  more  recent  years  it  was  possible,  with  the  aid  of  the  measures  of 
eradication  adopted  in  1879,  to  restrict  the  disease  within  narrow  limits.  In 
1892  it  again  commenced. to  spread  westward,  but  gradually  diminished  since  1894, 
and  since  1897  it  recurs  only  east  of  the  Caucasian  Mountains,  where  it  prevailed  in 
1907  in  six  government  districts  affecting  812  townships.  In  November,  1908,  three 
infected  transports  were  brought  from  Petropawlowsk  (Siberia)  to  the  abattoir  of 
St.  Petersburg,  but  the  localization  of  the  disease  appears  to  have  been  successful. 

Rinderpest  occurs  continuously  in  Turkey,  and  appears  especially  in  the  vicinity 
of  Constantinople,  as  well  as  on  the  coast  of  the  Marmara  Sea.  Detailed  statistics 
of  its   occurrence   are  not   available. 

The  entire  territory  of  Asia,  including  the  East  Indian  groups  of  islands,  is 
infected;  and  in  Asiatic  Eussia  alone  the  losses  in  1906  amounted  to  25,093  cattle; 
(according  to  Yersin  the  disease  rages  in  Indo-China  also  among  the  buffaloes). 
In  1892  the  plague  was  carried  from  Corea  to  Japan,  but  in  two  years  its  successful 
eradication  was  accomplished  with  energetic  measures. 

Previous  to  1864  rinderpest  was  known  to  exist  in  Africa  only  in  Egypt, 
but  during  the  Italian  invasion  of  1890  it  spread  southward  along  the  Nile,  and 
inside  of  five  years  reached  the  South  African  States  as  well  as  the  West  African 
Colonies  of  Germany.  Transvaal  lost  980,000  cattle  in  1897,  while  in  the  Cape 
Colony  1,300,000  animals  died  of  the  disease  in  the  years  of  1897-1898.  After 
that  time  the  plague  diminished  somewhat,  but  gained  again  in  severity  in  t>he  years 
of  1901  and  1904,  until  during  recent  years  it  has  been  considerably  limited  by  the 
persistent  employment  of  protective  vaccination.  According  to  Littlewood  the 
disease  was  again  introduced  fnto  Egypt  from  Minor  Asia  in  June,  1903,  appearing 
in  the   Province   Behera,  where   it  spread  with   great   severity,   and   according   to 


Etiolojry.     Pathoji-eii  icily.  237 

offioial  reports,  147,285  animals,  out  of  a  total  numlier  of  about  3,000,000  cattle 
and  buffaloes,  had  fallen  victims  to  the  disease  up  to  the  end  of  1906.  Ninety-three 
tliousaml  cases  of  these  o<-ciirred  in  northern  E^n-jjt.  Arloing  estimates  the  losses 
at  5,000,000  cattle,  and  the  valuation  at  150,000,000  francs. 

Etiology.  Nocard,  as  well  as  Tartakowsky,  proved  that  tlie 
pure  tissue  fluids  of  affected  animals  contain  no  niicro-orc^an- 
isms  visible  with  the  microscope,  and  that  no  or,o:anisms  could 
be  cultivated  with  the  ordinary  methods  of  procedure.  Nicolle 
&  Adil-Bey  demonstrated  that  brain  emulsion,  intestinal  con- 
tents, cerebro-spinal  fluid  or  peritoneal  exudate,  when  diluted 
with  water  pass  through  the  Berkefeld  or  Chamberland 
filter;  that  such  filtrates  are  infectious,  and  that  therefore  the 
contagion  belongs  to  the  group  of  ultramicroscopical  micro- 
organisms. 

Pathogenicity.  The  contagion  is  present  during  the  entire 
disease  in  all  tissue  fluids  (the  nasal  secretion  of  inoculated  ani- 
mals is  infective  twenty-four  hours  after  inoculation  according 
toRaupach).  Blood  taken  at  the  height  of  the  disease  and 
injected  subcutaneously  into  a  full  grown  animal  in  as  small 
a  (quantity  as  0.001  g.  will  produce  the  disease  with  the  same 
intensity  as  if  for  instance  41.  of  blood  had  been  injected 
subcutaneously  (Nicolle  &  Adil-Bey).  Besides  the  tissue  fluids 
the  virus  is  present  in  the  different  secretions  (saliva,  nasal  dis- 
charge, urine,  feces,  bile,  tears,  vaginal  discharge,  perspiration), 
while  the  infectiousness  of  the  exhaled  air  is  doubtful.  Infec- 
tion is  readily  accomplished  by  subcutaneous  injections  or  by 
feeding  infectious  material,  while  by  intravenous  injections  in- 
fection results  only  exceptionally  (Kolle).  Repeated  passage 
-of  the  virus  through  the  bodies  of  cattle  does  not  modify  its 
virulence  (Nicolle  &  Adil-Bey) ;  on  the  other  hand  when  passed 
through  the  bodies  of  sheep  and  goats  it  becomes  attenuated 
(Galambos,  Koch). 

Besides  cattle  and  buffaloes,  sheep  (Galambos)  and  goats 
(Woronzow^  &  Eckert)  as  w^ell  as  camels  (Tartakow^sky)  may  be 
infected  by  subcutaneous  injections,  while  infection  is  less  cer- 
tainly transmitted  by  feeding  infectious  material. 

The  ({uestion  whether  hogs  are  also  susceptible  to  the  virus  of 
rinderpest  has  not  yet  been  positively  established.  While  Carre  & 
Fraimbault  succeeded  in  infecting  these  animals  with  subcutaneous 
injections  of  virulent  blood,  and  Penning  obtained  positive  results  on 
wild  hogs,  and  later  reinfected  calves  from  them,  Theiler  failed  in 
all  attempts  to  produce  the  disease  in  hogs  in  a  similar  manner. 

Tenacity.  Blood  or  other  infections  fluids,  sealed  in  a  glass  tube,  remain 
virulent  for  several  months  (Semmer) ;  the  same  applies  to  spleen  tissue  when  kept 
in  a  fiark  jdace.  Distilled  water  mixed  with  blood  loses  its  virulence  within  4  to  5 
days  (Nencki),  and  if  mixed  with  glycerin  insitle  of  8  days  (Edington)  ;  blood 
mixed  with  an  equal  quantity  of  bile  becomes  avirulent  in  two  hours  (Lingard). 
According  to  older  observations  (Haubner,  Dieekerhoff)  the  virus  remains  virulent 
on  hay  kept  in  the  stable,  or  in  the  hay  loft  for  3  to  4  months  (?),  but  when  exposed 
to  the  sunlight  it  is  destroyed  in  two  days.  When  dried  on  wool  out  of  doors 
it  becomes  avirulent  in   three   days    (Woronzow   &    Kckort).      Hides  salted   for   two 


238  Rinderpest. 

to  three  days,  then  kept  for  4  or  5  days  in  a  shady  place,  also  bone  marrow  after 
the  bono  has  been  dried  for  30  days,  may  still  contain  infectious  virus.  By  heating 
to  58-60°C.  it  is  destroyed  immediately,  while  a  temperature  of  20-25°C.  destroys  its 
virulence  only  after  it  has  been  subjected  for  a  longer  period.  Blood  becomes 
avirulent  when  subjected  to  a  temperature  of  37°C.  for  2  to  3  days   (Theiler). 

According  to  older  data  the  virus  is  destroyed  very  slowly  by  putrefaction. 
Thus  meat  which  has  been  buried  for  three  months  is  supposed  to  have  been  still 
infective  (Vieq  D'Azyr).  Arloing,  however,  found  that  the  virus  retains  its 
virulence  in  meat  only  for  4  days.  The  infectiveness  of  manure  which  has  been 
contaminated  with  the  excrements  of  affected  animals  contains  the  virus  for  one 
month,  according  to  Bouley,  and  according  to  Krajewski  it  may  sometimes  be 
infectious  even  after  five  months.  More  recent  investigations  in  this  direction 
proved,  however,  that  the  virus  is  destroyed  by  putrefaction  in  a  few  days   (Kolle). 

Besides  glycerin  carbolic  acid  (2%),  sublimate  (1-1000),  milk  of  lime  (1%) 
are  effective  as  disinfectants;  on  the  other  hand  the  virulence  of  the  blood  is  not 
modified  by  a  %%  carbolic  acid  solution   (Kolle). 

Natural  infection  results  either  by  direct  contact  with 
affected  animals  or  is  transmitted  through  the  raw  products  of 
such  animals,  such  as  parts  of  carcasses,  as  well  as  by  persons 
contaminated  by  such  carcasses  or  by  infected  secretions  and 
excretions.  Food,  drinking  water,  stable  utensils,  clothes,  etc., 
may  also  transmit  the  infection.  In  most  instances,  however, 
the  infection  is  disseminated  by  affected  animals  in  the  ordinary 
traffic  with  cattle,  which  mode  of  transmission  is  the  more  im- 
portant as  some  animals  may  be  only  very  slightly  affected  and 
yet  retain  the  virus  in  the  body  for  14  days,  in  chronic  cases 
probably  even  somewhat  longer  (Stockman;  the  maximum  time 
in  which  the  animal  may  be  infectious  for  others  is  supposed 
to  be  30  days). 

The  infection  usually  occurs  through  the  digestive  tract, 
probably  through  the  lyiuph  spaces,  even  of  healthy  mucous 
membranes.  The  possibility  of  infection  through  the  air  pas- 
sages has  not  been  positively  established,  as  it  is  questionable 
whether  the  contagion  is  disseminated  through  the  air.  Out  of 
doors  the  spread  of  the  disease  may  be  prevented  by  digging 
a  trench  around  the  infected  herd  which  the  animals  are  unable 
to  pass,  and  in  such  cases  cattle  on  the  other  side  of  the  trench 
remain  healthy  (Eaupach).  Likewise  it  is  possible  to  prevent 
its  spread  by  isolating  affected  cattle  for  a  distance  of  10 
meters,  when  it  will  be  found  that  healthy  animals  will  not 
contract  the  disease  (Piot-Bey).  In  the  stable  healthy  cattle 
may  be  protected  from  the  neighboring  infected  animals  by 
simple  board  partitions  (Nencki). 

The  susceptibility  is  very  great  in  cattle,  especially  in  the 
young  animals,  although  there  appears  to  be  considerable  differ- 
ence in  the  various  breeds.  According  to  some  authors  ( Jessen, 
Haupt)  cattle  exposed  to  the  infection  become  affected  as  a 
rule  without  consideration  of  the  breed.  Some  Russian  authors, 
however,  claim  that  the  long  horned  ranch  cattle  are  less  sus- 
ceptible to  the  infection  tlian  the  breeds  of  Western  Europe. 
Cattle  of  the  gray  breeds  show  a  greater  resistance  to  artificial 
infection,  and  the  course  of  the  disease  in  them  is  usually  milder. 

According  to  Semmer  only  5  to  10%  of  ranch  cattle  succumb  to  an  artificial 
infection  with  virulent  virus;  against  90  to  98%  of  other  breeds.    Nicolle  &  Adil-Bey 


Pathogenesis.  239 

also  observeil  that  the  time  of  incubation  after  virulent  inoculations  is  24  hours 
shorter  in  the  higher  bre.l  animals,  an-l  <leath  as  a  rule  follows  half  a  .lay  earlier 
than  in  tlie  Mack  Anatolian  cattle,  ami  that  these  latter  may  be  much  more  readily 
imnninize.l.  In  South  Africa  (Stockman)  an. I  in  In.lia  (Eogers)  the  cattle  of  the 
mountains  appear  to  be  much  more   susceptible  than   the  animals  in  the  lowlands. 

Buffaloes  are  niiieli  less  susceptil)le.  During  the  existence 
of  an  outbreak  they  l)eeonie  alTi'cted  only  exceptionally,  and  even 
young  animals  ni'av  withstand  artilicial  infection  (Nicolle  & 
Adil-Bev ;  although*  the  disease  exists  among  buffaloes  on  the 
East  Indian  islands  in  an  epizootic  form,  Van  Ecke,  Blin  & 
Carrougeau).  . 

Of  other  animals  camels  are  susceptible  (according  to  i  ar- 
takowskv  the  disease  is  always  mild  in  these  animals);  also 
sheep,  goats  and  ruminants  living  wild,  especially  deer,^  zelm, 
gazelle,'  etc.,  and  these  animals  bear  an  important  part  in  the 
distribution  of  the  disease.  Solipeds  and  carnivora  are  not  sus- 
ceptible, and  the  reliabilitv  of  the  observations  relative  to  the 
occurrence  of  the  affection  in  hogs  (Percari,  Driessa,  Pinning) 
has  not  been  proven  beyond  a  doul)t  (see  p.  237).  Man  is 
not  susceptible  to  rinderpest. 

One  attack  of  the  disease  usually  abolishes  the  susceptibility 
of  the  animal;  and  while  repeated  attacks  were  observed  in 
exceptional  cases  the  infection  was  usually  of  a  mild  form.  (In 
the  Vaccine  Institute  of  Karlowka  it  was  not  possible  to  repro- 
duce the  disease  in  a  steer  which  had  recovered  from  the  affec- 
tion produced  bv  inoculation  six  years  previously.)  Calves 
from  cows  which  "became  ill  during  advanced  pregnancy  are  also 
resistant  against  the  infection  (Gerlach,  Semmer,  Rogers),  or 
they  become  affected  only  with  mild  s^Tiiptoms  (Yersin). 

Pathogenesis.  The  first  symptoms  are  apparently  produced 
by  the  virus  which  enters  the  l)lood  and  propagates  with  great 
rapidity.  The  virus  appears  to  have  a  predilection  for  exerting 
inflaminatory  changes  on  the  mucous  membranes,  producing 
catarrhal  s^ptoms  in  the  very  beginning  of  the  disease.  The 
croupous-diphtheric  inflammation  which  then  develops  with 
great  rapidity  is  evidently  the  result  of  secondary  infection  by 
other  micro-organisms  from  the  digestive  tract  on  the  weakened 
mucous  membrane.  These  bacteria  cannot  be  designated  exactly 
at  present  (colon  and  necrophorus  bacilli  ?)  in  the  absence  of 
accurate  bacteriological  and  histological  examinations.  The  tis- 
sue changes  consist  principally  in  that  the  epithelial  layer  of  the 
h:^T)eremic  and  swollen  mucous  membrane  changes  together 
with  the  exudate  which  comes  from  the  blood  vessels  into  an 
easilv  detachable  and  friable  pseudo-membrane.  Sometimes  the 
tissue  of  the  mucous  membrane  proper  becomes  necrotic  to  a 
certain  deptli,  forming  thicker  membranes  that  are  more  adhe- 
rent. The  mucous  glands,  especially  those  of  the  intestinal 
mucous  membrane  swell  as  a  result  of  cellular  infiltration,_and 
later  become  necrotic.    The  inflammatory  process  is  sometimes 


240  Rinderpest. 

also  observed  in  the  cutis  of  the  skin,  which  is  a  direct  result 
of  the  softening-  and  sloughing  of  the  epithelial  layer. 

The  continuous  high  fever  and  great  debility,  the  weakness 
of  the  heart,  the  hemorrhages  of  the  serous  and  mucous  mem- 
branes, as  well  as  the  pronounced  difficulties  in  respiration,  indi- 
cate also  a  severe  action  of  the  filterable  virus  on  the  central 
nervous  system. 

Anatomical  Changes.  Carcasses  dead  of  rinderpest  are 
greatly  emaciated.  The  skin  surrounding  the  sunken  eyes,  the 
nostrils  and  the  lips  are  profusely  covered  with  tenacious 
mucus  and  saliva,  the  anal  region  is  soiled  with  dried  feces, 
the  mucous  membrane  of  the  rectum  is  greatly  swollen  and 
cyanotic.  In  some  of  the  cases  the  skin  shows  the  changes  which 
can  be  noticed  already  during  life  (see  p.  246),  while  in  the  sub- 
cutaneous connective  tissue  the  flabby  and  easily  torn  veins  are 
dilated  and  filled  with  blood.  The  abdominal  and  thoracic 
cavities  contain  in  some  cases  a  yellowish-red  or  dirty-brown 
fluid,  which  is  odorless  or  may  have  a  sickening,  sweetish  odor. 

The  most  important  changes  appear  in  the  mucous  mem- 
branes, and  especially  on  that  of  the  digestive  tract. 

In  the  mouth,  especially  on  the  mucous  membrane  of  the 
lips,  lying  opposite  the  gums,  under  the  tongue  and  on  the  phre- 
num,  more  rarely  on  the  cheeks  and  on  the  hard  palate,  on  the 
soft  palate  and  on  the  borders  of  the  tongue,  there  are  yellowish- 
gray  nodules  and  granular  pulpy  deposits.  There  may  be  also 
areas  the  epithelial  layer  of  which  has  exfoliated,  or  even  deeper 
ulcers,  while  in  other  spots  the  mucous  membrane  usually  shows 
reddish  maculae,  or  appears  as  if  it  had  been  sprinkled  with 
bran  as  a  result  of  a  necrosis  of  the  epithelial  layer  (sometimes 
pin-head  sized  ulcerations  are  present  on  the  tongue,  gums  and 
in  the  pharynx).  The  mucous  membrane  of  the  pharynx  is 
hyperemic,  and  contains  small  hemorrhages,  while  in  the  cpsopli- 
agus  it  is  usually  normal;  exceptionally  a  necrosis  may  be 
observed  in  the  superficial  layers  of  the  oesophagus  which  are 
of  hemp-seed  to  lentil  sized  dimensions. 

The  omasum  contains  very  dry  food ;  the  abomasum,  which 
usually  contains  only  a  small  quantity  of  a  tenacious  mucus, 
shows  the  most  varied  shadings  from  a  brick-red  to  a  dark- 
brown  coloration  in  its  mucous  membrane.  The  reddening  is 
most  intensive  in  the  region  of  the  pylorus,  and  especially  on  the 
tops  of  the  folds.  At  the  same  time  the  mucous  membrane  is 
swollen,  and  the  submucosa  thickened  as  a  result  of  an  edema- 
tous infiltration.  In  a  later  stage  plate-like  deposits  may  be 
observed,  especially  on  the  folds  of  the  mucous  membrane,  which 
are  hemp-seed  to  lentil  in  size,  dirty-gray  or  brownish  in  color, 
and  flat  or  rounded  in  form.  These  deposits  are  only  loosely 
attached  with  their  soft  borders,  while  in  the  center  they  adhere 
more  strongly  to  the  base.  If  they  are  picked  off  highly  red- 
dened depressions  remain  in  their  places. 


Anatomical  Changes.  241 

The  into.-tinal  canal  contains  dirty-^ray  or  from  the  admix- 
ture of  blood,  darkish-brown,  very  liquid  feces  which  have  a 
sweetish  stale  odor  and  are  often  mixed  with  membranous 
shreds.  The  mucous  membrane  is  much  reddened,  the  subjacent 
connective  tissue  gelatinously  swollen,  Tlie  mucous  membi-ane 
of  the  duodenum  and  of  the  jejunum  shows  plate-like  deposits 
similar  to  those  in  the  abomasum,  and  occasionally  they  are  also 
found  in  the  ileum.  The  solitary  follicles  are  swollen  to  the 
size  of  a  hemp  seed  or  even  larger,  and  form  small  nodules 
from  which  a  purulent  or  yellow  caseous  mass  may  be  squeezed. 
(If  the  necrotic  epithelial  cells  are  not  thrown  oif,  they  together 
with  the  swollen  glands  cause  the  mucous  membrane  to  resemble 
the  skin  of  a  boiled  eel.)  The  Peyer's  ])atciies  are  at  first  uni- 
formly swollen,  and  rise  with  a  flat  prominence  over  the  sur- 
rounding tissue ;  later  small  dirty-gray  deposits  appear  around 
them,  which  subsequently  confluate  to  a  dry, caseous  and  strongly 
adherent  or  a  mush-like,  soft  deposit,  several  millimeters  in 
extent.  In  rare  cases  the  epithelial  layer  forms  with  the  coagu- 
lated exudate  a  membranous  cylinder  several  millimeters  thick 
on  the  inner  surface  of  the  intestinal  tube;  in  other  cases  the 
necrotic  tissue  of  the  mucous  membrane  changes  into  a  friable, 
dry,  caseous  mass,  when  after  its  removal  the  smooth  muscular 
layer  is  exposed. 

The  large  intestines  show  similar  changes,  Init  in  these  the 
lesions  are  less  pronounced  than  in  the  small  intestines.  Fre- 
quently they  show  only  indications  of  a  simple  acute  catarrh, 
or  the  mucous  membrane  appears  as  if  sprinkled  with  bran 
because  of  the  superficial  necrosis  of  the  epithelial  layer.  Some- 
times the  mucous  membrane  of  the  large  and  small  intestines 
presents  broad,  bright-red  transverse  stripes  or  extravasations 
of  blood  so  that  it  greatly  resembles  the  skin  of  a  zebra 
(Verney). 

In  the  bright-red  air  passages,  punctiform  or  linear  hemor- 
rhages and  catarrhal  swelling  of  the  mucous  membrane,  as  well 
as  edematous  infiltration  of  the  submucous  connective  tissue, 
especially  in  the  nose  and  in  the  larynx,  are  almost  constant 
lesions.  There  are  frequently  croupous,  pseudo-membranous 
deposits  in  the  nose,  and  especially  on  the  nostrils,  also  in  the 
larynx  and  in  the  trachea,  under  which  ulcerative  erosions  are 
found.  The  mucous  membrane  of  the  bronchi  usually  manifests 
only  a  ring-form  deposit,  and  is  covered  with  a  purulent  secre- 
tion, which  may  in  places  entirely  fill  the  small  bronchi  and 
pop  out  on  the  cut  surface  on  slight  pressure  in  the  form  of 
white  plugs. 

Similar  changes  may  frequently  be  observed  on  the  mucous 
membrane  of  the  female  genital  organs,  and  especially  in  the 
anterior  part  of  the  vagina,  while  further  back  the  lesions  are 
usually  less  marked. 

The  liver  shows  parench>nnatous  or  fatty  degeneration. 
The  gall  bladder  is  distended  and  contains  thin,  green  or  yellow, 


242  Einderpest, 

or  even  dirty-gray  bile.  The  mucous  membrane  is  in  some 
instances  at  first  covered  with  vesicles  and  ulcers,  later  with 
greenish-yellow  patches  of  necrotic  tissue.  The  spleen  is  usu- 
ally unchanged,  sometimes,  however,  it  may  here  and  there  be 
acutely  swollen.  The  kidneys  manifest  cloudy  swelling  or  fatty 
degeneration,  the  mucous  membrane  of  the  hylus  of  the  kidneys 
and  of  the  urinary  bladder  shows  catarrhal  swelling  and  small 
hemorrhages. 

The  lungs  show  an  acute  hyperemia,  and  sometimes  contain 
scattered  areas  of  catarrhal  pneumonia.  Frequently  an  inter- 
stitial emphysema  is  present,  and  in  some  cases  air  bubl^les  are 
found  under  the  pleura,  in  the  mediastinum,  in  the  surrounding 
tissue  of  the  trachea,  as  w^ell  as  in  the  subcutaneous  and  sub- 
peritoneal connective  tissue.  The  heart  is  flabby,  the  muscles 
are  friable,  of  a  dull,  grayish-brown  color,  sometimes  showing 
butter-yellow  streaks.  Under  the  pericardium  as  well  as  be- 
neath the  endocardium,  hemorrhages  are  frequent.  The  blood 
is  dark  red  and  only  partially  coagulated. 

The  lymph  glands,  especially  in  the  mesentery,  show  an 
acute  swelling,  their  tissue  is  reddened  and  moist,  but  contains 
no  hemorrhages. 

In  the  brain  and  in  the  cerebral  meninges  only  a  hyperemia 
and  moderate  edema  of  the  white  brain  substance  may  be  found. 

The  described  anatomical  changes  are  present  in  animals  which 
die  at  the  height  of  the  disease,  or  which  were  killed  not  earlier  than 
on  the  third  or  fourth  day  of  the  affection.  Pronounced  lesions  on 
the  mucous  membrane  of  the  digestive  tract,  and  especially  in  the 
abomasum,  are  present  in  almost  every  instance,  while  the  mucous 
membrane  of  the  air  passages  and  genital  organs  may  only  occasionally 
manifest  an  acute  catarrh.  However  the  affection  of  the  intestinal 
tract  is  not  always  uniform,  for  instance,  the  very  decided  affection 
of  Pe.ver's  patches  Avhich  was  observed  in  every  case  by  Gerlach  is 
according  to  Bristowe,  Murchison  and  Dieckerhoff  in  some  eases  en- 
tirely absent.  Again  Koch  observed  in  South  Africa,  and  Nicolle 
in  Turkey,  that  the  diphtheritic  changes  in  the  buccal  cavity  and  in 
the  intestines  were  only  slightly  i:)ronounced  in  those  countries  in  the 
rinderpest  of  cattle.  In  the  gray  range  cattle  the  anatomical  changes 
are  usually  less  prominent  than  in  cattle  of  Western  European  breeds. 

Symptoms.  The  time  of  incubation  in  cattle  extends  from  3 
to  9  days. 

Eaiipaeh  inoculated  865  cattle,  of  which  70  (8.1%)  developed  the  disease  on 
the  fourth,  227  (26.25%)  on  the  fifth,  303  (35%)  on  the  sixth,  208  (24.15%)  on 
the  seventh,  and  57  (6.6%)  on  tlie  eighth  day.  Sanderson  and  Sennner  have 
observed  in  exceptional  cases  a  febrile  rise  in  temperature  36  to  48  hours  after 
inoculation.  Of  390  animals  inoculated  by  Tode  55  became  affected  on  the  fourth 
to  tenth,  21  on  the  eleventh  to  twentieth,  20  on  the  twenty-first  to  twenty-sixth  day. 
Of  the  more  recent  authors  Koch  observed  the  development  of  fever  as  the  first 
indication  of  the  disease  in  from  3  to  9,  Theiler  from  3  to  6,  Nicolle  &  Adil-Bey 
from  4  to  6  days. 

The  establishment  of  the  accurate  time  of  incubation  was  of  special  impor- 
tance during  the  time  when  cattle  imported  from  Roumania  and  Russia  to  Austria- 
Hungary  and  Prussia,  were  sulijected  to  a  quarantine  on  the  borders.  For  this 
reason  the  international  veterinary  congresses  repeatedly  discussed  this  question  (in 


Symptoms.  243 

1863  in  Hamburg,  in  the  years  18(5.")  ami  1n()7  in  Vienna).  Nine  days  was  estab- 
lished as  the  maximal  duration,  and  after  the  international  hygienic  conference  in 
ISTii  haii  also  substantiated  this  finding,  the  duration  of  the  (luarantine  was  reduced 
from  L'l  to  10  days. 

The  first  syiiiptoni  of  the  disease  which  usually  precedes 
the  other  manit'estations  by  one  or  two  days  is  the  rise  in  the 
temperature  which  in  the  Western  i]uroi)ean  cattle  reaches  on 
the  lirst  or  not  later  than  on  the  second  day  40-42.2''C.  (Gerlacli). 
In  range  cattle  however  it  usually  does  not  reach  that  height 
(Medvedski.  According  to  Dieckerhoff  the  rise  in  the  tempera- 
ture connnences  in  exceptional  cases  only  10  to  20  hours  after 
the  appearance  of  the  otlier  sym])toms). 

At  the  same  time  the  animals  manifest  a  marked  depression 
and  dullness.  They  stand  in  the  stable,  or  apart  from  tiie 
other  animals  in  the  barnyard  or  pasture,  with  head  di"ooi)(Ml, 
sometimes  supporting  it  on  the  cril),  the  ears  drooped,  and 
the  back  arched.  Excei)tionally  the  affected  animals  lirst  sliow 
great  excitement,  constantly  moving  about,  attempting  to  break 
loose  when  tied,  shaking  their  heads,  tearing  up  the  ground 
with  their  horns  and  feet,  and  sometimes  even  assuming  a 
lighting  attitude.  This  excitement  however  lasts  only  a  short 
time,  not  longer  than  a  few  hours,  and  is  soon  relieved  by  the 
above-mentioned  depression. 

The  appetite  is  depressed,  the  thirst  on  the  other  hand 
being  sometimes  increased  (according  to  Dieckerhoff  many 
animals  manifest  frequent  yawning,  and  the  swallowing  of 
pieces  of  mortar) ;  rumination  is  delayed  or  sometimes  ceases, 
the  feces  which  are  passed  at  long  intervals  are  dry,  dark- 
colored,  and  do  not  form  curled  cakes.  The  urine  is  diminished 
in  quantity  and  of  a  darker  color.  The  milk  secretion  is  con- 
siderably diminished  from  the  beginning  of  the  disease. 

In  the  meantime  the  animals  treml)le,  shaking  severely 
over  the  entire  body  at  short  intervals.  They  grind  their  teeth, 
and  certain  groups  of  muscles,  especially  on  the  neck  and  near 
the  flank,  show^  fibrillar  twitching.  The  temperature  is  unevenly 
distributed  over  the  body  surface,  the  horns  and  the  ears  feel 
■warm  to  the  touch,  the  muzzle  is  dry,  the  skin  at  the  flexor 
surfaces  of  the  extremities  and  in  the  surrounding  parts,  is 
covered  with  perspiration,  the  hair  especially  over  the  vertebral 
column  is  lusterless  and  erect. 

Eespiration  and  pulse  become  somewhat  accelerated,  and 
the  frequency  of  the  pulse  is  affected  by  even  slight  external 
influences.  Many  of  the  affected  animals  cough  frequently,  even 
in  the  first  stages  of  the  disease,  without  it  being  possible  to 
detect  any  changes  in  the  thoracic  organs. 

From  the  second  day  of  the  manifest  affection  inflammatory 
changes  of  the  mucous  membrane  appear  in  the  foreground, 
which  render  the  symptoms  of  the  disease  characteristic. 

The  conjunctivae  are  l)right  red,  the  lids  are  swollen, 
cushion-like,  while  tears  run  profusely  from  the  narrow  opening 
of  the   eve.     Later   the   secretion   becomes   mucous   and   soon 


244 


Rinderpest. 


purulent.  On  forcibly  separating  the  lids  a  great  quantity  of 
discharge  runs  out,  and  dries  below  the  inner  canthus  of  the 
eye  into  dry  crusts.  On  the  surface  of  the  inflamed  conjunctivae 
fine  pseudo-membranes  form,  and  sometimes  the  cornea  becomes 
cloudy  (according  to  Krajewski  especially  in  dry  warm 
weather). 

From  the  nasal  opening  there  is  first  a  glassy  transparent, 
tenacious,  later  a  more  purulent  and  at  last  a  dirty  gray  or 
brown,  fetid,  ichorous  or  bloody  discharge  running  down  the 


Fig.  43.     Stomatitis  in  rinderpest.     (After  the  reports  of  the  English  Commission 

of  the  year  1866.) 


muzzle.  The  nasal  mucous  membrane  as  far  as  it  may  be 
examined,  is  at  first  spotted,  later  uniformly  reddened,  and 
sprinkled  wath  dark  red,  punctiform  hemorrhages.  The  itching 
produced  by  the  inflammation  of  the  mucous  membrane  causes 
the  animals  to  blow  frequently,  and  to  continuously  move  the 
head  up  and  down,  or  from  right  to  left,  and  sometimes  to 
even  shake  it  violently.  As  a  result  of  the  developing  difficulty 
in  respiration  the  animals  sometimes  shake  their  whole  bodies. 


Syiiiptimis.  245 

thus  caiisiiis'  a  rattling  of  the  cliaiii  with  which  tlicy  arc  fastened 
by  the  head  or  neck,  by  the  sound  of  which  affected  animals  may 
frequently  be  recoi;nized  in  an  infected  stable. 

In  the  buccal  cavity  the  mucous  membrane  is  at  lirst  red- 
dened in  spots,  later  assuming  a  uniform,  livid  or  bright  red 
color,  and  not  infrequently  becomes  covered  with  dark  red 
eccll^^noses ;  these  changes  ai)pear  first  on  the  gums,  and  on 
the  inner  surface  of  the  lips,  later  in  the  corners  of  the  mouth, 
on  the  borders  of  the  tongue,  in  the  vicinity  of  the  phremun 
of  the  tongue,  on  the  upper  lips,  and  on  the  cheeks.  Soon 
hemp-seed  to  lentil-sized  gray  spots  appear  on  the  surface, 
which  conHuate  forming  larger-,  connecting,  gray  or  grayish- 
yellow,  ])atch-like  de])osits;  after  their  loosening,  wiping  off 
or  throwing  off,  the  bright  red,  bleeding,  deeper  la^'er  of  the 
mucous  membrane  becomes  visible  (so  called  erosion  ulcera- 
tions; see  Fig.  43). 

As  a  result  of  the  affection  of  the  intestinal  tract,  there 
is  in  the  first  two  days  obstipation,  later  profuse  diarrhea. 
The  feces  which  at  first  were  firm  and  sometimes  mixed  with 
blood,  become  softer  and  later  very  thin;  they  are  passed  under 
great  strain,  in  which  the  dark  red,  or  livid,  greatlv  swollen 
rectal  mucous  membrane  protrudes.  The  parts  surrounding 
the  anus  are  soiled  by  the  watery,  later  dirty  gray  and  then 
dark  brown,  fetid,  sometimes  bloody  feces,  which  contain 
mucous  shreds,  gray  detritus,  or  even^  large  pieces  of  pseudo- 
meinl)ranes.  Towards  the  end  of  the  disease,  about  the  fifth  dav, 
involuntary  passages  of  the  bowels  take  place  at  short  intervals 
and  in  small  quantities,  from  the  flabby  and  open  rectum  of  the 
animals  which  lie  on  the  ground  at  this  stage. 

Even  in  the  earliest  stages  a  mucous  or  muco-purulent  dis- 
charge, which  is  sometimes  mixed  with  blood  flows  from  the 
vagina  of  cows  and  heifers,  the  vulva  showing  a  swelling  and 
higher  temperature.  The  mucous  membrane  of  the  vagina  and 
the  vulva  is  reddened,  and  on  the  surface  small  grav,  or  yellow, 
pseudo-membranes  form,  which  later  are  thrown'  off  leaving 
dark  red,  bleeding,  superficial  erosions  in  their  places. 

The  animals  urinate  frequently.  The  urine  flows  almost 
continually  in  drops  at  short  intervals,  and  is  sometimes 
yellowish-red  to  coffee  brown  in  color  (Eggebrecht). 

As  an  indication  of  an  affection  of  the  respiratory  organs 
a  frequent  painful  cough  is  observed  as  the  first  sVmptom, 
which  however  disappears  after  the  disease  has  coinpletely 
developed  (Dieckerhoff).  The  respiration  is  accelerated,  40-60 
per  minute,  later  it  is  labored  to  a  high  degree,  and  the  grunt- 
ing of  the  animal  is  audil)le  for  a  great  distance.  Percussion 
of  the  thorax  reveals  nothing  abnormal,  or  only  a  louder  per- 
cussion sound.  Auscultation  reveals  intensified  vesicular  breath- 
ing, later  dry  and  moist  rales.  In  some  cases  a  subcutaneous 
emphysema  develops  in  association  with  the  interstitial  lung 
emphysema,  which  results  from  the  very  difficult  respiration. 


246 


Rindei'iDest. 


In  such  cases  the  emphysema  is  first  indicated  on  both  sides 
of  the  vertebrae,  then  on  the  neck,  shoulders  and  thorax. 

The  heart's  action  is  at  first  sufficiently  strong,  but  grad- 
ually weakens.  The  constantly  increased  frequency  in  pulse 
is  at  first  50-60,  later  80-100  and  even  more  per  minute.  The 
pulse  is  weak,  small,  and  toward  the  end  of  the  disease  wiry. 

The  leucocytes  increase  in  the  blood  with  the  onset  of  the  fever 
up  to  the  fifth  day  of  the  affection.  From  this  time  on  their  number 
diminishes  to  4,000  per  cubic  millimeter  in  the  unfavora])le  cases.  If 
the  animal  remains  alive  their  number  increases  towards  the  sixteenth 
or  seventeenth  day  of  the  disease  to  28,000-30,000,  which  is  again 
followed  by  a  rapid  diminution,  whereupon  by  the  twentieth  day  the 
normal  condition  is  re-established. 

The  continuous  fever  usu- 
ally reaches  its  height  on 
the  fifth  or  sixth  day,  the 
daily  differences  varying  by 
one  degree,  and  rapidly  drops 
with  the  onset  of  the  diarrhea 
in  the  severe  cases  to  below 
normal;  whereas  if  there  is 
an  indication  of  improvement 
the  fever  subsides  gradually 
(Fig.  44).  The  height  of  the 
fever  does  not  always  cor- 
respond with  the  severity  of 
the  other  symptoms. 

In  some  cases,  particularly 
in  range  cattle,  the  skin  be- 
comes affected  in  a  peculiar 
manner.  Two  or  three  days 
after  the  appearance  of  the 


Fig.  44.  Fever  curve  in  rinderpest,  follow- 
ing a  subcutaneous  injection  of  a  drop  of 
virulent  blood  ;  three  year  old  cow.     (Af- 
ter Nicolle  and  Adil-Bey.) 


disease,  sometimes  even  earlier,  small  protuberances  and 
vesicles  develop  on  the  neck,  before  and  behind  the  shoulders, 
along  the  vertebral  column,  on  the  shanks,  on  the  udder  or  on 
the  scrotum,  and  in  the  flank.  Over  these  areas  the  hairs  stick 
together,  later  thick  scabs  cover  the  wrinkled  skin.  In  case 
the  animal  improves  the  scabs  are  thrown  off,  the  epithelium 
desquamates,  at  the  same  time  the  hair  falls  out,  and  sometimes 
the  animals  may  even  lose  the  hair  from  the  tips  of  their  tails. 

Russian  authors  and  also  Zlamal,  laid  great  stress  on  the  affection 
of  the  skin  which  occurs  quite  frecjuently  in  range  cattle,  and  accord- 
ingly they  distinguished  an  exanthematous  form  of  rinderpest,  from 
one  in  which  no  exanthema  developed.  In  confirmation  of  older  con- 
ceptions, they  consider  the  appearance  of  the  exanthema  a  favorable 
prognostic  indication.  The  skin  affection  however  which  develops  in 
some  of  the  outbreaks  quite  fre(iuently,  in  others  but  rarely,  may 
exceptionally  occur  also  in  Western  European  cattle  and  in  spite  of 
this  favorable  symptom  the  disease  may  terminate  unfavorably.  (The 
exanthema  was  frequently  observed  in  Hungary  in  the  outbreak  of  1852, 


(."(lursi'  of  1  )isease, 


247 


whereas  in  tlie  years  lSt)l-J8(j;J  it  was  not  ohserved  in  a  single  instance 
[Zlaimil].) 

Willi  tlio  (liiiiinisliiiig  milk  seerotioii  the  udder  becomes 
flabby,  wrinkled  and  cold;  tlio  milk  which  is  secreted  in  small 
quantity  is  watery  and  of  a  pronounced  yellow  color.  Pre<'-nant 
animals  usually  abort  at  the  height  of  the  disease. 

During-  the  develo])ment  of  tiie  described  symptoms  the 
animals  have  no  api)elito  and  do  not  ruminate,  become  rapidly 
emaciated  and  steadily  lose  in  strength.  Tlie  skin  loses  its 
elasticity,  becomes  stiff  and  dry,  the  hair  dull  and  Instei-less. 
The  advanced  stage  of  the  disease  appears  characteristic  in 
the  presence  of  a  dull  look  from  the  deeply  sujda'ii  eyes,  puruh'ut 
secretions  from  the  eyes,  dirty  nasal  discharge,  foamy  saliva 
in  the  corners  of  the  month,  grinding  of  the  teeth,  accelerated 
and  grunting  respiration  accompanied  by  shaking  of  the  body, 
muscular  treml)Iing,  and  the  peculiar  repulsive  odor  of  the 
excrements.  Soon  the  animals  are  not  capa])le  of  standing 
np,  they  lie  constantly  on  the  ground  with  head  extended  or 
turned  on  the  shonlder,  and  finally  they  succumb,  completely 
exhausted,  in  convulsions  or  without  struggle. 

Course.  The  described  sjanptoms  do  not  all  develop  in 
every  case  of  rinderpest.  Furthermore  according  to  Lorinser 
the  entire  sjmiptom  complex  is  never  present  in  one  animal  or 
even  in  the  herd,  but  from  case  to  case  the  changes  in  the 
respiratory  organs,  or  those  of  the  digestive  tract  predominate, 
and  in  other  instances  s\^nptoms  of  the  genital  organs ;  in  most 
instances  all  the  organs  mentioned  may  be  affected,  at  the  same 
time  but  in  varying  intensity. 

In  the  great  majority  of  the  severe  cases  the  disease  lasts 
on  an  average  of  from  4-7  days.  The  affection  of  the  mucous 
membrane  can  usually  be  detected  on  the  second  day  after 
the  appearance  of  the  febrile  symptoms.  The  clinical  mani- 
festations develop  in  their  full  intensity  on  the  third  or  fourth 
day;  in  exceptional  cases  the  condition  becomes  very  rapidly 
aggravated,  when  death  may  result  on  the  second  or  third  day, 
while  in  other  cases  the  course  may  extend  from  14-16  days. 
The  convalescence  lasts  from  2-3  weeks,  and  the  spnptoms, 
especially  those  of  the  intestinal  inflammation  diminish  very 
gradually. 

In  the  milder  cases,  such  as  are  usually  observed  among 
range  cattle,  the  symptoms  do  not  develop  to  such  a  degree,  and 
usually  commence  to  recede  about  the  fourth  or  fifth  day.  Ac- 
cording to  the  observations  of  Russian  authors  and  Eggebrecht, 
the  disease  among  these  breeds  of  cattle  may  be  manifested 
only  by  a  febrile  condition  lasting  for  a  few  days,  and  b}^  a 
mild  catarrh  of  the  mucous  membranes  of  the  respiratory 
organs,  as  well  as  of  the  digestive  tract.  As  a  result  of  these 
the  disease  may  sometimes  even  pass  unnoticed  in  the  larger 
herds.      This    mild   form    of    rinderpest   is    observed    in   very 


248  Rinderpest. 

exceptional  cases  also  among  cattle  of  the  Western  European 
breeds  (Dieckerhoff ;  according-  to  Stockman  the  disease  some- 
times may  run  a  very  chronic  course  in  the  presence  of  mild 
symptoms). 

In  Turkey,  Russia  and  Africa  animals  frequently  become  affected 
which  have  previously  been  infected  with  the  parasites  of  infectious 
hemoglobinuria,  or  coast  fever.  In  such  animals  rinderpest  runs  the 
usual  course,  but  at  the  same  time  the  piroplasma  which  were  present 
prior  to  the  infection  with  rinderpest  only  in  unimportant  numbers 
in  the  blood  increase  very  rapidly  (Nicolle  &  Adil-Bey,  Kowalewsky, 
Theiler,  Koch).  Latent  cases  of  trypanosomiasis  are  likewise  influenced 
by  rinderpest   (Holmes,  Woolley). 

Rinderpest  as  a  plague  does  not  spread  very  rapidly  in 
large  herds.  After  placing  an  affected  animal  in  a  stall,  usually 
after  1-2  weeks  the  animals  in  close  proximity  first  become 
affected,  whereupon  however  the  disease  attacks  the  other 
animals  with  a  greater  rapidity  in  a  similar  way.  According 
to  Haupt  it  requires  from  5-6  weeks  for  the  disease  to  affect 
all  the  animals  in  a  herd  of  15-20  head. 

Diagnosis.  The  sudden  appearance  and  the  rapid  develop- 
ment of  the  symptoms,  among  which  the  characteristic  affection 
of  several  mucous  membranes  is  of  great  importance,  aid  in 
the  recognition  of  the  disease.  In  establishing  a  diagnosis 
careful  data  on  the  history,  first  on  the  possibility  of  an  intro- 
duction of  the  infection  as  well  as  the  mode  of  spreading  in 
the  affected  herd,  must  be  carefully  considered,  because  of  the 
far-reaching  consequences  which  may  follow  the  presence  of 
the  disease.  The  diagnosis  is  formed  with  difficulty,  in  the 
beginning  of  an  outbreak,  especially  if  the  disease  affects  the 
first  animals  in  an  unusually  mild  form,  but  a  sudden  rise  in 
the  temperature  is  sufficient  to  justify  a  suspicion  of  the  pres- 
ence of  rinderpest. 

From  the  standpoint  of  differential  diagnosis  the  follow- 
ing diseases  are  principally  to  be  considered : 

1.  Coccidiosis  (red  scour).  The  resemblance  consists  in 
the  fact  that  in  this  disease  there  is  also  a  febrile  diarrhea 
and  rapid  loss  of  strength ;  further  autopsy  may  reveal  necrosis 
of  the  epithelium  and  even  of  the  deeper  layers  of  the  gastric 
and  intestinal  mucous  membrane.  It  is  distinguished  from 
rinderpest  in  that  the  digestive  disturbances  precede  the  febrile 
rise  in  temperature,  further  the  excrements  retain  their  original 
color  for  a  longer  period,  but  may  become  mixed  with  blood 
even  at  the  beginning  of  the  disease.  The  affection  remains 
exclusively  confined  to  the  gastro-intestinal  canal,  and  in  older 
animals  the  affection  of  the  rectum  is  especially  marked; 
whereas  the  mucous  membranes  of  the  head,  and  of  the  eyes, 
remain  normal.  Further  the  disease  is  not  contagious,  and 
cannot  be  transmitted,  even  by  inoculation.    Similar  differences 


DinpKisis.  I'lni^iuisis.  o^D 

exist  between  the  acute  gastio-iiitestiiial  eatanii,  the  mycotic 
and  toxic  enteritis,  on  one  side,  and  rinderpest  on  the  otlier. 

Tsclnidiiiow  o])serve(l  an  aflfection  in  cattle  after  fecdiiifj  swill  heated  to  a 
temperature  of  58-54°,  which  consisted  in  fever  of  40-42°,  difhcult  respiration,  red 
Fpots  on  the  buccal  mucous  menil)rane,  catarrh  of  the  conjunctivae,  scanty  hair, 
mucous  discdiarge  from  the  nose,  and  a  bloody  mucous  diarrhea.  The  autopsy 
reveale<i  in  one  case  hyperemia,  and  homorrhaiies  in  the  mucous  membrane  of  the 
rumen  and  of  the  intestinal  canal. 

2.  Malignant  catarrlial  fever  of  cattle,  with  wiiich  rinder- 
pest has  been  frequently  confounded.  This  disease  resembles 
rinderpest  inasmuch  as  it  also  runs  a  severe  course,  and  as 
all  mucous  membranes  may  become  affected.  However  tlie 
most  severe  changes  are  found  in  the  mucous  meml)ranes  of 
the  eyes,  nose  and  sinuses  of  the  head,  while  the  digestive  tract 
and  the  genital  organs  are  usually  only  slightly  affected.  The 
head  feels  warm  to  the  touch,  the  horns  sometimes  fall  off,  tlie 
depression  of  the  animals  is  pronounced  fi'om  the  onset  of  the 
disease.  Besides  cloudiness  of  the  cornea,  a  fibrinous  iritis  may 
also  develop,  and  it  should  be  taken  into  consideration  that  the 
disease  is  not  contagious  and  usually  occurs  only  sporadically. 

3.  Foot-and-mouth  disease  can  only  be  mistaken  for  rinder- 
pest when  the  ulcerations  in  the  mouth  extend  to  the  deeper 
parts,  and  when  the  ulcerations  later  become  covered  with  tissue 
detritus  and  coagulated  exudate;  further  when  high  fever  and 
indications  of  enteritis  can  be  associated  with  the  disease.  In 
foot-and-mouth  disease  however  the  ulcerations  develop  at  the 
site  of  the  vesicles;  the  nose  and  the  eyes  are  not  affected,  wliile 
frequently  inflammatory  changes  are  present  in  the  interdigital 
spaces;  furthermore  foot-and-mouth  disease  spreads  more 
rapidly  through  the  affected  herds  than  rinderpest. 

4.  Piroplasmosis  may  cause  suspicion  of  rinderjjest, 
especially  on  autopsy,  in  cases  where  the  mucous  membrane 
of  the  abomasum  and  of  the  small  intestines  contain  ulcerations, 
and  even  patch-like  deposits.  Normal  appearance  of  the  mucous 
membrane  of  the  mouth,  air  passages  and  genitals,  the  presence 
of  hemoglol)in  in  the  urine,  acute  swelling  of  the  spleen, 
yellowish  discoloration  of  the  subperitoneal  fat,  as  well  as  an 
enzootic  character  of  the  outbreak,  afford  sufficient  grounds 
for  excluding  rinderpest.  However  the  establishment  of  the 
piroplasmosis,  or  the  presence  of  piroplasma  in  the  blood  does 
not  exclude  the  simultaneous  presence  of  rinderpest,  as  mixed 
infections  of  this  kind  occur  quite  frequently  (see  pp.  248  and 
255;  according  to  Arloing  &  Ball  the  swollen  lymph  glands  are 
free  from  hemorrhages  only  when  piroplasmosis  exists  in  asso- 
ciation with  rinderpest).  A  demonstration  of  trypanosoiues  in 
the  blood  also  has  no  importance  from  the  standpoint  of  a 
differential  diagnosis. 

Prognosis.  The  termination  of  the  disease  depends  in  the 
first  i)lace  on  the  character  of  the  outbreak,  and  on  the  breed 


250  Rinderpest. 

of  the  affected  animals.  The  mortality  fluctuates  within  wide 
limits,  and  is  estimated  among  cattle  of  the  colored  breeds  at 
75%,  in  range  cattle  at  less  than  50%. 

In  England  during  the  outbreak  in  1866  the  affected  animals  died  almost 
without  exception,  whereas  at  the  same  time  in  Holland  only  two-thirds  of  the 
diseased  animals  succumbed,  and  in  France  in  1S71  the  mortality  amounted  in 
places  to  only  20%.  In  Hungary  the  losses  in  1852  did  not  exceed  10%,  on  the 
other  hand  in  the  years  1861-1863  they  reached  75%.  According  to  Krajewski  the 
disease  sometimes  runs  a  mild  course,  especially  after  a  rapid  spread  through  large 
herds  (losses  of  15  to  20%  or  even  less),  but  occasionally,  even  among  range  cattle, 
85%  may  die.  In  India  the  mortality  among  cattle  of  the  lowlands  is  about  20%, 
while  in  mountain  cattle  it  reaches  90%. 

Experience  has  shown  that  if  the  disease  returns  after  a 
long  period  of  absence,  a  greater  number  of  animals  fall  victims, 
and  on  the  other  hand  the  mortality  immediately  after  the  out- 
break is  greater  than  in  its  later  course.  Under  favorable 
hygienic  conditions,  pure  air  and  dry  weather,  the  losses  are 
lighter  than  under  adverse  conditions. 

Treatment.  Medicinal  treatment  of  the  affected  animals 
gives  no  result,  as  was  proven  by  the  completely  negative  re- 
sults obtained  in  experiments  in  England  and  Holland  on  the 
occasion  of  the  last  outbreak.  A  favorable  influence  can  be 
hoped  for  only  from  serum  treatment,  in  which  the  patient 
should  be  given  40-80  cc.  of  immune  serum  subcutaneously  or 
intravenously  at  the  beginning  of  the  febrile  stage,  or  not  later 
than  the  appearance  of  the  first  manifestations  (see  p.  252; 
Fedetzky  found  the  curative  inoculation  valueless). 

The  opportunities  for  therapeutic  treatment  are  remote, 
as  all  of  the  European  countries  which  are  free  from  the 
disease,  with  the  exception  of  Turkey,  require  the  killing  of  all 
affected  and  suspected  animals. 

Immunization.  The  possibility  of  an  effective  immuniza- 
tion against  rinderpest  is  indicated  by  the  numerous  instances 
in  which  recovery  from  the  disease  has  afforded  the  animals 
an  immunity  lasting  for  a  long  time,  usually  as^  long  as  they 
live.  The  intensity  of  the  immunity  thus  obtained  develops 
in  a  degree  relative  to  the  severity  of  the  affection.  However, 
as  affected  animals  infect  others  during  the  course  of  the  dis- 
ease, and  as  they  may  disseminate  the  infection,  immunization 
except  with  pure  serum  inoculations,  is  only  indicated  in  badly 
affected  localities,  in  order  that  the  otherwise  very  great  losses 
may  be  reduced. 

As  this  purpose  was  not  attained  with  older  methods^  of 
immunization,  owing  to  the  considerable  losses  from  the  im- 
munization, it  has  been  abandoned  not  only  in  the  Central  and 
Western  European  countries  but  also  recently  in  Eussia.  The 
occurrence  of  the  disease  with  great  severity  in  the  last  decade, 
especiallv  in  South  and  North  Africa,  has  again  placed  the 
question'  in   the   foreground   and   the   experiments   conducted 


Imiiiuiiizatioii.  251 

there  have  resulted  in  more  effective  methods  by  which  more 
satisfactory  results  are  being-  obtained  in  affected  localities. 

I.  Immunization   with   Secretions   of   Affected   Animals. 

Stimulated  by  the  favorable  results  of  smallpox  vaccination, 
innnunization  against  rinderpest  was  undertaken  in  the  mitldle 
of  the  eigiiteenth  century  (1744)  in  Phigland  (Dodson),  in 
France  and  in  Germany,  as  well  as  in  Holland,  and  later  was 
employed  to  a  great  extent  in  Russia. 

The  procedure  consisted  in  the  introduction  of  the  nasal  discharges  or  lachrymal 
secretions  of  affected  cattle  into  healthy  animals,  under  the  skin  of  the  tail  or 
other  parts  of  the  body.  After  the  iiiocidation  the  disease  developed  in  a  very  mild 
form,  especially  in  the  gra}-  range  cattle,  and  the  mortality  reached  only  a  small 
percentage.  Jessen  experimented  later  with  a  supposedly  attenuated  virus,  which 
he  carried  through  .several  generations  of  cattle.  After  such  inoculations  in  the 
Vaccine  Institute  of  Karlowka,  in  the  years  1857-1873,  the  entire  loss  among 
2629  cattle  amounted  to  only  5. 979;^. 

Tliis  method  of  immunization,  however,  did  not  appeal  to  Western  Europe, 
inasmuch  as  the  breeds  of  cattle  in  those  countries  l)ecame  severely  affected  from 
the  inoculation  and  the  losses  were  considerable,  and  further  than  this,  the  inoculated 
animals  endangered  the  lives  of  those  which  had  not  been  treated.  After  the  inter- 
national conference  in  Vienna  in  1S72  had  resolved  that  the  immunization  against 
rinderpest  should  not  be  considered  as  a  valuable  method,  it  was  abandoned  even 
in  Kussia,  and  in  1874  the  last  serum  institute  was  given  up. 

II.  Immunization  with  the  Bile  of  Affected  Animals.  The 
blood  and  the  bile  of  animals  dead  from  rinderpest  has  been 
used  for  a  long  time  for  immunization  purposes  by  the  Boers 
in  the  Transvaal  and  in  the  Orange  Free  States.  Koch  later 
demonstrated  (1897)  that  the  bile  of  such  animals  in  quantities 
of  100  cc.  injected  into  healthy  animals  afforded  them  a  very 
valuable  immunity  against  the  infection.  The  immunity  can 
be  established  by  the  tenth  day  following  the  immunization, 
and  is  of  such  intensity  that  the  immunized  animals  withstand 
an  injection -of  40  cc.  of  virulent  blood  without  ill  effects  even 
four  weeks  after  the  inoculation,  and  they  are  also  able  to 
resist  natural  infection.  The  immunity  probably  results  from 
the  virus  contained  in  the  bile  which  gives  the  animals  a  mild 
local  affection,  due  to  the  retention  of  the  virus  at  the  point 
of  inoculation  through  the  action  of  certain  ingredients  of  the 
bile  (Kolle). 

The  immunization  employed  in  practice  showed  that  the  immunity 
following  the  injection  of  bile  sometimes  appears  on  the  sixth  day, 
and  lasts  from  four  to  six  months  (Kolle).  In  other  cases,  however, 
it  lasts  only  from  3-4  weeks  (Kohlstock),  and  the  inoculation  occa- 
sionally causes  not  only  a  local  swelling  at  the  place  of  inoculation, 
but  it  may  also  cause  a  severe  general  affection,  and  exceptionally 
the  death  of  the  animal,  especially  if  the  bile  contained  some  blood 
(Theiler).  Further,  as  the  liile  inoculation  in  already  infected  animals 
during  the  time  of  incubation  is  entirely  without  etfect,  the  applica- 
tion of  this  method  could  only  come  into  consideration  if  rinderpest 
suddenly  broke  out  in  certain  localities  and  a  more  effective  method 
of  immunization  could  not  be  employed. 

Potent  bile  can  be  obtained  only  after  the  seventh  day  of  the  dis- 


252  Rinderpest. 

ease;  it  should  be  of  a  green  color,  odorless,  and  on  shaking  should 
form  a  white  foam.  An  animal  dead  from  the  disease  produces  a 
quantity  sufficient  for  not  more  than  20-25  cattle. 

In  South  Africa  in  the  years  from  1896  to  1898  over  2,000,000  cattle  were 
immunized  with  bile  with  apparently  satisfactory  results,  and  according  to  Adani 
it  has  proved  beneficial  in  Erythraa.  Eogers  also  found  this  method  effective  in 
India,  however  only  in  cattle  of  the  lowlands,  since  mountain  cattle,  which  are 
much  less  frequently  exposed  to  the  infection,  nearly  all  succumbed  to  the  disease, 
when  inoculated  with  virulent  blood  10  days  to  41/^  months  after  they  had  been 
immunized  with  bile.  (In  some  localities  of  South  Africa  the  immunizations  were 
repeated  every  three  months,  and  in  spite  of  this  deaths  from  the  disease  were 
occasionally   observed). 

Ediugton  mixes  bile  (2  parts)  with  glycerine  (1  part)  and  injects  this  mix- 
ture subeutaneously,  20  to  25  cc.  to  adult  cattle  and  15  ce.  to  calves.  According 
to  Turner  immunity  cannot  be  established  by  this  method,  as  the  glycerin  kills  the 
virus  contained  in  the  bile;  Eogers  likewise  asserts  the  ineffectiveness  of  the  addition 
of  glycerin.  Filtering  the  bile  before  the  injection  through  a  porcelain  filter  (Turner 
&  Kolle)  also  reduces  its  immunizing  action,  and  at  best  only  has  the  advantage 
that  by  this  procedure  bile  which  is  no  longer  fresh  may  be  utilized  for  immunization 
(Eogers).  Lingard  on  the  other  hand  found  that  laile  from  healthy  animals  if 
subeutaneously  inoculated  four  times  at  several  days  intervals  in  50  cc.  doses,  also 
gave  an  effective  immunity  against  subcutaneous  virulent  infections. 

Lingard  uses  instead  of  fluid  bile  a  precipitate  which  he  obtains  by  the 
addition  of  Almen's  reagent  (5  g.  tannin,  10.0  cc.  acetic  acid,  and  240  cc.  of  45% 
alcohol).  The  precipitate  which  is  washed  in  a  1%  soda  solution,  neutralizes  the 
virus  in  vitro,  and  inoculations  by  this  method  are  supposed  to  have  given  good 
results  in  India  even  in  the  mountain  cattle. 

Active  immunization  with  bile  and  with  virulent  blood.  In 
order  to  produce  a  more  lasting  immunity,  Kohlstock,  and  later  also 
Henning  &  Edington  injected  subeutaneously  virulent  blood  (0.2  cc.) 
about  two  weeks  following  the  Inle  inoculation.  The  animals  thus 
injected  became  sick,  however  wdth  only  a  few  exceptions  they  re- 
covered and  later  proved  that  they  possessed  a  lasting  immunity.  In 
German  South  Africa  this  method  has  found  extensive  use,  and  with 
its  aid  the  disease  was  successfully  eradicated  in  a  few  months  at 
the  time  of  the  severe  outl)reak  of  1897  (Rassau).  It  has  likewise 
proven  satisfactory  in  Tientsin  (Asia)  where  of  the  immunized  animals 
66%  showed  no  disease  whatsoever,  while  24%  became  only  slightly 
affected,  and  10%  died  as  a  result  of  the  inoculation  (Haedicke)  ; 
Edington  on  the  other  hand  observed  at  Kimberley  great  losses  from 
such  combined  inoculations. 

III.  Immunization  With  Blood  Serum.  Semnier  found  in 
1893  tliat  blood  serum  from  cattle  which  recovered  from  rinder- 
pest possessed  immunizing  properties,  and  these  findings  have 
since  been  confirmed.  However  such  serum  exerts  its  protective 
action  only  when  relatively  large  quantities  are  used  (100-200 
cc),  still  its  action  may  be  increased  hj  injecting  the  animals 
with  large  quantities  of  virulent  blood. 

The  passive  immunity  produced  by  the  serum  inoculation 
only  lasts  from  10-21  days,  and  the  duration  cannot  be  increased 
to  over  four  months  even  by  the  use  of  greater  quantities  of 
serum  (100-200  cc).  Accordingly  it  may  be  suitably  applied 
whenever,  after  the  slaughtering  of  the  affected  animals,  the 
remaining  cattle,  if  treated  with  serum,  will  not  be  likely  to 
become  exposed  later  to  the  infection;  further  it  may  be  used 
where   infection   is    threatened   by   outbreaks   in   neighboring 


1  iiiiiiunizatioii.  253 

localities  when  the  serum  will  l)e  found  to  afford  protection 
for  at  least  a  short  time.  One  advantage  of  this  method  lies 
in  the  fact  that  it  is  also  effective  during  the  period  of  ..incuba- 
tion, and  that  the  inoculated  annuals  do  not  become  affected 
and  therefore  do  not  spread  the  disease. 

Tokishige  (1897)  in  Japan,  jiiul  Pitr-iifora  &  Theilor,  as  well  as 
Roi-dct  »t  Diuiysz.  (luring  the  invasion  of  tiie  disease  in  South  Africa, 
aimed  to  increase  the  potency  of  the  blood  serum  of  recovered  (so- 
called  salted)  cattle,  by  injections  of  virulent  blood.  Kolle  &  Turner 
injected  at  first  100  cc.  subcutaneously  in  recovered  animals  after  the 
disappearance  of  the  fever,  then  at  intervals  of  several  days  increasing 
((uantities  of  virulent  blood  (the  last  time  5  liters  in  one  injection). 
After  3-4  pronounced  reactions  the  animals  produced  a  serum  of  which 
20  cc.  protected  an  aninuil  weighing  300  kg.  against  a  pathogenic 
action  of  1  cc.  of  virulent  blood  (for  use  in  practice  the  blood  serum 
nuist  have  at  least  such  a  potency).  Animals  which  have  not  recovered 
from  rinderpest  nuist  l)e  treated  first  with  ])ile,  or  with  blood  serum 
and  blood,  and  only  later  with  virulent  blood. 

Nicolle  &  Adil-Bey  observed  in  Constantinople  that  animals  which 
recovered  from  rinderpest  could  not  again  be  made  sick  by  a  sul)- 
cutaneous  or  intraperitoneal  injection  of  a  large  quantity  of  virulent 
blood  (up  to  10  liters),  even  when  inoculated  immediately  after  the 
recovery.  Accordingly  recovered  animals  were  injected  subcutaneously 
at  first  with  4  liters  of  blood,  and  later  the  quantity  was  increased. 
Another  method  of  these  authors  consists  in  the  injection  into  the 
abdominal  cavity  of  an  affected  animal  which  already  has  diarrhea, 
of  6  liters  of  a  physiological  salt  solution  containing  peptone.  Three 
to  six  hours  after  the  injection  the  animal  is  bled  to  death,  and  a 
healthy  animal  is  then  injected  subcutaneously  with  2-3  liters  of  the 
fluid  collected  from  the  abdominal  cavity.  The  blood  taken  after  10, 
15  or  20  days  from  this  animal  produces  a  potent  serum;  later  the 
animal  again  receives  the  abdominal  fluid  subcutaneously,  and  the 
method  is  continued  in  this  manner.  Two  weeks  following  the  injection 
of  4  liters  of  blood  the  animals  produce  a  similarly  potent  serum, 
no  matter  whether  this  quantity  has  been  injected  immediately  after 
the  first  opportunity  or  only  in  gradually  increasing  quantities.  Sheep 
are  also  adapted  to  the  production  of  immune  serum,  the  horse  and 
the  goat  however  are  not.  By  adding  to  the  immune  serum  14  to 
1/2%  of  carbolic  acid  and  keeping  it  in  a  dark  place  it  remains  potent 
for  four  years   (Theiler). 

The  dose  of  the  serum  is  50-100  cc,  according  to  the  si2e  of  the  animal.  In 
India  the  very  susceptible  mountain  cattle  are  injected  with  IS  times  larger  doses 
than  are  given  to  the  cattle  of  the  lowlands,  and  the  quantity  also  depends  on  the 
severity  of  the  disease  before  the  inoculations  have  been  undertaken  (Walker). 

According  to  the  statistics  of  Turner,  in  1897  33  herds  on  several  farms, 
with  a  total  of  3318  cattle,  of  which  45.5  animals  had  already  been  affected,  were 
subjected  to  the  serum  treatment.  Of  these  inoculated  animals  455  died,  while 
2857  (86.1%)  remained  healthy.  In  the  English  Egyptian  Soudan  Head  lost  2% 
out  of  7386  inoculated  animals.  The  serum  inoculation  has  been  applied  in  China 
to  about   11,000  cattle,  with   very  satisfactory  results    (Keylock). 

As  it  is  sometimes  difficult  to  obtain  virulent  blood,  Riidiger  injects  cattle 
intraperitoneally  with  5  litei-s  of  a  ^2%  potassium  citrate  solution.  The  animals 
are  slaughtered  an  hour  later.  The  fluid  thus  injected  proves  very  virulent  and 
when  mixed  with  equal  quantities  of  \arulent  blood  produces  a  very  effective  and 
a  correspondingly  cheaper  material   for  the  preliminary  treatment   of  serum  cattle. 


254  Rinderpest. 

Dschunkowsky  &  Kupziz  prodiiced  a  dry  preparation  from  the  liquid  serum 
by  evaporation,  at  30.32°,  and  by  adding  at  the  same  time  1-5%  of  sodium  hydrate; 
this  has,  however,  not  yet  been  tested  in  practice. 

IV.  Immunization  With  Immune  Serum  and  Virulent  Blood. 

(Simultaneous  Method.)  Kolle  &  Turner  produced  an  immunity 
in  cattle  which  lasted  for  at  least  five  months,  by  injecting  the 
animals  subcutaneously  on  one  side  of  the  rump,  with  one  cc. 
of  virulent  blood,  and  on  the  other  side,  according  to  the  size 
and  age  of  the  animal,  8  to  25  cc.  of  immune  serum.  This 
immune  serum  is  the  same  as  that  which  is  used  for  ordinary 
serum  inoculations,  while  the  blood  originates  from  animals 
either  affected  with  the  natural  disease  or  from  such  as  were 
artificially  infected,  and  should  be  taken  on  the  fifth  or  sixth 
day  of  the  disease  (sheep  infected  with  blood  are  also  suitable 
for  this  purpose).  Some  of  the  animals  inoculated  by  this 
method  react  wdth  a  fever  lasting  for  several  days,  while  about 
10%  of  the  vaccinated  cattle,  especially  common  range  cattle, 
do  not  manifest  any  reaction  whatsoever.  The  blood  of  the 
reacting  animals  is  infectious  during  the  febrile  stage.  In 
exceptional  cases  severe  symptoms  of  rinderpest  develop  in 
the  inoculated  animals,  and  some  (about  1%)  may  even  die 
with  the  disease. 

The  simultaneous  method  has  the  advantage  over  the  other 
methods  that  it  causes  a  relatively  small  loss,  and  with  very 
rare  exceptions  it  produces  a  lasting  immunity.  However  while 
only  a  small  proportion  of  the  inoculated  animals  become 
affected  with  severe  symptoms,  they  may  transmit  the  disease 
to  healthy  animals,  and  therefore  its  application  is  only  indi- 
cated in  already  infected  territories,  and  in  these  localities 
only  under  assurances  that  the  blood  does  not  contain  other 
poisonous  substances  in  addition  to  the  virus  of  rinderpest, 
and  it  should  especially  be  free  of  protozoa  (see  p.  255). 

This  method  has  been  employed  for  several  years  in  Africa,*  in 
Asiatic  Russia  (Nencki,  Siebert  &  Wyznikiewicz),  in  Turkey  (Nicolle 
&  Adil-Bey),  and  in  India  (Rogers),  and  the  first  reports  from  all 
these  places  indicated  favoral)le  results.  In  India,  however,  in  the 
less  resistant  mountain  cattle  the  immunity  obtained  was  not  sufficient, 
although  the  dose  of  the  serum  was  increased  6  to  9  times.  Rogers 
therefore  injects  another  10  cc.  of  virulent  blood  subcutaneously  10 
days  after  the  simultaneous  inoculation.  The  simultaneous  method  may 
be  also  adopted  for  the  immunization  of  buffaloes  as  well  as  goats 
(3  to  5  cc.  of  blood  serum,  and  1  cc.  of  blood). 

According  to  Turner,  10,407  cattle  were  inoculated  by  this  method  in  South 
Africa  (Ehodesia,  Cape  Colonies  and  Pretoria),  and  the  loss  from  inoculation 
amounted  to  136  animals  (1.31%);  Head  inoculated  7,386  animals  in  the  Egyptian 
Soudan,  with  a  loss  of  only  2%,  Fedetzky  and  Gorain  observed  a  loss  of  1-2%, 
Stockman  on  the  other  hand  'observed  in  one  herd  deaths  amounting  to  12%.  Very 
good  results  are  reported  by  Eggebrecht  in  Eastern  Asia. 

For  a  time  another  method  of  immunization  was  used  in  South  Africa,  which 
has  since  been  introduced  into  practice  by  Bordet  &  Danysz,  as  well  as  by  Pitchford 
&  Theiler,  and  which  consisted  in  injecting  subcutaneously  into  the  animals 
100-200  cc.  of  defibrinated  blood  from  animals  which  had  recovered  from  rinderpest. 


Coiii])liea(i(nis.      (^luiniiiliiio.  255 

This  injection  was  followed  by  rubhiny  int'ectioiis  saliva  or  bloo<l  into  the  nose, 
and  after  tive  days  100  cc.  of  blood  was  ajjain  injected  siibciitaneously.  Conti 
ininmnized  animals  with  20  cc.  of  serum  from  animals  which  had  recovered  from 
the  disease,  to  which  3  cc.  of  blood  from  an  animal  which  had  been  affected  for 
47  hours  with  rinder]>est  was  added.  The  author  reports  favorable  results  from 
this  method  of  immunization. 

Complications.  Several  years  ago  Koch  (11)04)  and  later  Tlieiler 
and  Woolley,  ])()inted  out  the  dangers  in  the  application  of  the  simul- 
taneous inoculation.  In  localities  where  piroplasinosis  or  trypano- 
somiasis is  prevalent  there  is  the  danger  that  i)ai-asites  of  the  mentioned 
diseases  may  he  transmitted  with  the  blood  from  cattle  affected  with 
rin(lerj>est,  causing  di.sea.ses  from  which  the  animals  die;  tlius  in  Egy])t 
in  1  !>();{  of  animals  which  had  been  inoculated  with  serum  obtained 
in  Constantinople  (25  cc),  and  virulent  blood  (1  cc),  SO-DO^o  died 
within  a  short  time,  and  the  losses  appeared  at  least  partially  to  be 
caused  l\v  a  piroplasmosis  which  resembled  the  East  African  coast 
fever.  The  existence  of  this  disease  in  Egypt  has  been  established 
])y  Koch  (he  therefore  reconunends  large  serum  doses  of  100  cc  to 
be  used  repeatedly  instead  of  the  simultaneous  inoculation).  Theiler 
also  observed  a  mortality  of  6.8%  among  452  cattle  in  South  Africa 
which  were  inoculated  by  the  sinuiltaneous  method.  In  cattle  coming 
from  localities  free  of  Texas  fever  (124  head),  for  which  a  possible 
piroplasma  infection  is  much  more  dangerous,  the  loss  amounted  to 
27.4%.  As  it  is  impossible  in  practice  to  exclude  the  blood  from  animals 
which  have  recovered  from  Texas  fever,  but  still  contain  in  their  blood 
])iropla.sms,  it  was  deemed  advisable  in  the  Transvaal  to  abstain  from 
the  simultaneous  inoculation,  and  serum  has  been  used  exclusively,  by 
which  means  an  eradication  of  rinderpest  was  accomplished  in  1903. 
AVoolley  rei>orts  a  case  in  which  all  of  the  56  cows  imported  from 
the  United  States  to  the  Philippines  died  after  the  simultaneous  inocula- 
tion, probably  from  piroplasmosis,  while  according  to  Nesom's  o})serva- 
tions,  in  the  Philippines,  the  otherwise  effective  simultaneous  inocula- 
tion causes  a  loss  of  4%  as  a  result  of  trypanosomiasis,  which  develops 
after  the  injection.  Spirillae,  or  the  virus  of  heart  water,  may  also  be 
the  cause  of  possible  bad  results  from  this  method. 

Veterinary  Police.  The  safest  prophylactic  measure  con- 
sists in  a  quarantine  against  countries  in  wliicli  rinderpest  pre- 
vails. Since  the  practical  application  of  this  principle  Western 
and  Central  Europe  have  been  freed  of  the  disease,  although 
the  plague  has  appeared  repeatedly  in  an  epizootic  form  in 
Russia  and  on  the  Balkan  Peninsula.  The  introduction  of  the 
disease  may  also  be  prevented  to  some  extent  by  establishing 
a  carefully  executed  registration  of  cattle  at  the  endangered 
l)orders  of  the  countries,  which  would  considerably  facilitate 
the  establishment  of  the  origin  of  the  disease,  if  it  has  been  in- 
troduced. 

If  the  disease  should  make  its  appearance  in  any  locality 
the  innnediate  slaughter  of  all  affected,  as  well  as  all  exposed 
animals,  together  with  tlie  thorough  disinfection  constitutes  the 
surest  method  for  its  eradication.  If  however  such  a  procedure 
cannot  be  executed  it  is  advisable  to  segregate  the  infected 
lierds  into  small  groups,  keeping  them  completely  isolated  under 
observation.     (According  to  Piot-Bey  better  results  were  ob- 


256  Kinderpest. 

tained  in  Egypt  with  this  method  than  from  serum  inocula- 
tions.) At  the  same  time  the  other  ruminants,  especially  sheep 
and  goats,  should  also  be  considered  as  carriers  of  the  virus. 
In  the  meantime  the  losses  in  infected  herds  may  be  diminished 
by  the  application  of  one  of  the  above-described  modes  of  im- 
munization and  in  neighboring  herds  the  animals  should  all 
be  given  serum  inoculations  thereby  producing  an  immune  zone 
around  the  infected  herds. 

Literature.  Dieckerhoff,  History  of  Einderpest  and  Its  Literature,  Berlin, 
1890.— Semnier,  B.  t.  W.,  1893,  590.— Koch,  Zbl.  f.  Bakt.,  1897,  XXI,  526;  Veroff. 
d.  G.-A.,  1904,  V,  681.— Kohlstock,  Ibid.,  1897,  XXII,  787.— Kolle,  Z.  f.  Hyg.,  1898, 
XXVII,  45;  Er^ebn.  d.  allg.  Path.,  1899,  VI,  470  (Lit.).— Kolle  &  Turner,  Z.  f. 
Hyg.,  1898,  XXIX,  309.— Theiler,  D.  t.  W.,  1898,  205;  Monh.,  1901,  XIII,  145.— 
Eogers,  Z.  f.  Hyg.,  1900,  XXXV,  59.— Nicolle  &  Adil-Bey,  A.  P.,  1899,  XIIT,  329; 
1902,  XVI,  56.— Blin  &  Carrougeau,  Bull.,  1902,  107.— Yersin,  A.  P.,  1904,  XVIII, 
417.— Hadieke,  B.  t.  W.,  1904,  823.— Arloing,  Journ.  de  med.  vet.,  1905,  LVI, 
385.— Holmes,  J.  of  conip.  Path.,  1905,  XVIII,  207.— Stockman,  Ibid.,  p.  207.— 
Head,  Ibid.,  1906,  XIX,  12.— Eassau,  Z.  f.  Infkr.,  1906,  I,  382.— Woolley,  Eev.  gen., 
1907,  X,  68.— Kowalewsky,  J.  vet.,  1908,  146.— Eiidiger.  D.  t.  W.,  1909,  400.— 
Eggebrecht,  Z.  f.   Infkr.,   1910,  VII,  54. 


Rinderpest  in  sheep  and  goats.  In  1861  Galambos  established 
with  certainty  a  disease  in  sheep  identical  with  rinderpest,  and  he 
succeeded  also  in  transmitting  it  artificially  to  sheep  (6  animals  in- 
oculated became  affected  on  the  10th  day).  Since  that  time  the  sus- 
ceptibility of  sheep  as  well  as  of  goats  has  been  confirmed  repeatedly, 
and  according  to  Roll  only  about  55%  of  these  animals  resist  artificial 
infection. 

Extensive  outbreaks  among  sheep  were  observed  in  1862  in  Poland, 
where  64-74%  of  the  flocks  became  affected  (Seifmann)  ;  in  1863  in 
Sicily,  where  20,000  sheep  and  goats  succumbed  to  the  disease  (Chicoli)  ; 
further  in  1870-1871  it  affected  the  sheep  in  France  and  Alsace-Lorraine, 
in  the  latter  provinces  causing  a  loss  of  4,000  animals  (Zundel). 

The  clinical  manifestations  consist  in  the  milder  forms,  in  fever, 
catarrh  of  the  conjunctivae  and  the  nasal  mucous  membranes,  accelerated 
respiration,  dry  cough,  and  passing  of  very  dry  feces.  In  severe  cases 
there  is  great  de])ility  and  apathy,  a  yellowish-white  discharge  from 
the  eyes  and  nose,  moist  cough  and  frequent  passage  of  thin,  greenish- 
brown  excrements  mixed  with  mucus. 

In  favorable  cases  the  patients  improve  very  rapidly  after  an 
illness  lasting  4-5  days,  while  in  severe  cases  death  ensues  in  the  same 
length  of  time.  The  mortality  in  sheep  and  goats  is  generally  smaller 
than  in  cattle,  rarely  exceeding  25-30%,  Tamilini  however  observed 
a  loss  of  75%. 

The  anatomical  changes  resem])le  those  in  cattle,  but  extensive 
pseudo-membranes  and  ulcerations  on  the  mucous  membranes  do  not 
usually  occur.  The  ordinary  changes  consist  in  a  hemorrhagic  inflam- 
mation of  the  mucous  membrane  of  abomasum  and  intestines,  with 
reddish-yellow,  loosely  adhering  deposits.  Similar  changes  are  also 
present  in  the  mucous  membrane  of  the  air  passages  and  in  the  bladder. 
There  is  also  anemia  of  the  lungs,  and  an  interstitial  emphysema 
(according  to  Roll  a  catarrhal  pneumonia  is  noted  with  relative  fre- 
quency). 

Literature.  Galambos,  Gyogyasyat,  1862,  Nr.  4. — Maresch,  O.  Vjschr.,  1863, 
XIX,  34. — Eoll,  Einderpestiihnl.*  Krankh.  d.  Schafe  u.  Ziegen.  Wien.,  1864. 


Heart  water.      Ilnj;  Clinlera.  25" 

Heartwater.  Aecordiufi;  to  Tlicih  r  m  discaso  of  cnlllo  occurs  in 
several  localilics  oi"  Transvaal,  which  is  known  thci-c  as  Vehlt-sickness. 
The  most  sti'ikinj;  symptom  of  the  disease  is  the  lillinj^  of  the  pericardium 
^vilh  a  colorless  or  yelloAvish  Huid  (hence  the  name  heartwater).  There 
is  also  a  pronounced  indication  of  acute  gastro-enteritis  present.  The; 
micro-organism  is,  according  to  Counsbury,  transmitted  from  the  af- 
fected to  tiie  healthy  aninuils,  by  a  tick  (Amblyoinma  hel)raeinn); 
sheep  and  goats  are  also  very  susceptible. 

The  same  disease  occurs  also  among  .sheep  and  goats,  and  may 
readily  be  ])roduced  by  the  subcutaneous  or  intravenous  injection  of 
blooil,  but  uot  of  the  pericardial  fluid.  The  transmission  may  be  made 
from  sheep  to  cattle,  and  vice  versa.  The  symptoms  develop  5-15  days 
after  the  injection,  and  consist  of  high  fever,  dullness,  exceptionally 
also  in  nervous  symptoms,  such  as  continuous  moving  of  the  tongue 
and  the  jaws,  turning  in  a  circle,  later  a  stiffness  of  the  neck  (hence 
the  name  "brainwater").  The  autopsy  reveals  a  gr(>at  (piantity  of 
Huid  in  the  pericardium  and  ])leural  cavity,  also  petechiae  on  the  peri- 
cardium, edema  of  the  lungs  and  moderate  acute  swelling  of  the  spleen. 

The  disease,  which  has  been  known  in  South  Africa  for  about 
40  years  occurs  only  in  certain  localities,  principally  during  the  summer 
time,  and  in  pastures  located  upon  high  lands.  The  Kaffir  goat  and 
the  native  fat-tailed  sheep  are  not  susceptible,  while  the  Persian  sheep 
are  only  slightly  susceptible  to  the  disease. 

Ilyperinnnunized  cattle,  sheep  and  goats  produce  an  effective 
serum  for  their  respective  species,  a  practical  immunization  however 
has  not  yet  been  established. 

The  supposition  of  Edington  that  the  disease  is  identical  with 
"horse-sickness"  is  considered  by  Theiler  as  incorrect,  as  horse-sickness 
can  be  transmitted  artificially  only  to  horses  (see  page  286). 

Aeeordiiifj  to  Ediugton's  view  the  disease  is  identical  with  the  African  horse- 
sickness  (see  that  disease).  Spreull  on  the  other  hand  contends  that  the  diseases 
of  cattle  occurring  in  South  Africa  under  the  names  Laniziekte,  Gall-sickness,  Veldt- 
sickness,  Blood-lung  and  Inapunga  are  identical  with  Heartwater,  and  he  considers 
their  causative  agent  to  lie  a  motile  bipolar  bacillus.  Clinically  he  distinguishes  an 
edematous  form,  with  swellings  on  the  neck  and  head,  a  thoracic  form  with  con- 
gestion and  hepati7ation  of  the  lungs,  and  a  paralytic  form  which  is  associate<l 
with  a  stiffness  of  the  gait. 

Literature.  Theiler,  The  A^et.  J.,  1904,  IX,  300;  The  transv.  agrie.  J.,  1904, 
IT,  16.3;  Bull.  Pasteur,  1905,  III,  617;  J.  of  comp.  Path.,  1905,  XVIII,  155.— Eding- 
ton, J.  of  comp.   Path.,  1904,  XVII,  141.— Spreull,  V.  J.,   1908,  358. 

11.    Hog  Cholera.    Pestis  suum. 

{Swine  fever,  Typhoid  fever;  Schiveinepest  [German^;  Clinlera 
suum,  Pesfe  clu  pore  [Fre^icli];  Peste  porciua  [Italian].) 

Ho^  cliolera  is  usually  an  acute,  sub-aoiite  or  chronic,  more 
rarely  a  peracute,  conta.s^ioiis,  infections  disease  of  hog-s,  caused 
by  a  filteral)le  virus.  In  the  course  of  the  disease,  with  the  excep- 
tion of  the  peracute  cases,  inflammatory  and  necrotic  processes 
develop,  produced  either  by  the  bacillus  suipestifer  when  the 
lesions  occur  in  the  intestinal  canal  and  in  the  abdominal  lymph 
glands,  or  by  the  bacillus  suisepticus  when  the  lesions  are  mani- 
fested in  the  lunofs. 


258  Hog  Chulera. 

History.  The  disease  has  been  recognized  in  their  studies  of 
American  diseases  of  hogs  by  Sahuon  &  Smith  (1885)  as  an  independent 
affection  (hog  cholera)  as  the  cause  of  which  they  designated  a  short 
motile  rod.  Based  on  these  findings  they  sharply  separated  the  disease 
from  swine  septicemia  (swine  plague),  considering  this  as  identical  with 
swine  plague  of  Germany,  which  was  recognized  just  about  that  time.  At 
the  same  time  they  proved  that  the  two  diseases  are  frequently  present 
in  one  and  the  same  animal,  and  that  the  severity  of  the  American 
outbreaks  is  brought  on  by  such  mixed  infections.  The  same  stand- 
point was  accepted  in  America  by  Moore  and  de  Schweinitz,  in  Europe 
by  Raccuglia  and  Aff'anasieff.  The  frequent  simultaneous  occurrence 
of  the  two  forms  of  diseases,  that  is  the  frequency  of  the  mixed  infec- 
tions, caused  Billings  in  America,  and  Silberschmidt  and  Voges  in 
Europe,  to  take  a  stand  against  the  identity  of  these  two  diseases  and 
their  supposed  causative  agent  (the  common  name  of  ''pneumonoenterite 
infectieuse"  used  in  France  and  England  corresponds  with  this  con- 
ception), while  Bang,  Schiitz,  Jensen  and  Preisz  (1898)  confirmed  the 
correctness  of  the  original  stand  of  Salmon  and  Smith. 

Through  the  experimental  investigations  of  the  last  decade  the  etiol- 
ogy of  the  disease  appears  to  have  been  definitely  established.  In  1904 
the  American  investigators  de  Schweinitz  &  Dorset  made  the  discovery 
that  a  disease  occurring  in  the  State  of  Iowa  which  clinically  resembled 
hog  cholera  was  transmissible  from  affected  animals  to  healthy  hogs 
by  filtered  bacteria-free  blood.  Soon  afterward  Dorset,  Bolton  and 
McBryde  proved  that  the  disease  was  identical  with  hog  cholera,  and 
therefore  that  this  disease  is  also  caused  by  a  filtrable  virus,  whereas 
the  formerly  supposed  causative  agent,  the  bacillus  suipestifer,  produces 
the  characteristic  changes  in  the  intestines  only  secondarily  in  the 
already  affected  animal.  Similar  results  were  also  obtained  in  Michigan 
almost  at  the  same  time  by  Boxmeyer  (1904),  while  Hutyra  (1906), 
then  the  Board's  Laboratory  of  England,  Ostertag  (1907),  as  well 
as  Uhlenhuth,  Xylander,  Hlibener  &  Bohtz  (1907),  later  Carre, 
Leclainche  &  Vallee,  also  Wassermann,  confirmed  the  correctness  of 
the  new  conception  of  the  disease  in  Europe  and  Theiler  in  South 
Africa.  At  the  same  time  the  views  concerning  the  part  of  the  bacillus 
suisepticus  in  the  production  of  the  secondary  affection  of  the  organs 
were  changed,  whereby  the  disease  formerly  considered  swine  plague, 
is  now  considered  in  most  cases  to  be  a  complication  of  hog  cholera. 

The  accurate  determination  of  its  etiology  directed  the  combating 
of  the  disease  into  new  lines,  and  the  attempts  at  immunization  by 
Dorset,  McBryde  and  Niles,  as  well  as  those  by  Uhlenhuth  and  his 
co-workers,  also  those  by  Hutyra,  have  given  valuable  practical  results. 

Occurrence.  Hog  cliolera  is  at  present  very  widely  spread 
in  America,  and  in  almost  every  European  country,  causing 
annually  great  losses  among  hogs.  The  disease,  wliicli  in 
itself  is  not  very  malignant,  becomes  very  fatal  as  a  result  of 
the  frequent,  secondary  inflammatory  processes  in  the  in- 
testines and  in  the  lungs,  wdiicli,  especially  in  young  animals, 
exist  in  an  epizootic  form.  It  causes  the  greatest  loss  in  places 
Avhere  hogs  are  kept  in  large  herds,  whereas  in  localities  with 
smaller  droves  the  disease  is  combated  with  better  success. 

Hog  cholera  is  supposed  to  have  first  appeared  in  North  America 
in  the  State  of  Ohio  in  1833,  and  from  there  it  spread  over  the  entire 


Occiuifiu'c.  250 

territory  of  llu'  riiitt<l  Slates.  li  was  ]^i-o])al)ly  can-icd  to  iMirope 
ill  tlic  go's  of  tilt'  last  ft'iitury.  Its  oci-urri'iicc  was  lirst  fstahlislicd 
ill  England  in  18(32  (swiiu'  fever,  typhoid  fever),  where  it  lias  since 
appeared  from  year  to  year,  causing  in  18!)G  the  loss  of  as  high  as 
307t)  of  all  hogs  in  the  country.  From  England  it  was  supposed  to 
have  been  spread  to  Sweden  in  1887,  with  an  importation  of  hoars, 
and  from  there  in  the  same  year  to  Deiiiiiai-k,  to  tlie  Island  of  Amagai-, 
and  from  tiiere  it  later  extended  to  other  localities  in  the  countiy.  At 
tlie  same  time  it  appeared  in  France  in  the  vicinity  of  IMarseillcs 
(it  is  supposed  as  a  result  of  an  iiiti-oduction  from  Algeria),  spi-eadiiig 
to  all  ])arts  of  this  country,  as  well  as  Sjiain  and  Italy. 

Rolotf  reported  in  18G6  in  Germany  the  occurrence  of  an  infec- 
tious "caseous  intestinal  inflammation"  in  young  hogs  of  English 
breed  in  the  Province  of  Saxony,  which  according  to  the  accurate  de- 
scription of  the  changes  in  the  caecum  and  colon  was  possibly  identical 
with  hog  cholei-a.  Hog  cholera  was  observed  in  18i);i  as  a  severe  fatal 
atl'ection  in  Poseii,  and  shortly  afterwards  in  Prussian-Silesia,  from 
which  country  it  has  bei'ii  disseminated  to  the  neighboring  territories 
of  Austria.  P^xteiuling  in  an  eastern  and  soutlieastern  direction  it 
reached  Hungary  in  1895,  where  it  first  made  its  appearance  in  the 
fattening  establishments  of  Kcilianya  and  Gyor,  causing  great  losses. 
At  the  occurrence  of  the  outbreak  at  Kobanya  of  the  180,000  animals 
8,368  died,  or  had  to  be  slaughtered  in  May;  10,288  in  June,  and  at 
the  end  of  that  year  with  the  exception  of  Siebenbiirgen,  all  counties 
were  infected.  In  the  following  year  the  disease  existed  throughout  the 
entire  country. 

In  Germany  during  the  period  of  ISOS-lOOf!  the  number  of  townships  infected 
with  hog  cholera  and  swine  plague  increased  from  1,817  to  ll,ol3,  ami  the  numljer 
of  the  affected  animals  from  11,813  to  104,728.  Subsequently  up  to  the  year  of 
1908  the  number  of  townshijJS  infected  diminished  to  8,782,  and  the  number  of 
cases  to  75,688.  The  total  loss  amounted  in  1908  to  60,101  hogs,  and  the  disease 
was  most  widely  spread  in  the  government  districts  of  Breslau,  Liegnitz,  Posen, 
Bromberg,  Potsdam,  Frankfurt,  and  Oppeln.  At  the  end  of  1907  there  were 
infected  1,339  townships,  and  86.6%  of  all  outbreaks  were  confined  to  Prussia. 

Hog  cholera  is  widely  spread  in  France,  and  all  parts  of  the  country  are 
infected  with  the  disease.  in  1908  from  13  to  20  districts  were  said  to  be 
infected  during  different  months;   however  the  reports  are  not  accurate. 

For  a  time  the  disease  has  greatly  diminished  in  Great  Britain,  as  a  result 
of  the  measures  of  eradication  which  were  inaugurated  in  1893.  While  in  1S94 
5,862  outbreaks  were  established  in  73  counties,  in  1905  only  817  outbreaks  occurred 
in  58  counties.  In  1894  to  1896  the  number  of  hogs,  which  were  excluded  from 
traffic  on  account  of  the  disease  or  on  suspicion,  amounted  to  56,296,  69,931 
and  79,586,  while  in  the  year  190.")  only  3,876  animals  were  affected  by  this 
measure.  In  1906  the  disease  spread  again  more  extensively,  and  in  1908  there 
occurred  2,067  outbreaks  in  68  counties,  and  14,096  affected  or  suspected  hogs 
were  slaughtered. 

The  disease  diminished  in  Austria  as  a  result  of  regulations  passed  in  1895, 
and  consequently  from  1896  to  1898  a  gradual  decrease  in  the  number  of  outbreaks 
resulted;  later  however  it  again  spread  to  a  considerable  extent.  In  1895,  2,767 
outbreaks  with  28,142  affected  animals  were  recorded;  in  1898,  654  outbreaks  with 
4,610  affected  animals;  an<l  in  1900,  1,100  localities  with  35,984  affections.  In 
1908  the  weekly  number  of  outbreaks  fluctuated  between  104  and  208.  The  disease 
was  most  extensive  in  Galieia,  Bohemia,  Moravia  and  Lower  Austria,  while  Dalmatia 
was  free  from  it. 

in  Hungary  in  the  first  year  (1895)  after  the  appearance  of  the  affection 
1,478  and  in  the  following  year  3,569  townships,  with  413,562  and  868,777  animals, 
were  affected.  From  this  time  on  the  disease  gradually  diminished,  but  even  in 
1908  2.200  townships  were  noted,  with  263,945  cases,  of  which  148,110  (56.8%) 
died  (in  the  first  2  years  the  mortality  amounte<i  to  81.4%  and  73.6%).  The 
disea,se  is  most  widely  spread  in  the  section  south  of  the  Tisi'a  and  Danube  rivers. 

Of  other   countries   the   disease   was  discovered   in    1908   in   Bulgaria,   affecting 


260 


Hoo'  Cholera. 


73  townships,  in  Italy  14,499,  in  Roinnania  1,829,  in  Eussia  27,223,  in  Servia  45 
cases,  while  in  Denmark  and  in  Hollantl  the  disease  appealed  less  frequently,  in 
Sweden  and  Norway  (in  19(13  468  cases,  of  which  450  occurred  in  Dep.  Akershus) 
only  sporadically. 

In  the  United  States  the  disease  (hog  cholera  and  swine  plague)  caused 
in  the  year  of  1873  losses  amounting  to  20  million,  in  1882  13  million,  in  1884 
and  1885  25  and  30  million  dollars  respectively,  while  in  1888  the  loss  was  estimated 
to  have  affected  45,000,000  hogs  of  a  value  of  200  million  dollars,  and  in  1903 
Salmon  estimated  the  loss  at  50  million  dollars. 

Etiology.  According  to  the  results  of  investigations  by 
Dorset  and  his  co-workers  which,  as  already  mentioned,  have 
since  l)een  substantiated  by  other  investigators,  hog  cholera  is 
caused  by  an  ultra-microscopic  virus,  which  passes  the  ordinary 
porcelain  filter.  Attempts  at  cultivation,  or  even  increasing  the 
amount  of  virus  have  up  to  the  present  iDeen  fruitless. 

Pathogenicity.  Subcutaneous  injections  of  1-2  cc.  of  filtered, 
defibrinated  blood,  blood  serum  or  organ  juices,  produce  in 
young  hogs,  after  an  average  incubation  period  of  8  to  10  days, 
sometimes  however  in  four  days  or  only  after  20  days,  and 
without  any  local  reaction,  an  acute  febrile  affection  with  inflam- 


Fig.  45.     Ho(]  Cholera.     Artificial  infection  with  filtered  material  from  a  hog  affected 

with  cholera.     Tlie  first  rise  ii]i  to  tlie  fourth  day  of  sickness  is  caused  by  the  primary 

infection,  tlie  second  by  the  secondary  infection. 

matory  swelling  of  the  conjunctivae,  eczematous  eruption  of  the 
skin,  followed  by  diarrhea  (Fig.  45;  the  quantity  of  blood  does 
not  aifect  the  outcome  of  the  disease).  In  some  of  the  cases 
the  animals  die  in  3  to  4  days  with  an  acute  affection,  whereupon 
the  autopsy  reveals  exclusively  hyperemia  and  acute  swelling 
of  the  internal  organs,  as  well  as  hemorrhages  on  the  serous  and 
mucous  membranes  (sometimes  also  a  great  quantity  of  serous 
transudate  in  the  pericardium).  If  the  animals  remain  alive 
for  a  longer  time  ulcerative  and  necrotic  processes  may  be  found 
in  the  intestines,  in  other  cases  again  pneumonic  changes 
will  be  observed  which  are  similar  to  those  found  in  the  acute 
pure  swine  plague.  If  the  animals  remain  alive  still  longer  the 
affection  of  the  intestines  and  the  lungs  develops  in  a  more 
chronic  form,  whereupon  the  animals  die  greatly  emaciated, 


I';illi(ii;ciiicit  V. 


L'Ol 


or  recover  oomplololy.  Such  rocovcrod  animals  avo  snhsoqnciitly 
imiiiuiie  ai;aiiist  aititicial,  as  well  as  against  natural  infection. 

Animals  artiiicially  infected  in  the  above  manner  may 
readily  transmit  the  disease  to  healthy  hogs  by  cohabitation, 
and  their  blood  e\'en  in  a  filtered  condition,  and  in  small  (pian- 
tities,  is  also  infections.  ]^y  serial  re-inocnlations  the  virus  may 
be  propagated  from  generation  to  generation. 

The  artificial  affection  is,  although  with  less  certainty,  also 
successful,  by  the  administration  of  l)lood  and  blood  serum  in 
gelatine  capsules  per  os,  or  by  feeding  the  same  with  food,  when 
unfiltered  material  acts  more  strongly  than  filtered.  The  virus 
is  as  a  rule  also  present  in  the  bile  and  the  urine,  while  the  intes- 
tinal contents  freipiently  prove  noninfectious  (Uhlenhuth).  By 
feeding  internal  organs  of  diseased  hogs  the  disease  may  readily 
be  produced  artificially.  Other  species  of  animals  aside  fioni 
the  hog  are  not  susceptible  to  the  virus. 

Tenacity.  Fluid  material  ooiitaiuiiifr  tlie  virus  retains  its  vinileiice  at  room 
temiierature  for  10  to  14  weeks.  Heatiiiff  for  one  lionr  at  GO  to  70°('.  destroys 
the  viniSj  wliile  in  the  <iried  condition  subjected  to  72  to  7(>°  it  requires  an  hour 
to  flestroy  its  virulence.  Blooil  frozen  below  — 1S°  and  thawed  out  after  24 
hours,  proved  fully  virulent,  likewise  blood  which  had  been  dried  for  three  days. 
The  addition  of  a  1:1000  corrosive  sublimate  solution  in  the  proportion  of  1  to 
2,  or  of  a  5%  glycerine-carbolic  acid  solution  in  the  ])ro])ortion  of  2:5  does  not 
destroy  the  virus  inside  of  <S  days;  on  the  other  hand  the  virus  in  serum  is  rendered 
ineffective  liy  the  addition  of  2%  formalin  in  la  days,  by  2.5%  antiformin  in 
2  hours.  The  virus  in  old  i)utrefled  organs  loses  its  virulence  in  eight  davs 
(Uhlenhuth). 

Besides  the  filtrable  virus,  two  species  of  bacteria,  the 
bacillus  suipestifer  and  the  bacillus  suisepticus,  play  an  imy)or- 
tant  part  in  tlie  etiology  of  liog  cholera.     The  secondary  aifec- 


Fig.  46.  lidcilliifi  siiiprstifrr.  Agar  cul- 
ture, tiK'hsin  staining. 


47.    Jiacilhifi  siiipcftiifer.  with  fla- 
gella.     Agiir  culture. 


tions  of  the  intestines  and  of  the  lymph  glands  or  of  the  lungs 
are  usually  produced  by  the  pathogenic  action  of  these  bacteria. 

1.  The  bacillus  suipestifer  (Bac.  cholerae  suis)  resembles 
the  colon  bacillus  and  belongs  to  the  paratyphus  B-group.  It 
is  motile,  possessing  peritrically  arranged  (3-9)  flagellae,  and 
multiplies  exclusively  by  fission  (Fig.  46  and  47).     In  tissues 


262 


HoEf  Cholera. 


it  occurs  singly  or  in  pairs,  in  cultures  however  it  also  forms 
longer  chains  or  even  slightly  curved  filaments. 

Staining.  With  aiiiieous  aniline  dyes  the  organism  usually  stains 
uniformly,  sometimes,  however  when  stained  with  diluted  methylene 
blue  solution,  it  may  stain  more  intensively  on  the  poles.  It  does  not 
stain  by  Gram's  method. 

Cultivation.  The  l)aeillus  groAvs  aerobically  as  well  as 
anaerohically  on  all  artificial  media,  in  room  temperature 
as  well  as  body  temperature ;  in  the  latter  however  con- 
siderably faster  (the  temperature  limits  are  according  to 
Frosch  -)-8  and  4-42°C.).  On  gelatin  plates  bluish,  trans- 
parent, uniformly  rounded  colonies  de- 
velop, while  in  stab  cultures  a  continuous 
grayish-white  streak  forms  along  the  stab, 
surrounding  which  the  nutritive  medium 
is  sometimes  turbid.  Gelatin  is  not  lique- 
fied (Fig.  48).  On  agar  bluish,  trans- 
parent, fiat,  round  colonies  develop  which 
do  not  closely  adhere  (Fig.  49)  ;  the  growth 
on  coagulated  blood  serum  is  similar.  On 
Loffler's  malachite-green  plates,  and  on 
endo-plates,  colorless  colonies  form,  while 
on  Drigalski's  plates  the  colonies  are  blu- 
ish. Peptone  bouillon  becomes  uniformly 
cloudy,  later  a  loose  sediment  settles  on 
the  bottom  of  the  tube ;  indol  does  not 
form  in  the  cultures.  On  potatoes  a  color- 
less, moist,  lustrous,  or  a  brownish-yellow 
I  deposit  forms  (the  variance  is  probably 
due  to  the  different  kinds  of  potatoes). 
Milk  becomes  grayish,  in  3  to  4  weeks  sa- 
ponified, and  still  later  it  is  changed  to  a 
stiff,  alkaline  .jelly.  Litmus  milk  is  some- 
what reddened,  but  after  2  to  4  days  it  be- 
comes decidedly  bluish.  Dextrose  is  fer- 
mented by  the  bacillus,  lactose  on  the  other 
hand  is  not. 

Tenacity.  The  cholera  bacillus  withstands 
simple  drying  for  four  months,  but  in  the  in- 
Fig.  48.  Four  Aucnce  of  sunlight  and  by  alternate  drying  and 
day  old  gelatin  moistening  it  is  quickly  killed.  In  ordinary  drink- 
stab  cultnie  of  "^S'  water,  also  in  soil  infected  with  feces  of 
the  bacillus  affected  animals,  it  retains  its  virulence  for  65 
suipestifcr.  \^  ^^  t^ays,  while  a  temperature  of  50°  destroys  it 
in  66  hours,  and  one  of  55°  in  one  hour  (Preisz). 
Of  the  disinfectants  the  growth  of  the  bacillus  in  inhibited  by  1:4000  sulphuric 
acid,  1:900  potassium  hydrate;  it  is  ilestroyed  in  one  minute  by  a  1%  carbolic  acid, 
solution,  1:10,000  corrosive  sublimate,  1%  creolin,  in  10  niiuntes  by  1%  milk 
of  lime,  in  three  minutes  by  a  1%  copper  sulphate  solution,  in  ILj  minutes  by  0.1% 
formalin  solution,  and  in  three  hours  by  a  2%  iron  suli)hate  solution  (Koppanyi  & 
Erdos).  The  bacillus  suipestifer  is  considerably  more  resistant  than  the  liacillus 
suisepticus. 

Pathogenicity.  Mice  are  susceptible  to  artificial  infections, 
and  after  an  inoculation  with  0.1  mg.  of  bouillon  culture  they  die 
of  septicemia  in  from  3  to  5  days.     The  guinea  pig  and  rabbit 


Fig.  49.  Two- 
day  old  agar 
culture  of  the 
bacillus  s u i~ 
pestifer. 


I'atliuuc'iiii-ity.      Natural  Jii t'ection.  '         263 

are  less  susceptible  (after  a  successful  subcutaneous  infection 
they  die  in  G  to  7  days;  showing  enlarged  spleen  and  necrotic 
foci  in  the  liver).  Pigeons  are  only  very  slightly  susceptible 
(muscle  necrosis  develops  after  an  intra-muscular  infection), 
Avhile  chickens  are  not  susceptible.  If  the  culture  is  injected 
into  the  caecum  of  a  rabbit,  small  white  dots  at  first  develop  on 
the  mucous  membrane  (swollen  hmpli  follicles);  later  ulcers 
appear  in  sizes  up  to  a  lentil. 

By  feeding  large  quantities  of  cultures  or  injecting  cultures 
into  the  intestines  of  hogs,  either  acute  or  more  chronic  infl.im- 
matory  and  necrotic  processes  develop,  in  some  cases  according 
to  the  intensity  of  the  infection  (dysenteric  necrosis  and  ulcera- 
tions on  the  intestinal  mucous  membrane,  swelling  and  caseation 
of  the  Ivniph  glands,  etc.).  After  previous  starvation  or  neu- 
tralization of  the  hydrochloric  acid  of  the  stomach,  the  disease 
results  in  a  much  more  acute  and  severe  form,  and  the  animal 
may  die  on  the  third  day  with  symptoms  of  septicemia  (Salmon 
&  Smith).  The  subcutaneous  injection  of  the  culture  results 
in  an  inflammation  of  the  neighboring  h^npll  vessels  and  lymph 
glands,  leading  to  necrosis,  and  the  animals  die  in  from  2  to  3 
weeks,  or  even  later.  In  some  of  the  cases  ulcerations  develop 
in  the  meanwhile  on  the  intestinal  wall,  and  metastatic,  caseous 
areas  appear  in  various  internal  organs.  Intravenous  injec- 
tions may  result  in  a  hemorrhagic  septicemia  producing  death 
in  1  to  3  days.    The  infection  cannot  be  produced  by  inhalation. 

Contrary  to  the  infection  produced  by  virulent  blood,  hogs 
which  are  infected  with  pure  cultures  of  the  bacillus  suipestifer 
do  not  transmit  the  disease  to  healthy  hogs,  and  if  they  recover 
they  continue  to  be  susceptible  to  natural  infection. 

2.  The  bacillus  suisepticus  is  in  every  particular  identical 
with  the  organism  of  pure  swine  plagiie  (see  p.  125). 

Natural  infection  results  apparently  from  the  digestive  tract 
and  appears  to  be  transmitted  especially  by  the  strongly  viru- 
lent urine  of  affected  animals,  while  the  excrements  are  fre- 
quently only  slightly  or  not  at  all  virulent,  and  therefore  play 
a  less  important  part  in  the  transmission  of  the  disease.  In 
piggeries  of  localities  which  were  previously  free  of  the  disease 
it  always  results  from  an  introduction  from  the  outside,  while 
in  already  infected  premises  and  stables  the  affection  may  re- 
peatedly appear  without  a  new  introduction,  as  the  virus  retains 
its  viriilence  for  a  long  time  outside  of  the  animal  body,  in 
fluids  as  well  as  in  a  dry  material.  This  is  proved  by  the  fact 
that  the  disease  which  was  formerly  unknown  in  Europe  spread 
in  the  course  of  the  last  decade  along  the  road  of  swine  traffic, 
and  then  remained  permanently  in  the  infected  countries,  caus- 
ing severe  losses  from  year  to  year. 

The  very  extensive  traffic  in  hogs  which  exists  everywhere 
and  which  is  difficult  to  control,  is  generally  the  most  effective 
disseminator  of  the  disease,  and  in  this  the  hog  markets,  the 


2G4  ^^S  Cholera. 

stock  dealers,  castrators  and  wandering  gypsies  (the  latter  by 
taking  with  them  the  hog  carcasses  and  throwing  the  viscera 
abont  in  different  pastures)  contribute  materially  to  the  spread 
of  the  contagion. 

In  herds  of  hogs  which  have  been  healthy  the  disease  is  in 
most  cases  introduced  by  sick  animals,  and  not  alone  by  those 
in  which  acute  sj^mptoms  may  be  detected,  but  also  through  the 
so-called  runts  in  whose  bodies  the  filterable  virus  may  also  be 
concealed.  Infection  may  also  occur  during  the  pasturing  of 
the  animals,  in  the  piggeries,  during  driving  on  highways  or 
transportation  in  railroad  cars,  which  have  been  contaminated 
by  the  excrements  of  affected  animals  days  or  weeks  previously. 
The  contagion  may  be  spread  from  one  locality  to  the  other 
by  flowing  water,  into  which  carcasses  of  hogs  have  been  thrown, 
and  carcasses  which  have  been  left  in  pastures  or  which  have 
not  been  buried  satisfactorily  may  also  occasionally  be  the  cause 
of  an  outbreak  of  the  disease. 

Although  hogs  of  all  breeds  and  of  any  age  may  become 
affected  with  hog  cholera,  the  higher  bred  stock  and  young  hogs 
are  much  more  susceptible  to  the  disease.  Sucking  pigs  become 
affected  only  very  exceptionally,  and  as  a  rule  the  influence  of 
age  is  especially  marked  in  localities  in  which  the  disease  has 
existed  for  a  long  time.  Thus  during  the  first  years  of  the 
existence  of  the  disease  in  Hungary  the  older  hogs  became 
affected  quite  frequently,  while  since  that  time  the  disease  is 
confined  more  and  more  to  younger  animals.  The  greater 
resistance  of  the  older  animals  in  infected  localities  is  in  all 
probability  due  to  the  fact  that  they  passed  through  a  mild  form 
of  the  disease  while  young. 

Pathogenesis.  According  to  the  most  recent  experimental 
investigations  the  disease  is  without  a  doubt  caused  by  a  fil- 
terable hog  cholera  virus,  which  enters  the  body  fluids  and  multi- 
plies there.  It  causes  directly  a  febrile  condition,  with  acute 
catarrh  of  the  mucous  membrane,  and  in  case  of  a  severe  infec- 
tion death  results  with  manifestations  of  hemorrhagic  septi- 
cemia. In  the  great  majority  of  cases  however  secondary  inflam- 
matory changes  of  different  organs  may  become  associated  with 
the  general  blood  infection.  Such  secondary  changes  occur  espe- 
cially in  the  pharynx,  stomach  and  intestines,  in  the  correspond- 
ing lymph  glands  and  in  the  lungs,  being  caused  without  a  doubt 
by  the  bacillus  suipestifer  or  the  bacillus  suisepticus.  The 
etiological  part  of  these  organisms  came  into  the  proper  light 
only  after  the  virulence  of  the  filtered  blood  of  affected  animals 
had  been  established. 

Contrary  to  the  former  conception  by  wdiicli  the  bacillus 
suipestifer  was  considered  as  the  original  and  true  cause  of  the 
disease,  there  now  exists  hardly  any  donlit  that  it  participates 
only  in  a  secondary  manner,  yet  though  it  is  only  granted  an 
inferior  part  in  the  transmission  of  the  disease  it  is  very  active, 


Patli.)t^vii(.'sis.  265 

and  lias  a  i^rcat  share  in  the  (l('\('loi)iM('iit  ol'  tlic  or<>'anic  afl'ec- 
tioiis  which  develop  in  association  with  the  primary  at't'ection. 
According-  to  Dorset,  JMcBryde  antl  Bolton  the  following  factors 
proved  that  this  organism  is  not  the  primary  cause  of  hog 
cholera:  1.  The  artilicial  transmission  of  the  disease  can  be 
much  more  readily  affected  by  bh)od  from  an  affected  animal, 
than  by  subcutaneous  injection  of  pure  cultures  of  the  bacillus 
suipestifer.  2.  Hogs  which  were  affected  either  by  natural 
infection  or  by  subcutaneous  injections  with  virulent  blood 
transmit  the  disease  very  readily  to  healthy  animals,  whereas 
animals  which  were  infected  with  cultures  of  bacilli  do  not  infect 
healthy  hogs.  3.  Blood  from  hogs  which  have  been  infected  with 
blood,  ])roves  virulent  by  subcutaneous  injection,  while  the  blood 
from  hogs  infected  with  cultures  of  the  bacilli  is  harndess  for 
healthy  animals.  4.  Recovery  from  the  natural  or  the  artificially 
produced  disease  confers  a  lasting  innnnnity,  whereas  hogs  inoc- 
ulated with  the  bacillus  suipestifer  continue  to  be  susceptible  to 
the  natural  infection. 

Besides  those  considerations  it  should  also  be  noted  that  the  bacillus 
suipestifer  cannot  ])e  demonstrated  ])acteriologically  in  all  cases  of  true 
hog  cholera.  Thus  Uhlenhuth  found  the  organism  only  in  76  out 
of  178  affected  hogs,  while  in  the  other  cases  in  seven  so  called  varieties 
of  this  organism  (some  of  which  do  not  ferment  dextrose)  three  times 
varieties  resembling  the  paratyphus  A-Group,  once  the  bacillus  en- 
teritidis  Gartner,  50  times  the  bacillus  pyocyaneus,  36  times  streptococci, 
27  times  staphylococci,  and  110  times  colon  bacilli,  were  isolated  from 
the  organs;  while  in  14  cases  the  organs  proved  sterile.  In  some  of 
the  outbreaks  the  bacillus  appears  to  occur  only  rarely,  as  Boxmeyer 
in  Michigan  and  Theiler  in  South  Africa  failed  to  demonstrate  the 
bacillus  in  typically  affected  hogs.  These  findings  make  it  probable 
"that  in  different  localities  various  bacteria,  especially  of  the  paratyphus 
B,  or  of  the  hog  cholera  group,  may  produce  the  usual  changes  in  the 
intestines  found  in  hog  cholera. 

According  to  views  accepted  at  the  present  time  the  bacillus 
suipestifer  forms  a  group  in  common  with  the  bacillus  paratyphi  B 
and  Bac.  botulinus,  which  are  pathogenic  for  man,  also  including  the 
mice  typhus  and  the  psitticosis  bacillus,  as  well  as  the  Bae.  Sanarelli. 
This  group  is  designated  as  the  hog  cholera,  or  the  paratyphus  B-Group, 
and  the  various  organisms  of  this  group  cannot  be  distinguished  from 
each  other,  either  by  their  morphologic  and  culture  characteristics,  or 
by  sero-diagnostic  methods  (agglutination).  The  only  distinguishing 
signs  consist,  excepting  when  their  origin  may  lie  demonstrated,  in 
certain,  not  constant,  and  therefore  not  characteristic  pathogenic  prop- 
erties. The  very  close  relation  which  almost  borders  on  identity,  would 
ex])lain  in  hogs,  for  instance,  why  it  is  that  various  representatives 
of  this  group  may  produce  very  similar  pathological  changes,  and 
attain  pathogenic  properties  for  man  (this  theoretical  possibility  has 
net  yet  been  proven  for  the  true  suipestifer  bacillus).  Bang  and  Th. 
Smith,  also  Uhlenhuth  and  his  co-workers  cultivated  strains  of  the 
bacillus  suipestifer  from  hog  cholera  pigs,  which  showed  certain 
deviations  from  the  common  type,  and  therefore  are  considered  as 
varieties  (some  strains  produce  no  gas  in  dextrose,  others  coagulate 
milk,   and   Smith   &  ^Ntoore  even  descrilied   a   non-motile  variety). 


266  Hog  Cholera. 

Against  the  idea  that  the  bacillus  suipestifer  is  the  primary  virus 
of  hog  cholera  are  the  experimental  observations  of  Uhlenhuth  and  his 
co-workers,  who  found  that  virus  which  was  treated  for  one  hour  with 
2.5%  antiformin  still  proved  virulent,  while  cultui'es  of  the  bacillus 
suipestifer  lost  their  pathogenic  action  even  for  the  very  susceptible 
rabbit,  after  being  subjected  to  such  a  solution  from  30  to  40  minutes, 
the  organism  being  readily  dissolved  by  the  antiformin.  A  similar 
difference  is  also  shown  to  exist  by  the  fact  that  the  hog  cholera  virus 
is  destroyed  by  shaking  with  a  10%  uric  acid  only  in  four  days 
(Marxer),  whereas  the  bacillus  suipestifer  is  killed  in  23  hours 
(Stilling)  ;  the  observation  that  the  bacillus  suipestifer  agglutinates 
the  serum  from  hogs  affected  with  acute  cholera  in  dilutions  of  only 
1:5-20  (Uhlenhuth),  whereas  in  animals  artificially  infected  with  this 
bacillus  the  agglutination  takes  place  in  higher  dilutions  (1:1000  and 
over)  should  also  be  noted.  Moreover  in  virulent  hog  cholera  serum 
there  are  no  opsonins  or  bacteriotropins,  which  have  an  influence  on 
the  bacillus  suipestifer  (Broil). 

Eecently  (1907)  Loureus  took  a  stand  relative  to  the  importance  of  the  bacillus 
suipestifer  as  the  primary  cause  of  hog  cholera,  when  he  proved  that  this  bacillus 
passes  through  the  porcelain  filter  in  a  granular  form,  and  that  it  may  later 
multiply  in  the  filtrate.  Filtrates  containing  bacilli,  however,  produce  inflammatory 
changes  at  the  place  of  injection,  and  since  the  disease  always  develops  in  one 
to  two  days,  Lourens '  findings  are  in  no  way  sufiicieut  to  weaken  the  importance 
of  the  results  obtained  with  fresh  blood  and  filtrates  of  organs,  or  to  shake  general 
belief  in  the  correctness  of  recent  discoveries.  Moreover  McBryde  found  recently 
that  the  bacillus  suipestifer  may  pass  through  some  of  the  Berkefeld  filters,  but 
not  Chamberland  B  and  F,  which  however  allow  the  hog   cholera  virus  to  pass. 

The  same  applies  to  the  theory  of  Schreiber,  according  to  which  the  blood  of 
hogs  affected  with  hog  cholera  supports,  through  the  agressins  which  it  contains, 
the  pathogenic  action  of  the  Ijacilliis  suipestifer,  or  mobilizes  the  same,  the  bacillus 
being  a  frequent  habitant  of  the  intestines  of  hogs.  This  theory  stands  in  contra- 
diction to  the  fact  that  even  small  quantities  of  blood,  and  especially  from  hogs 
which  have  not  yet  <leveloped  intestinal  changes,  produce  the  disease,  and  further 
that  artificial  infection  may  also  result  from  feeding  such  blood,  and  that  antiformin- 
blood  mixtures  prove  effective,  in  spite  of  the  fact  that  the  endotoxins  of  the 
bacillus  suipestifer  are  destroyed  by  this  product. 

The  view  that  the  bacillus  suipestifer  plays  only  a  secondary  part 
in  the  etiology  of  hog  cholera  is  further  substantiated  by  the  discovery 
that  bacilli  which  morphologically,  culturally,  and  biologically  corres- 
pond to  the  bacillus  suipestifer  not  infrequently  occur  in  the  intestines 
of  entirely  healthy  hogs;  thus  Garbert  succeeded  in  demonstrating  such 
in  seven  out  of  23,  Uhlenhuth  in  8.4%  of  600  healthy  hogs.  Similar 
results  are  also  reported  by  IMorgan  from  England,  Gardenghi  from 
Italy,  and  Velzen  from  Holland.  Furthermore  Titze  &  Weichel  found 
organisms  in  the  intestinal  contents  of  calves  affected  with  white  scour, 
w^iicli  absolutely  corresponded  to  hog  cholera  bacilli,  and  also  in  one 
healthy  calf. 

The  facts  mentioned  here,  as  well  as  the  experimental 
observation  that  lio^s  which  were  inoculated  with  the  Rltrable 
virus  develop  intestinal  changes  caused  by  the  bacillus  suipes- 
tifer, lead  to  the  belief  that  the  bacillus  suipestifer  being  a 
frequent  normal  habitant  of  hog  intestines,  penetrates  into  the 
tissues  injured  by  the  filtrable  cholera  virus,  and  exerts  in  the 
same  its  pathogenic  properties. 


PaUioiji'iiesis.  2G7 

A  similar  \  iuw  woiihl  proltabiy  also  apply  to  the  })art  of  tlio 
bacillus  siiisc'pticus.  Ovoid  bacteria  whicli  correspond  in  all 
their  eliarat'teristics  to  these  ori^aiiisms  occur  as  saprophytes 
ill  healthy  hoi-s  (see  ]).  \'2\)).  Animals  which  have  ])eeu  injected 
subciitaiieoiisly  with  liltered  cholera  blood  frequently  develo]) 
acute,  iibrinous,  catarrhal  or  necrotic  pneumonia,  in  which  the 
ovoid  bacteria  are  present  in  great  numbers. 

These  lindiiius  can  be  explained  satisfactorily  only  by  con- 
sidering that  the  bacillus  suisepticus,  like  the  l)acillus  suipes- 
tifer,  tiiids  favorable  conditions  for  its  propagation  in  the  body 
affected  by  the  cholera  virus,  and  thereby  exerts  its  pathogenic 
action  in  the  ])roduction  of  a  multiple  necrotic  pneumonia. 
From  case  to  case  one  or  the  other  of  these  bacilli,  and  fre- 
quently both  at  the  same  time  or  following  each  other,  may 
become  conspicuous  in  the  pathological  changes. 

Therefore  in  association  with  the  primary  cholera  infection 
there  may  be  not  only  the  characteristic  anatomical  changes  of 
hog  cholera  present,  but  also  those  of  swine  plague;  thus  not 
only  the  anatomical  hog  cholera,  but  also  the  anatomical  swine 
plague  as  it  occurs  in  outbreaks  of  cholera,  either  in  association 
with  the  former,  or  alone,  is  primarily  brought  on  by  the  filtera- 
ble cholera  virus.  In  all  of  these  cases  only  one  disease  comes 
into  consideration,  and  that  is  hog  cholera,  which  however  mani- 
fests itself  in  various  clinical  and  anatomical  pictures,  depending 
on  the  secondary  infection,  namely  either  as  a  pure  septicemia, 
as  hog  cholera  or  as  pure  swine  plague,  or  the  changes  may  indi- 
cate a  mixed  infection  with  the  last  two  forms.  Accordingly  a 
septicemic,  a  pectoral  and  a  mixed  form  of  hog  cholera  may  l)e 
distinguished.  It  should  however  be  distinctly  understood  that 
the  intestinal  and  the  pectoral  changes  in  the  organs  are  only 
secondary  complications,  and  that  strictly  they  should  not  be 
considered  as  belonging  to  the  manifestations  of  hog  cholera. 

Contrary  to  the  ahove-aeseriijed  views  relative  to  the  secondary 
action  of  the  bacillus  suisepticus,  Ostertag  contends  that  pure  swine 
plague  may  occur  as  an  independent  acute  disease  even  under  favoral)le 
hygienic  conditions,  infecting  old,  as  well  as  young  animals,  and  causing 
losses  amounting  to  75%.  He  further  claims  that  chronic  swine  plague 
is  directly  connected  with  the  acute,  destructive,  classical  swine  plague. 
He  bases  this  view  mainly  on  the  observation  that  the  acute  form 
may  pass  into  chronic,  and  as  such  may  again  introduce  the  acute 
fatal  form,  and  that  with  the  material  of  both  forms,  either  of  the 
forms  may  he  alternately  produced  (see  also  p.  128). 

On  the  other  hand  Uldenhuth  and  his  co-workers  perfectly  agree 
with  the  view  of  Hutyra.  Tiiey  found  that  pigs  infected  with  filtrated 
blood  frequently  develop  a  pleiiro-pneuinonia,  and  that  the  treatment 
of  pigs  with  imunnie  scrum  protects  them  also  against  a  secondary 
pneumonia.  They  therefore  emphasize  the  suggestion  that  changes 
in  the  lungs  belong  to  the  accompanying  hog  cholera  symptoms,  and 
therefore  are  to  he  considered  as  symptoms  of  the  disease.  Therefore 
the  so  called  pure  cases  of  swine  plague  in  outbreaks  of  cholera  should 
be  considered  as  cholera  infections,  and  the  previously  considered  mixed 


268  Hog  Cholera. 

forms,  that  is  the  cases  which  were  heretofore  considered  as  results 
of  two  entirely  different  infectious  diseases,  are  etiologically  due  to 
one  primary  cause,  namely  to  the  infection  of  the  body  by  the  cholera 
virus. 

At  the  present  time  it  cannot  even  be  imagined  in  what  w'ay  the 
filterable  virus  exerts  its  pathogenic  action;  on  the  other  hand  the 
pathogenicity  of  the  bacillus  suipestifer  and  the  bacillus  suisepticus 
is  quite  well  understood.  Eegarding  the  first  one  it  must  be  accepted 
that  as  a  rule  it  penetrates  into  the  follicles  of  the  already  catarrhal 
intestinal  mucous  membrane,  where  it  produces  a  cellular  infiltration 
of  the  follicles,  with  which  a  necrosis  of  the  tissues  soon  becomes 
associated.  In  this  manner  nodules  first  develop,  then  small,  deep 
round  ulcerations  covered  with  caseous  material,  which  gradually 
become  larger.  At  the  same  time  usually,  but  in  some  instances  quite 
independently,  a  necrosis  of  the  epithelium  and  of  the  superficial  layers 
of  the  mucous  membrane  results  from  the  immigration  of  the  bacilli 
into  the  l.ymph  spaces  of  the  mucous  membrane,  whereupon  diphtheritic 
or  croupous  inflannuation  results.  Such  deposits  also  develop  very  fre- 
quently on  the  mucous  membrane  of  the  stomacli,  and  of  the  pharynx. 

From  the  intestinal  wall  the  bacilli  pass  through  the  lymph  vessels 
into  the  mesenteric  lymph  glands,  where  they  produce  a  cellular  infiltra- 
tion, and  consequently  a  tissue  necrosis,  as  a  result  of  which  dry  caseous 
areas  develop  in  the  enlarged  glands.  In  chronic  eases  the  process 
may  remain  confined  to  the  intestinal  wall  and  to  the  mesenteric  lymph 
glands,  and  may  by  disturbing  the  digestion  finally  result  in  complete 
exhaustion  of  the  animals. 

In  other  cases  the  bacilli  may  be  disseminated  along  the  lymph 
vessels,  to  distant  lymph  glands  and  into  the  blood  circulation.  The 
infection  of  the  blood  may  sometimes  occur  in  the  early  stages,  and 
contribute  to  the  aggravation  of  the  already  existing  septic  condition. 
Besides  bacillary  emboli  may  cause  the  development  of  metastatic 
inflammatory  lesions,  w^hich  will  later  caseate  beginning  at  the  center 
(such  caseated  areas  are  most  frequently  found  in  the  lungs,  kidneys, 
spleen  and  the  liver). 

The  necrosis  (caseation)  which  is  quite  characteristic  of  hog  cholera, 
is  pro])a])ly  to  some  extent  the  result  of  an  obstruction  of  the  blood 
vessels  ])y  masses  of  bacilli,  and  the  conseciuently  developing  nutritive 
disturbances.  In  the  first  place  however  it  is  probably  due  to  the 
toxic  action  of  the  bacilli. 

Up  to  the  present  time  experiments  for  the  demonstration  of  toxins  in  cul- 
tures of  the  bacillus  suipestifer  have  not  given  uniform  results.  While  Preisz  found 
that  neither  inactivated  cultures  nor  bacteria-free  filtrates  of  cultures  were  toxic  for 
test  animals,  Voges  and  Karlinski  claimed  that  the  killeil  bacteria  contain  an 
intra-cellular  toxin  (according  to  Voges  10  mg.  of  killed  bacteria  are  fatal  to  guinea 
pigs).  De  Schweinitz  produced  a  jitomaine  from  cultTires  by  piecijiitation  with 
alcohol  (Sucholotoxin)  and  also  a  poisonous  albumose  (Sucholoallmiuin).  He  fur- 
ther found  two  kinds  of  enzymes  in  acpieous  extracts  of  agar  cultures,  as  well  as 
in  milk  in  which  the  bacilli  were  grown  for  thiee  weeks,  of  which  the  one  converts 
starch  into  dextrose  (Diastase),  while  the  other  liquefies  gelatin  an<l  digests  fibrin 
and  albumen  (trypsin-enzym).  Prettner  also  found  in  the  cultures  bacteriolytic 
enzymes,  which  slowly  dissolve  gelatin.  According  to  the  investigations  of  Prett- 
ner and  Emmerich  the  bacillus  produces  nitrous  acid  in  material  containing  nitrates, 
as  well  as  in  the  intestinal  canal,  which  may  cause  a  nitrite  i^oisoning  in  the  body 
of  the  animal  (cyanosis,  necrosis  of  the  intestinal  epithelia,  paralysis  or  gangrene 
of  the  sympathicus,  serous  transudations  in  the  intestinal  lumen,  formation  of 
niethemoglobin  in  the  blood).  F.  Schmidt  aimed  to  obtain  specific  substances  from 
cholera  bacilli,  by  the  use  of  Brieger 's  method  (suspension  of  cultures  grown  on 
agar  in  water  and  shaking)   as  well  as  through  the  method  of  Conradi   (autolysis)^ 


ralliuyeiiesis.  269 

ami  further  -vvitli  tlio  aitl  of  ^rcFailyoau's  apiiaratus  for  I  irakiii^f  up  l)actcria, 
but  he  failed  in  iiniuuiiiziujr  test  animals  with  tlie  sulistances  olitained  Ijy  any  of  the 
three  niethotis.  The  toxicity  of  killed  bacilli  (endotoxins)  is  shown  by  the  experi- 
ments of  riilenhuth  and  his  co-workers,  who  succeeded  in  produciuir  a  typical  ana- 
tomical jHcture  of  hoj;  cliolera  by  intravenous  injections  of  cultures  heated  to  ()0"C. 
Accordinj;^  to  liauj^'s  investijjations,  the  necrophorus  liacillus  is  also  a  ])artic- 
ipant  in  the  pioductiou  of  the  necrotic  processes,  aii<l  as  a  matter  of  fact  it 
is  very  frequently  fouml  in  larye  clumjjs  at  the  base  of  the  ulcers  as  well  as  in 
the  nodules  along  the  bor<ler  between  the  necrotic  and  living  ti!:isue. 

The  bacillus  siiisepticiis  exerts  its  pathogenic  action  in  a  similar 
way  in  cases  of  pure  swine  plagne  (see  p.  127).  in  the  ])eracn1e  cases 
it  is  found  quite  fre(|n(Mitly  in  the  l)lood  more  often  than  the  l)acillns 
suipestifer.  The  lesions  of  hemorrhagic  sei)ticemia  wliich  are  found 
at  the  autopsy  of  such  cases  are  evidently  largely  due  to  its  action. 
Often,  however,  the  frecpient  pneumonia  and  pleurisy  is  directly  asso- 
ciated with  the  activity  of  this  organism. 

The  fact  that  the  bacilhis  suipestifer  and  tlio  hacilliis  siiisoi)- 
ticus  are  very  frequently  actively  concerned  in  hoi^  cliolera 
besides  the  hltrable  virus,  exi)lains  why  clinical  as  well  as  ana- 
tomical iiii(lini>-s  shonid  vary  to  such  a  great  extent  from  case 
to  case.  In  the  majority  of  the  dead  or  emergency  slaughtered 
animals  in  infected  lierds  examination  discloses  an  ulcerative 
inflammation  of  the  intestines  and  caseation  of  the  lym|)h  glands, 
also  necrotic  iiiHammation  of  the  lungs,  fibrinous  deposits  on  the 
serous  membranes,  as  well  as  hemorrliages,  while  careful  ])ac- 
teriological  examinations  prove  the  presence  of  both  species  of 
the  bacteria  mentioned.  In  the  course  of  some  outbreaks,  as 
well  as  after  the  artificial  infection  of  lierds  (by  introducing 
affected  animals  into  healthy  herds,  the  placing  of  a  healthy 
herd  on  infected  premises),  septicemic  affections  usually  pre- 
dominate. The  first  animals  dead  from  the  disease,  wdiich 
probably  had  the  least  resistance,  show  acute  catarrli  of  the 
mucous  membranes  exclusively,  and  more  or  less  numerous 
hemorrhages,  somewhat  later  pleuro-pneumonia  may  also  be 
present,  w^hile  on  the  mucous  membranes  of  the  intestines  small 
follicular  ulcerations  or  superficial  desquamation  of  the  mucous 
membrane  may  be  seen  here  and  there.  Later  the  characteristic 
intestinal  changes  of  cliolera  develop,  in  constantly  greater  ex- 
tension and  intensity;  first  a  superficial  desquamation  of  the 
epithelium,  then  a  follicular  ulceration,  or  a  diffuse,  diphtheritic 
inflammation  of  the  mucous  meml)rane.  At  the  same  time  the 
pleuro-pneumonia  occurs  Avith  greater  frequency,  so  much  so 
that  toward  the  end  of  the  outbreak  it  is  present  in  the  great 
majority  of  cases.  In  the  animals  which  still  remain  debilitated 
after  the  acute  outbreak  has  passed  off  changes  of  a  chronic 
character  are  present  either  in  the  intestines  or  in  the  lungs. 

These  successive  anatomical  findings  may  be  explained  by 
the  fact  that  the  most  susceptible  and  the  least  resistant  animals 
are  killed  by  tlie  specific  cholera  virus  at  the  beginning  of  the 
outbreak,  whereas  tlie  more  resistant  withstand  the  primary 
infection  for  a  time  and  are  only  exhausted  by  the  organic  affec- 
tions which  develop  later. 


270 


Hog  Cholera. 


Anatomical  Changes.  According  to  tlie  presence  and  the 
nature  of  the  secondary  infection,  the  following  forms  of  the 
disease  may  be  distinguished: 

1.  Pure  Hog  Cholera  ( septicemic  form ) .  In  this  the  autopsy 
findings  correspond  to  those  of  an  acute  hemorrhagic  septicemia, 
namely  hemorrhages  in  the  serous  membranes  _  and  in  the 
mucous  membranes  of  the  pharynx,  stomach  and  intestines,  in 
the  acutely  swollen  lymph  glands  and  probably  also  in  the  kid- 
neys.   Further  there*  is  also  a  moderately  acute  swelling  of  the 

spleen.      In   the 
meantime     in 
some    cases    the 
peritoneum    is 
covered    with    a 
fibrinous  pseudo- 
membrane,    and 
the     intestinal 
walls  are  hemor- 
rhagic.   Even  in 
such   cases   fine, 
croupous    pseu- 
do-membranes 
may    frequently 
be  found  on  the 
swollen  and  hy- 
peremic   mucous 
membranes    of 
the  stomach  and 
intestines,  some- 
times also  a  dif- 
fuse,   superficial 
necrosis     (bile 
stained,    mushy 
deposits),  or  here 
and    there     yel- 
lowish scales. 

2.  Intestinal 
Form.  In  this 
most  frequent 
form  of  the  dis- 
ease, the  intes- 
tinal tracts,  es- 
pecially the  cae- 
cum and  the 
large  intestines, 
show  intensive  changes.  In  the  less  acute  cases  a  hard 
round  nodule  may  be  felt  on  palpation  of  the  wall  of  the 
large  intestines,  or  this  is  thickened  either  in  part  or  uniformly 


Fig.  50. 


Intestine  of  hog  with  follicular  ulceration  of  hog- 
cholera. 


Aiiatniiiical    ( 'liaiijres.  271 

in  its  entire  lengtli.  At  llio  same  time  the  flexures  of  the  intes- 
tines may  stick  to,<>etli('r,  and  this  condition  may  also  be  seen  in 
the  convohitions  of  tlie  small  intestines,  or  there  may  even  be 
adhesions.  In  acute  cases  there  are  lentil  to  dollar-sized,  flat, 
round,  yellow,  greenish-yellow,  brown  or  blackish-gray,  dry 
scabs  on  the  mucous  membrane  of  the  colon  and  ciecum,  espe- 
cially around  the  Bauhin's  fold  (ileo-caecal  valve),  and  some- 
times also  in  the  adjoining  small  intestines,  under  which  the  sub- 
niucosa  or  the  muscularis  is  infiltrated  or  thickened.  Between 
these  the  follicles  are  swollen  to  hemp-seed  size  hard  nodules, 
from  which  a  caseous  mass  may  be  squeezed.  In  some  cases 
the  affection  nuiy  be  confined  exclusively  to  an  ulceration  of 
the  follicles,  in  which  deep  ulcerations,  with  raised,  thickened 
margins,  coyer  the  mucous  membrane  of  the  intestines.  These 
ulcerations  increase  in  numl)ers  posteriorly,  and  are  of  the  size 
of  lentils,  round  and  covered  with  dry  tissue  debris  (Fig.  50). 

In  more  chronic  cases  the  inner  surface  of  the  intestines 
usually  contains  thick,  hard  scabs,  in  small  numbers,  sometimes 
flat,  at  other  times  hemispherical,  colored  similarly  to  the  above- 
described  lesions,  so-called  buttons  or  boutons,  which  protrude 
over  the  neighboring  nnicous  membrane  (Fig.  51).  The  cut  sur- 
face of  these  buttons  appears  sometimes  in  layers,  they  adhere 
firmly  to  the  submucosa  or  the  muscularis,  and  are  surrounded 
by  a  thickened  ring  of  the  mucous  membrane.  Around  these 
nodules  the  intestinal  wall  is  frequently  thickened  and  stiff. 

In  some  cases  the  mucous  membrane  may  be  necrotic  over 
large  sections  of  the  large  intestines ;  in  less  advanced  cases  the 
necrotic  epithelium  forms  a  mushy  deposit  on  the  surface  of 
the  mucous  membrane,  while  later  it  may  change  in  its  entire 
thickness  to  a  dirty  yellow,  or  greenish-yellow,  dry,  mushy  detri- 
tus. At  the  same  time  the  outer  layers  of  the  avails  of  tlie  large 
intestines  are  greatly  thickened,  so  much  so  that  the  affected  sec- 
tion represents  a  stiff  tube  with  a  constricted  lumen. 

The  mucous  membrane  of  the  stomach,  especially  in  acute 
cases,  shows  a  pronounced  hemorrhagic  inflammation,  and  is 
frequently  covered  with  croupous  pseudo-membranes. 

In  the  acute  cases  the  lymph  glands  are  swollen,  h^^eremic, 
and  even  hemorrhagic.  In  the  later  stage  they  contain  small, 
grajdsh  points,  disseminated  in  reddish  tissue;  in  still  more 
severe  cases  they  change  to  hard  growths  up  to  the  size  of  a 
hen's  egg,  which  on  the  cut  surface  prove  to  consist  of  a  gray- 
ish-red, dry,  homogenous  necrotic  tissue,  or  of  a  dry  or  soft 
caseous  mass.  These  changes  are  most  frequently  and  most 
prominently  present  in  the  mesenteric  glands,  less  frequently  in 
the  other  Iwiph  glands  of  the  abdominal  cavity,  are  sometimes 
also  to  be  found  in  the  glands  of  the  thoracic  cavity,  and  in 
rare  cases  even  in  the  body  h^iiph  glands. 

In  some  cases  tumor-like  lesions  which  resemble  those  of 
the  lymph  glands  may  be  found  in  other  internal  organs,  which 


272  Hog  Cholera. 

may  reach  tlie  size  of  a  walnut,  and  contain  caseous  masses. 
Such  are  most  often  found  in  the  liver,  the  kidneys,  lungs,  spleen, 
udder,  bone  marrow,  etc.  The  lungs  may  in  exceptional  cases 
also  contain  circumscribed  pneumonic  areas,  with  a  yellowish- 
gray  cut  surface,  without  necrosis  or  pleurisy  (Preisz). 

In  the  pharynx,  at  the  l)ase  and  on  the  borders  of  the  tongue, 
sometimes  also  in  other  parts  of  the  buccal  cavity,  and  in  the 
larynx  hemorrhagic  inflammations  of  the  mucous  meml)rane, 
wdth  croupous  pseudo-membranes  and  ulcerations,  together  w^itli 
a  superficial  or  deep  necrosis  may  very  frequently  be  found. 

Among  other  changes  which  may  occur  are  necrosis  of  the 
mucous  membrane  of  the  gall  bladder,  the  vagina,  and  the  l)lad- 
der,  localized  or  extensive  necrosis  of  the  skin,  cloudy  swelling 
of  the  parenchymatous  organs,  etc. 


Fig.  51.     So  called  hiifton  on  the  mucous  membrane  of  the  large  intestine  in  hog  cholera. 

The  intestines  of  animals  slaughtered  during  convalescence 
show  at  the  places  of  the  thrown-off  necrotic  nodules,  ulcera- 
tions w^ith  a  granulating  base,  or  small  white  scars  may  serve 
to  indicate  the  pre-existing  ulcerations  (Gerosat  and  Bilitz  ob- 
served in  exceptional  cases  cicatrized  constrictions  of  the  intes- 
tines). The  lymph  glands  of  other  organs  may  at  times  also 
contain  caseous  foci. 

The  bacillus  suipestifer  may  be  demonstrated  only  in  acute 
cases  in  the  Ijlood,  and  even  then  only  in  small  numbers,  while 
in  the  spleen  it  may  be  present  in  greater  numbers.  The  same 
organism  may  also  be  found  in  the  affected  lymph  glands,  in 
the  necrotic  nodules  of  the  intestinal  mucous  membrane  and  in 
the  caseous  metastatic  lesions  of  the  internal  organs. 

The  necrotic  and  ulcerative  processes  on  the  intestinal  mucous  membranes 
develop  quite  slowly.  Thus  in  an  animal  12  days  after  the  infection  there  are, 
Vjesiiles  the  bean-sized  mesenteric  lymph  glands,  only  hemp-seed  size  yellow 
deposits  of  exudate  on  the  intestinal  mucous  membrane;  after  14  days  they  attain 
the  size  of  a  lentil,  and  after  IS  days  the  exudate  or  ulcerations  may  be  the  size 
of  a  dime.    At  this  stage  the  mesenteric  lymph  glands  reach  the  size  of  an  almond; 


Anatctiiiical   Cliaiii^es.  273 

21  (lavs  after  tlie  infection  laiyo  sections  of  tlie  intestinal  niucous  membrane  may 
lie  covered  with  a  deposit  or  exudate,  and  tlie  intestinal  wall  may  be  3  to  4  mm. 
in  thickness.  The  mucous  niend)rane  of  the  cecum  however  may  show  necrotic 
areas  as  jarj^e  as  a  qnaiter  in  si/e. 

Accordinjj-  to  Marek 's  liistoioy:ical  examinations  the  nature  of  the  changes 
in  the  intestinal  niucous  nieinbrane  are  those  of  a  croupous,  or  croupous-diphtlieritic 
character.  The  ei)ithelial  layer  and  the  propria  mucosae  chan<;es  tiuough  a  coagu- 
lation necrosis,  into  a  homogenous  layer,  wliich  contains  fibrinous  tlireads  and 
obstructed  blood  vessels.  Tiiis  layer  is  surrounded  l)y  a  wall  of  polynuclear  leuco- 
cytes. The  bacillus  suipestifer  and  the  Bac.  necrophorus  are  found  in  great 
numbers   on  the  border   line  Vietween   the   necrotic   and   healthy  tissue.      The   putlio- 


P  ■»*-<   "  -  ^'^ 

Fig.  52.     Hog  Cholera.     Pig  affected  for  two  weeks. 

logical  process  frequently  commences  in  the  follicles,  occasionally  however  the 
necrotic  layers  may  contain  healthy  follicles.  Jf  larger  bacterial  colonies  develop 
in  other  organs  they  may  cause  coagulation  necrosis  in  such  places,  which  later 
results  in  the  formation  of  sequesters. 

3.  Pectoral  Form.  This  form  is  characterized  by  an  acute, 
usually  croupous,  more  rarely  catarrhal  pneumouia,  which  in  the 
later  stages  passes  into  multiple  necrosis.  Frequently  there  is 
also  a  fibrinous  or  sero-fibrinons  pleurisy  and  in  some  instances 
also  a  similar  pericarditis.  Besides  this,  the  mucous  membrane 
of  the  g'astro-intestinal  tract  reveals  a  ditTuse,  acute  inflamma- 
tion, while  in  acute  cases  the  other  organs  indicate  a  general 
septic  infection.  Otherwise  the  autopsy  findings  are  identical 
with  those  of  swine  plague  (see  p.  130),  and  the  disease  can 
only  be  distinguished  from  this  by  the  fact  that  tlie  filtered  blood 
or  material  from  the  organs  is  virulent  (see  diagnosis). 

4.  Mixed  Form.  The  great  majority  of  cases  whicli  are 
found  in  infected  herds  l)elong  to  this  class.  The  lesions  of  the 
intestinal  and  pectoral  forms,  witli  the  corresponding  changes 
of  the  organs,  are  present  simidtaneously  from  case  to  case 
but  in  varying:  intensity;  therefore  the  autopsy  findings  vary 
greatly,  even  in  the  animals  of  one  and  the  same  herd.     In 


274  ■  Hog  Cholera. 

acute  cases  the  mucous  membranes  of  the  gastro-intestinal 
tracts,  as  well  as  of  the  lungs,  are  simultaneously  affected  in 
the  above-described  manner,  while  in  chronic  cases  one  or  the 
other  form  is  often  exclusively  present. 

Symptoms.  The  time  of  incubation  of  hog  cholera  in  arti- 
ficial infections,  carried  out  as  closely  to  the  natural  mode  of 
infections  as  possible  (cohabiting  healthy  animals  with  affected 
hogs,  or  in  infected  premises,  Preisz,  Hutyra),  is  at  least  4 
days,  usually  however  13  to  18  days.  After  a  subcutaneous 
injection  of  virulent  blood  the  first  symptoms  also  appear  at  the 
earliest  on  the  fifth  day,  more  frequently  however  in  8  to  10 
days,  and  in  some  cases  only  after  from  2  to  3  weeks  (Uhlen- 
huth). 

1.  Pure  Hog  Cholera  (septicemic  form).  Excepting  the 
very  rare  peracute  cases  which  develop  almost  exclusively  at 
the  beginning  of  an  outbreak  and  terminate  in  from  2  to  3  days 
with  manifestations  of  an  acute  hemorrhagic  septicemia,  the 
clinical  develophient  of  the  acute  cases  is  usually  somewhat 
slow.  One  of  the  first  indications  of  the  presence  of  the  disease 
is  impairment  of  the  appetite.  The  animals  take  their  food  less 
eagerly,  they  separate,  apparently  quickly  satisfied,  from  the 
other  animals  of  the  herd,  stand  at  one  side,  alone,  or  crawl  into 
some  secluded  corner  of  the  stable  or  yard.  Later  they  appear 
only  hesitatingly  or  not  at  all  for  their  feed.  If  urged  to  leave 
their  place  they  show  great  reluctance  to  move,  and  do  so  slowly 
and  feebly.  They  soon  stop,  and  remain  for  long  periods  in 
one  place  with  back  arched,  and  with  head  depressed. 

One  of  the  first  symptoms  and  one  almost  invariably  present 
is  an  acute  conjunctivitis,  with  the  production  of  a  mucous  or 
muco-purulent  secretion.  Vomiting  is  frequently  observed  on 
the  first  or  second  day,  the  vomited  material  containing  mucus 
and  being  stained  yellow  by  bile.  There  is  at  first  constipation, 
but  diarrhea  sets  in  after  a  short  time.  The  feces  are  thin  and 
sometimes  bloody.  In  this  stage  the  patients  become  more 
or  less  weakened,  and  if  the  disease  does  not  turn  toward  im- 
provement, or  if  it  does  not  become  chronic,  death  ensues  in 
from  4  to  7  days,  with  septic  manifestations. 

2.  Intestinal  Form.  This  develops  like  the  first  form,  but 
is  less  acute.  The  more  intense  affection  is  indicated  by  a  dis- 
tinctly yellowish  or  greenish  coloration,  and  by  the  very  fetid 
odor  of  the  feces.  At  the  same  time  inflammatory  or  diphtheritic 
changes  appear  on  the  buccal  mucous  membrane.  The  borders, 
the  dorsum  and  the  base  of  the  tongue,  the  cheeks  and  the 
pharynx  become  covered  with  a  dirty  gray  or  yellow,  loose  de- 
posit of  exudate,  the  tonsils  are  greatly  swollen,  or  ulcerations 
covered  by  a  mushy  mass  develop  upon  them.  These  changes 
may  be  observed  by  examining  the  buccal  cavity.    There  is  also 


Syiiii>t(iiiis.  275 

pharyngitis,  associated  witli  dirticulty  in  s\vallo\viii<;-,  frcciuciitly 
also  by  difficult,  rattling  respiration,  and  death  may  result  from 
asphyxiation. 

in  the  less  severe  form  these  symptoms  continue  to  exist, 
and  in  some  cases  seviM-al  small  or  larger  growths  may  after 
a  time  be  felt  in  the  abdominal  cavity  by  palpating  the  relaxed 
abdominal  wall  (lymph  glands  and  adherent  intestinal  loops). 

In  severe  cases  the  animals,  having  lost  their  appetite,  be- 
come more  and  more  emaciated,  the  diarrhea  alternates  with 
constipation  (this  is  sometimes  also  observed  in  extensive  ulcera- 
tions of  the  intestines),  they  become  very  weak  and  anemic, 
move  only  with  difficulty  and  with  a  staggering  gait,  or  they 
stand  in  one  place  with'  back  arched,  and  with  croup  sunken 
(Fig.  r)2).  Towards  the  end  they  continuously  lie  on  the  ground, 
and  die  completely  exhausted,  at  the  earliest  on  the  llth  day 
after  the  infection,  mostly  however  in  from  2  to  3  weeks. 

In  other  cases  the  acute  symptoms  of  an  intestinal  affection 
diniiuish  in  1  to  3  weeks,  the  appetite  gradually  improves,  the 
diarrhea  ceases,  the  animal  moves  about  more  lively,  and  linally 
a  complete  recovery  takes  place.  Sometimes  the  animals  con- 
tinue to  be  sickly,  in  spite  of  the  fact  that  the  acute  symptoms 
become  milder.  The  appetite  remains  irregular,  normal  move- 
ment of  the  bowels  alternates  with  diarrhea,  the  animals  do  not 
show  a  normal  development,  gradually  a  severe  anemia  and 
cachexia  sets  in,  which  finally  leads  after  some  months  to  com- 
plete exhaustion. 

3.  Pectoral  Form.  With  the  initial  s^auptoms  of  pure  hog 
cholera  manifestations  of  an  acute  pneumonia  or  pleuro-pneu- 
monia  become  associated  after  several  days  and  from  this  stage 
on  the  clinical  development  is  identical  with  the  acute  or  chronic 
swine  plaane  (see  p.  132). 

4.  Mixed  Form.  In  this  form  symptoms  of  varying  inten- 
sity develop  in  connection  with  the  s^anptoms  of  hog  cholera 
infection,  which  indicate  gastro-intestinal  trouble,  as  well  as 
an  affection  of  the  thoracic  organs.  Besides  inappetence  and 
diarrhea  there  is  a  cough,  and  increasing  difficulty  in  respira- 
tion, and  in  unfavorable  cases  death  results  as  a  rule  directly 
from  the  affection  of  the  thoracic  organs.  In  the  later  course 
the  symptom-complex  of  both  forms  may  exist  for  a  long  time, 
and  they  are  not  infrequently  observed  simultaneously  even  in 
the  chronic  cases;  while  occasionally  the  manifestations  of  the 
lung  affection  are  less  pronounced  in  the  early  stages,  they  later 
become  mihh'r,  and  the  dominating  s>iuptoms  then  consist  of 
a  changeable  or  depraved  appetite  and  diarrhea. 

The  cases  belonging  to  this  form  manifest  with  relative 
frequency  changes  in  the  skin.  Aside  from  the  extensive  necro- 
sis which  is  sometimes  present,  resulting  from  the  action  of  the 
hog  cholera  bacillus,  and  being  principally  observed  on  the  ears, 


276  Hog  Cholera. 

red  spots  frequently  appear  on  tlie  finer  parts  of  tlie  skin,  which 
develop  as  a  result  of  a  simple  dilation  of  the  vessels.  Later 
small  vesicles  form  in  these  places,  and  soon  the  superficial 
epithelial  layer  separates  in  fine  lamellae.  The  abdomen  some- 
times shows  numerous  punctiform  hemorrhages,  which  remain 
noticeable  for  a  long  time  even  after  recovery.  Occasionally 
urticaria  may  develop,  when  vesicles  will  appear  on  the  flat, 
raised  lesions  (Schindelka).  In  some  cases  the  bristles  may 
fall  out  on  different  spots  or  over  the  entire  body,  animals  with 
dark  pigmented  skin  may  become  white,  and  if  the  animals  re- 
main alive  white  bristles  grow  on  the  bald  places,  w^hich  however 
may  later  be  replaced  by  black. 

Diagnosis.  The  clinical  symptoms  do  not  afford  sufficient 
grounds  for  the  establishment  of  a  positive  diagnosis.  Although 
they  cause  a  well-founded  suspicion  of  hog  cholera,  especially  in 
already  affected  herds  or  if  the  disease  is  prevalent  in  tlie  local- 
ity, the  determination  however  must  be  made  dependent  on 
the  autopsy  findings.  As  in  accordance  with  the  present  state 
of  our  knowledge  the  bacillus  suipestifer  or  other  bacteria  of 
the  hog  cholera  group  under  natural  conditions  produce  only 
in  the  body  weakened  by  the  filtrable  cholera  virus  follicular 
lesions  on  the  intestinal  mucous  membrane,  and  the  ulcerations 
and  buttons  resulting  from  these  with  simultaneous  caseation  of 
the  regional  lymph  glands,  these  changes  must  be  considered  as 
characteristic  of  hog  cholera.  Therefore  where  they  are  pres- 
ent the  diagnosis  of  hog  cholera  may  be  established  without 
consideration  of  accessory  circumstances. 

The  fact  that  it  is  sometimes  possible  to  proiluee  the  anatomical  hog  cholera 
artificially,  with  the  bacillus  suipestifer  alone,  does  not  indicate  that  this  occurs 
under  natural  conditions,  especially  as  positive  results  have  only  been  obtained  in 
feeding  experiments  with  very  large  quantities  of  culture.  Glasser  is  nevertheless 
of  the  opinion  that  an  organism  which  he  isolated  from  two  apparently  sponta- 
neously affected  pigs,  and  which  biologically  differed  from  the  bacillus  suipestifer 
resembling  more  the  human  typhoid  liacillus  (Bac.  typhi  suis),  may  independently 
produce  a  contagions  epizootic  infection  (typhus  of  hogs).  However  the  occurrence 
of  such  a  spontaneous  enzootic,  or  even  epizootic,  has  not  been  confirmed  from  any 
other  source.  According  to  a  preliminary  report  of  Stedefeder  the  bacillus  suipes- 
tifer also  may  produce  spontaneous  affections  independently,  without  any  pre- 
existing accessory  influence  of  an  ultravisible  virus. 

Contrary  to  the  formation  of  intestinal  lesions,  the  presence 
of  a  necrotic  pneumonia,  even  in  a  typical  form,  has  not  the 
same  pathognomic  significance,  as  this  form  may  occur  inde- 
pendently without  any  participation  of  the  filteral)le  hog  cholera 
virus,  and  in  such  case  it  must  be  considered  as  pure  swine 
plague.  The  decision  whether  in  a  single  case  one  is  dealing 
with  pure  swine  plague,  or  hog  cholera  with  swine  plague  symp- 
toms, is  in  practice  sometimes  very  difficult.  If  besides  tlie 
inflammatory  infection  of  the  lungs  tliere  are  at  the  same  time 
scabs,  round  iilcers  with  discolored  covering,  or  even  button- 
like scabs  on  the  mucous  membrane  of  the  intestinal  canal,  with 
or  without  swelling  of  the  lymph  glands,  a  cholera  infection 


Diagnosis.  277 

must  always  be  considered.  On  the  otlier  liaiid,  ir  tliere  is  pres- 
ent a  pure  liemorrha^^ic  septicemia,  or  only  an  acute  croupous 
catarrhal,  lieinorrhai^ic,  or  a  necrotic  pneuiiionia,  with  or  with- 
out a  librinous  phnirisy,  or  if  the  case  shows  chronic  remnants 
of  a  pre-existing-  acute  pneumonia  (large  necrotic  areas,  seques- 
ters) then  the  anatomical  changes,  together  with  tlie  micro- 
scopical and  cultural  iin(hngs,  do  not  clear  the  true  nature  of 
the  affection.  In  such  cases  liltration  tests  are  final,  and  if  a 
positive  result  is  obtained  with  these  the  presence  of  a  cholera 
infection  is  thereby  established.  Still,  a  negative  result  of 
such  a  test  is  not  conclusive;  as  the  cholera  virus  which  has  been 
present  in  the  body  fluids  nuiy  already  have  disappeared  from 
the  body  to  a  great  extent  or  entirely.  In  such  cases  the  diag- 
nosis must  depend  upon  whether  the  animal  comes  from  a  herd 
infected  with  hog  cholera,  and  whether  in  any  of  the  other  ani- 
nuds  tliere  were  any  lesions  jiointing  to  an  infection  of  hog  cJiol- 
era,  or  if  a  case  represents  a  sporadic  affection  from  a  herd 
which  has  proved  healthy.  It  is  essential  therefore,  in  such 
cases,  to  consider  the  epidemiologic  factors,  and  to  attach  to 
them  their  appropriate  value,  estal)lishing  the  diagnosis. 

Of  course  this  presents  far  greater  difficulty  in  reacliing 
a  diagnosis,  M'lien  compared  with  the  former  conditions,  in  which 
the  bacteriological  demonstration  of  bipolar  ovoid  bacteria  or 
cholera  bacilli  in  the  organs  showing  the  inflannnatory  changes 
were  alone  sufficient  for  the  determination  of  the  disease.  By 
such  findings  the  disease  was  designated  as  hog  cholera  or 
swine  plague.  At  present  however  the  demonstration  of  these 
bacteria,  whether  in  the  blood  or  in  the  organs,  is  not  of  con- 
.clusive  importance  for  the  establishment  of  the  diagnosis  of 
hog  cholera  or  swine  plague.  It  now  becomes  necessary  to 
consider  the  gross  anatomical  changes  of  the  organs,  in  doubt- 
ful cases  also  the  epidemiologic  accessory  circumstances,  and 
the  nature  of  the  affection  of  other  animals  in  the  same  herd. 

Tn  baeteriolog^ical  examinations  the  simple  microscopic  examination  does  not 
always  give  positive  results,  but  with  the  aid  of  culture  and  ajjglutination  tests 
it  is  in  most  instances  possible  to  demonstrate  the  bacteria  which  participate  in 
causing  the  pathological  processes.  Animal  inoculations  with  material  from  lesions 
as  a  rule  is  only  a<lopted  for  the  demonstration  of  the  septicemia  bacillus,  as 
small  animals  are  killed  by  these  organisms  in  from  24  to  36  hours,  and  their  blood 
or  the  exudate  of  the  abdominal  cavity  contains  in  such  instances  only  this  bacillus, 
even  though  the  inoculated  material  also  contained  the  cholera  bacillus. 

Swine  erysipelas  frequently  greatly  resembles  a  septi- 
cemic form  of  hog  cholera,  especially  Avlien  tliere  are  only  few 
and  small  hemorrhages  present  in  the  internal  organs,  such 
cases  usually  occurring  in  the  beginning  of  out])reaks.  The 
microscopical  finding  of  erysipelas  bacilli  in  the  blood  or  in 
the  spleen  of  course  establishes  the  diagnosis  of  erysipelas.  It 
is  advisable  however  to  postpone  the  final  decision  in  negative 
findings  and  to  depend  on  the  autopsies  of  other  animals  which 
may  die  or  which  are  slaughtered  in  emergency.    If  hog  cholera 


278  .  Ho-  Cholera. 

exists  it  is  certain  that  in  u;ie  of  the  other  animals  there  will  be 
found  intestinal  or  pulmonary  lesions  pointing  to  the  disease. 
Chronic  cases  of  hog  cholera  may  be  mistaken  for  tuber- 
culosis ;  a  distinction  is  only  possible  by  a  bacteriological  exami- 
nation, unless  the  intestines  contain  the  characteristic  ulcera- 
tions of  hog  cholera. 

Neither  the  allergic  cutaneous,  the  ophthalmo-reaction,  nor  the  complement 
fixation  method  can  be  utilized  for  the  diagnosis  of  hog  cholera  (Uhlenhuth  and 
others;  the  authors  also  failed  to  obtain  satisfactory  results  with  the  second  of 
these  methods). 

Course  and  Prognosis.  The  septicemic  and  the  intestinal 
form  of  hog  cholera  is  considered  among  the  less  fatal  dis- 
eases, as  it  leads  to  recovery  with  relative  frequency.  In  herds 
infected  with  the  mixed  infection  those  animals  usually  recover 
in  which  symptoms  of  a  lung  affection  are  absent  or  occur  only 
in  a  mild  form. 

On  the  other  hand  the  pectoral  and  the  mixed  form  has  a 
much  more  malignant  character,  but  even  in  these  cases  the 
mortality  fluctuates  within  wide  limits.  While  in  localities  in 
which  the  disease  has  appeared  for  the  first  time,  the  mortality, 
especially  among  the  young  hogs,  may  reach  80-90%,  in  later 
years  it  will  be  much  lower.  In  herds  which  are  kept  under 
favorable  hygienic  conditions  very  frequently  only  10-15%  of 
the  animals  may  die,  and  by  taking  proper  precautions  it  is 
possible  to  reduce  even  this  number. 

Herds  in  which  cholera  has  already  caused  a  loss  of  about 
15%  and  over  usually  resist  later  infections  permanently,  there- 
fore a  repeated  appearance  of  the  disease  in  the  same  herd  is 
observed  only  very  exceptionally. 

The  case  reported  by  Toth  is  probably  isolated,  in  which  in  a  herd  of  550 
hogs  18%  died  first,  several  months  afterwards  32%,  and  after  another  two 
months  12%o. 

In  giving  a  prognosis  the  character  of  the  disease  should 
be  considered,  that  is  the  more  the  septicemic  and  the  pectoral 
manifestations  predominate,  the  less  favorable  is  the  prognosis. 
Hemorrhages  from  the  body  cavities  are  almost  certain  fore- 
runners of  approaching  death;  likewise  the  severe  pneumonias 
terminate  in  most  instances  unfavorably.  On  the  other  hand 
in  cases  where  only  the  intestinal  affection  appears  to  be  pres- 
ent, the  recovery  of  the  animal  is  more  or  less  certain,  accord- 
ing to  its  intensity. 

Treatment.  At  the  beginning  of  the  disease,  when  no  com- 
plications, especially  of  the  thoracic  organs,  have  become  asso- 
ciated with  the  affection,  therefore  in  the  first  4  or  5  days  of 
the  febrile  condition,  treatment  with  the  specific  immune  serum 
frequently  gives  good  results.  Quite  often  a  rapid  recovery 
takes  place  after  a  single  injection  of  serum,  while  in  other 


Treat  iiR'iit.      Preveiitinti.  279 

cases  1  to  2  repetitions  of  the  injection  hriiii.-  about  recovery. 
(See  I'lirtlier  under  innnunization.) 

Medicinal  treatment  lias  not  given  any  decided  results.  In 
consideration  of  the  supposition  that  the  infection  results  i'rom 
the  intestinal  canal,  tlie  achninist ration  of  disinfectants  was 
tried,  hut  witiiout  much  benelit.  Of  such  remedies  milk  of  lime, 
naphthol,  iron  sulphate,  carbolic  acid,  calomel  (2  g.),  creolin 
(2^0  solution),  arsenous  acid  (0.2  g-.),  and  formalin  milk 
(^/4-yi>7o)  liave  been  tried.  According  to  observations  sucli  a 
treatment  couhl  l)e  only  coiisidered  for  the  purpose  of  protecting 
if  i)ossible  liealtiiy  animals  from  the  infection.  (The  carbolic 
acid  enemas  recommended  by  Trevisan,  800-1500  g.  of  a  0.5% 
solution  twice  daily,  has  also  l)een  found  effective  in  several 
cases  by  Kolisch). 

Some  authors  recommended  the  intravenous  or  subcuta- 
neous injection  of  antiseptics;  thus  Marenghi  advised  corrosive 
sublimate  (1  part  corrosive  sublimate,  3  parts  salt,  1000  ])arts 
water ;  0.5  to  2  g.  of  this  injected  into  the  auricular  vein)  ;  Ilajnal 
suggests  lysol  (subcutaneous  injection  of  5  g.  of  a  20%  alcoholic 
solution)  and  also  antipyrin ;  Kevesz  chinosol  (3  cc.  of  a  2% 
solution  subcutaneously).  The  effectiveness  of  these  treatments 
however  lias  not  yet  been  confirmed  by  other  observers. 

It  is  essential  to  place  the  patients  in  a  clean  airy  place, 
and  they  should  be  given  easily  digestible  feed;  if  the" clinical 
manifestations  indicate  a  severe  infection  the  early  slaughter 
of  the  animal  should  be  recommended. 

Prevention.  Herds  which  are  free  from  the  disease  should 
be  protected  as  much  as  possible  from  infection.  Animals  just 
purchased  should  be  kept  isolated  for  at  least  three  weeks.'  In 
large  herds  infection  of  the  animals  is  not  infrequently  avoided 
by  preventing  the  contact  of  the  herd  with  strange  hogs,  espe- 
cially with  those  belonging  to  the  farm  hands,  as  well  as  by 
keeping  them  from  strange  pastures  and  highwavs.  Cleanli- 
ness of  the  piggeries  and  their  surroundings,  as  well  as  peri- 
odical disinfection  aid  considerably  in  maintaining  the  health 
of  the  hogs. 

If  the  disease  has  already  appeared,  tlie  affected  animals 
should  be  slaughtered  or  left  in  the  infected  locality,  while  the 
healthy  hogs  should  if  possil)le  be  divided  into  small  groups, 
and  driven  to  uninfected  places.  Should  new  cases  develop  in 
these  parts  the  procedure  should  be  repeated,  and  the  infected 
pasture  should  always  l)e  avoided.  If  the  disease  has  appeared 
in  the  public  pasture,  and  if  it  is  not  possible  to  remove  the 
remaining  healthy  animals  to  a  clean  pasture,  the  spread  of  the 
disease  may  be  prevented  by  subjecting  the  animals  to  a  con- 
tinuous stabling,  for  at  least  two  weeks.  Of  course  the  premises 
should  be  placed  under  veterinary  supervision,  and  where  the 
disease  appears  the  contagion  should  be  destroyed  rapidly  by 
early  slaughter  of  the  affected  animals  and  thorough  disinfec- 
tion of  the  stables. 


280  Hog  Cholera. 

Immunization.  Practical  results  can  be  only  lioped  for  from 
a  method  of  iunnunization  wliicli  will  afford  effective  protection 
against  primary  infection  with  the  filterable  cholera  virus.  After 
the  demonstration  of  the  latest  facts  regarding  the  etiology  of 
the  disease  by  establishing  the  virulence  of  the  filtered  tissue 
fluids  of  affected  animals,  experiments  were  undertaken  to  work 
out  a  suitable  method  of  iunnunization,  and  they  have  already 
led  to  valuable  results. 

Purely  practical  observations  showed  years  ag^o  that  animals  recovering  from 
hog  cholera  were  usually  immune  for  their  entire  lives.  This  fact  has  ])een  utili2e(l 
by  Hungarian  hog  feeders,  as  they  prefer  to  feed  animals  from  herds  in  which 
the  disease  has  already  caused  some  losses.  As  a  matter  of  fact  they  pay  consid- 
erably higher  prices  for  such  animals. 

The  idea  of  using  serum  from  hogs  which  recovered  from  cholera  for  immu- 
nizing purposes,  was  first  utilized  by  Preisz  (1897).  He  obtained  serum  from  a 
hog  which  had  been  convalescent  for  three  weeks  after  a  severe  attack  of  cholera, 
and  in  which  the  autopsy  revealed  marked  lesions  of  cholera  in  the  intestines  and 
mesenteric  lymph  glands.  The  serum  was  injected  into  30  pigs  from  3  to  4  months 
old,  each  animal  being  injected  with  10  cc.  of  such  serum.  These  30  animals  were 
later  placed  in  a  stalde  with  30  healthy  pigs,  and  with  several  affected  hogs.  In 
the  course  of  one  month,  18  of  the  inoculated  animals  became  sick,  and  9  of  them 
died,   while  all   of   the   control  animals   succundjed    (the   last  one   after  4  months). 

As  a  result  of  these  findings  immunization  with  blood  serum  from  slaughtered 
or  recovered  animals  has  been  used  extensively  in  Hungary.  The  results  however 
failed  to  come  up  to  expectations,  which  probal)ly  was  due  to  the  fact  that  the 
material  was  not  always  taken  from  recovered  animals  which  had  passed  through  a 
severe  form  of  the  affection. 

After  the  presence  of  the  causative  factor  of  the  disease  had 
been  recognized  in  the  filterable  virus,  the  attempt  was  imme- 
diately made  to  hyperimmunize  hogs  artificially,  according  to 
the  method  of  immunization  used  against  rinderpest,  and 
thereby  prepare  a  suitable  serum  for  passive  immunization,  and 
by  the  simultaneous  use  of  virulent  blood  to  produce,  if  possible, 
an  active  immunity.  These  expectations  have  lieen  fulfilled, 
insofar  as  satisfactory  methods  of  immunization  have  been  de- 
veloped wliicli  are  practical  for  both  purposes. 

1.  Immunization  with  Immune  Serum.  (Passive  Immuniza- 
tion.) According  to  the  experiments  of  Dorset,  McBryde  & 
Niles,  Uhlenhuth,  Xylander,  Hiibener  &  Bolitz,  Ostertag  and 
Stadie,  as  well  as  Hutyra  &  Wetzl,  hogs  which  acquired  an 
immunity  from  a  natural  or  artificial  infection  of  hog  cholera, 
wdien  injected  by  a  single  large  dose,  or  by  several  small  doses 
of  virulent  blood,  produce  a  serum  which  protects  susceptible 
hogs  for  at  least  three  weeks  against  artificial,  as  well  as  against 
natural  infection.  This  immunity  is  also  effective  during  tlie 
first  six  days  of  the  incubation  period  (Hutyra  &  Wetzl).  Tlie 
results  in  practice  proved  satisfactory,  as  with  the  aid  of  this 
method  it  is  possible  to  considerably  reduce  the  losses  in  herds 
which  have  been  affected  only  for  a  short  time,  and  in  many 
cases  to  check  the  outbreak  abruptly.  Besides  this,  in  annuals 
which  are  in  the  stage  of  incubation,  or  which  have  only  lieen 
affected  for  a  few  days,  the  serum  possesses  a  curative  action. 
It  was  found  further  that  in  infected  herds  the  animals  which 


Iimiuiiiizatidii.  281 

were  protected  by  tlic  serum  iiioculalioii  will  not  l)econie  affected 
by  the  disease  later  on,  or  only  exceptionally,  in  spite  ot*  the 
existing  dangers  of  infection.  This  leads  to  the  belief  that  the 
animals  which  were  given  a  passive  immunity  by  the  innnnne 
serum,  have  accinircd  an  active  immunity  as  a  result  of  a  natural 
infection  which  has  taken  ])lace  in  the  meantime. 

On  the  basis  of  this  experience  it  is  a(lvisal)le  to  treat  all 
herds  which  are  threatened  by  the  infection  with  the  immune 
serum,  and  especially  those  in  which  the  disease  has  already 
ai)peared,  and  to  retain  tlie  drove  in  the  same  place  until  the 
infection  is  eradicated.  At  the  same  time  the  apparently 
affected  animals  should  be  separated,  and  those  wdiicli  are  af- 
fected severely  should  be  slaughtered.  In  case  the  disease 
appears  again  in  the  herd  it  is  advisable  to  rei)eat  the  injection 
with  tlie  imnuine  serum. 

Dorset,  McBrydo  &  Niles  (1905-1907)  treated  iminmie  hogs  by 
two  iiietiiods.  In 'the  "(iiiiek  metliod"  they  injected  one  dose  of  900 
to  1500  cc.  of  virulent  blood  (10  cc.  per  pound  of  body  weight)  sul)- 
cutaneously,  in  the  "slow  method"  gradually  increasing  doses  of  500 
to  900  cc.  (1  to  5  cc.  per  pound  of  body  weight)  of  such  blood  at 
intervals  of  3  to  4  weeks  or  even  longer  periods.  About  three  weeks 
after  the  single  injections,  or  after  the  last  injection,  as  well  as  later  at 
various  intervals,  they  have  drawn  lilood  from  the  injected  animals. 
The  scn-um  from  such  blood  when  ol)tained  by  defibrinating,  or  by  allow- 
ing it  to  stand  inununized  animals  weighing  from  25  to  50  pounds  when 
injected  in  20  cc.  doses,  against  a  simultaneous  infection  of  1  to  2  g. 
of  virulent  blood,  and  also  against  subsequent  natural  exposures. 

Later  the  forced  ininnnii^ation  was  accomplished  by  injecting  the  hogs  once 
or  twice  intravenously  with  5  cc.  of  virulent  blood  per  pound  of  body  weight,  or 
with  10  cc.  intraperitoneally  by  a  single  injection. 

The  ininiune  serum  is  used  in  the  United  States  mostly  for  simultaneous 
inoculations  (see  below),  and  is  only  rarely  employed  alone.  Experiments  regard- 
ing the  curative  action  of  the  serum  showed  that  if  the  serum  treatment  is  umler- 
taken  not  later  than  four  days  after  infection,  the  outlireak  of  the  disease  may 
be  jirevented.  According  to  the  reports  of  the  Bureau  of  Animal  Industry  the 
results  from  the  practical  application  of  the  serum  are  very  satisfactory. 

Uhlenhuth  and  his  co-workers  (1907)  produced  a  similarly  potent 
serum  from  hogs,  to  which  they  had  given  several  subcutaneous  injec- 
tions of  25  to  100  cc.  of  virulent  material,  mostly  l)lood.  The  serum 
in  doses  of  10  to  50  cc.  protected  healthy  pigs  from  a  subseciuent 
severe,  natural  infection,  while  animals  which  were  not  inoculated, 
or  which  were  given  large  doses  of  horse  serum,  died  from  hog  cholera. 
Doses  of  10  to  20  cc.  also  protected  against  the  pathogenic  effects  of 
0.5  cc.  of  virulent  blood,  when  injected  subcutaneously  at  the  same 
time.  Potent  serum  can  be  prepared  only  from  hogs,  not  from  horses 
or  asses. 

Practical  experiments  with  immune  serum  have  lieen  maile  in  various  herds, 
most  of  which  were  severely  atfected,  IV.'.O  out  of  74:5  hogs  being  immunized  while 
41."?  were  not  given  the  treatment.  The  loss  among  the  inoculateil  hogs  was  ()1 
(18.4%),  among  those  which  were  not  inoculated  212  (.51.3%).  The  dose  of  the 
serum  was  20  to  50  cc. 

Ostertag's  laboratory  experiments  with  serum  of  successively 
highly  immunized  hogs  have  also  given  good  results.     With  this  serum 


282  Hog  Cholera. 

pigs  may  be  protected  against  an  infection  of  cholera,  and  Stadie  & 
Raebiger  have  obtained  mostly  good  results  in  practice  with  his  serum, 
testing  it  upon  24  herds. 

In  Germany  a  serum  prepared  by  Gans  is  also  in  use,  and  Spitzer,  Stock  and 
Pfeil  obtained  beneficial  results  from  its  application. 

Hutyra  &  Wetzl  treat  hogs  weighing  from  60-100  kg.  which  have 
recovered  from  the  disease,  either  with  a  single  injection  of  1000-1200 
cc.  or  2-3  injections  of  500-600  cc.  of  fresh  detibrinated  blood  from 
slaughtered  hogs  affected  with  hog  cholera.  Ten  days  after  the  last 
subcutaneous  injection,  and  at  intervals  of  2  to  3  weeks  afterwards, 
they  are  bled  from  the  tail,  and  finally  they  are  bled  to  death.  The 
blood  is  used  for  immunizing  purposes,  either  detibrinated,  or  it  is 
used  after  centrifugation  as  pure  serum.  Finding  that  the  pre- 
liminary tests  gave  favorable  results,  serum  immunizations  have  been 
employed  regularly  in  Hungary  since  1909,  and  on  the  whole  with 
satisfactory  results. 

In  the  preliminary  tests  285  hogs  of  five  herds  were  injected  once  or  twice 
with  10  cc.  of  filtered  serum,  or  15  cc.  of  defibrinated  blood,  while  2-40  animals 
were  not  injected.  After  placing  the  animals  in  badly  infected  stables,  the  losses 
among  the  inoculated  animals  in  the  various  herds  amounted  to  6.1  to  35.4%i,  among 
the  hogs  which  were  not  inoculated  40  to  66%,  the  difference  in  favor  of  the  inocu- 
lated animals  amounting  to  20  to  60%. 

Up  to  October  15,  1909,  reports  from  106  farms,  with  a  total  of  10,661 
apparently  healthy  hogs,  gave  the  results  of  the  serum  treatment  as  follows :  in 
42  herds  with  3,125  inoculations  the  disease  was  immediately  checked;  in  22  herds 
with  3,754  inoculations  the  loss  amounted  to  1.9%,  in  7  herds  with  730  inoculations 
the  loss  was  8.2%,  in  14  herds  with  1611  inoculations  15.7%  succumbed,  in  the 
remaining  21  herds  the  losses  amounted  to  23.7  to  57.6%.  In  46  herds  in  which 
4,189  animals  were  inoculated,  5,008  hogs  not  being  given  the  treatment,  8.8%  of  the 
inoculated  animals  died,  and  30.9%  of  those  which  were  not  inoculated.  The  inocu- 
lations were  absolutely  without  results  in  only  eight  herds,  with  a  total  of  599 
inoculated,  and  659  non-inoculated  animals.  The  losses  in  these  eases  amounted 
to  63.8  and  57.9%,  respectively. 

The  treatment  of  animals  which  were  already  manifestly  diseased  (2,681 
cases)  was  in  only  a  few  cases  successful  and  then  the  animals  improved  very 
rapidly  and  recovered. 

The  recurrence  of  the  disease  in  herds  which  had  been  treated  previously 
with  the  serum,  and  from  which  the  disease  had  been  eradicated,  has  up  to  ]May, 
1910,  been  observed  in  only  five  instances.  (The  dose  of  serum  was  10  cc.  per 
animal  weighing  from  20  to  40  kg.) 

Favorable  results  with  the  serum  are  also  reported  by  Szuran,  Szabo,  Tokayer 
and  Marton,  but  Szuran  and  Marton  failed  to  obtain  good  results  in  one  herd 
each  where  the  majority  of  the  animals  were  already  affected.  In  one  instance 
the  outbreak  was  abruptly  checked  by  the  immunization,  but  55  days  later  the 
disease  recurred  with  great  severity. 

2.    Immunization  with  Immune  Serum  and  Virulent  Blood. 

(Simultaneous  Method.)  In  the  United  States  this  method  is 
mostly  used  according  to  the  procedure  of  Dorset,  McBryde  and 
Niles,  the  animals  being  injected  subciitaneonsly  with  20  cc.  of 
immune  serum,  and  1-2  cc.  of  virulent  blood.  This  treatment 
has  also  by  our  numerous  observations  been  proven  to  confer 
an  active  immunity  upon  the  animals  which  lasts  at  least  six 
months,  and  probably  even  a  longer  time.  Nevertheless  the 
practical  application  of  this  method  does  not,  at  least  for  the 
present,  appear  to  be  altogether  without  danger,  as  some  of  the 
inoculated   animals   apparently  become   affected,   and   scatter 


liiiiiiuiiizatioii.  283 

tlie  virus.  Such  accidents  cannot  be  excluded  at  the  present 
time,  as  the  virulence  of  the  blood  fluctuates  considerably  in 
the  affected  animals,  and  there  is  no  satisfactory  niethod  by 
whicli  tiie  virulence  of  each  can  be  establislied  rapidly;  there 
is  likewise  no  quick  method  for  the  standardization  of  the  serum. 

In  lOO.l-lOOG  1G8  hogs  were  treated  in  the  United  States  by  the  simul- 
taneous niethod  (2.5-20  cc.  serum,  and  (1.25-5.0  cc.  of  virulent  l.lood,  each  separately, 
but  simultaneously  injected).  Of  these  35  (21%)  became  slitrhtly  affected,  while 
15  (f>%)  succundied.  On  the  other  hand  54  ho^s  became  affected  after  the  injection 
of  the  same  quantities  of  virulent  blood,  and  50  (02.5%)  of  these  succunilieil 
to  the  disease.  When  the  hogs  which  had  been  treated  by  the  method  described 
were  exposed  on  infected  premises,  they  remained  healthy  with  very  few  exceptions, 
while  all  control  animals  V>ecame  severely  ill,  and  most  of  tliem  died.  Some  experi- 
nents  on  suckling  ]iigs  sliowed  that  immunization  may  also  probably  be  used  with 
good  results  at  a  very  early  age  (Dorset,  McBryde  &  Niles).  Up  to  November,  1909, 
about  2,000  hogs  were  treated  with  satisfactory  results,  the  losses  among  the  inocu- 
lated animals  in  infected  herds  amounting  to  5-15%,  in  herds  free  from  the 
disease  0%,  whereas  among  the  animals  which  were  not  inoculated  the  losses 
amounted  to  75-89  and  35%    (Melvin). 

3.  Other  Methods  of  Immunization.  The  preparation  o^  a 
potent  serum  from  horses  and  cattle  has  not  been  successful 
(Uhlenhuth  and  Hutyra),  and  except  for  the  method  described 
aliove  there  is  at  the  present  time  no  procedure  which  has 
been  tried  in  practice  sufficiently. 

Marxer  prepared  a  vaccine  by  shaking  virulent  hog  blood  at  37°C.  for  four 
days  in  10%  uric  aciil,  or  for  three  days  with  25%  galactose,  this  vaccine  proving 
effective  in  immunizing  pigs  in  laboratory  experiments.  Inoculated  animals  did 
not  become  infected,  and  failed  to  infect  healthy  pigs.  For  its  practical  appli- 
cation it  is  recommen<led  to  inject  the  animals  at  intervals  of  several  months, 
from  3  to  4  times,  with  5  cc.  of  the  vaccine.  Uhlenhuth  and  his  associates  found 
on  the  other  hand  that  pigs  treated  by  this  niethod  do  not  acquire  an  immunity, 
and  that  it  is  not  possible  to  establish  an  immunity  with  virus  attenuated  or  killed 
by  either  physical  or  chemical  means. 

King  employed  for  a  vaccine  the  serum  of  horses  which  had  shortly  before 
been  injected  intravenously  with  S5-200  cc.  of  virulent  hog  serum.  On  the  assump- 
tion that  the  virus  is  gradually  attenuated  in  the  body  of  the  horse,  he  used  the 
blood  of  a  horse  which  was  drawn  six  hours  after  the  intravenous  injection  as  a 
vaccine.  He  treated  several  hundred  hogs  by  this  method  in  practice,  the  results 
however  were  varied.  While  apparently  favorable  results  were  obtained  in  several 
herds,  the  disease  appeared  shortly  after  inoculation  in  11  other  herds  which  had 
hitherto  been  free  from  the  disease. 

Immunization  Against  the  Bacillus  Suipestifer.  Before  the  establishment  of 
the  etiology  of  hog  cholera,  the  immunization  experiments  were  directeil  against 
the  bacillus  suipestifer,  as  the  supposed  causative  factor  of  the  disease.  The  prac- 
tical results  however  proved  entirely  unsatisfactory  in  spite  of  the  apparent  good 
results  in  laboratory  tests  on  small  animals.  At  present  the  tedious  experimental 
investigations  are  only  of  generally  scientific  interest,  as  it  appears  very  improb- 
able that  the  treatment  of  hogs  with  a  serum  which,  although  successful  against 
the  secondary  infection  of  the  bacillus  suipestifer,  will  ever  prove  of  any  advan- 
tage  in    its   practical    application. 

Recently  Stedefeder  reports  on  several  experiments  in  wliich  he  succeeded  in 
immunizing  pigs  against  the  suipestifer  disease,  which  is  said  to  occur  independently 
(see  p.  270).  The  serum  was  obtained  by  a  preparatory  treatment  of  rabbits, 
horses  and  hogs. 

Veterinary  Police.  Tlie  observations  made  in  recent  years 
have  proved  repeatedly  that  hog  cholera  may  be  limited  to 
single  premises  or  farms,  and  the  losses  be  rerluced  in  a  great 
measure  by  the  immediate  application  of  suitable  methods  of 


284  Hog  Cholera. 

prevention  and  eradication.  Accordingly  the  veterinary  police 
measures  (compulsory  reporting,  isolation  of  affected  animals, 
farm  or  town  quarantine,  isolation  and  if  jjossible  slaughtering 
of  the  affected  animals,  destruction  of  the  carcasses,  closing 
up  of  the  hog  markets,  and  prohibition  of  the  peddling  of  ani- 
mals, etc.),  when  applied  at  the  right  time  and  if  energetically 
executed  will  lead  to  favorable  results. 

As  hog  cholera  always  develops  as  the  result  of  the  intro- 
duction of  the  virus,  and  as  it  is  of  a  decidedly  contagious 
nature,  there  remains  no  doubt  that  it  may  be  eradicated  from 
large  territories  by  obligatory  slaughter  of  the  affected  and  sus- 
pected animals.  This  procedure,  when  vigorously  executed,  has 
brought  good  results  in  several  places  in  which  the  disease  has 
not  become  prevalent  to  a  great  extent,  and  wdiere  hogs  were 
kept  in  small  groups,  and  the  traffic  with  these  animals  was  not 
very  extensive  (for  instance  in  Sweden  and  Norway).  Such  a 
method  of  eradication  would  also  bring  about  the  desired  re- 
sults in  countries  in  which  hog  breeding  is  well  developed,  where 
the  traffic  in  hogs  is  very  extensive,  and  the  disease  has  already 
spread  considerably.  Eradication  based  on  this  principle 
w^ould  of  course  necessitate  a  corresponding  indemnity  to  the 
owners,  and  would  also  have  to  be  aided  by  immunization.  At 
the  present  time  the  most  powerful  obstacles  in  the  way  of  such 
a  procedure  are  the  financial  difficulties. 

The  eradication  has  been  in  progress  in  Great  Britain  since  1893,  and  the 
results  are  indicated,  at  least  up  to  1905,  ]\y  a  marked  reduction  in  the  number 
of  cases   (see  p.  259). 

In  Austria  a  law  of  1899  requires  the  oV)ligatory  slaughter  of  affected,  exposed 
and  suspected  animals,  for  which  an  indemnity  reimburses  the  owners.  Until 
the  end  of  1901  102,769  hogs  were  slaughtered,  and  the  entire  cost  of  the  eradica- 
tion amounted  to  2,625,470  crowns.  The  residts  of  the  eradication  did  not  come 
up  to  expectations,  as  repeated  introductions  from  foreign  countries  have  greatly 
hampered  it,  although  in  recent  years  a  diminution  of  the  disease  has  been  observed 
in  the  Alpine  countries. 

Veterinary  police  measures  may  be  aided  greatly  by  im- 
munization, inasmuch  as  outbreaks  may  be  checked  and  the 
spreading  of  the  disease  to  surrounding  herds  may  be  pre- 
vented by  serum  inoculations. 

In  the  United  States  a  procedure  is  followed  to  a  great  extent,  in  which 
the  newly  infected  herds  are  treated  with  serum,  and  the  droves  of  the  immediate 
vicinity  which  are  not  yet  infected  are  inoculated  by  the  simultaneous  method. 
At  the  same  time  further  extension  is  prevented  by  quarantine  of  the  infected 
herds,  slaughter  of  the  affected  animals,  and  the  disinfection  of  the  premises 
(Melvin). 

Literature.  T^p  to  the  year  1905  Joest,  Hog  Cholera  and  Swine  Plague, 
Jena,  1906. — De  Schweinitz  &  Dorset,  Bureau  of  Animal  Industry,  XX,  Eep.,  1903. 
157._I)orset,  Bolton  &  McBryde,  Ibid.,  XXI,  Eep.,  1904,  138;  Ibid.  Bull.  Nr..  102, 
1908.— Clintock,  Boxmever  &'  Siffer,  Journ.  of  Diseases,  1905,  II,  351.— Hottinger, 
Schw.  A.,  1905,  XVTT,  255.— Hutvra,  B.  t.  W.,  1906,  607.— Ostertag,  Ibid.,  p.  623.— 
Ostertag  &  Stadie,  Z.  f.  Infkr.,  1907,  II,  113  u.  425.— Theiler,  F.  d.  Vhyg..  1906, 
IV,  121— Glasser,  D.  t.  AV.,  1907,  617.— Lourens,  Zbl.  f.  Bakt.,  1907,  XLIV,  420.— 
IThlenhuth,  Xvlander,  Hiiliener  &  Bohtz,  Arb.  d.  G.-A.,  1908,  XXVII,  1  (Lit.); 
1909,   XXX,   217    (Lit.).— Marxer,   B.    t.   W.,    1908,   401.— Hutyra   &   Wetzl.,   Z.   ,t 


Arric-aii    lloisf-Sickni'ss.  285 

Iiifkikli..    ]!t(i9,   VI,    1;    H.    t.    W.,    I'.XHt,   ,s();!.— Sta.lii",   B.    t.    W.,    lUiiy,    li:5.— Stede- 
fedor,  1).  t.  W.,  IIM)!),  540. 

12.    African  Horse-Sickness,     Pestis  equorum. 

{Si'idafrikanisdie   Pferdcsterbe,    [German];    Pcsfr    (hi    chcrul, 
[French];  Paardrnziekte,  Pcrrrziolxfe,  [Holland].) 

African  iiorse-sickness  is  an  acnte  or  snbaente,  infectious 
disease  of  solipeds,  caused  by  an  ultravisible  virus.  It  exists 
in  an  epizootic  form  in  Africa,  and  is  cliaraeterized  l)y  exten- 
sive edematous  swellings,  and  hemorrhages  of  the  internal 
organs. 

History.  Tlio  disease,  Avliieh  lias  l)een  Known  in  South  Africa 
for  over  a  century,  lias  in  recent  times  l)een  confused  eitlier  with 
anthrax  (Lanil)ert,  Sander),  or  with  })iroplasniosis  (Rickniann,  Eding- 
ton).  lioth  views  were  al)andoned  since  McL'adyean  (11)00),  and  hiter* 
Noeard  (1901),  proved  that  the  virus  passes  through  the  porcetein 
filter.  The  disease  has  been  studied  especially  by  Theiler,  from  its 
etiological  and  clinical  standpoints,  whih>  the  (juestion  of  imnuuiiza- 
tion  has  also  been  investigated  by  Edington,  Koch  and  Rickmann. 

Occurrence.  The  disease  occurs  annually  in  South  Africa 
during  the  rainy,  warmer  months,  January  to  jMarcli,  especially 
in  low,  moist  localities.  In  years  with  great  precipitation  the 
disease  rages  among  horses  and  mules  to  such  an  extent* that  in 
the  affected  localities  35%  of  the  animals  succumb,  and  some 
of  the  localities  are  devastated  to  such  a  degree  that  not  a.  sin- 
gle horse  remains  alive  unless  some  of  the  animals  have  pre- 
viouslv  withstood  the  disease  in  some  other  place  (has  been 
''salted"). 

In  the  Cape  Colony  64,850  horses  and  mules  perished  from  horse-sickness  in 
1854  and  1855.  Since  that  time  the  annual  losses  are  estimated  at  14,(l()()  animals. 
In  German  Southwest  Africa  the  losses  amounted  in  some  years  to  66%,  in 
Ehodesia  to  as  much  as  90%  of  the  entire  number  of  animals. 

According  to  Memnio  and  Brumpt  the  disease  occurs  also  in  Abyssinia,  and 
according  to  Friedrichsen   in   East  Africa. 

Etiolog-y.  The  causative  factor  of  the  disease  belongs  to 
the  ultra-microscopical  micro-organisms,  as  the  filtrate  of  the 
blood  diluted  with  physiological  salt  solution  (Berkefeld  or 
Chamberland  B  and  F  filters)  proves  infectious.  Blood  taken 
from  affected  horses  in  any  stage  of  the  disease,  and  injected 
subcutaneously,  intratracheally,  intravenously  or  into  the  lungs 
(0.01-1.0  cc,  or  only  0.0005  cc.)  or  administered  per  os  (100-156.0 
cc),  produces  the  disease  in  the  horse.  The  exudates  and  the 
bronchial  secretions  also  contain  the  virus,  but  the  infectious- 
ness of  the  excrement  is  considered  to  be  doubtful.  Blood  from 
recovered  animals  has  no  infectious  action. 

Horses  are  highly  susceptil)le  to  artiiicial  infections,  nniles 
and  asses  to  a  lesser  extent.  According  to  Edington  it  is  also 
possible  to  infect  cattle  fatally,  and  to  produce  febrile  reactions 
in  goats  and  sheep.     Theiler  &  Stockman  found,  however,  that 


286  African   Horse- Sickness. 

this  is  only  possible  in  young  Angora  goats,  their  blood  becom- 
ing infections  to  horses  and  mules,  but  not  for  other  goats.  On 
the  other  hand  they  succeeded  by  intravenous  injections  of  large 
quantities  of  unfiltered  horse  blood,  to  cause  severe  illness  in 
dogs,  and  to  infect  other  dogs  as  well  as  horses  with  their  blood; 
McFadyean  however  failed  to  observe  any  manifestations  of 
disease  in  three  dogs  after  subcutaneous  injections  of  small 
quantities  of  virus.  Man  is  not  susceptible,  as  has  been  estab- 
lished by  Rickmann  and  Kaestner  through  subcutaneous  injec- 
tions on  their  own  bodies. 

Edington  and  Morton  Coutts  consider  horse  sickness  and  heart 
water  (see  p.  257)  as  identical,  or  at  least  as  closely  related  diseases. 
They  succeeded  in  producing  in  horses  a  disease  resembling  horse 
sickness,  with  the  virus  of  goats  affected  with  heart  water.  The  virus 
of  this  disease  however  possessed  only  a  slight  virulence  for  horses. 
This  view  is  disputed  by  Theiler  and  Stockman,  as  their  experiments 
have  shown  that  goats  treated  with  the  virus  of  horse  sickness  remain 
susceptible  for  heart  water,  and  likewise  horses  inoculated  with  heart 
water  blood  may  later  become  affected  with  horse  sickness. 

Whether  there  exists  a  close  relation  between  horse  sickness  and 
infectious  anemia  (see  that  disease),  in  the  sense  that  the  anemia  rep- 
resents a  mild  form  of  horse  sickness,  is  not  conclusively  established, 
and  requires  closer  investigation. 

Natural  infection  occurs  in  the  periods  of  the  year  men- 
tioned, usually  out  of  doors  and  at  night;  keeping  the  horses 
in  the  same  places  in  day  time  from  the  time  when  the  dew  dries 
until  sunset,  as  well  as  during  rainy  weather,  is  not  dangerous 
for  them.  The  first  frost  usually  terminates  the  disease,  so  that 
from  the  eighth  day  following  it  no  more  cases  occur  (in  dry 
weather  the  disease  occurs  only  very  exceptionally).  Although 
the  disease  may  be  produced  by  feeding  great  quantities  of 
virus,  the  observation  that  in  the  dangerous  pastures  horses  are 
not  protected  by  muzzles,  indicates  that  the  infection  is  trans- 
mitted by  some  insect  or  fly.  According  to  Pitchford  anopheles 
mosquitoes  and  stegomya  which  have  been  within  48  hours  upon 
the  body  of  an  affected  animal  serve  to  transmit  the  disease  to 
healthy  horses;  Reinecke  succeeded  by  a  test  in  Germany  in 
producing  a  fatal  disease  in  one  horse  by  subcutaneous  injec- 
tions with  an  extract  from  ticks  which  he  had  collected  in  the 
African  horse-sickness  district  one  year  before.  This  may  ex- 
plain why  smoke  near  the  horses  (Theiler),  or  keeping  them  in  a 
stable  protected  by  a  net  (Pitchford),  prevents  the  disease. 

Anatomical  Changes.  The  autopsy  reveals  in  locations 
varying  from  case  to  case,  a  gelatinous  infiltration  of  the  sub- 
cutaneous and  intermuscular  connective  tissue,  especially 
around  the  eyes  and  the  region  of  the  throat.  There  is  acute 
swelling  of  the  superficial  lymph  glands,  severe  catarrhal  swell- 
ing of  the  mucous  membrane  of  the  stomach,  the  anterior  por- 
tion of  the  small  intestines  and  occasionally  also  of  the  large 


Anatomical    ("hanyes.      Syiii])t.)iiis.  Og7 

intestines.  Tlie  intestines  may  also  show  lieniorrhages  and 
ulcerations,  and  m  about  tuo-tiiirds  of  the  cases  a  well  niarked 
acute  edema  ot  the  lun^s  with  serous  infiltration  of  the  inter- 
obular  connective  tissue;  sometimes  gelatinous  pseudo-mem- 
branes will  be  found  on  tiie  i)h'ura,  and  hemorrhages  under  the 
pen-  and  endocardium,  as  well  as  in  the  heart  muscle  The 
spleen  is  normal  or  only  sli-htly  enlarged,  the  liver  hyperemic, 
the  kidneys  show  hyperemia,  or  an  acute  iiiHammation  with 
small  hemorrhages.. 

Symptoms.    Horse-sickness  usually  develops  after  a  period 
ot  incubation  averaging  G  to  7  days  in  two  forms  (Theiler). 

_  In  the  acute  cases  ( Dunkop-Paardenziekte,  Dun-Perre- 
ziekte,  pulmonal  form)  the  body  temi)erature  rises  within  a  few 
days  up  to  40-42°.  The  patients  show  corresponding  signs  of 
teelmg  ill,  although  the  ai)petite  remains  unimpaired  for  a  long 
time.  At  the  height  of  the  disease,  towards  the  end  of  the  first 
week,  the  animals  are  strikingly  feeble,  the  pulse  is  fre(ineiit 
and  small,  the  heart  thro))bing,  the  respiration  accelerated  and 
labored.  In  a  small  number  of  cases  improvement  and  subse- 
quent recovery  take  place  in  the  course  of  the  second  week,  the 
tever  diminishing.  In  most  cases  however  at  this  time,  1  to  2 
days  before  death,  manifestations  of  edema  of  the  lungs  de"^ 
velop,  as  a  result  of  which  the  animals  show  verv  htbored 
respiration,  at  the  same  time  passing  great  quantities  of  a 
yellowish-white  foam  from  mouth  and  nose,  which  is  also  ex- 
pelled by  spasmodic  coughing.  Swelling  of  the  superficial  Ivmph 
glands  may  also  be  observed,  and  frequent  manifestations  of 
metritis  (Friedrichsen).  In  rare  cases  the  course  takes  a 
sudden  unfavorable  turn,  after  slight  prodromal  febrile  mani- 
festations lasting  4  to  6  days.  The  condition  of  the  animal 
becoming  worse  from  hour  to  hour,  the  temperature  drops  and 
death  ensues  inside  of  from  4  to  6  hours  with  s^anptoms  of 
dyspnea  and  heart  weakness  ( Theiler 's  peracute  septicemic 
form ) . 

In  the  subacute  form  (Dikkop-Paardenziekte,  Dikkopziekte) 
the  disease  develops  in  a  similar  manner,  although  considerably 
more  slowly.  At  the  height  of  the  fever,  or  possibly  somewhat 
later,  the  parts  surrounding  the  orbits  become  edematously 
swollen,  and  at  the  same  time  an  exophthalmia  develops ;  then  iii 
some  cases  edematous  s^vellings  appear  on  the  forehead,  on  the 
head,  on  the  chest  and  abdomen,  on  the  back  and  on  the  extremi- 
ties, and  sometimes  even  the  tongue  is  swollen  to  a  great  extent 
(blue  tongue).  In  the  meantime  marked  muscular  weakness  is 
noticea])le  in  the  animals,  in  the  majority  of  cases  however 
recovery  finally  takes  place. 

Frf'i  (l(Mnonstratpd  by  extensive  physical-chemical  blood  and  serum 
examinations  the  following:  differences  from  normal  l)lood :  the  volume 
of  red  blood  corpuscles  and  the  viscosity  is  increased  at  the  height 
of  the  disease,   later  diminished;  specific  gravity,   inside  friction,   and 


288  African   Horse- Sickness. 

conductivity  of  the  serum  is  always  below  the  normal  average.     Similar 
changes  are  also  present  in  immune  horses. 

The  course  of  the  acute  and  peracute  horse-sickness  is  usu- 
ally unfavorable,  inasmuch  as  horses,  especially  those  brought 
from  non-infected  territories,  frequently  succumb  almost  with- 
out exception,  while  the  subacute  form  runs  a  much  milder 
course. 

The  disease  is  distinguished  from  anthrax  by  its  slower 
course,  and  especially  by  the  absence  of  the  pronounced,  acute 
enlargement  of  the  spleen;  from  piroplasmosis,  by  the  absence 
of  icterus,  by  the  edematous  swellings,  the  severe  inflammation 
of  the  left  half  of  the  stomach  and  by  its  occurring  only  at  cer- 
tain periods  of  the  year.  Microscopical  examination  of  the  blood 
in  the  diseases  mentioned  gives  positive  results,  however  the 
presence  of  piroplasmas  does  not  exclude  horse  sickness. 

Prevention.  The  treatment  attempted  up  to  the  present 
time  has  generally  proved  ineffective.  In  order  to  prevent  the 
disease,  horses  are  in  the  summer  driven  to  high  pastures,  which 
are  known  to  be  non-infectious,  and  in  suspected  places  they 
are  allowed  to  pasture  only  in  day  time.  By  persistent  breeding 
of  immune  horses  and  mules  it  will  probably  be  possible  to 
produce  resistant  breeds  in  the  infected  localities  (Rickmann). 

Immunization.  Recovery  from  the  disease  reduces  the  sus- 
ceptibility of  the  animals,  but  does  not  entirely  eliminate  it, 
as  even  comparatively  immune  ("salted,"  "gezouten")  horses 
may  become  affected  by  a  virulent  infection  (Theiler).  Never- 
theless this  acquired  immunity  protects  the  animals  from 
natural  infection,  in  about  two-thirds  of  the  cases,  and  when 
they  do  become  affected  the  course  of  the  disease  is  much  milder. 

Immunity  may  be  produced  artificially  in  various  ways,  but 
only  in  mules  without  great  losses.  In  these  animals  immuniza- 
tion has  been  applied  in  practice  in  South  Africa  for  several 
years,  but  it  must  be  repeated  annually,  as  the  immunity  gradu- 
ally vanishes. 

Koch's  Method  of  Immunization.  Koch  obtained  a  serum  from 
''salted  horses"  which  were  injected  subcutaneously  and  intravenously 
with  increased  doses  (up  to  2000  cc.)  of  virulent  blood  at  intervals  of 
from  3  to  4  weeks,  which  produced  passive  immunity  on  being  injected 
into  healthy  horses  without  exerting  a  hemolytic  action,  as  was  the 
case  with  sera  prepared  by  other  methods.  Further  experiments  showed 
that  by  repeated  injections  of  virulent  lilood  and  then  of  serum  horses 
may  be  actively  immunized.  The  (|uantity  of  virus  and  serum  nmst  be 
proportioned  in  such  a  way  that  the  animals  become  affected  by  the 
disease  without  dying  of  it. 

It  was  found  most  effective  to  make  an  inoculation  of  0.01  cc.  of  virus 
and  100  cc.  of  serum  for  the  first  injection,  the  dose  of  the  virus  to  be  increased 
to  0.05  and  0.2  cc,  at  the  same  time  reducing  the  serum  to  50  cc.  and  finally 
continuing  the  inoculations  with   the  pure  virus    (0.5,  1.0,  2.0  cc).     The  serum  is 


Iiiiinuiii/.atiuii.  289 

always  injeototl  four  days  after  tlio  vims,  while  eadi  subsequent  inoculation  is 
ina.le  V2  days  at't(M-  tlu'  last,  in  1 1^  to  '2  months  the  liorscs  may  bo  inimuni>ed 
to  suc'li  an  extt'nt  that  they  withstand  5  cc.  of  virulent  ]>loo«l  without  any   reaction. 

The  blood  necessary  for  tiie  imniunii'atiou  is  taken  from  atfeited  animals 
sliortly  before  death,  it  is  delibrinated,  filtered,  nii.xed  with  an  eijual  (luantity  of 
Klyeerin  and  water,  ami  ;>:  10(11)  carbolic  aci.l,  and  allowed  to  stand  from  2  to  :'. 
weeks.  Afi\M-  repeated  fdtration  it  is  stored  in  small  liottles.  Immediately  before 
inoculation  the  recjuired  quantity  of  virus  is  diluted  with  5  ce.  of  physiological  salt 
solution. 

For  the  prepaiation  of  the  immune  serum  older  (salted)  horses  are  injectetl 
in  the  jujjular  with  fresh  delibrinated  virulent  blood  at  two-weekly  intervals  (the 
lirst  time  2,000  cc,  later  somewhat  smaller  doses).  The  blood,  wliich  is  subsccjnently 
drawn,  produces  the  serum,  and  is  preserved  by  Khrlich 's  method  (to  90  parts 
serum  10  i)arts  of  a  nii.\ture  of  5.o  parts  carbolic  acid,  20  parts  glycerin  and  74.5 
parts  of  water  is  added). 

Theiler's  Method  of  Immunization.  According  to  Tlieiler  the 
safest  iiuiiiunizatiou  consists  in  liie  injirtion  of  iiniiinne  seniiu  (:{00  cc.) 
into  the  jugnhir,  and  virulent  blood  (1-2  cc.)  under  the  skin;  after 
the  appearance  of  the  febrile  reaction  a  second  serum  injection 
(50-100  cc.)  appears  indicated. 

In  the  Transvaal  and  Khodesia  8,766  mules  were  treated  by  this  method,  with 
a  loss  of  3.7%  from  the  inoculation.  Subsequently  only  1.3%  fell  victim  to  the 
disease  from  natural  infection  in  affected  territories.  As  it  has  since  been  found 
that  serum  prepared  with  a  certain  virus  is  sufficiently  effective,  only  against  this 
virus,  Theiler  recommends  the  preparation  of  a  polyvalent  immune  serum. 

Other  Methods  of  Immunization.  Rickmann  employs  material 
originating-  from  mules  which  are  first  injected  subcutaneously  with 
0.1  ec.  of  virulent  blood,  three  days  later  with  100-200  cc.  of  serum, 
and  after  12  to  14  days  again  with  1  cc.  of  virus  (incubation  method). 

A  second  method  consists  in  the  simultaneous  but  separate  sub- 
cutaneous injection  of  0.2  cc.  of  virus,  and  200  cc.  of  serum,  and  21 
days  later  the  subsequent  subcutaneous  inoculation  of  25  ec.  of  virus 
(simultaneous  method). 

According  to  Eeinecke  of  280  mules  treated  by  the  first  method,  and  of  160 
injected  by  the  second  method  8%  died,  and  the  percentage  l>eing  somewhat 
higher  in  the  simultaneous  than  in  the  incubation  method.  Practically  all  of  the 
inoculated  animals  remained  well,  while  the  losses  among  the  mules  which  were 
not  inoculated,  and  kept  at  the  same  place,  amounted  to  3.3 '^f  as  a  result  of 
natural  infection. 

Leipziger  gives  for  the  first  dose  subcutaneous  injections  of  1  cc.  of  virus, 
and  300  cc.  of  highly  potent  serum ;  for  the  second  dose  20  cc.  of  virus.  The  losses 
from  the  inoculations  amounted  to  3.5%.  For  the  immunization  of  horses  he 
recommends  first  the  subcutaneous  simultaneous  method,  with  0.1  cc.  of  virus  and 
400  ce.  of  serum;  three  weeks  later  an  injection  of  0.3  ce.  of  virus  and  100-200  cc. 
of  serum;  then  the  animals  should  be  injected  daily,  first  subcutaneously,  later 
intravenously,  with  diminishing  quantities  (down  to  0.01  cc.)  and  later  again  with 
increasing  quantities  of  virus,  until  a  reaction  takes  place. 

Literature.  Theiler,  Schw.  A.,  1893,  145;  D.  t.  W.,  1901,  209;  Bull.  P.,  1905, 
JIT,  617;  Eep.  of  the  Gov.  Vet.  Bact.,  1905-1908.— E.iington,  The  Vet.,  1895,  XLI, 
595;  J.  of  comp.  Path.,  1900,  XIII,  223  u.  281.— Eickniann,  B.  t.  W.,  1895,  289; 
A.  f.  Tk.,  1907,  XXXllI,  372;  B.  t.  W.,  1908,  883.— Sander,  A.  f.  Tk.,  1896,  XXI, 
249.— MacFadyean,  J.  of  comp.  Path.,  1900,  XIII,  1;  1901,  XIY,  103.— Nocard, 
Bull.,  1901,  37.— Koch,  A.  f.  Tk.,  1905,  XXXI,  330.— Eeinecke,  Diss.  Bern,  1909 
(Lit.);  Z.  f.  Yk.,  1910,  76.— Leipziger,  Diss.  Bern,  1909  (Lit.).— Frei,  Z.  f.  Infkr., 
1909,  AT,  363. 
Vol.  1—19 


290  Fowl  Pest. 

13.    Fowl  Pest.   Pestis  avium, 

{Pestis  gallinarum,  Typhus  exsudativus  gallinarum  Rivolta  & 

Delprato^  Peritonitis  epizootica  Scheuerlen  &  Buhl, 

KyanolopMaea  Lode  &  Ctruber;  Peste  aviaire, 

[French];   GeflUgelpest,    [Germcui].) 

Fowl  pest  is  an  acute,  contagious,  infectious  disease  of 
fowls,  especially  of  geese,  which  in  its  course  greatly  resembles 
chicken  cholera;  it  is  however  caused  by  an  ultra-microscopical 
virus. 

History.  The  disease  was  first  described  in  1878  by  Perroncito, 
and  was  shortly  afterwards  recognized  as  a  disease  differing  from 
fowl  cholera  by  Rivolta  &  Delprato  (1880).  Later  on  Italian  authors 
treated  the  disease  repeatedly  as  a  dangerous  plague,  which  caused 
great  losses  especially  in  Northern  Italy.  Centanni  &  Savonuzzi  (1901) 
proved  that  the  virus  passes  the  porcelain  filter,  and  similar  results 
were  also  obtained  l)y  Maggiore  &  Valenti,  as  well  as  by  Lode  &  Grul)er, 
Ostertag  &  AVolffhiigel,  Maue  and  others.  Recently  Kleine,  Moller, 
Rosenthal  and  Schiff'mann  established  the  occurrence  of  the  disease 
in  geese,  Prowazek,  Kraus  &  Doerr,  as  well  as  Marchoux  contributed 
to  its  etiology,  and  Freese  to  its  pathological  anatomy. 

Occurrence.  The  disease  raged,  especially  since  the  year 
1894,  independently  of  chicken  cholera,  as  a  very  fatal  plague 
in  Northern  Italy,  from  which  region  it  was  recently  introduced 
into  Tyrol  and  Germany,  and  later  into  Belgium  and  France. 

In  Southern  Germany  it  appears  to  have  occurred  since  1898  (Scheuerlen  & 
Bnhl),  but  was  spread  more  extensively  by  the  Brunswick  fowl  exposition  in 
1891,  at  tirst  in  Wiirttemberg-,  later  in  the  Northern  states,  especially  in  Prussia. 
In  1908  the  disease  was  oflfieially  recognized  in  Germany  in  r^l  townships,  affecting 
1,826  chickens,  159  geese  and  3  ducks  (considerably  less  than  in  previous  years). 
In  Hungary  it  has  been  known  since  190.3. 

Alarcone  observed  the  disease  in  Capodinionte  in  a  pheasantry,  Eggebrecht 
in  Tsingtau  as  a  severe  plague  of  chickens. 

Etiology.  The  infective  agent  is  contained  in  the  blood,  in 
the  nervous  system,  in  the  nasal  secretion  and  in  the  droppings, 
as  well  as  in  the  exudate  of  the  serous  cavities  and  in  the  bile 
of  the  affected  animals.  By  the  inoculation  of  minimal  quan- 
tities of  these  substances  (for  instance  0.000,001  cc.  of  blood), 
the  disease  may  be  positively  transmitted  to  chickens.  Simi- 
larly effective,  although  in  a  lesser  degree,  are  the  filtrates  of 
the  above  mentioned  substances  through  porcelain. 

According  to  Landsteiner  the  virus  appears  to  adhere  to  the  blood  corpuscles 
as  serum  alone  proved  only  slightly  or  not  at  all  virulent.  Eosenthal,  Kleine  and 
Sehiflfmann  found  in  the  brain,  intra-  and  extra-cellular,  round  or  oval,  sometimes 
also  ring-shaped  bodies,  the  true  nature  of  which  (protozoa  or  products  of  degen- 
eration?) has  not  been  established  at  the  present  time.  Prowazek  could  not  confirm 
these  findings,  and  believes  that  the  carriers  of  the  virus  are  1  to  1.5  /x  sized,  some- 
times dumb-bell  shaped,  forms  in  the  brain,  which  frequently  lie  closely  against 
the  red  blood  corpuscles ;  further  fine  single  and  double  granules  in  the  filtrates. 
Marchoux  reports  the  successful  cultivation  of  the  virus  by  spreading  blood  on 
peptone-agar  containing  sugar;  0.2  cc.  of  culture  of  the  10th  generation  killed  a 
chicken  in  two  days. 


EtioloiiV.      Piitlioiicnicity.  291 

Tenacity,  lilootl  ]ila('Cil  in  j^lius  tulies,  the  oiuls  of  whicli  were  closed  by 
melting,  an'l  kept  in  a  ilark  plai-e,  retained  its  virulence  for  three  months,  while 
the  filtrate  was  virulent  for  only  one  week.  Heatinjx  to  55°  destroys  the  virus 
within  a  half  hour,  at  IJ0°  in  5  minutes,  at  1)5"  immediately  (Centanni).  Aecordint^ 
to  Maue  the  virus  remains  active  in  dried  spinal  cord,  or  liver  substance,  for  UOO 
days,  in  blood  mixed  with  i;lycerin  (aa)  for  270  days.  Ac<'ordinj,'  to  Ostcrtafj  & 
Huir^'e  it  is  destroyed  by  dryiii^^  in  a  thin  layer,  or  by  juitrefaction  after  'MJ  "lays; 
on  beinjj  subjected  to  a  temperature  of  70°  it  is  killed  instantly.  A  1%  corrosive 
sublimate  solution  destroys  it  in  30,  a  1%  sulphuric  acid  and  a  •i%  chlorate  of  lime 
solution  in  10  minutes  (Lode).  A  hot  2%  soda  solution,  as  well  as  a  hot  5%  creolin 
solution  are  also  eflfective   (Ostertag  &  Bugge). 

Pathogenicity.  Cliickons  aiul  turkeys,  plieasants,  sparrows, 
l)lac'k-l»irils,  spariuw-liawks,  owls  and  ])arrots  are  susceptihle  to 
the  virus,  while  water  fowls  and  ])i.i>eoiis  as  a  rule  resist  the 
natural,  and  frequently  also  the  artilicial  infection;  mammalia 
are  not  at  all  snsceptilble. 

Old  geese  can  be  infected  only  by  subdural  inoculations,  those 
only  half  a  year  old  however  by  subcutaneous  or  intramuscular  inocula- 
tions, as  well  as  per  os.  In  these  birds  the  disease  manifests  itself 
priiu'ipally  in  nervous  symptoms  (see  symptoms).  Lode  &  Gruber 
and  ("entanni  succeeded  in  infecting  pigeons  only  by  repeated  injections 
of  large  (juantities  of  vii'us,  ]\Iaggiore  &  Valenti  only  after  previous 
starvation  with  l)lood  injections;  Freese  however  produced  the  disease  in 
them  by  letting  them  live  with  chickens.  Successful  infections  in  ducks 
are  reported  by  Leclainche,  and  spontaneous  infection  of  a  parrot  by 
Stazzi. 

The  natural  infection  is  probalily  transmitted  mostly  by  the  droppings  and 
the  nasal  secretion  of  affected  birds,  and  also  by  the  lilood  of  killed  animals  and  by 
the  organs  of  those  dead  from  the  disease,  which  are  ingested  with  the  food  by 
healthy  chickens  (by  feeding  such  material  the  disease  has  been  produced  arti- 
ficially). Occasionally  the  virus  may  enter  the  l)ody  through  injuries  of  the  skin; 
at  least  it  was  found  that  the  disease  may  be  produced  artificially  very  easily  and 
positively  in  this  manner  (it  is  sufficient  to  dip  the  needle  of  a  syringe  into  infected 
blood,  and  slightly  scarify  the  skin  with  it;  Kleine  &  Mollers  succeeded  in  pro- 
ducing the  disease  by  dropping  the  virus  into  the  conjunctival  sac). 

Parasites  living  on  affected  fowls  (Dermanyssus  avium)  cannot 
transmit  the  disease,  and  it  cannot  be  even  produced  by  subcutaneous 
injections  of  such  macerated  parasites   (Centanni). 

Anatomical  Changes,  In  very  acute  cases  the  autopsy 
sometimes  reveals  negative  findings,  or  frequently  only  punc- 
tiform  liemorrliages  on  the  inner  surface  of  the  breast  ])one,  on 
the  visceral  layer  of  the  pericardium,  on  the  peritoneum,  in  the 
fat  tissue  of  the  gizzard,  and  on  its  peritoneal  attachment,  as 
well  as  in  the  mucous  membrane  of  the  air  passages.  There 
may  also  be  hyperemia  of  the  spleen  and  of  the  kidneys.  In 
less  acute  cases  there  is  an  edematous  swelling  of  the  subcu- 
taneous connective  tissue  on  the  neck  and  breast,  also  a  great 
amount  of  a  pale  yellow,  slightly  cloudy  fluid  in  the  pericardium, 
which  rapidly  coagulates  in  the  air.  The  layers  of  the  pericar- 
dium sometimes  appear  to  he  adherent  by  fine  fibrinous  threads. 
Italian  authors  mention  as  a  frequent  finding  a  fibrinous  exu- 
date on  the  pleura  and  peritoneum  (therefore  the  name  of 
"TjTohus  exudativus"). 

The  comh  and  the  wattles  are  dark,  hluish-red,  the  con- 
junctivae  show  catarrhal   swelling.     There  is   a   considerable 


292 


Fowl  Pest. 


quantity  of  mucus  in  the  mouth  and  in  the  nose,  which  is  some- 
times bloody.  The  lungs  are  congested  and  sometimes  contain 
atelectatic  areas. 

The  intestinal  tract  contains  on  the  smooth  mucous  mem-' 
brane  grayish-white,  sometimes  greenish  excrement ;  at  the  pas- 
sage between  the  glandular  and  muscular  stomach,  as  w^ell  as 
between  and  on  the  conical  protuberances  of  the  glandular 
stomach,  there  are  superficial  or  deep  hemorrhages,  sometimes 
only  very  small  (Freese).  The  mucous  membrane  at  the  begm- 
ning  of  the  small  intestines  shows  sometimes  only  catarrhal 
reddening,  in  other  cases  it  is  inflamed  more  markedly.  The 
liver  and  spleen  show  no  striking  changes.  The  kidneys  are 
either  grayish-brown  in  color  and  cloudy  or  dark  brown  and 
moist  on  the  cut  surface.  The  serous  membrane  of  the  egg  yolk 
is  markedly  congested,  revealing  sometimes  hemorrhages  which 
may  also  be  present  in  the  yolk  itself  (Freese). 

Symptoms.  The  time  of  incubation  in  the  natural  infection 
is,  as  a  rule,  3  to  5  days,  exceptionally  2,  or  on  the  contrary 
it  may  be  even  7  days  (Freese),  while  after  artificial  infection 
death  ensues  not  infrequently  inside  of  36  to  48  hours. 

The  disease  commences  with  depression  and  diminished 
appetite,  which  condition  soon  changes  to  a  conspicuous  dullness 
and  sleepiness.     The  chickens  creep  into  dark  corners,  and  sit 

with  drooping  head  and  wings 
as  when  brooding,  or  crouch 
motionless  in  one  place.  Even 
at  the  onset  of  the  disease  they 
do  not  resist  being  caught,  and 
some  of  the  birds  give  a  peculiar 
loud  cry  when  picked  up.  When 
driven  about  they  move  with  a 
staggering,  irregular  walk,  later 
it  is  hardly  possible  for  them 
to  move  at  all.  Setting  them  on 
the  perch  they  find  their  equi- 
librium only  after  long  balanc- 
ing, or  not  at  all. 

In  the  meantime  the  comb 
and  the  wattles  become  dark 
red,  and  finally  are  blackish- 
red  in  color  (hence  the  name 
Kyanolophiaea),  while  towards 
the  termination  of  the  disease 
grayish  scales  sometimes  de- 
velop on  the  skin.  A  similar 
discoloration  is  also  observed  around  the  eyes,  while  the  eyelids 
are  usually  closed,  tears  accumulating  under  them  profusely,  the 
conjunctivae  being  injected  and  swollen. 

On  pressure  of  the  bill  a  grayish  or  reddish,  tenacious 
mucus  oozes  from  the  opening,  and  a  similar  secretion  is  also 


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Fig.  53.     Fever  curve  in  chicken  pest 
Following  inoculation  of  virulent  blood 


tSyinptoins.  293 

observed  in  the  throat,  while  on  the  buccal  iiiiicous  membrane 
small  hemorrhai^es  may  sometimes  be  found.  Some  patients 
periodically  shake  their  heads,  at  the  same  time  giving-  a  pecu- 
liar sound,  and  expelling  saliva  from  nose  and  mouth.  In  rare 
cases  profuse  diarrhea  is  o))served,  the  droppings  being  dirty 
gray  or  greenish,  fluid  and  exceptionally  i-ed  colored. 

Towards  the  end  of  the  disease  the  affected  birds  hold  llicir 
heads  turned  toward  the  back,  their  respiration  is  very  labored, 
and  finally  paralysis  appears,  which  progresses  from  the  ex- 
tremities to  the  head. 

In  artilicial  infection  the  body  temperature  commences  to 
rise  after  1 2  hours,  and  later  may  exceed  44°C.  At  the  approach 
of  death  however  it  drops  rapidly,  even  to  30°  (Fig.  53). 

]\Iaggiora  &  Valenti  describe  a  diphtheroid  form  of  the  disease, 
in  which  a  muco-fibrinous  exudate  forms  on  the  surface  of  the  swollen, 
bright  red  mucous  membrane  of  the  mouth,  throat  and  nose. 

The  same  authors  observed  in  several  affected  chickens  peculiar 
nervous  symptoms  in  addition  to  irregularity  in  walk,  and  symptoms 
of  paralysis,  which  Avere  manifested  })y  moving  the  head  in  a  circle; 
Centanni  has  seen  disturl)ances  in  the  e(|uilibrium,  lasting  for 
weeks  in  pigeons  which  were  inoculated  with  l)lood,  especially  turning 
the  head,  moving  in  a  circle,  and  a  desire  to  turn  tlie  body  around 
its  long  or  transverse  axis.  The  examination  revealed  as  the  cause 
of  these  disturbances  an  exudative  inflammation  of  the  membranous, 
semi-circular  canals  of  the  organs  of  hearing  (seraicirculitis  specifica). 
Calamida  has  also  observed  the  turning  of  the  head  backwards,  and 
besides,  shortly  before  death,  attacks  of  delirium  which  somewhat  re- 
semble rabies,  the  birds  jumping  very  high  during  these  attacks. 

In  artificially  infected  geese  the  disease  runs  a  slower  course  (an 
average  of  7  days),  and  as  a  rule  under  manifestations  of  striking 
nervous  symptoms,  which  are  indicated  by  tonic-clonic  spasms,  involun- 
tary movements,  fluttering  of  the  wings,  spasmodic  extension  of  the 
neck,  increased  reflex  irritability,  etc.  At  the  approach  of  death  the 
symptoms  pass  into  paralysis.  The  blood  of  these  birds,  as  well  as  of 
artificially  infected  pigeons,  is  infectious  only  at  the  ])eginning  of 
the  affection,  while  later  the  virus  disappears  entirely.  The  brain  and 
spinal  cord,  on  the  other  hand,  remain  highly  infective  even  after 
death  (Kleine).  This  may  be  explained  by  the  fact  that  the  virus 
emigrates  from  the  blood  into  the  nervous  cellular  elements,  and 
becomes  anchored  there  as  a  result  of  its  specific  affinity  for  the  cell 
plasma.  This  would  correspond  with  the  histological  findings  (prolifera- 
tion of  round  cells,  the  above-mentioned  bodies)  as  well  as  with  the 
findings  of  Landsteiner,  according  to  which  the  virus  is,  in  contrast  to 
bacteria,  quickly  destroyed  by  a  I'/t    saponin  solution. 

Kleine  o])served  atrophic  areas  in  the  eye  ground  of  a  chicken, 
and  various  kinds  of  chorio-retinitic  areas  in  geese. 

Course.  The  course  of  the  disease  is  2  to  4  days  as  a  rule 
wdtli  the  exception  of  the  very  rapidly  terminating  cases,  and 
only  exceptionally  it  extends  to  7  or  8  days.  The  terminatioPi 
appears  to  be  fatal  in  the  great  majority  of  cases. 

Diagnosis.  The  disease  greatly  resembles  chicken  cholera 
in  its  course,  and  is  only  distinguished  from  it  in  that  in  this 


294  Fowl  Pest. 

disease,  at  least  in  the  somewhat  protracted  cases,  a  bloody 
diarrhea  develops  quite  frequently.  The  cyanosis  of  the  comb 
and  of  the  wattles  is  an  indication  of  pest,  but  does  not  exclude 
cholera,  as  it  is  also  frequently  present  in  this  disease.  In  the 
autopsy  decided  sub-epicardial  hemorrhages,  fibrinous  deposits 
on  the  heart,  severe  hemorrhagic  inflammation  of  the  intes- 
tines, and  pneumonic  areas  are  indications  of  cholera,  and  speak 
against  the  presence  of  pest.  The  differentiation  is  only  certain 
by  bacteriological  examination.  In  pest  no  bacteria  can  be  dem- 
onstrated in  the  blood  of  fresh  carcasses,  either  by  a  micro- 
scopical examination  or  by  cultivation,  although  the  fresh 
blood,  as  well  as  the  filtrate  through  porcelain  is  virulent,  but 
only  for  chickens;  whereas  the  virus  of  cholera  which  can  be 
shown  microscopically  and  also  by  cultivation,  is  also  path.o- 
genic  for  other  species  of  fowls,  especially  pigeons,  and  like- 
wise for  rodents. 

Treatment  and  Prevention.  The  treatment  of  affected  ani- 
mals has  thus  far  proven  ineffective. 

In  the  prevention  of  the  disease  the  same  measures  are 
indicated  as  were  given  for  fowl  cholera  (see  p.  94),  only 
that  in  chicken  pest  the  chickens  should  be  especially  protected 
against  the  infection.  Germany,  Austria  and  Hungary  have 
recently  adopted  official  measures  against  the  disease,  which  in 
their  nature  are  similar  to  those  established  against  cholera. 

According  to  Maggiora  &  Valenti  serum  of  recovered  geese  which 
were  siibse(}uently  treated  with  virulent  blood,  is  supposed  to  protect 
chickens  effectively  against  the  disease,  and  is  also  said  to  possess 
a  curative  action.  According  to  Ostertag  &  Bugge  the  blood  of  chickens 
which  were  treated  in  a  similar  manner  only  renders  the  virus  ineffective 
when  given  in  large  doses  (10  cc).  According  to  Kraus  &  Schiffmann, 
dried  (at  22°)  spinal  cords  from  geese  which  were  inoculated  intra- 
muscularly, protected  young  geese  against  a  similar  infection ;  on  the 
other  hand  geese  may  he  actively  immunized  with  virulent  spinal  cords 
from  chickens  against  a  fatal  subdural  infection. 

Literature.  For  literature  see  Freese,  D.  t.  W.,  190S,  173. — Also  Mane,  Arb. 
d.  G.-A.,  1904,  XXI,  537.— Eosenthal,  Cbl.  f.  Bakt.,  1905,  XL,  204.— Landsteiner, 
Cbl.  f.  Bakt.  Eef.,  190(i,  XXXVTIT,  540.— Kraus  &  Sdiiffmann,  Ibid.,  1907,  XLTII, 
825.— Schiffmann,  Ibid.,  1907,  XLV,  393.— Prowayek,  M.  m.  W.,  1908,  165,  and 
1016.— Kraus  &  Doerr,  Cbl.  f.  Bakt.,  1908,  XLVI,  709.— Marchoux,  C.  E.,  1908, 
CXLVII,  357. 


Group  II. 

ACUTE  EXANTHEMATOUS  INFECTIOUS  DISEASES 

1.    Pox.    Variola. 

{PocJx-oihidnlJnif    [(trrnian];   Variole    [Froicli];    Vajuolo 

[Italian].) 

As  pox  are  desii'-iiated  acute  febrile,  infections  diseases, 
which  nsnally  take  a  typical  course  and  are  characterized  by 
a  peculiar  vesico-pustular  exanthema  which  develops  on  the 
skin,  either  over  the  entire  surface  of  the  body  or  only  over 
certain  parts.  In  its  first  form  the  disease  occurs  in  man,  in 
sheep,  and,  allh()u,<>h  more  rarely,  in  o-oats  and  ho,i>'s ;  in  cattle 
and  horses  it  is  almost  invariably  observed  only  as  a  benign 
local  aiTection. 

Accordingly  only  sheep  pox,  and  to  some  extent  also  pox 
of  goats  and  swine,  are  of  any  economic  hnportance,  inasmuch 
as  sheep  pox  usually  occurs  in  an  epizootic  form  and  causes 
notable  losses. 

Etiology.  All  that  is  known  at  the  present  time  regarding 
the  virus  of  variola  in  the  various  species  of  animals  and  in 
man,  is  that  in  filtration  of  the  contents  of  the  vesicles  under 
high  pressure  it  passes  through  moderately  dense  porcelain 
filters,  and  therefore  probably  belongs  to  the  ultra-microscopical 
mic  ro  -0  rgani  sm  s . 

The  very  immeroiis  ])acteriologieal  investigations  wliieh  Avcre  made 
principally  with  the  infectious  material  from  human  and  from  cow 
pox,  have  up  to  the  present  time  failed  to  give  positive  results.  For- 
merly the  causative  agent  of  the  disease  was  believed  to  he  a  bacterium 
(Kleber,  Simon,  Hallier,  Cohn,  Toussaint,  Klebs,  Voigt,  Garre,  IMarrotta 
and  others),  in  recent  times  it  has  been  considered  as  a  protozoon. 
Pfeiffer  &  Rieck  ol)served  in  the  lymph  of  the  vesicles,  spherical  bodies 
containing  a  nucleus,  and  of  a  greenish  histrous  color,  with  a  move- 
ment somewhat  resembling  that  of  amoebae.  They  considered  these 
bodies  as  parasites  belonging  to  the  species  of  protozoa,  or  to  the  class 
of  monocystidea,  naming  them  sporidium  vaccinale.  Funck  on  the 
other  hand  considers  them  as  spores  of  these  parasites,  while  Guarnieri 
attributes  the  causative  role  to  certain  contents  of  epithelial  cells 
(Cytorhyctes  vaccinae  et  variolae),  which  he  believed  to  have  cultivated 
on  the  cornea  of  rabbits;  the  same  view  is  also  accepted  by  Siegel. 
Other  authors  liowever  consider  them  as  parts  of  cells,  or  as  remains 
of  polyiuiclear  leucocytes  which  have  penetrated  into  the  epithelial  cells 
(Salmon,  London,  Schrumpf,  IMiihlens  &  Hartmaini).  Calmette  & 
Guerin  are  inclined  to  regard  as  the  causative  factor  of  pox,  extremely 

20.5 


296  Pox. 

fine  granules  which  they  observe  in  the  lymph  with  highly  magnifying 
lenses,  and  Bosc  describes  extremely  small  granules  in  the  vaccinia  as 
well  as  in  the  ovina,  which  gradually  become  larger,  and  after  the 
appearance  of  a  nucleus  in  their  bodies  divide  by  schizogony,  the  nucleus 
breaking  up  into  fine  granules   (merozoites). 

The  findings  of  Prowazek  are  similar  (1905).  According  to  these, 
the  vaccinia  contains  as  characteristic  constituents  in  the  smallest 
epithelial  fragments  elongated  motile  bodies.  These  stain  with  hema- 
toxylin, and  consist  mostly  of  two  corpuscles  (lymph  corpuscles) 
slightly  varying  in  size,  and  contain  in  their  structureless  sulistance 
one  to  two  enclosures,  l-lYoi^.  in  size,  exceptionally  punctiform,  mostly 
however  rod  or  club-shaped,  so  called  initial  bodies.  They  are  also 
found  in  the  cornea  of  ral)bits  after  inoculation  with  vaccine.  In 
such  cases  they  are  present  within  and  without  the  Guarnieri  bodies, 
and  their  development  may  be  explained  by  the  fact  that  the  nucleus 
of  the  epithelial  cell  reacts  with  the  production  of  vaccine  bodies  to  the 
invasion  of  the  initial  body,  which  should  be  considered  as  the  carrier 
of  the  pox  virus.  According  to  these  findings,  which  were  confirmed 
by  Volpino,  the  pox  virus  would  belong  to  Prowazek 's  so  called 
chlamyclozoa. 

The  spirochetes  which  were  described  by  Bonhoff  as  the  causative 
factors  of  pox  (sp.  vaccinae)  were  considered  by  Slipfle,  Carini, 
]\Iiihlens  &  Hartmann  as  artifacts. 

The  bacteriological  examination  gave  positive  results  only  insofar 
as  it  showed  that  the  pustules  of  pox  always  contain  pyogenic  bacteria ; 
thus  Garre  found  in  human  pox  the  streptococcus  pyogenes,  Guttman 
the  staphylococcus  pyogenes  aureus,  Grigorjew  the  same  and  the  staph, 
pyog.  citreus.  These,  and  probably  also  other  liacteria  (for  instance 
the  bacillus  neerophoms)  however  play  undoubtedly  only  a  subordinate 
or  secondary  role,  as  compared  to  that  of  the  true,  as  yet  unknown  cause 
of  pox. 

The  contagion  of  pox  is  contained  in  the  lymph  of  the 
nodules  and  vesicles,  and  also  in  the  scabs  which  develop  in 
place  of  the  latter,  while  the  infectiousness  of  the  blood,  and 
of  the  exhaled  air,  and  also  of  tlie  skin  exhalations  of  affected 
animals  during  the  fever  period  is  doubtful.  The  secretions 
and  excretions  contain  the  infections  material  only  in  those 
instances  in  which  they  become  mixed  with  the  virulent  con- 
tents of  the  vesicles. 

Pathogenicity.  After  inoculating  infectious  material  into 
the  skin  betw^een  the  cells  of  the  epithelial  layer,  characteristic 
pox  developed  at  the  point  of  inoculation  in  susceptible  indi- 
viduals, sometimes  however  the  inoculation  results  in  a  general 
eruption  of  pox.  This  may  sometimes  also  be  produced  by 
intravenous  or  intra-tracheal  injections  of  pox  lymph. 

Pathogenesis.  The  epithelial  layers  of  the  skin  and  of  the 
mucous  membrane  are  the  most  favorable  places  for  the  propaga- 
tion of  the  pox  virus.  If  this  is  inoculated  or  rubbed  into  these 
parts  it  enters  directly  between  the  epithelial  cells  and  if  the 
infection    occurs    by   inhalation    the    virus    reaches   the    same 


Patlii.gciiesis.  297 

localization  by  transmission  with  the  ])loo(l  stroam.  In  these 
parts  the  virus  propai^ates,  and  causes  the  development  of  the 
characteristic  exanthema  of  i)0x.  The  epithelial  cells  in  the 
stratum  mncosnm  swell,  cliaiiKiii.i''  to  pale  flakes  without  nucleus, 
and  then  dissolve  com[)letely  in  the  serous  lluid.  Some  of  these 
cells  resist  this  process,  and  are  under  the  pressure  of  the 
accnmulatini^-  exudate  drawn  out  to  fine  threads  which  then  form 
a  loose  network  in  tlio  inside  of  the  vesicle.  At  this  stage 
the  contents  of  tlie  vesicle  are  enclosed,  on  the  inside  by  the 
papillary  body,  which  un\y  be  still  covered  l)y  a  thin  layer  of 
epithelium,  or  may  be  entirely  denuded,  and  at  the  same  tinie 
is  intiltrated  with  small  roniid  cells.  From  the  outside  it  is 
closed  by  the  corneal  layer.  Later  a  navel-like  depression  (pit) 
forms  on  the  to])  of  the  vesicle,  the  develo])m('nt  of  which 
is  explained  in  various  ways.  According  to  Kindtieisch  the 
depression  in  the  covering  of  the  vesicle  is  caused  by  the  horny 
layer  of  the  epidermis  of  the  hair  follicle,  or  the  excretory 
duct  of  the  sweat  gland  around  whicli  the  pox  is  arranged 
in  a  concentric  manner.  According  to  the  view  of  Yirchow^  and 
Weigert  the  crater-like  depression  is  formed  because  tlie 
central  necrotic  part  of  the  pox,  which  does  not  take  part 
in  the  expansion,  acts  as  a  retinaculum  of  the  covering  of  the 
vesicle,  while  the  progressive  accumulation  of  pus  extends  the 
periphery  of  the  pox.  As  a  result  of  the  migration  of  leucocytes 
the  contents  of  the  vessels  become  purulent,  and  at  the  same 
time  the  network  in  the  inside  undergoes  dissolution.  Finally 
a  scab  forms,  owing  to  the  drying  of  the  contents  under  which 
the  coriuni  becomes  covered  by  fresh  epithelium;  Init  if  the 
inflanmiation  extended  to  the  deeper  parts,  a  scarred  depression 
remains  at  the  place  of  the  destroyed  papilla. 

This  peculiar  pathological  process  develops  to  maturity 
as  the  result  of  the  pathogenic  action  of  the  pox  virus  itself, 
while  the  subsequent  suppuration  of  the  contents  of  the  vesicles 
is  produced  by  pyogenic  bacteria,  w^hich  probably  penetrate 
from  the  glandular  duct  and  the  hair  follicles  of  the  skin,  into 
the  inside  of  the  vesicles.  According  to  their  nature  and  viru- 
lence the  inflammatory  process  may  be  more  or  less  intensely 
influenced  by  them.  Especially  the  occasional  hemorrhages 
and  the  deeper  destruction  of  the  corium,  as  well  as  the  subse- 
quent pyemia  or  septicemia  should  be  considered  only  as  ac- 
cidental'infections,  and  therefore  the  mild  or  severe  character 
of  different  outbreaks  also  depends  on  such  secondary  infec- 
tion. At  places  which  are  protected  from  this  the  virus  of 
pox  propagates  without  foreign  contamination,  and  in  such 
cases,  as  for  instance  in  the  hard  nodules  wliich  sometimes 
occur  under  the  skin  of  sheep,  the  contents  consist  of  virulent 
pox  h^nph  which  is  free  of  pyogenic  bacteria. 

Whetlier  tlie  eruptions  of  pox  remain  local  or  l)ecome 
generalized  deijends,  aside  from  the  susce])tibility  of  the  re- 
spective animal  species,  upon  tlie  virulence  of  the  virus  and 


298  l^ox. 

on  the  method  of  infection,  as  well  as  to  some  extent  upon 
the  condition  of  the  epithelial  layer.  The  skin  inoculation,  even 
if  effected  with  strong  virus,  produces  as  a  rule  only  a  local 
eruption,  as  in  such  cases  the  virus  propagates  only  at  the 
point  of  inoculation.  A  portion  of  the  virus  may  later  be  ab- 
sorbed into  the  circulation,  and  be  disseminated  by  the  blood 
to  other  parts  of  the  skin  and  mucous  membranes,  but  in  these 
places  it  is  no  longer  capable  of  exerting  a  specific  action,  as 
the  body  has  already  been  immunized  during  the  development 
of  the  local  eruption  (Chauveau).  If  however  inhaled  virus 
enters  the  lungs,  or  if  it  is  injected  directly  into  the  blood 
circulation,  it  is  conveyed  by  the  blood  stream,  to  the  papillae 
of  the  skin,  as  well  as  to  the  tissue  of  the  mucous  membranes, 
where  it  produces  a  generalized  eruption  of  pox.  The  infection 
is  favored  by  injury  of  the  epithelium,  or  other  pathological 
conditions  (Calmette  &  Guerin),  but  the  exanthema  may  de- 
velop in  the  absence  of  any  lesions. 

Of  course  deviations  from  the  rule  may  occur.  If  in  skin 
inoculations  very  virulent  or  massive  virus  enters  the  tissue, 
or  if  the  local  exanthema  produced  by  the  inoculation  develops 
slowly,  a  generalized  affection  may  result,  even  after  cutaneoun 
or  subcutaneous  inoculation.  On  the  other  hand  if  only  a 
very  small  quantity,  or  very  weak  virus  enters  directly  into 
the  blood  circulation,  the  pox  eruptions  develop  only  in  a  few 
places  or  not  at  all. 

As  the  virus  of  variola  does  not  propagate  in  the  blood, 
the  blood  of  affected  animals  is  not,  or  only  exceptionally,  in- 
fectious. It  is  infectious  only  when  the  virus  circulates  in 
the  blood  immediately  before  the  development  of  generalized 
pox  eruptions.  In  this  manner  the  fact  may  be  also  explained 
that  the  excrements  and  secretions  are  non-infectious ;  the  milk, 
how^ever,  is  sometimes  an  exception,  namely,  in  those  instances 
when  pox  develops  in  the  milk  ducts,  the  contents  of  which 
then  become  mixed  with  the  milk. 

Immunity.  Recovery  from  pox  produces  in  man  and  in 
animals,  an  immunity  which  lasts  for  several  years,  whether 
the  infection  was  produced  naturally  or  artificially.  The  im- 
munity develops  in  a  generalized  pox  eruption  in  the  same 
manner  as  after  a  local  eruption  from  inoculation  (according; 
to  Chauveau  a  re-infection  can  not  be  produced  after  the  fiftli 
day  of  the  development  of  the  pox),  and  further  a  pox  exanthema 
is  not  absolutely  necessary  for  the  production  of  immunity, 
as  calves  may  be  immunized  by  intravenous  injections  of  vaccine 
(Strausz,  Chambon  &  Menard),  rabbits  by  an  inoculation  into 
the  Jungs  or  into  the  trachea  (Calmette  &  Guerin),  and  sheep 
by  intravenous  injections  of  ovine  (Semner  &  Raupach),  al- 
though in  such  cases  the  infection  does  not  produce  manifesta- 
tions of  variola. 

Regarding  the  possibility  of  reciprocal  immunization  in  the 


Tiiiiiiuiiity.  299 

different  forms  of  i)ox,  experiments  prove  that  horses  and  cattle 
may  be  imniunized  with  variola  a.naiiist  vaccinia,  man  with 
vaccinia  a.uaiiisl  the  variohi;  luit  a  simihir  reciprocal  action  of 
vaccinia  and  ovina  is  very  questionable. 

The  mode  of  development  of  the  immunity  is  not  yet  snffieiently 
known.  Aeeording  to  Heelere,  ('haml)oii  &  IMenard,  as  well  as  .Maiiins, 
the  blood  of  animals  which  were  inoculated  with  vaccnna  or  with 
variohi.  and  in  a  still  greater  degree  that  of  persons  who  have  passed 
Ihiough  an  affection  of  pox,  contains  substances  which  prevent  the 
pox  lymi)h  from  exerting  its  action.  At  the  same  time  they  have  an 
immunizing  action,  and  the  favora])le  results  o])tained  in  recent  times 
with  tiie  blood  serum  of  iiighly  immunized  animals,  especially  sheep, 
make  this  conception  very  prol)al)le  (see  p.  817),  however  the  nature 
of  these  substances  is  not  even  remotely  known.  As  the  pox  eruptions 
develop  only  several  days  after  tlie  penetration  of  the  virus  into  the 
hlood  circulation,  potent  blood  serum  may  exert  its  innunnizing  action 
even  during  the  time  of  incubation.  The  immunization  may  be  success- 
fully accomplislied  also  with  lymph  heated  to  60^  (Siipfle)  and  with 
nitrates  through  porcelain  (Green). 

The  inoculation  of  virulent  Ij^npli  into  the  skin  results 
in  a  slow  ly  developing-  immunity,  and  in  all  probalnlity  is  due 
to  tlio  influence  of  the  substances  absorbed  from  the  point  of 
inoculation,  as  in  such  instances  the  virus  itself  does  not  pass 
into  the  blood  circulation  (Siipfle).  As  a  rule  only  a  local 
eruption  develops  after  such  an  infection;  if  hoAvever  the 
inoculated  part  of  the  skin  is  removed  24  hours  after  the 
inoculation,  a  generalized  pox  eruption  develops  (Chauveau). 
In  the  first  instance  an  immunity  results  already  during  the 
development  of  vesicles,  and  the  virus  which  later  penetrates 
into  the  blood  circulation  can  no  longer  attack  the  tissues,  while 
in  the  second  case  the  resistance  of  the  tissue  has  not  been 
increased  to  a  degree  in  which  it  could  oppose  the  pathogenic 
action  of  the  virus  by  the  removal  of  the  source  from  which 
the  immunizing  substances  develop.  In  infections  resulting 
from  inhalation  the  virus  enters  directly  into  the  blood  circula- 
tion, and  thereby  meets  everywdiere  unresisting  tissues,^  and 
in  such  cases  a  more  or  less  generalized  pox  eruption  invariably 

develops. 

Offspring  from  animals  which  recovered  from  a  general 
or  local  variola  during  pregnancy  are  inunune,  but  this  im- 
munity becomes  gradually  weaker  (in  lambs  according  to 
Duclert  from  the  3d-4th  month  on),  and  disappears  entirely 
in  the  second  generation.  The  pox  immunity  is  only  excep- 
tionally inherited,  and  even  in  such  cases  it  affords  only  a  partial 
and  passing  protection  (Siipfle). 

The  etiological  relation  of  human  and  animal  pox  to  each 
other  is  not  sufficiently  establislied.  The  uniform  anatoniical 
structure,  and  the  similar  development  of  the  characteristic 
vessels  indicates  the  etiological  identity  of  the  different  forms 
of  pox.    However  observations  relative  to  the  reciprocal  infec- 


300  Pox. 

tiousness  or  susceptibility  do  not  .seem  to  corroborate  this  con- 
ception. 

Although  the  disease  occurs  in  man  and  in  sheep  in  the 
form  of  a  severe  general  disease,  and  with  an  extensive  pox 
eruption,  in  cattle  and  goats  eruptions  are  almost  invariably 
confined  to  certain  parts  of  the  bodies,  their  development  being 
associated  with  only  very  mild  general  symptoms.  The  disease 
in  man  and  sheep  may  very  readily  become  epidemic,  while 
among  other  animals  the  infection  is  usually  confined  within 
restricted  limits. 

Very  close  relations  exist  undoubtedly  between  human  and 
cow  pox.  The  vaccine  of  cow  pox  may  be  very  readily  inoculated 
into  man,  but  the  inoculation  produces  only  an  eruption  con- 
fined to  the  point  of  inoculation,  and  never  a  general  infection 
analogous  to  variola.  On  the  other  hand  human  pox  are  less 
surely  transmissible  to  cattle.  In  some  experimental  cases 
characteristic  pox  developed  in  cattle  at  the  point  of  inoculation 
(Nmnan,  Ceely,  Fischer,  Eternod  &  Haccius,  Simpson,  Freyer, 
Meder),  in  other  cases  only  hard  nodules  developed  after  the 
inoculation,  which  healed  without  changing  into  vesicles  or 
scabs  (Chauveau)  or  again  the  inoculation  remains  entirely 
negative  (Ducamp  &  Pourquier  obtained  a  positive  result  in 
only  one  case,  Juhel  &  Resnoy). 

These  experimental  observations  appear  to  indicate  that  the 
virus  of  human  pox  (Variola),  and  that  of  cow  pox  (Vaccinia) 
are  two  different  modifications  of  one  and  the  same  pox  virus. 
Fischer  and  Eternod  &  Haccius  aimed  to  prove  this  by  re- 
inoculating  man  with  pox  lymph  of  calves  which  had  been  re- 
peatedly inoculated  with  variola  lymph,  whereupon  in  several 
thousand  persons  only  a  local  pox  eruption  developed.  From 
the  above  findings  these  authors,  as  well  as  Roloff  and  Bollinger 
conclude  that  variola  may  be  changed  into  vaccinia  by  passage 
through  the  body  of  cattle,  and  that  therefore  the  vaccinia  rep- 
resents an  attenuated  modification  of  variola.  That  such  a 
transformation  does  however  not  easily  and  constantly  result  is 
proven  by  the  experiments  of  Chauveau,  who  after  inoculations 
of  lymph  from  cows  which  were  inoculated  with  variola  virus, 
repeatedly  observed  in  man  the  development  of  pox  as  a  severe 
general  affection. 

The  very  close  relation  between  variola  Immana  and  variola 
vaccinia  is  proven  by  the  fact  that  vaccinia  produces  a  lasting 
immunity  against  variola.  Inasmuch  as  the  local  affection 
which  develops  after  vaccination  in  man  represents  a  very  mild 
form  of  human  pox,  vaccinia  must  be  considered  as  an  atten- 
uated variola  virus.  If  it  is  further  considered  that  the  trans- 
mission of  the  contagion  from  man  to  man,  as  it  has  usually 
been  practiced  in  former  times,  produces  in  most  cases  only 
a  local  affection,  and  further  that  pox  in  cows  originally  results 
as  a  rule,  and  probably  invariably,  from  transmissions  from 


Ixt'liitidii    1)1'   Iliiiiian    ;ui(l   Animal  Pox.  3QI 

man  alTectcd  witli  i)ox,  tlio  fouclusioii  is  .iustiliod  that  tlio  con- 
tagion of  cow  pox  represents  a  modification  of  the  human  pox 
virus  Avhieh  has  become  atteniuited  in  the  liuman  bod  v.  Such 
virus  loses  its  dangerous  properties  for  man  permanently  in 
the  body  of  cattle. 

Jenncr  shared  tlie  lu'lii't'  of  the  people  in  the  vicinity  of  Gloueeslei-, 
that  vaccinia  invariably  results  from  an  infection  from  horses  affected 
with  pox,  and  that  it  is  therefore  identical  with  horse  pox.  His  view 
was  later  shared  hy  Lafosse  and  sul)se(iuen11y  hy  Bouley,  and  under 
the  influence  of  their  authority  and  that  of  Chauveau,  this  opinion 
has  been  generally  accepted  in  France.  In  recent  times,  however,  after 
the  findings  of  Warleniont  &  Hugues,  that  the  horse  is  only  very 
slightly  susceptible  for  the  vaccinia,  Dieckerhoff  and  Grawitz  asserted 
that  the  epizootic  disease  observed  by  the  French  authors  did  not  rep- 
resent the  pox  affection,  but  eith(M-  a  stomatitis  or  a  contagious  pustular 
dermatitis,  which  diseases  may  be  transmitted  to  other  species  of 
animals,  and  also  to  man;  and  they  opposed,  in  conseciuence,  the  pn;- 
vailing  view. 

Sheep  pox  usually  spreads  only  among  sheep,  and  the  dis- 
ease, although  very  fatal  among  these  animals,  does  not  even 
pass  naturally  to  the  closely-related  goats,  neither  is  it  danger- 
ous for  man.  On  the  other  hand  human  pox  can  only  excep- 
tionally be  transmitted  to  sheep  (Manson,  Simond),  and  even 
artificially  a  severe  pox  affection  can  only  be  transmitted  to 
these  animals  by  intravenous  injections  of  variola  virus 
(Kiiclienmeister,  Tappe).  It  is  not  possible  to  immunize  cattle 
with  pox  Ijanph  from  sheep  against  cow  pox,  and  vice  versa 
(Peuch,  Voigt),  therefore  sheep  pox  must  be  considered  as  a 
specific  affection  of  sheep. 

Goats  are  likewise  only  susceptible  to  the  contagion  of 
goat  pox,  as  sheep  do  not  become  infected  in  severely  affected 
goat  herds,  and  it  is  even  difficult  to  infect  them  artificially. 
On  the  other  hand  the  transmission  of  sheep  pox  to  goats  is 
also  difficult  (Bremond,  Bonvicini,  Nocard),  while  an  infection 
with  human  pox  is  not  possible  (Voigt) ;  finally  cattle  are  not 
susceptible  to  goat  pox  (Bonvicini).  Accordingly  goat  pox  may 
likewise  be  considered  as  a  specific  affection  of  goats. 

Pox  of  other  species  of  animals,  if  such  occurs  at  all,  results 
from  an  infection  from  man  or  from  the  disease  affecting  one 
of  the  above  mentioned  species  of  animals,  and  therefore  can- 
not be  recognized  as  independent  forms  of  the  disease. 

According  to  the  present  state  of  knowledge,  therefore, 
human  pox,  sheep  pox  and  goat  pox  represent  independent 
forms  of  the  disease,  occurring  and  spreading  independently  of 
each  other,  wdiereas  the  pox  of  other  species  of  animals  always 
have  some  connection  M'ith  one  of  the  above  mentioned  forms 
of  the  disease.    This  view  however  does  not  at  all  exclude  the 


302  Sheep  Pox. 

mutual  relationship  of  these  forms  of  the  disease.  On  the  con- 
trary, the  uniformity  of  the  development  of  the  specific  patho- 
logical processes  points  to  the  probability  that  the  pox  disease 
was  originally  a  specific,  independent  affectiovi  of  one  of  the 
susceptible  species  of  animals  or  of  man,  and  was  here  and 
there  transmitted  to  other  species  of  animals.  However  as 
the  virus,  in  the  course  of  time,  passed  through  many  genera- 
tions of  various  species  of  animals  it  adapted  itself  in  point  of 
virulence,  and  probably  also  in  its  other  properties,  to  the 
organisms  of  these  respective  species  of  animals.  As  the  result 
of  this  the  pathogenicity  of  such  an  adapted  virus  has  been 
partly  or  entirely  lost  against  other  species  of  animals. 

Literature.  Jeniier,  Inqu.  into  the  causes  u.  effects  of  the  Variolae-Vaecinae. 
London  1798.— Chauveau,  Eec,  1866,  305  u.  625;  Bull.,  1893,  51.— Bouiey,  Diet, 
de  med.  vet.,  1871,  IX,  451.— Eoloff,  Pr.  Mt.,  1870-71.— Bollinger,  Volkniauns 
Samml.  klin.  Vortr.,  1877,  Nr.  116  (Lit.).— Dieckerhoff  &  Grawitz,  V.  A.,  1885, 
CII,  148.— Prowazek,  Arb.  d.  G.-A.,  1905,  XXIII,  535.— Miihlens  &  Hartmann, 
Zbl.  f.  Bakt.,  1906,  XLI,  41  (Lit.  on  the  so  called  vaccine-virus). — Voigt,  Z,  f. 
Infkrkh..   1909,  VI,  101.— Siiple,  A.  f.  Hyg.,  1908,  LXVIII,  237. 


(a)     Sheep  Pox.    Variola  ovina. 

{Scahrot,  Schafpocken  [German];  Clavelee,  Picotte  [French]; 
Vajuolo  pecorino  [Italian].) 

History.  Sheep  pox  was  probably  introduced  from  Central  Asia, 
since  human  pox  which  is  closely  related  to  pox  of  animals  is  known 
to  have  existed  in  India  a  long  time  before  the  birth  of  Christ.  Sheep 
pox  was  extensively  studied  for  the  first  time  by  Joubert  and  Rabelais 
towards  the  end  of  the  sixteenth  century ;  its  infectiousness  however 
was  established  by  Bourgelat  in  1763.  As  a  result  of  the  customary 
immunizations  of  sheep  at  that  time,  and  through  the  use  of  Spanish 
sheep  for  the  improvement  of  existing  breeds,  the  disease  attained  a 
large  distribution  in  Europe. 

The  etiology  and  pathogenesis  of  the  disease  were  investigated 
especially  by  Chauveau  (1868)  in  more  recent  times  by  Borrel  (1902), 
whose  work  has  created  great  interest  in  the  matter  of  immunization, 
which  had  been  neglected  for  a  time. 

Occurrence.  Pox  among  sheep  has  in  recent  times  been 
entirely  eradicated  in  the  northern  and  central  countries  of 
Europe  by  proper  measures,  while  in  France  and  in  the 
countries  lying  south  and  east  the  disease  occurs  even  now  in 
an  epizootic  form.  In  the  affected  territories  extensive  out- 
breaks appear  especially  during  the  warm  weather,  but  even 
in  these  localities  the  disease  does  not  attain  the  extension  of 
former  times.  Its  economic  importance  results  from  the  great 
losses  which  occur  occasionally,  and  also  from  the  considerable 
loss  of  wool  which  follows  the  disease. 

Severe  outbreaks  are  mentioned  as  having  occurred  in  the  be- 
ginning of  the  last  century,  thus  Salmuth  estimated  in  1804  that  the 


Occurreiu'o.      Etiology.  303 

annual  losses  of  sheep  from  pox  ainonnted  lo  more  than  one-oif;hth 
of  the  lolal  nuin])er  of  animals,  further  Heintl,  in  1823,  gives  the 
aiuuial  loss  in  xVustria  as  400. OOO  animals,  and  in  France  it  is  elaiiued 
that  in  181!)  more  than  one  million  sheep  fell  victims  to  the  disease. 

Gonnany  was  oiitiioly  i'rov  in  tho  years  1889-1^99,  the  disease  however  ai)peare(l 
in  19(10  in  a  township  of  the  Governmental  District  Liineberji;  (220  cases  with 
two  deaths).  In  the  foilowinjj  year  it  was  discovered  in  four  townships  of  the 
government  districts  Koniysherj);  and  Gnmbinnen,  afi'ectiiif,'  1005  sheep,  of  wlii(di 
.■?S  succnndied.  The  country  was  free  from  the  disease  for  one  and  a  half  years, 
luit  it  reappeared  in  the  above  districts,  as  well  as  in  Marienwerder  in  ]i)0:5, 
and  on  this  occasion  1157  sheep  became  afl'ected,  of  which  4(55  died.  It  is  supposed 
that  at  this  time  the  disease  had  been  broufjht  in  by  smnj,rfi;lers  or  butchers  from 
Kussia.  Two  years  later  it  was  brought  from  Russia  into  Eastern  Prussia,  by 
agricultural  laborers,  where  20  townships  with  30  farms,  and  isolated  farms  in 
Saxony  and  Anhalt,  were  infecteil.  The  total  cases  amounted  to  .3,220  sheej),  704 
of  which  succund)ed.  Since  that  time  several  outbreaks  have  been  observeil  annually 
in  Prussia,  and  in  the  year  1908  4  townships  with  402  eases,  and  154  deaths,  were 
recorded. 

The  disease  formerly  raged  in  a  severe  form  in  France,  especially  in  the 
Southern  provinces,  but  also  occurred  in  other  parts  of  the  country,  es])ecially  after 
the  importation  of  sheep  from  foreign  countries  was  restricted  while  large  numbers 
were  imported  from  Algeria. 

Austria  was  free  from  the  disease  in  1894,  but  since  that  time  this  has  again 
become  widely  spread,  especially  in  the  years  1898-1900  in  Tyrol,  and  still  more 
in  Dalmatia;  in  the  latter  year  21,575  sheep  in  72  townships  were  affected,  and 
of  these  10,007  died  or  were  slaughtered.  After  that  time  the  disease  diminished 
greatly,  and  no  outbreaks  have  occurred  since   1903. 

The  disease  was  ahvays  more  or  less  confined  in  Hungary  to  the  Southeastern 
part,  and  in  recent  times  it  occurs  almost  exclusively  in  the  counties  which  are 
adjacent  to  Ronniania  and  Servia.  From  1899  to  1908  an  average  of  59  townships 
were  infected,  with  15,275  cases,  of  which  2,175  died.  Since  1904  the  tlisease 
attained  again  a  greater  extension,  and  occurred  in  1908  in  113  townships  of 
27  counties  with  19,131  cases,  the  total  deaths  being  4,443. 

In  the  same  year  466  townships  were  affected  in  Bulgaria;  40,744  in  Eoumania; 

in   European   Russia  23,034   animals  became   affected.      The   disease  also  frequently 

.occurs    in    Spain,   while   the    other    European    countries    have    been    free    for    many 

years.     It  is  widely  spread  in  Asia,  and  is  also  known  in  Africa  (Egypt,  Algeria), 

while  there  are  no  statistics  relative  to  its  occurrence  in  America  and  Australia. 

Etiology.  Eegardiiig  the  nature  of  the  virus,  it  is  at  present 
only  known  that  in  diluted  pox  lymph  and  under  great  pressure 
it  passes  the  porous  Chamberland  filters  (F^  and  F").  The 
filtrate  is  not  even  under  highest  power  found  to  contain  formed 
bodies,  and  attempts  at  cultivation  fail  to  give  positive  results 
(Borrel). 

Tenacity.  Tn  glass  tubes,  closed  on  both  ends  by  melting,  and  kept  in  dark 
and  moderately  cool  places,  the  pox  lymph  retains  its  virnlence  even  for  two  years. 
At  a  somewhat  higher  temperature,  for  instance  at  35°  it  is  active  for  months. 
Its  virulence  is  attenuated  by  higher  temperatures,  and  at  48°  it  is  destroyed 
in  a  short  time,  while  when  subjected  to  a  cold  of  — 12-15°  it  does  not  become 
attenuated  for  two  months  (Nocard).  Glycerin  attenuates  it  projiortionately  to 
its  quantity,  and  a  mixture  of  equal  parts  of  lymjih  and  glycerin  becomes  avirulent 
in  12  days  when  kept  at  a  temjierature  of  25°  (Duclert).  Of  the  disinfectants  a 
3%  boracic  acid,  or  2%  sodium  salicylate  have  hardly  any  influence  on  the  l^miph 
(Galtier)  and  likewise  2%  sulphate  of  zinc  and  10%  chlorate  of  lime  solutions  are 
ineflfective  (Peuch).  Putrefaction,  diluted  hydrochloric  acid,  lVi%  carbolic  acid, 
~V-2%.  sulphuric  acid,  10%  wine  vinegar,  spirits  of  turpentine  (Griinwald)  and 
also  a  mild  iodine  solution  (1:10000)  (Peuch)  exert  a  quick  destructive  action 
on  the  lymph.  The  virus  dies  in  the  fleece  of  sheep  affected  with  pox,  at  the 
latest  in   two  months    (Duclert  &   Gonte). 

Experience  gained  in  practice  also  points  to  the  considerable  resistance  of 
the  pox  virus.     When  kept  in  a  moderately  warm  place,  protected  from  draughts, 


304  Sheep  Pox. 

as  for  instance  in  sheep  stables,  it  may  retain  its  virulence  for  six  months,  and 
even  out  of  doors  it  may  remain  infectious  for  a  long  period  of  time.  In 
Siebenbiirgen  it  was  noted  in  one  case  that  lambs  became  affected  with  pox  in 
great  numbers,  in  a  stubble  pasture  in  which  62  days  previously  sheep  affected 
with  pox  had  been  pastured  on  young  wheat   (Dely). 

Pathogenicity.  A  cutaneous  inoculation  of  a  small  drop 
of  pox  lymph  usually  produces  in  susceptible  slieej)  only  a  local 
pox  eruption.  In  some  cases,  liowever,  especially  in  lambs  and 
by  using  very  virulent  lymph,  a  generalized  pox  eruption  re- 
sults. In  the  latter  case,  after  an  incubation  period  of  2-2 1^ 
days,  a  dark  red  nodule  develops  at  the  X)oint  of  inoculation, 
which  from  the  fourth  to  fifth  day  on  changes  into  a  vesicle. 
When  the  nodule  begins  to  soften  the  body  temperature  rises 
to  39.5-40.6°  C,  later  to  41.5-42.6°,  indicating  the  entrance  of  the 
virus  into  the  blood  circulation.  This  is  followed  by  the  forma- 
tion of  nodules,  which  change  into  pox  vesicles  on  the  mucous 
membrane  of  the  lips,  on  the  nostrils,  the  eyelids,  later  also  in  the 
axillary  region,  on  the  thighs,  around  the  vulva  and  rectum.  At 
the  same  time  the  general  febrile  symptoms  reach  a  high  degree 
until  at  the  beginning  of  the  third  week,  or  somewhat  later,  death 
ensues  with  manifestations  of  septicemia.  After  subcutaneous 
infection  the  temperature  rises  with  the  beginning  of  the  local  in- 
flammation; this  is  shown  by  a  firm  swelling  which  may  reach 
the  size  of  a  fist,  containing  numerous  nodules,  later  forming 
confluating  pox  vesicles  on  its  surface,  while  the  general  pox 
eruption  develops  in  from  5-6  days  after  the  infection  in  the 
same  manner  as  though  resulting  from  a  cutaneous  inoculation. 
Intra-peritoneal  injections  of  lymph  are  followed  by  the  forma- 
tion of  nodules  on  the  peritoneum,  with  bloating  and  sensitive- 
ness of  the  abdomen,  while  injections  into  the  trachea  lead  to 
a  specific  inflammation  of  the  mucous  membrane  of  the  air 
passages,  with  marked  difficulty  in  respiration  as  an  immediate 
result,  whereupon,  in  from  6-8  days  a  generalized  pox  eruption 
develops  (Bosc).  Injections  of  lymph  into  the  circulation  may 
produce  only  febrile  manifestations  without  eruptions,  Init  sheep 
are  immunized  after  such  a  short  affection  to  the  same  extent 
as  after  recovery  from  a  typical  infection  (Semmer  &  Raupach). 
An  intra-cerebral  inoculation  results  in  6-8  days  in  fever,  the 
animals  dying  within  one  week  afterwards,  while  injections  of 
lymph  into  the  milk  cistern  produces  a  pox  eruption  on  the 
mucous  membrane  of  the  milk  ducts,  the  milk  in  such  cases 
containing  the  infective  agent  for  two  weeks  (Nocard). 

Outside  of  the  contents  of  the  vesicles  the  virus  is  not 
present  in  the  pure  secretions  or  in  the  blood,  or  in  the  latter 
only  exceptionally  immediately  before  or  at  the  beginning  of 
the  pox  eruption  (Bosc;  Nocard  &  Roux  failed  to  obtain  any 
positive  results  from  the  inoculation  of  blood). 

Natural  Infection.  The  virus  of  sheep  pox  probably  enters 
the  lungs  with  the  inhaled  air,  and  from  there  passes  through 
the  alveoli  directly  into  the  blood,  which  disseminates  the  virus 


Natural    Jnl'i-'cliiin.  ,'j05 

into  llio  snporfioial  vessels  of  tlie  skin  and  iimeoiis  nieml)ranes. 
The  disease  may  be  invariably  proihiccd  by  injecting-  or  aloniiz- 
in,H-  pox  lynipli  into  tiie  traeliea  of  snseeptible  sheep,  while  the 
feeding:  of  lynipli,  when  the  jjossibility  of  iniudation  is  excluded, 
is  not  effective  (Nocard). 

The  pox  virus  eontainccl  in  tlie  vesicles  and  in  the  scabs 
becomes  i)ulverized  and  disseminated  in  the  air,  as  a  result  of 
which  a  certain  area  surroundini;-  the  infected  animals  becomes 
infectious  (according-  to  Gilbei't  in  calm  weather  for  l^O-'J;")  paces, 
in  windy  weather  even  further).  If  the  food  is  contaminated 
by  scabs  the  virus  is  inhaled  by  sheep  witli  tlie  dust  disturbed 
during  feeding, 

Tlie  disease  usually  develops  in  flocks  of  sheep  when  they 
come  in  contact  witli  affected  animals  or  when  sick  or  not 
entirely  recovered  shee])  are  placed  among-  healtliy  animals.  In 
this  respect  sheep  which  become  ill  from  iimnnnization,  es- 
pecially young:  lambs,  are  also  dangerous.  Susceptible  sheep 
associating?  Avitli  such  lambs  may  also  become  affected  wath  a 
generalized,  severe  form  of  pox,  as  the  virus  used  for  the  im- 
munization is  not  attenuated  in  any  way.  The  frequent  occur- 
rence of  the  disease  among  lambs  in  the  spring  of  the  year  is 
often  associated  with  the  usual  immunization  carried  out  at 
that  season  in  many  localities.  The  infection  may  also  be  trans- 
mitted by  contaminated  utensils  or  attendants,  by  skins,  wool, 
feed,  manure,  straw,  pasture,  highways,  transportation  wagons, 
further  by  shepherds  and  their  clothes,  dogs,  cats,  fowl,  etc. 

The  infectiousness  of  a  diseased  animal  is  especially  great 
when  the  eruption  becomes  matured  on  the  body  surface,  and 
-to  a  still  higher  degree  during  the  stage  of  scab  formation 
and  desquamation.  The  contagion  may  remain  virulent  in  the 
scabs  under  the  wool  from  6-8  wrecks,  and  therefore  the  infection 
may  be  communicated  by  animals  wdiich  have  already  passed 
through  the  disease. 

The  susceptibility  of  the  various  breeds  of  sheep  is  not  uni- 
form. The  most  susceptible  are  the  Merino  sheep,  somewhat 
less  the  more  hardy,  coarse-wooled  sheep.  In  the  tirst  the  dis- 
ease develops  as  a  rule  in  a  more  severe  form  than  in  the  latter. 
In  northern  countries  it  is  less  severe  and  less  frequent  than 
in  the  south,  wdiicli  is  probably  due  to  the  higher  temperature 
which  favors  the  development  of  pox.  According  to  Nocard 
the  sheep  of  Bretagne  are  not  susceptible  to  pox,  and  the  same 
opinion  is  also  held  by  Chauveau  concerning  the  Algerian  sheep. 
AValdteufel  &  Nocard  however  found  that  pox  exists  continu- 
ously among  the  sheep  of  Algeria,  although  m  a  very  mild 
form  (if  affected  Algerian  sheep  come  in  contact  with  French 
sheep,  the  latter  become  severely  affected). 

Young  sheep  are  more  susceptible  to  ])ox  than  older 
animals,  and  in  affected  herds  the  lambs  as  a  rule  become 
severely  ill  without  exception. 

Affected  ewes  may  transmit  the  disease  to  their  offspring, 

Vol.  1—20 


306  Sheep   Pox. 

which  in  such  cases  are  Ijorii  with  pox  eruptions ;  in  other  cases 
the  fetuses  in  utero  remain  healthy  in  spite  of  the  infection  of 
the  mother,  such  lambs  having  developed  an  immunity  against 
the  disease. 

Eickert  vaccinated  about  700  In-eeding  ewes  in  the  last  week  of  pregnancy. 
Eepeated  inoculations  of  the  lambs  born  from  these  animals  were  ineffective,  while 
36  lambs,  from  ewes  which  were  not  vaccinated,  developed  pox  nine  days  after 
the  inoculation.  Three  years  later  the  inoculation  gave  positive  results  in  the 
first,  while  the  latter  failed  to  contract  the  disease.  Anacker  likewise  failed  to 
produce  the  disease  in  60,  Peuch  in  three  lambs  from  affected  sheep. 

Other  species  of  animals  as  well  as  man,  are  not  susceptible 
to  sheep  pox,  or  only  in  a  very  sHght  degree.  Goats  occasionally 
become  affected  as  a  result  of  contact  with  sheep  affected  with 
pox,  and  according  to  Borrel  &  Konew  the  sheep  virus  gains 
in  virulence  for  goats  by  passage  through  their  bodies,  while 
it  becomes  attenuated  for  sheep  (see  p.  327).  Supposed  in- 
fections of  horses  by  affected  sheep  are  reported  by  Berger  & 
Pecus. 

Anatomical  Changes.  The  autopsy  of  sheep  dead  from 
pox  reveals,  as  a  rule,  besides  the  characteristic  changes  of 
the  skin,  hemorrhagic  inflammation  of  the  mucous  membrane 
of  the  air  passages  and  of  the  gastro-intestinal  canal.  On  the 
mucous  membrane  of  the  pharynx  and  trachea,  less  frequently 
in  the  abomasum,  pox  vesicles  are  occasionally  present,  or 
ulcerations  which  have  developed  from  them.  The  lungs, 
especially  near  the  pleurae,  contain  small,  gray  translucent 
nodules,  which  may  show  a  central  caseation;  these  nodules  are 
located  within  pneumonic  areas  (Morel  &  Vallee).  In  the 
other  internal  organs  changes  indicating  pyemia  or  septicemia 
may  be  found  (acute  swelling  of  the  lymph  glands,  petechiae 
on  the  serous  membranes,  parenchymatous  and  fatty  degenera- 
tion of  the  parench}^natous  organs,  subpleural  infarcts  in  the 
lungs,  initial  acute  interstitial  nephritis,  etc.). 

Under  the  skin  hard  nodules  the  size  of  hazelnuts  and 
showing  a  homogenous  cut  surface,  may  occur;  they  consist 
of  thick  masses  of  polynuclear  leucocytes,  lodged  between 
shreds  of  subcutaneous  connective  tissue,  many  of  these 
leucocytes  containing  broken  down  nuclei. 

Symptoms.  The  pox  exanthema  is  preceded  by  an  incuba- 
tion period  of  six  to  eight  days,  which  is  somewhat  longer  in 
cold  weather.  After  this  has  passed  the  disease  commences 
with  febrile  and  catarrhal  symptoms,  which  consist  in  dullness, 
loss  of  appetite,  and  elevation  of  temperature  up  to  41-42°, 
accelerated  pulse  and  respiration;  sometimes  trembling  and 
chills  may  be  also  observed.  Pressure  on  the  vertebral  column, 
especially  in  the  lumbar  region,  causes  many  of  the  affected 
animals  to  show  signs  of  pain.  The  eyelids  are  swollen,  the 
conjunctivae  reddened,  and  from  the  narrowed  slit  of  the  eyes 
tears  mixed  with  mucus  are  discharged.    From  the  nose  there 


Syiii|tt(mi^ 


■M)] 


is  also  a  imico-piiniloiil  discliar^c,  and  soiiietiiuos  a  snuffling 
respiration  is  observed.  T-lie  ton^L^ue  is  coated,  and  the  exlialed 
air  fi'(M|U('nlly  disseminates  a  disagreeable  odor.  Tlie  mneons 
membranes  of  tiie  elieeks  and  of  the  phai'ynx  show  either  uni- 
form or  s])otted  reddeninii-.  The  animals  are  constii)ated,  the 
urine  is  diminished  in 
(luantity  and  has  a  lii,ij:h 
s])e(*ilie  ii'ravity.    Auseul-  ; 

tation    of    the   lungs  re-  *• 

veals    intense    vesicular  "^ 

breathing.  -  .,  - 

T  h  i  s  condition  lasts 
from    one    1o    two    days,  ^ 

whereu])on,  r  o  u  n  d  red 
spots  ap])ear  upon  the 
skin  (ros(M)la  variolosa), 
whieh  in  some  ]i  1  a  c  e  s 
may  be  surrounded  by  a 
moderate  serous  infiltra- 
tion, manifested  by  an 
ui'tiearia  -  like  elevation 
of  the  affected  parts  of 
the  skin.  Such  spots  are 
found  in  the  vicinity  of 
the  eyes,  on  the  cheeks, 
lips,  and  nostrils,  on  the 
vulva,  or  on  the  borders 
of  the  prepuce,  on  the 
udder,  or  on  the  scrotum, 
on  the  surface  of  the  tail 
and  on  the  inside  of  the 
thigli,  therefore  princi- 
pally on  those  parts  of 
the  l)ody  which  are  free 
from,  or  only  slightly 
covered  by  wooh  Less 
frequently  they  occur  al- 
so on  the  chest  and  on 
the  lower  abdomen. 

On  the  following  day 
hemp-seed  size,  round 
reddish  nodules  may  be 
observed  in  the  middle  of 
the  red  spots,  which  lose 
their  color  on  pressure. 

Thev  continue  to  increase  in  size  on  the  following  days  to  such 
an  extent  that  the  base  may  reach  the  size  of  a  ten  cent  piece 
(stadium  papulosum).  From  the  surface  of  the  nodules  a  tena- 
cious fluid  oozes  out ;  soon  the  superticial  layers  become  raised, 
and  a  clear  yellowish   serous   fluid   accumulates   under  them. 


\ 


I, 


308  Sheep  Pox. 

wlierebj^  a  fine,  bluisli-wliite  vesicle  develops  with  a  transparent 
wall.  This  continues  to  enlarge  on  the  following  day,  and  at 
the  same  time  a  slight  depression  (navel)  develops  on  the  top 
(stad.  vesiculosuni;  Fig.  54).  The  development  of  the  vesicles 
occurs  in  the  same  succession  as  is  the  case  in  the  appearance 
of  the  red  spots  and  the  nodules,  and  it  may  take  several  days 
for  the  development  of  all  the  vesicles.  The  vesicles  attain  a 
size  ranging  from  that  of  a  lentil  to  that  of  a  bean ;  while  the 
larger  vesicles  are  more  flat  and  in  their  center  the  navel  is 
never  absent,  the  smaller  ones  are  less  elevated,  resembling 
more  blunt  ended  pins  and  on  them  the  navel  may  frequently 
be  absent.  The  closer  the  vesicles  are  located  to  each  other  the 
smaller  their  size,  and  vice  versa.  In  pricking  the  vesicles  their 
serous  contents  ooze  out  slowly,  on  account  of  their  compart- 
ment-like construction. 

Immediately  surrounding  the  vesicles  the  skin  is  as  a 
rule  hyperemic,  and  therefore  forms  red  zones  around  them; 
the  skin  and  the  subcutaneous  connective  tissue  of  the 
affected  parts  are  also  edematous,  as  a  result  of  which  the 
respective  regions  of  the  body,  especially  the  head,  and  on 
this  particularly  the  eyelids  and  the  region  of  the  nose  are 
swollen,  so  that  the  corresponding  openings  and  slits  become 
constricted.  The  development  of  the  exanthema  up  to  this 
degree  usually  takes  from  5  to  6  days. 

In  the  completely  developed  ripe  vesicles  the  clear  yellowish 
or  pale  red  hmiph-like  contents  changes  after  2  to  3  days,  or  6  to 
7  days  from  the  onset  of  the  disease,  into  a  cloudy  fluid  owing  to 
the  admixture  of  pus  cells,  finally  becoming  entirely  white,  at 
the  same  time  the  vesicle  may  increase  somewhat  in  size  and 
the  navel-like  depression  may  also  disappear  (stad.  pustulosum 
s.  suppurationis),  while  the  edematous  infiltration  of  the  skin 
in  their  immediate  surroundings  becomes  as  a  rule  still  more 
intense.    This  stage  usually  lasts  three  days. 

This  completes  the  development  of  the  vesicles ;  a  depres- 
sion again  appears  on  their  tops,  the  wall  becomes  withered  and 
wrinkled,  and  after  the  horny  layer  has  taken  on  a  brownish 
color  the  vesicle  dries  with  its  contents  to  a  i/>-l  mm.  thick 
brown  scab  (stad.  crustosum  s.  exsiccationis).  N'ew  epithelia 
form  under  this  from  the  borders  and  from  the  base  of  the 
vesicle,  whereupon  the  scab  drops  off  in  from  4  to  6  days  (stad. 
decrustationis).  In  its  place  a  red  spot  or  a  red  scar  remains 
for  a  time,  which  gradually  turns  pale  and  at  the  same  time 
becomes  somewhat  depressed. 

The  development  of  the  eruption  is  associated  more  or  less 
with  severe  general  s>miptoms.  The  sudden  high  fever  at  the 
onset  of  the  disease  diminishes  from  the  second  to  third  day 
on,  and  in  the  pustular,  as  well  as  in  the  vesicular  stage  only 
a  moderate  fever  is  present.  With  the  appearance  of  suppura- 
tion it  again  increases,  and  again  drops  rapidly  after  2  to  3 
days,  so  that  the  drying  of  the  vesicles,  as  well  as  the  falling  off 
of  the  scabs  occurs  under  normal  temperature. 


Syni  Jit  runs.  309 

"With  the  ai)i)earaiic('  of  tlio  eruption  the  j;eiieral  condition 
ini])rove8,  and  (hiring-  the  (h'veh)i)nient  of  the  vesich's  tlie 
patients  usually  are  (piite  bri.nht.  The.y  partake  of  some  food, 
and  also  ruminate  periodically.  Profuse  secretion  continues 
to  he  discharged  from  the  eyes  and  nose,  the  respiration  may 
be  snuffling-  owing  to  the  swelling  of  the  skin  of  the  head,  and 
especially  of  the  nostrils.  From  the  corners  of  the  mouth  a 
tenacious,  foamy  saliva  hangs  in  long  strings;  the  extremities 
are  usually  edematously  swollen.  The  animal  disseminates  a 
peculiar,  sweetish,  repulsive  odor,  which  becomes  more  pro- 
noun(?ed  during  the  period  of  suppuration.  The  general  con- 
dition later  becomes  worse,  but  as  soon  as  the  suppurative 
process  is  concluded,  and  the  drying  commences  and  with  the 
disappearance  of  the  fever  the  catarrh  of  the  mucous  mem- 
branes also  diminishes  whereupon  the  patients  usually  regain 
their  normal  health  in  a  relatively  short  time,  on  an  average 
in  3  to  4  days. 

The  pox  develop  in  a  similar  manner  on  the  mucous  mem- 
brane, and  sinndtaneously  the  eruptions  on  the  skin.  Their 
appearance  in  the  mouth  is  usually  associated  with  profuse 
salivation,  and  when  they  are  present  in  the  pharynx  there  is 
difficulty  in  swallowing,  while  their  appearance  on  the  tongue 
sometimes  causes  a  marked  swelling  of  this  organ. 

Pox  with  an  Atypical  Course.  Deviations  from  the  regular 
course  are  very  frequent.  It  is  probable  that  the  catarrh  of  the 
air  passages  and  of  the  eyes  which  is  sometimes  observed  in 
some  sheep  of  an  infected  herd  without  other  symptoms,  and 
without  their  developing  a  severe  affection,  is  the  result  of  a 
pox  infection,  which  however,  owing  to  the  resistance  of  the 
animals,  was  not  sufficiently  severe  to  produce  an  eruption  of 
pox  (variola  sine  exanthemate). 

Freqnenth'  it  is  also  observed  that  the  eruptions  do  not 
develop  into  the  vesicular  stage,  but  the  red  and  frequently  elon- 
gated nodules  remain  stationary  for  a  long  time,  peel  off  after 
a  few  days  and  disappear  (so  called  abortive  or  stone  pox). 
These  abortive  lesions  occur  sometimes  also  between  well  devel- 
oped vesicles,  especially  on  the  parts  of  the  body  which  are 
exposed  to  a  greater  pressure  (variolae  compressac,  flattened 
pox),  wdiile  in  other  cases  the  atfection  is  exclusively  manifested 
in  an  eruption  of  such  nodules.  The  disease  frequently  occurs 
in  this  mild  form  among  Algerian  sheep,  in  which  case  small, 
hard  nodules  develop  only  on  the  head,  around  the  eyes,  nasal 
openings  and  lips;  and  in  the  outbreaks  in  Germany,  in  1905, 
the  manifestations  were  similar,  although  the  course  was  quite 
severe  (see  p.  303). 

After  Ostertag  had  as  the  first  recognized  the  disease  to  l)e  pox,  its 
symptoms  Avere  described  more  accurately  by  R.  Friihner,  Kleiiipaul, 
Eber,    Roesslcr,    Xoack,    Klehha,    Ilaak,    and   the    autopsy    findings   by 


310  Sheep  Pox. 

Joest.  The  difference  from  the  usual  course  is  not  shown  so  much 
in  the  general  symptoms  (fever,  acute  catarrh  of  the  mucous  mem- 
branes, dullness,  etc.),  as  these  greatly  resembled  those  of  the  typical 
form,  but  in  this  atypical  form  hard  nodules  as  large  as  lentils  or 

hazelnuts  usually   developed   on    the 

skin  (Fig.  55).     They  were  not  sur- 

\  rounded  by  a  red  zone,  and  showed 
no  indications  w^hatsoever  of  vesicular 
or  pustular  formation.  Although  the 
'  exanthema  often  extended  over  the  en- 
tire body,  it  appeared  that  the  lesions 
occurred  preferably  in  the  vicinity  of 
-^«?  the  nose,  lips,  vulva,  and  on  the  udder. 

:'-? ~~J      The  affected  parts  of  the  body  fre- 
quently showed  a  marked  inflammatory 
Fig.  55.    Atypical  sheep  pox.  swelling.     Later   the    papules   dried, 

(After  Joest.)  ^^^^  dropped  off  entirely.      Not  infre- 

({uently  they  turned  into  suppuration 
or  gangrene,  whereupon  quite  deep  ulcerations  developed,  which  were 
covered  by  thick  scabs  and  crusts.  After  the  scabs  dropped  off,  cicatrices 
without  pigment  or  hair  remained.  Typical  pox  vesicles  develop  but  rarely 
and  only  later  in  an  outbreak.  Here  and  there  purulent  keratitis, 
sometimes  with  subsequent  panophthalmitis  and  blindness  resulted,  and 
lameness  resulted  frequently  from  an  inflammation  of  the  interdigital 
space,  also  erysipelas-like  swellings  of  the  skin  of  the  thighs;  further 
a  collifiuative  diarrhea  was  observed  in  severe  cases.  In  some  cases 
goats  became  affected  with  similar  symptoms,  and  the  transmission 
from  sheep  to  goats  was  also  successful  ])y  artificial  means  (Foth). 
Losses  in  affected  flocks  vary  among  the  different  animals  from  25-50%, 
or  even  a  larger  proportion.  (According  to  Lungershausen  the  disease 
showed  a  similar  character  in  the  outbreaks  of  1862-3.) 

The  number  of  papules  varies  greatly  from  case  to  case, 
sometimes  they  occur  only  sparingly,  while  in  other  cases  the 
parts  of  the  body  not  covered  by  wool,  as  well  as  the  other 
parts,  are  covered  with  great  numbers.  As  a  rule  they  are 
thickest  and  most  numerous  on  the  face. 

If  the  eruptions  appear  very  closely  together  they  may 
confluate  into  large  purulent  vesicles  (variola  confluens),  and  if 
this  occurs  in  many  places  the  neighboring  skin  and  subcu- 
taneous connective  tissue  becomes  greatly  edematous,  so  that 
the  head,  for  instance,  becomes  greatly  deformed,  and  the  face 
appears  as  though  covered  by  a  mask.  In  such  cases  the  papil- 
lary layer  under  the  suppuration  forms  a  continuous  wounded 
surface,  from  which  a  general  pyemia  or  septicemia  may  readily 
develop.  In  such  cases  numerous  papules  may  develop  on  the 
mucous  membrane  in  the  mouth,  pharynx  and  nose,  the  develop- 
ment of  these  being  associated  with  difficulty  in  swallowing  and 
respiration,  purulent  nasal  discharge,  and  profuse  salivation. 
Vesicles  may  occasionally  develop  on  the  conjunctivae,  and  also 
on  the  corneae.  In  such  cases  the  disease  usually  terminates  in 
death,  and  if  the  animals  should  recover  after  the  falling  off 


Pox  with   Atyi)i(al    Course.  311 

of  the  thick  scahs,  an  oxtciidcd  ulcerative  surface  remains,  wliicli 
heals  only  after  a  lono-  time  k-aviiiu'  irregular  shaped  cicatriza- 
tions. 

Most  nnfavoral)lo  is  the  course  in  those  eases  in  wliich,  (hir- 
ing" the  deveh:)pment  of  the  ernptions  extensive  hemorrhages  ap- 
pear (variohi  liemorrliai^ica  s.  nii;ra).  Althon,i;ii  dissemiiuited 
small  liemorrhaiii's  may  occur  in  the  mild  cases,  tiie  hemorrhagic 
character  of  the  affections  is  at  other  times  pronounced.  Be- 
tween papules  of  normal  appearance,  dark  red  eruptions  are 
observed,  which  do  not  disai^pear  on  pressure,  liemori-hages 
also  occurring  on  the  smooth  skin  and  in  the  suhcutis.  In 
other  cases  the  exanthema  develops  at  first  normally,  although 
accompanied  by  severe  general  disturbances.  Suddenly,  how- 
ever, the  serous  contents  of  the  vesicles  become  hemorrhagic 
and  then  the  eruptions  appear  dark  red,  almost  blackish.  At 
the  same  time  a  bloody  nasal  discharge,  hematuria  and  bloody 
diarrhea,  indicate  similar  hemorrhages  in  the  internal  organs. 

The  severity  of  the  disease  is  also  manifested  in  the  be- 
havior of  the  affected  animals.  They  stand  in  one  place,  swing- 
ing their  bodies  with  drooping-  heads,  and  at  times  grinding  the 
teeth,  or  lie  motionless  on  the  ground.  The  respiration  is  very 
labored,  and  is  usually  done  through  the  mouth.  The  body  dis- 
seminates an  unpleasant  repulsive  odor.  The  affected  parts  of 
the  skin  turn  into  ulcers,  which  become  covered  with  a  dirty 
ichorous  mass,  while  other  parts  of  the  skin  may  become  gan- 
grenous, forming  dirty  brown  masses.  Gangrene  may  also  ex- 
tend to  the  muscles,  and  occasionally  the  ears,  lips,  eyelids,  etc., 
may  also  become  gangrenous,  these  parts  later  dropping  off 
(variola  gang-raenosa,  gangrenous  pox,  rot  pox ;  such  necrosis  is 
sometimes  observed  in  the  confluent  but  non-hemorrhagic 
papules).  Death  may  result  in  any  stage,  even  before  the  de- 
velopment of  the  vesicles. 

The  so  called  1>lack  pox  does  not  represent  a  special  form  of  the  disease, 
but  is  primarily  identical  with  the  ordinary  sheep  pox,  while  the  hemorrhages 
are  Aery  likely  originally  associated  with  an  especially  severe  accidental  septic 
infection. 

Most  frequent  are  those  complications  which  occur  in  the 
animals  as  a  result  of  scratching  and  rubbing  on  account  of 
itching.  Thus  a  severe  dermatitis  may  sometimes  develop  at 
the  places  of  the  ruptured  vesicles,  which  retards  the  subsequent 
healing,  and  as  a  result  of  this  marked  edematous  swelling  may 
develop,  even  in  mild  cases,  especially  on  the  head.  After  heal- 
ing scarred  depressions  result  from  such  wounds  at  the  place 
of  the  vesicles.  If  the  patients  rub  their  noses  much,  which 
they  frequently  do,  the  inflammation  may  also  extend  to  the 
nasal  septum,  and  to  the  periosteum  of  the  nasal  bones,  and  for 
this  reason  these  bones  sometimes  become  necrotic. 

ChcTuosis  of  the  conjunctivae,  which  in  severe  cases  of  con- 
junctivitis develops  not  infrequently,  may  result  in  an  ulcerative 


312  Sheep  Pox. 

breaking  down,  or  necrosis  of  the  cornea,  with  which  occa- 
sionally an  acute  inflammation  of  the  internal  parts  of  the  eyea 
becomes  associated,  leading  finally  to  atrophy  of  the  bulbus. 
Vesicles  which  develop  on  the  sclerotic  portion  of  the  conjunc- 
tiva may  extend  to  the  cornea,  leaving  a  permanent  cloudiness 
behind. 

The  catarrh  of  the  air  passages  may  sometimes  extend  to 
the  finest  bronchi,  when  it  causes  intense  difficulty  in  respiration, 
and  a  catarrhal  pneumonia  may  develop  as  a  result. 

The  pox  eruptions  are  usually  associated  with  gastro- 
intestinal catarrh;  in  severe  cases  it  becomes  more  intense,  and 
the  resulting  complete  inappetence  combined  with  the  profuse 
diarrhea  exhausts  the  strength  of  the  affected  animals. 

The  eruptions  on  the  lower  extremities,  on  the  coronary 
band,  and  in  the  interdigital  space,  lead  not  infrequently  to 
purulent  inflannnation  of  the  sensitive  lamina,  and  of  the  neigh- 
boring joints,  as  in  these  places  septic  infection  readily  occurs, 
whereupon  the  horny  capsules  drop  otf,  and  general  pyemia 
develops  from  pus  absorption. 

Of  other  complications  there  should  be  mentioned,  suppura- 
tion of  the  Ijanph  glands,  metastatic  abscesses  in  various  inter- 
nal organs  and  in  the  subcutaneous  connective  tissue,  diphthe- 
ritic inflammation  of  the  mucous  membranes,  pneumonia  and 
pleurisy,  necrosis  of  the  tendons,  etc. 

Course.  The  course  of  pox  is  always  acute,  and  except  for 
some  of  the  outl^reaks  (see  p.  309),  is  in  the  majority  of  cases 
typical  unless  the  development  is  hindered  by  outside  condi- 
tions. The  development  of  the  vesicle  occurs  with  few  excep- 
tions always  in  the  same  order,  and  the  other  manifestations 
also  follow  a  typical  course.  Accordingly  the  average  duration 
of  the  disease,  from  the  beginning  of  the  exanthema  until  the 
scabs  fall  off  and  to  the  new  formation  of  the  epithelium,  is  from 
3  to  4  weeks.  The  course  may  however  be  influenced  by  external 
conditions,  as  it  is  known  that  the  disease  runs  a  slower  course 
in  dry  winter  weather  than  in  summer,  and  cold  rainy  weather 
has  an  unfavorable  effect  on  its  course.  Further,  the  disease 
develops  more  slowly  in  anemic,  poorly  nourished  animals, 
and  if  they  survive  at  all  the  period  of  desquamation  especially 
requires  a  longer  time. 

In  severe  cases,  with  very  extensive  pox  eruptions,  death 
may  ensue  even  in  the  early  stages  of  the  disease,  possibly  from 
hemorrhage.  Usually  however  unfavorable  changes  take  place 
during  the  suppuration  period,  although  in  exceptional  cases 
animals  may  die  even  if  they  are  on  the  road  to  recovery,  as  a 
result  of  exhaustion  or  some  complication. 

The  mortality  varies  greatly  in  different  outbreaks.  While 
the  loss  sometimes  amounts  only  to  from  2  to  5%,  in  other  cases, 
especially  when  the  coalescing  and  hemorrhagic  forms  are  more 
freauent,  more  than  half  of  the  affected  animals  die. 


C'ouisc.      DiamKtsis.  .']!.'} 

If  an  outbreak  has  apix-an-d  in  a  lar^c  Hock  the  eases  lirst 
appear  at  intervals  of  10  to  14  days,  later  however  in  more  ra])i(l 
sneeession,  until  finally,  with  the  exception  of  al)0ut  2  to  o%, 
ail  animals  have  become  alTected.  In  some  cases  only  a  small 
part  of  the  herd  becomes  alTected  at  lirst,  and  only  o  to  4  weeks 
later  when  the  animals  that  were  stricken  lirst  already  show 
indications  of  recovery  does  the  disease  break  out  suddenly 
in  a  s;reat  number  of  sheep,  and  (iiudly  after  a  further  intei'val 
all  of  the  Jinimals  of  the  Hock  which  have  been  spared  become 
alTected. 

Diagnosis.  The  character  of  the  exanthema  and  the  typical 
course  of  tiie  disease  as  a  rule  make  a  ])ositive  diagnosis  pos- 
sible. If  the  danger  of  contagion  exists  the  first  prodromal 
symptoms  are  sufficient  to  arouse  a  suspicion  of  the  disease, 
otherwise  however  the  diagnosis  should  be  suspended  until 
tjT^ical  vesicles  have  developed  from  the  nodules.  The  pres- 
ence of  vesicles  and  pustules  is  not  absolutely  necessary  in  the 
clinical  develoy^nient  of  the  disease,  as  was  shown  by  recent 
German  and  Algerian  ol)servations,  and  therefore  in  such  an 
atypical  course  a  papular  exanthema  is  sufficient  to  establish  at 
least  a  suspicion  of  the  disease,  especially  when  such  lesions 
develop  in  association  with  fever  and  catarrh  of  the  mucous 
membranes.  The  diagnosis  may  be  confirmed  later  by  inocula- 
tions of  the  contents  of  the  nodules  into  healthy  animals. 

The  disease  may  be  mistaken  for  scabies  and  pustular 
eczema,  especially  in  the  stage  of  pustule  and  scab  formation. 
In  these  diseases  however  there  are  no  severe  prodromal  symp- 
toms preceding  the  development  of  the  lesions,  besides  this, 
eczema  is  not  infectious,  and  in  its  course  no  larger  vesicles 
develop,  while  scabies,  although  infectious,  spreads  very  slowly, 
and  scabies  mites  may  be  readily  demonstrated  with  the  micro- 
scope in  the  scabs  and  crusts. 

Prognosis.  In  cases  in  which  the  pox  eruptions  are  few  and 
the  individual  papules  develo})  in  the  regular  order  the  prog- 
nosis is  favorable.  On  the  other  hand  in  those  cases  in  which 
the  exanthema  extends  over  a  larger  portion  of  the  body,  and  in 
which  the  vesicles  show  a  tendency  toward  coalescing,  it  is 
doubtful.  Hemorrhages  are  always  unfavoral)le  indications, 
irrespective  of  the  stage  in  which  they  appear. 

Very  old  or  very  young  animals  show,  under  otherwise  like 
conditions,  feelde  resistance  and  sucking  lambs  especially  be- 
come severely  ill  with  otherwise  mild  pox  on  account  of  the  usual 
association  of  gastro-intestinal  catarrh.  In  flocks  where  the 
animals  are  confined  in  narrow  quarters  the  disease  runs  a  more 
unfavorable  course  than  in  animals  kept  out  of  doors.  In  the 
latter  again  great  heat  or  dam])  chilly  weather  has  a  bad  effect. 
Sheep  which  come  from  localities  in  which  i)ox  is  prevalent 
become  more  readily  affected  than  those  which  come  from 
localities  wher(^  the  disease  has  not  existed  for  a  long  period. 


314  Sheep  Pox. 

In  the  prognosis,  the  possibility  of  complications  and  after 
effects  (lameness,  chronic  ailment)  should  be  given  due  con- 
sideration. 

Treatment.  In  the  treatment  of  sheep  pox,  regulation  of 
hygienic  conditions  is  the  essential  factor  to  be  considered.  The 
animals  should  be  given  proper  food  and  pure,  fresh,  uniformly 
warm  air,  wherefore  in  favorable  weather  it  is  best  to  keep 
the  sheep  out  of  doors.  The  early  slaughter  of  the  severely 
affected  animals  appears  indicated,  because  through  this  pro- 
cedure the  danger  of  a  subsequent  septic  infection  of  the  ani- 
mals with  a  milder  attack  is  diminished. 

During  the  stage  of  incubation  in  the  beginning  of  the  affec- 
tion, immune  serum  of  high  potency  (see  p.  317)  may  give 
good  service. 

Pox  Immunization  (Ovinatio).  As  recovery  from  pox  usu- 
ally confers  upon  the  animals  an  immunity  for  their  entire 
lives,  the  production  of  the  disease  in  a  mild  form  appears 
advantageous  in  all  cases  in  which  it  is  feared  that  the  sheep 
will  become  severely  affected  from  natural  infection  (emer- 
gency immunization).  This  danger  exists  especially  when  the 
disease  has  already  attacked  some  sheep  in  a  fiock,  and  if  its 
further  spread  is  expected.  The  situation  is  similar  when  the 
disease  has  appeared  in  nearby  localities,  and  the  local  condi- 
tions appear  to  be  favorable  for  the  transmission  of  the  disease 
to  the  healthy  herds.  Under  such  conditions  it  should  be  aimed 
to  assure  as  much  as  possible  a  mild  course  for  the  disease,  and 
at  the  same  time  to  reduce  its  duration.  The  vaccination  of  the 
herds  exposed  to  the  infection  answers  for  both  purposes.  The 
disease  which  develops  subsequently  usually  takes  a  more  favor- 
able course  than  in  the  natural  infection,  provided  that  the 
vaccination  has  been  carried  out  properly  and  with  good  vac- 
cine. If  the  entire  flocks  have  been  vaccinated  the  disease  usu- 
ally disappears  within  a  few  weeks.  At  the  same  time  the 
spread  of  the  infection  to  non-vaccinated  herds  should  be  pre- 
vented by  quarantining  all  infected  herds. 

Vaccination  of  lambs  at  times  when  the  disease  does  not 
exist   (protective  or  preventive  vaccination)   is  not  indicated 

This  procedure  is  at  the  present  time  used  extensively  in  countries 
in  which  sheep  pox  is  prevalent,  and  is  in  many  places  carried  out 
annually  by  the  shepherds.  It  appears  to  have  a  very  old  origin,  hut 
has  attained  a  Avider  extension  in  Europe  since  Bourgelat  in  1765  and 
shortly  afterwards  Venel  and  Teisier,  Hurtrel  dArboval  and  others 
subjected  the  method  to  scientific  examination,  and  recommended  it 
as  a  suitable  protective  method.  In  the  first  half  of  the  last  century 
farmers  and  shepherds  applied  the  vaccination  very  generally,  and 
the  necessary  vaccine  was  prepared  for  this  purpose  in  specially  estab- 
lished institutes. 

As  a  matter  of  fact  the  vaccination  produces  a  lasting  immunity 
against  subsequent  natural  infection.     The  vaccination  is  followed  with 


Vox    Iiiiiiiuiii/alioii.  gir 

few  exception!?,  hy  only  a  local  and  very  mild  pox  crnption,  and  the 
time  for  vaeeination  may  be  chosen  aeeording  to  convenienee.  The 
nnfavoral)le  resnlts  which  are  observed  in  flocks  suffering  from  natural 
infection  and  the  severe  form  which  develops  in  unfavorable  weather, 
together  Mith  prolonged  duration  of  the  disease,  may  thereby  be 
eliminated.  The  vaccination  of  the  animals  therefore  serves  entirely 
the  purpose  for  which  it  is  intended. 

The  vaccine  is  the  original,  not  attenuated  vii-us  of  pox,  wliieli 
continues  to  propagate  in  this  liigldy  virulent  condition  in  the  inoculated 
animal.  As  a  result  of  this.  Hocks  which  have  not  been  vaccinated  are 
threatened  to  a  great  extent  by  the  vaccinated  animals,  and  particularly 
so  as  the  resulting  infection  usually  appears  generalized,  and  fre- 
({uently  causes  a  malignant  eruption  of  pox.  If  the  vaccination  were 
carried  out  from  year  to  year  on  all  sheep  of  a  country  all  subsefjuent 
infection  of  the  native  animals  could  be  excluded ;  since  however  vac- 
cination is  practiced  only  in  certain  localities,  and  there  mostly  in 
single  flocks,  every  vaccinated  herd  represents  annually  reproduced 
artiticial  infection,  from  which  the  artificially  propagated  virus  may 
sometimes  become  disseminated  and  produce  severe  outbreaks  of  pox.  ^ 

Considered  from  a  general  viewpoint  the  vaccination  of  lambs 
is  therefore  positively  harmful,  especially  as  the  location  of  the  flocks 
is  but  rarely  changed,  and  they  may  be  easily  protected  against  the 
infection  by  safer  measures. 

Oliservations  on  this  point  made  in  Germany  afford  convinoing:  proof.  Since 
187.^  the  vaccination  in  Prussia  has  been  dependent  upon  ofiicial  permits.  This 
resulted  immediately  in  a  conspicuous  reduction  of  ]>ox,  and  consequently  the 
Imperial  law  on  animal  diseases  in  ISIS  prohibited  vaccination  except  in  emerjjency 
cases.  The  results  came  up  to  expectations,  inasmuch  as  Germany  has  been  almost 
entirely  free  from  the  disease  since  that  time.  Pox  has  appeared  from  time  to 
time,  owing  to  importations  from  foreijjn  countries,  but  in  all  instances  the  disease 
has  been  controlled  and  limited  to  the  primarily  affected  flocks.  In  Austria  a 
law  was  passed  in  1880  by  which  the  vaccination  was  permitted  only  with  official 
.sanction,  and  this  also  resulted  in  a  striking  reduction  of  the  disease.  On  the 
other  hand  in  France,  Hungary,  and  in  the  eastern  and  southern  European  countries 
where  vaccination  is  still  in  vogue,  considerable  loss  from  pox  results  from  year  to 
year  among  the  sheep. 

Technique  of  the  Vaccination.  The  clear,  yellowish,  or  yellowish-red,  serous 
contents  of  the  ripe  vesicle  which  is  obtained  from  young  vigorous  sheep,  in  which 
the  eruption  develops  only  in  moderate  extension  and  in  association  with  only 
slight  febrile  symptoms  is  used  as  vaccine.  The  vaccine  should  never  be  taken 
from  a  purulent  vesicle,  and  is  still  more  dangerous  if  it  originates  from  animals 
in  which  the  papules  have  coalesced,  or  in  which  the  presence  of  hemorrhages 
indicate  a  severe  character  of  eruption.  At  the  l)eginning  of  an  outbreak  it  is 
advisable  to  vaccinate  only  a  few  sheep  from  the  first  affected  animals,  and  then 
from  these  the  lymph  should  be  taken  for  the  remaining  part  of  the  Hock.  Tn 
such  cases  the  lymph  may  be  taken  ten  to  twelve  days  after  vaccination,  otherwise 
in  from  5  to  7  days  after  the  appearance  of  the  eru))tions.  If  however  lymph 
from  the  animals  vaccinated  the  previous  year  is  available  it  is  best  to  use  such 
for  the  vaccination. 

The  contents  of  the  ripe  vesicle  are  collected  in  capillary  tubes.  The  tubes 
are  previously  heated,  and  one  end  of  the  tube  is  stuck  into  the  vesicle.  Tn  an 
emergency  however  the  lymph  may  be  collected  from  an  open  vesicle  in  glass  bottles. 
It  is  less  advisable  to  utilize  the  scabs  which  develop  at  the  place  of  the  vesicles 
for  the  vaccination.  Vaccinations  may  also  be  carried  out  directly  from  animal  to 
animal  by  first  inserting  the  vaccination  instrument  in  the  vesicle,  and  then  im- 
mediately into  the  skin  of  the  animal  to  be  vaccinated.  Serous  lluid  obtained  by 
squeezing  incised  nodules  may  be  also  utilized  for  vaccine. 

The  most  favorable  place  for  vaccination  is  the  under  surface  of  the  tail 
which  is  free  from  wool,  iJ-lO  cm.  from  the  rectum,  or  the  inner  surface  of 
the  ear  3-4  cm.  below  its  point.  Less  suitable  is  the  inside  of  the  thigh,  the  scrotum 
and   the  abdominal   region.     As  instruments,   the  vaccinating   lancet   or  still  better 


316  Sheep  Pox. 

the  vaccinatiug  ueeille  is  used,  which  after  the  opening  has  been  filled  with  lymph, 
is  stuck  into  the  stretched  skin  in  an  oblique  direction,  in  order  that  the  vaccine 
may  enter  the  deep  layers  of  the  e])ithelium,  and  not  under  the  skin;  however  the 
skin  may  be  also  superficially  scarified,  and  the  vaccine  rubbed  into  the  scratched 
area. 

In  susceptible  animals  a  typical  jiox  exanthema  develops  if  the  vaccination 
has  been  carried  out  properly,  usually  a  single  vesicle  develops  at  each  place  of 
pricking,  others  develop  exceptionally  in  the  surrounding  parts,  whereas  a  generalized 
eruption  of  pox   results   only  very  exceptionally. 

The  vaccinated  animals  should  be  kej>t  isolated  during  the  entire  duration 
of  the  local  affection  from  sheep  suffering  from  natural  infection,  as  well  as  from 
those  which  have  not  been  vaccinated.  After  a  period  of  about  a  week  the  vaccinated 
animals  should  be  examined  individually,  and  in  those  which  have  failed  to  take 
the  vaccination  the  operation  should  be  repeated.  If  the  vaccination  is  negative 
this  tin:e,  although  good  lymph  has  been  used,  the  respective  animals  should 
be  considered  as  immune.  Vaccination  with  contaminated  material  may  of  course 
result  in  various  wound  infections  (necrosis  of  the  skin,  purulent  inflammation  of 
the  connective  tissue,  pyemia,  tetanus). 

The  vaccination  of  lambs  is  carried  out  in  a  similar  manner,  but  usually  with 
lymph  which  was  taken  the  previous  year  from  vaccinated  lambs,  and  kept  in  air 
tight  bottles  in  a  cool  room. 

Production  and  Preservation  of  Pox  Lymph.  In  the  first  half  of  the  last 
century  sj)ecial  institutions  were  established  for  the  production  of  pox  lymph  in 
France,  and  also  in  other  countries,  where  the  lymph  originating  from  natural 
benign  pox  was  propagated  in  more  or  less  constant  virulence  by  continuous  trans- 
mission from  sheep  to  sheej),  and  was  increased  in  accordance  with  the  demand. 
Vaccination  with  such  lymph  usually  resulted  in  very  mild,  localized  pox,  but  it 
was  repeatedly  noted  that  the  artificially  kept  vaccine  was  capable,  without  any 
apparent  cause,  of  producing  a  generalized  eruption,  although  in  the  meantime  it 
had  passed  through  65,  9S,  and  even  140  generations  of  sheep  (Roll). 

Recently  Soulie  produced  a  vaccine  in  large  quantities  in  the  Pasteur  Institute 
of  Algeria,  by  injecting  single  droj^s  of  lymph  in  various  places  into  the  clipped  skin 
of  the  rump  of  healthy  sheep.  In  10  to  12  days  he  collects  the  contents  of  the  ripe 
vesicles  and  stores  them  in  a  diluted  state  (see  below).  Every  sheep  treated  in  this 
manner  produces  .500  cc.  of  diluted  lymph,  which  is  sufficient  for  the  vaccination 
of  10,000  animals.  This  vaccine  has  been  used  exclusively  in  Algeria  for  several 
years,  and  the  results  are  uniformly  satisfactory;  the  lymph  proves  effective  in  80% 
of  the  cases,  and  the  losses  amount  to  only  0.1-0.5%.  The  action  of  the  lymph 
however  is  not  constant,  as  occasionally,  especially  in  resistant  breeds,  the  vaccina- 
tion may  be  effective  in  only  20%,  and  even  in  only  8%  of  the  cases  (Martel). 

Borrel  strengthens  the  virus  by  injecting  pox  lymph  and  then  salt  solution 
mixed  with  bread  crund>s  into  the  pleural  cavity  of  sheep.  As  early  as  in  4  to  5  days 
a  considerable  quantity  of  a  virulent  fluid  may  be  obtained  from  the  thorax. 
Another  method  of  Borrel  consists  in  injecting  siilicutaneously  in  the  abdominal 
region  a  mixture  of  10  cc.  of  jiox  lymph  and  500  ce.  of  salt  solution,  of  which 
300-400  cc.  is  injected  into  the  animal.  The  fluid,  which  should  be  rubbed  over 
as  large  a  surface  as  possible,  is  usually  absorbed  by  the  third  day,  and  from  the 
fourth  day  on  a  marked  serous  infiltration  develops  in  the  respective  parts.  On 
the  eighth  day  the  animal  is  destroyed,  and  the  fluid  which  has  collected  under 
the  skin,  together  with  the  infiltrated  tissue,  is  ground  in  salt  solution ;  in  this 
manner  about  two  liters  of  a  liquid  are  obtained,  of  which  1/20,000  of  a  cc.  is 
effective. 

Various  methods  are  adopted  for  the  preservation  of  the  vaccine.  The  simplest 
method  consists  in  placing  it  in  capillary  tubes,  or  in  fine  glass  tubes,  the  center 
of  which  has  been  blown  into  spindle  shape.  The  ends  of  such  tubes,  after  filling, 
are  closed  by  melting,  or  sealed  with  sealing  wax.  For  the  same  purpose  two  plates 
of  glass  of  4  centimeters  square  may  l)e  used ;  the  surfaces  facing  each  other  are 
jiainted  with  the  vaccine  and  the  borders  are  closed  either  with  mastix  or  wax. 
The  lymph  may  be  also  preserved  in  clean  bottles,  which  are  closed  air  tight. 
(According  to  Peuch  old  lymph  which  on  cutaneous  vaccination  is  ineffective  may 
])roduce  typical  pox  if  injected  subcutaneously.)  Soulie  stores  the  lymph  with 
2-5  parts  of  a  3%  boracic  acid,  or  2%  salicylate  of  sodium,  and  immediately 
before  vaccination  he  dilutes  it  with  3  parts  of  its  quantity,  of  boiled  sterile  water. 
According  to  Bosc  sheep  pox  virus  remains  unattenuated  for  at  least  two  years 
in  the  intestinal  canal  of  leeches,  which  have  sucked  themselves  full  on  opened, 
ripe  pox  postules. 

Other  Methods  of  Vaccination.  In  order  to  prevent  a  generalized  eruption 
of  pox  the  attenuation  of  the  virus  was  undertaken,  but  with  unsatisfactory  results. 


Vaeeiiiatinii.      rimnuiiizatioii.  317 

Pcuch  (lilutod  for  this  ipiirposo  iho  lyiniili  olitaiiicl  from  the  vesicles  with  fiO-lOO-160 
times  its  tiiiaiitity  of  water,  Nucar-l  iV  Mollereau  with  water  containint,'  oxytren, 
Semmer  iV  J\'aiiiiai'li  l)y  lieatiiiji  to  ;")•">'.  After  tlie  inoculation  of  s\ich  vaccines  no 
erui)tions  resuite<i,  nevertheless  the  respective  sheep  jiroved  imniiuie.  Dnclert  kept 
fluid  Ivmph,  Conte  dried  lymph,  at  a  temjieratnre  of  12;")%  and  both  observed  a 
jjrailual  attenuation  of  the  virus.  The  vaccinations  undertaken  with  such  attenuated 
virus,  however  in  numerous  cases  failed  to  ix'i'^e  positive  results. 

Supposin^r  that  the  ovina  lieeomes  attenuateil  in  virulence  for  sheep  by  i)assaij;e 
throujih  jjoats  Konew  enii)]ovs  for  the  vaccination  of  sheej),  edema  fluid  obtained 
from  goats  (Kaprino)  which  have  receive.!  serial  subcutaneous  vaccination  with 
ovina.  I'p  to  liXiT,  91,7:1.')  sheep  were  vaccinated  with  such  lymph  in  Russia  with 
uniformlv  satisfactorv  results,  and  P.ridre  also  obtained  the  same  ««»''  results 
in  an  outbreak.  Voiijt  also  convinced  himself  that  sheep  caprinized  with  goat  ovina 
became  immune,  oiilv  he  found  that  a  necrosis  of  the  j.oint  of  vaccination  .icveloped 
from  the  subcutaneous,  as  well  as   from   the  cutaneous   injections. 

Following  the  initiative  of  Sacco,  sheep  were  vaccinated  for  a  time  with 
cow  pox  Ivmph,  but  without  results.  At  the  same  time  it  was  learned  that  vaccina- 
tion with  "cow  pox  Ivmph  took  only  in  few  sheep  (Pessina),  and  it  was  observed 
that  after  such  vaccinations  a  generalised  pox  eruption  with  considerable  loss 
occurred   (Fiirstenberg,  Gips). 

Serum  Immunization  and  Serum  Therapy.  Duelort  (1896)  fonnd 
that  blood  sei-iim  of  sheep  whicli  have  passed  through  an  attaek  of 
pox,  and  more  so  from  those  which  were  repeatedly  treated  with  virulent 
lymph,  has  a  protective  action  for  lambs  against  an  energetic  infection 
of  virulent  ly!iii)li.  l^orrell  (1902)  inaugurated  this  procedure  in 
practice. 

Sheep  which  have  reeoverea  from  pox  are  injected  subcutaneously  every  month 
with  200-.100  cc.  of  lymph  prepared  by  his  method  (see  ]).  H16).  After  5-0  ot 
nich  injections  the  sheep  produce  a  potent  blood  serum.  If  such  serum  is  mixed 
with  lynqih  ol>taine<l  from  jiox  vesicles,  and  diluted  with  53  parts  of  bouillon,  a 
cutaneous  inoculation  with  such  a  mixture  produces  results  according  to  the  quantity 
of  the  serum,  smaller  and  smaller  vesicles  are  developed  as  the  amount  of  serum 
is  increased  while  a  mixture  of  1  cc.  of  diluted  lymph  with  Va  cc.  of  blood  serum 
i)rove<l  entirely  ineffective.  The  cutaneous  inoculation  of  1  cc.  of  diluted  lymph 
i.roduces  a  bfister  with  a  diameter  of  6-7  cm.,  and  snbsequently  a  general  pox 
eruption  If  on  the  other  hand  such  sheep  receive  two  <lays  after  the  inoculation, 
from  2-10  cc.  of  blood  serum,  the  size  of  the  vesicles  is  diminished  in  accordance 
with  the  serum  used,  and  if  15-20  cc.  of  blood  serum  is  injected,  no  eruption 
whatever  develops. 

Immune  serum  has  been  used  in  practice  in  France  with  good 
results,  it  is  claimed,  although  mostly  under  very  unfavorable  condi- 
tions. According  to  Martel's  view  the  serum  inoculation  checks  the 
disease  in  infected  herds,  and  also  prevents  the  eruption  of  pox  in 
alreadv  febrile  (40  degrees)  sheep.  If  the  eruptions  are  already  in 
progress  usually  onlv  a  few  small  vesicles  develop,  and  even  if  they  do 
become  larger,  recoverv  takes  place  within  a  short  time.  In  some  sheep 
onlv  small  nodules  which  do  not  suppurate,  develop  under  the  skin.  The 
serum  immunization  is  supposed  to  confer  also  an  immunity  on  the 
otherwise  very  susceptible  lambs,  which  lasts  for  at  least  40  days 
(Borrel). 

The  dose  of  the  blood  serum  is  for  the  immunis'ation  proper  5  cc,  for 
therapeutical  purposes  at  least  10  cc.  In  alrea.ly  infecte.l  animals  the  sexum 
affords  only  a  protective  or  curative  action  in  the  incubative  stage  or,  at  hest, 
in  the  i)ro(fromal  stage  of  the  disease.  -,  ^   .^  i         i.  ir  i„i       i„ 

The  value  of  serum  immunisation  cannot  yet  be  definitely  established.  Jn 
the  fall  of  1902,  and  in  the  spring  of  190.3,  six  herds  were  given  the  serum 
treatment,  in  which  previous  to  the  treatment  10..3%  of  the  animals  died  from 
vox  Of  581  sheep  and  352  lambs  which  were  treated,  49  sheep  and  24  lambs  that 
is 'in  all  7  8%  died,  the  loss  fluctuating  in  the  individual  herds  between  0.0  and 
97  7%  In  a  her.l  consisting  of  500  sheep  and  150  lambs,  in  which  pox  had 
develope.l  two  weeks  previously,  the  disease  cease.l  imme.liately  after  ^lio  an.uutls 
had   been   injected   subcutaneously  with   5    cc.   of   serum.      Conte   treate.l   089   sheep 


3X8  Sheep  Pox. 

and  63  lambs  in  40  infected  herds  in  the  Department  Herault,  in  the  years  1903-1909; 
of  these  10  became  infected  subsequently,  two  of  which  died,  whereas  ni  137 
animals  which  were  not  given  the  treatment  the  mortality  amounted  to  38.7%. 

Bosc  foun.l  that  the  serum,  as  well  as  the  defibrinated  blood  of  lambs  severely 
affected  with  pox  (hyi>er-infected)  possessed  immunizing  properties,  inasmuch  as 
20  cc.  injected  into  healthv  lambs  protected  them  against  virulent  infection.  Lambs, 
and  also  donkevs,  which  ^  have  been  treated  repeatedly  with  such  serum  and  pox 
lymph,  produce "^  a  still  more  potent  serum,  which  may  confer  total  immunity,  or 
only  prevent  the  generalized  pox  eruption. 

Simultaneous  Immunization  (Sero-clavelisation).  For  producing 
a  lasting  immunity  Borrel  recommends  the  simultaneous  inoculation 
M'ith  his  immune  serum  (5-15  cc.  injected  subcutaneously  in  the  rump) 
and  virulent  lymph  (0.05  cc.  in  the  ear).  In  Aries  over  10,000  sheep 
were  treated  by  this  method,  and  none  of  the  animals  became  aft'ected 
with  pox,  and  from  subsequent  complications  only  0.27c  died.  Good 
results  were  also  obtained  by  this  method  by  Bridre  in  Tunis,  and  by 
Conte  in  France. 

Poenaru  vaccinated  262  sheep  with  threads  saturated  in  a  mixture  of  immune 
Ferum  and  lymph,  the  thread  was  introduced  under  the  skin,  whereupon  in  164 
animals  only  a  nodule  developed  at  the  point  of  inoculation,  in  94  a  small  postule, 
and  in  only  one  instance  had  several  postules  appeared. 

Veterinary  Police.  Outside  of  the  measures  for  compul- 
sory reporting  of  the  outbreaks,  the  quarantine  of  the  premises 
or  towmships^  and  the  harmless  disposition  of  the  carcasses, 
a  compulsory  immunization  of  the  healthy  animals  in  an  affected 
herd  appears  indicated.  In  case  the  disease  is  disseminated 
more  extensively,  or  if  infection  threatens,  vaccination  may 
also  he  applied  to  the  flocks  that  are  in  danger.  The  vaccination 
mav  l^e  omitted  if  the  sheep  which  are  not  affected  are  slaugh- 
tered within  a  short  time.  Vaccinated  sheep  should  he  subject 
to  the  same  police  measures  as  animals  affected  with  the  natural 
disease,  and  be  quarantined  for  the  duration  of  the  affection. 
The  raising  of  the  quarantine  from  infected  premises  should  be 
preceded  by  a  period  of  observation  of  at  least  45  days.  The 
pelts  of  sheep  affected  wdth  pox  may  be  considered  non-infec- 
tious after  complete  drying,  the  meat  how^ever,  if  its  condition 
permits  its  passing  for  food,  is  to  be  considered  non-infectious 
even  in  a  fresh  state. 

Literature.  Chauveau,  J.  vet.,  1868,  548.— Gerlach,  Ger.  Tk.,  1872,  65  (Lit.).— 
Nocard  Eec.  lsS8,  272;  Bull.,  1898,  43  and  331;  1899,  263;  1900,  21.— Peuch, 
C  E  1888,  CVII,  425.— Soulie,  Eev.  vet.,  1896,  421.— Borrel,  Soc.  biol.,  1902,  ;i9; 
A  P'  1903  XVI  123.— Bosc,  Cbl.  f.  Bakt.,  1903,  XXXIV,  413;  Eev.  gen.,  1904, 
TV,  273.-Poenaru,  Arhiva  vet.,  1904,  339.-Joest,  Z.  f.  Infkr  1906  I,  221  (Lit. 
on  the  last  pox  invasion  in  Germany).- Borrel  &  Konew,  Cbl.  ±.  Bakt.,  IJO/.— 
Foth,  Diss.  Leipzig,  1907.— Conte,  Eev.  vet.,  1910,  65. 

(b)    Cow  Pox.    Variola  vaccina. 

{Kuhpocken    [German];    Vaccinia    [Frowh];    Vajido    vacciuo 

[Italian'].) 

Occurrence.  Cow  pox,  the  relation  of  wdiicli  wdth  human 
pox  has  already  been  recognized  by  Jenner  (179(i),  occurs 
usually  only  sporadically,  or  as  an  enzootic  confined  to  indi- 
vidual herds.  In  most  cases  it  may  be  attributed  to  an  infection 
of  true  pox,  or  vaccination-pox  of  man. 


Cow   Pox.  ^-[C) 

Til  tlip  afToetPil  hoiils  a  jjreat  iimiilior  of  tlio  auiinals  may  lieooinc  infected 
within  a  short  tiiiio.  Thus  Bartos  oliservetl  aiiionj;  -K)  i-ows  W)  infectod  inside 
of  two  woolts.  In  this  instance  the  children  of  the  owner  liail  1  een  vaccinateii  (5 
days  previous  to  the  lirst  case.  The  disease  was  observed  in  an  epizootic  oiit!)reak 
by  Freger  in  tlie  Arrondissenient  de  Bayeux,  wlieie  tlie  milkers  disseminated  the 
disease  from  stalde  to  stable. 

Accordinj^  to  Leese  i)ox  occurs  in  Pendscdial)  amon^  camels  with  sii(di  fre- 
quency that  most  of  the  animals  become  affected  in  the  first  or  second  year  of 
their  lives.  As  a  result  of  this,  older  camels  rarely  become  all'ected,  but  if  so, 
usually   with   generaliied   pox   and    }»yemic   manifestations. 

Etiology.  According  to  the  investigations  of  Negri  (1905), 
wliicli  liavc  since  l)een  conlirnied  l)y  Kcnilinger  cK:  Osniaii  Xonri, 
C^ai'ini,  Xicollc  cV:  Adil-Bcy  and  others,  the  cow  pox  virus  passes 
throngli  not  too  dense  porcelain  iilters,  therefore  it  apparently 
belongs  to  the  nltra-visible  micro-organisms. 

Xt'^ri  liltiToil  vaccine  fluid  collected  from  young  cows  through 
l^erket'eld  filter  under  3  atmospheric  })ressures,  and  i)i'odneed  with  the 
flltrate,  the  charaeteristic  vaccinia  keratitis  in  ral)bits,  and  true  pox 
postules  on  the  udders  of  cows.  The  fact  that  filtrate  from  lymph  which 
has  stood  for  some  time  is  frecpiently  more  infective  than  similar  sub- 
stance from  fresh  material,  is  explained  In'  Carini  thus  that  the  virus 
is  contained  in  cells,  and  is  freed  only  after  long  maeeration.  (According 
to  Nicolle  &  AdibBey  this  may  ])e  hastencni  ))y  ])ancreatic  digestion). 
Up  to  the  present  time  only  al)ortive  pox  could  be  produced  with  filtrates. 

Proscher  is  said  to  have  succeeded  in  cultivating^  the  ultra-visible  pox  virus 
on  artificial  me<lia.  On  solid  media  prepared  especially  for  this  purpose,  smeary 
fleposits  develop  by  chanj^es  of  the  nutritive  substrata,  which  do  not  contain 
niicroscoi)ically  visible  micro-organisms,  but  which  yet  produce  pox  postules  in  calves 
up  to  the  tliird  or  fourth  passage. 

Pathogenicity.  Inoculation  of  cow  pox  lymph  into  the  skin 
of  cattle  results  in  a  typical  pox  eruption,  which  is  always  con- 
fined to  the  point  of  inoculation,  or  to  the  parts  immediately 
surrounding  it.  The  eruption  is  associated  with  very  slight 
general  disturbances.  Young  cattle  are  especially  susceptible 
to  infection,  which  is  favored  by  a  previous  injury  of  the  epi- 
thelium of  the  skin  (shaving,  etc.).  Man,  Imffaloes,  camels  and 
horses  are  susceptible  to  a  similar  extent ;  hogs,  sheep  and  dogs, 
to  a  lesser  degree,  and  in  these  animals  cutaneous  inocula- 
tion results  only  in  a  local  exanthema.  The  rabbit  is  very 
susceptible,  and  according  to  Calmette  &  Guerin,  the  guinea  pig 
likewise. 

Subcu.taneous  inoculation  of  the  virus  produces  in  cattle 
an  edematous  intiltration,  in  horses  in  addition  to  this  an  erup- 
tion of  pox,  while  an  intravenous  infection  causes  only  fever 
without  exanthema  in  these  animals.  Chauveau  and  Arloing 
observed  the  development  of  a  vesicular  exanthema  in  young 
horses  following  an  intravenous  infection. 

The  injection  of  lymph  into  the  milk  ducts  of  cows  results 
in  2  to  3  days  in  moderate  fever,  swelling  and  sensitiveness  of 
the  udder,  whereupon  on  the  ninth  day  the  secretion  of  the 
udder  becomes  purulent  and  soon  bloody.    The  secretion  retains 


320  Cow  Pox. 

its  virulence  even  after  14  days.  The  symptoms  are  caused  by 
the  development  of  vesicles  on  the  walls  of  the  milk  ducts 
(Lienaux  &  Hebrant). 

The  teaacity  of  the  virus  is  apparently  similar  to  that  of  the  virus  of  sheep 
pox.  It  resists  drying  for  several  weeks,  but  is  destroyed  at  a  temperature  of 
57.5°  in  five  minutes  (Power).  On  the  other  hand  it  is  not  destroyed  by  — ISO 
degrees,  and  its  virulence  is  not  greatly  influenced  by  the  action  of  glycerin,  as 
when  mixed  with  it  and  kept  in  a  dark  place  the  virus  retains  its  virulence  from 
8   to   10  months. 

Natural  Infection.  In  healthy  herds  the  infection  usually 
occurs  through  vaccinated  persons.  This  has  been  proven  by 
the  positive  results  of  inoculation  experiments  and  also  by  the 
observations  that  the  disease  attacks  quite  frequently  large 
numbers  of  cows  shortly  after  the  vaccination  of  children.  For 
instance  the  disease  is  usually  observed  among  cows  in  the 
spring,  at  which  time  the  vaccination  of  children  is  customary, 
when  the  dissemination  of  the  virus  is  given  a  very  favorable 
opportunity. 

Infection  usually  takes  place  during  milking,  when  the  virus 
is  easily  transmitted  from  the  hands  of  the  milkers  to  the 
superficially  injured  skin  of  the  udder.  The  disease  is  also 
frequently  transmitted  from  animal  to  animal  by  the  milkers 
during  milking,  but  contaminated  straw,  food  and  the  stable 
floor  may  play  a  part  as  intermediate  carriers  of  the  virus,  and 
this  infrequent  mode  of  infection  has  been  observed  in  young 
.  stock,  steers  and  oxen.  In  all  probability  the  infection  is  not 
transmitted  through  the  air. 

True  human  pox  may  also  in  all  probability  be  trans- 
mitted to  cattle,  although  the  results  of  artificial  inoculation 
do  not  prove  it  (see  p.  300).  As  a  matter  of  fact  in  the 
eighteenth  century  and  at  the  beginning  of  the  last  century,  at 
which  periods  human  pox  still  occurred"  frequently  in  an  epi- 
demic form,  the  disease  was  also  observed  with  great  frequency 
among  cows. 

Symptoms.  The  disease  usually  commences  after  an  incu- 
bation period  of  47  days,  with  moderate  febrile  symptoms  (rise 
in  temperature  of  i/.-l  degree,  diminished  appetite,  irregular 
rumination,  weakness,  etc.) .  In  many  cases  however  these  prod- 
romal symptoms  are  so  mild  that  they  pass  unnoticed.  During 
milking  it  is  noted  that  the  udder  is  sensitive,  the  milk  is 
thinner,  of  a  lower  specific  gravity  and  coagulates  more  quickly. 
On  the  slightly  warm  and  swollen  teats,  as  well  as  on  adjoining 
parts  of  the  udder,  hard  nodules  in  size  ranging  from  that  of 
a  lentil  to  a  pea  appear  on  the  second  to  third  day,  which  change 
inside  of  1  to  2  days  into  bean-sized  vesicles,  filled  with  a  clear, 
transparent  lymph.  The  vesicles  are  reddish  or  bluish,  or 
yellowish-white,  of  a  mother-of-pearl  or  metallic  luster,  some- 
times lusterless,  depending  on  the  thickness  of  the  skin,  and  on 
its  color.    On  the  body  of  the  udder  the  vesicles  are  uniformly 


Symptuius. 


321 


round,  oil  tlie  teats  tliey  are  oval  in  the  direction  of  the  lon^^ 
axis  of  the  teat,  and  they  are  surrounded  by  a  red  zone  of 
1  to  2  mm.  width.  Toward  the  eighth  to  eleventli  (hiv  they  usu- 
ally become  ripe,  and  then  they  show  in  their  eciiter  a  well- 
(h'liruHl  depression  ("Helle"  navel),  whieli  how(>ver  may  some- 
times be  absent.  Later  the  contents  of  the  vesicles  turn  puru- 
lent, and  dry  to  scabs  (Fig.  56).  After  the  scabs  drop  off  the 
underlying  skin  is  at  first  pale  red  and  swollen,  later  however  it 
shows  sliaHow,  white,  cicatricial  depressions  in  the  affected  parts. 
According  to  the  severity  of  the  case  one,  two  or  numerous, 
but  only  exceptionally  more  than  15  to  20,  vesicles  develop.  Tl)ey 
do  not  appear  at  the  same  time,  but  mostly  at  intervals  of  a 
few  days,  thus  between  the  appearance  of  the  first  and  the  last 


Fig.  56.     Cow  pox  on  the  udder.      (After  Freger.) 

vesicle  4  to  6  and  sometimes  even  14  days  may  elajise,  as  may 
be  seen  by  the  varying  stages  of  development  of  the  vesicles. 
Frequently  the  later  vesicles  are  smaller  than  the  early  ones. 
Outside  influences,  especially  traumatic,  have  frequentlv  an 
unfavorable  effect  on  the  otherwise  mild  course  of  the  disease. 
During  milking  the  vesicles  may  easily  rupture  before  thev 
obtain  their  full  ripeness.  On  such  an  exposed,  readilv  bleed- 
ing wound  the  scab  formation  cannot  take  place  on  account  of 
the  repeated  handling,  and  in  the  meantime  the  regeneration  of 
the  epithelium  does  not  take  place  in  the  usual  way,  but  on 
the  contrary  the  inflammation  of  the  surrounding  connective 
tissue  is  aggravated  from  the  frequent  irritation  of  the  wound. 

Vol.  1 — 21 


32^  ("ow  Pox. 

Occasionally  infection  of  such  wounds  may  lead  to  tlie  develop- 
ment of  severe  ulcerations,  which  considerably  retard  the  heal- 
ing process.  Frequently  30  to  40  days  may  be  required  in  such 
cases  for  recovery.  Exceptionally  a  parenchymatous  mastitis 
may  be  associated  with  the  eruption  of  pox.  As  the  milk  is 
mixed  with  the  secretion  of  the  wounds  it  of  course  becomes 
contaminated. 

In  rare  cases  eruptions  resembling  those  which  occur  on 
the  udder  of  cows  may  develop  on  the  scrotum  of  male  animals. 

A  generalized  pox  eruption  occurs  only  very  rarely  (Dupuis 
observed  it  in  two  cases,  Strebel  in  one  instance).  In  such 
cases  the  eruptions,  which  may  reach  the  size  of  hazelnuts, 
appear,  associated  with  febrile  symptoms,  on  the  udder,  also 
on  the  inner  surface  of  the  thigh,  on  the  croup,  rump,  chest, 
neck  and  in  the  muzzle.  (In  Strebel 's  case  paralysis  of  the 
stomach  and  intestines  was  observed  in  the  later  course  of  the 
disease,  and  after  a  temporary  improvement  of  8  to  10  days,  a 
fatal  peritonitis  developed.) 

Diagnosis.  The  diagnosis  of  cow  pox  is  based  on  the  pres- 
ence of  roundish  or  oval  vesicles  containing  a  depression  in  the 
center.  In  some  cases  the  spreading  of  the  eruption  to  other 
animals  and  a  similar  exanthema  on  the  hands  of  the  attendants 
handling  the  affected  animals,  may  reveal  the  nature  of  the 
affection.  The  injuries  and  irritations  which  are  usually  caused 
by  the  milking,  may  sometimes  interfere  with  the  establishment 
of  a  diagnosis. 

It  is  possible  to  mistake  the  exanthema  for  that  of  foot- 
and-mouth  disease,  but  in  this  the  vesicles  do  not  develop  from 
nodules,  they  are  larger  and  less  uniform  in  appearance,  and 
similar  vesicles  are  present  in  the  mouth  and  in  the  interdigital 
spaces  of  the  affected  animals  in  the  stable.  The  benign,  coital 
vesicular-exanthema  is  readily  recognized  by  the  simultaneous 
affection  of  the  genital  organs.  Pustules  may  sometimes  also 
develop  on  the  udder  in  rinderpest,  but  these  findings  are  unim- 
portant as  compared  with  the  other  general  and  local  manifes- 
tations of  the  disease. 

The  nature  of  the  eruptions,  which  have  ])een  described  by  Ger- 
man authors  as  "wind  and  stone  pox,"  is  as  yet  doubtful,  nevertheless 
the  possibility  does  not  appear  to  be  excluded  that  they  represent 
abortive  forms  of  true  cow  pox.  According  to  description  they  form 
hard  nodules  which  develop  on  the  lower  part  of  the  udder  and  on  the 
teats,  and  change  into  purulent  vesicles.  In  doubtful  cases  the  inocu- 
lation of  a  calf  would  readily  reveal  the  nature  of  the  affection  in  a 
short  time. 

Ehrhardt  described  under  the  name  of  false  cow  pox  (pointed  pox, 
varicellae)  a  stable  disease  of  cows,  in  the  course  of  which  desquama- 
tion of  epithelium  from  the  teats  occurs,  causing  severe  inflammation. 
In  one  case  the  milker  also  became  affected,  his  hand  was  greatly  swollen, 
and  numerous  vesicles  up  to  the  size  of  a  pea  appeared  on  his  skin, 
causing  considerable  pain. 


Dia.iiiKisis.      'rrcatiiHMit.  323 

In  hiiinaii  iiiedieine  llic  term  " varict'llon"  (sheep  pox,  water  pox, 
wind  pox),  designates  an  ai-ute  exanthema  of  children,  in  which  in 
the  course  of  only  a  few  hours  small  vesicles  develop  on  the  skin,  and 
sometimes  also  on  the  mucous  meml)rane,  which  however  soon  dry  iuto 
seal)S.  This  condition  is  associated  willi  mild  |j:eiieral  disturhances. 
Kecovery  from  this  disease  does  not  i)roduce  immunity  against  the  true 
pox,  and  therefore  the  atfeetions  are  considered  etiologically  different. 

Treatment.  Besides  koo])iii,<>-  tlio  affccicd  udder  clean  and 
dry,  it  is  advisable  to  milk  the  animals  daily  with  great  care, 
or  to  draw  the  milk  with  the  aid  of  milk  catheters.  If  ulcera- 
tions have  api^eai'ed  at  the  j)lace  of  the  vesicles  they  may  be 
treated  with  neutral  fats,  wdlli  zinc  or  lead  ointment.  If  milk- 
ing has  been  discontinued,  uneventful  recovery  takes  place 
within  10  to  15  days. 

Immunization.  Freger  vaccinated  all  cows  of  an  infected  herd 
with  calf  lymph  used  for  man.  The  vaccination  was  carried  out  on 
the  perineum  by  superficially  scarifying  the  skin.  Nodules  developed 
upon  the  already  affected  cows,  while  on  the  healthy  animals  typical 
pox  postules  appeared,  and  these  animals  did  not  contract  the  infection. 
The  same  procedure  was  also  employed  with  good  results  by  Krause 
in  a  large  herd,  in  which  the  affection  existed  for  VA  years;  newly 
introduced  animals  which  previous  to  the  vaccination  had  usually 
become  affected  within  3  to  4  weeks,  failed  to  develop  the  disease  after 
the  inauguration  of  this  method. 

Literature.  Jenner,  Inqu.  of  the  causes  anrl  effects  of  Variolae-Vaccinae. 
Loiitlon.  179S. — Bollinger,  Volkmann's  Samml.  Klin.  Vortr.,  1877,  Nr.  110  (Lit.). — 
Ehrhardt,  Schw.  A.,  1896,  81.— Strebel,  Schw.  A.,  1898,  XL,  113.— Negri,  Esper. 
siilla  filtr.  del  virus  vacc.  Pavia,  1905.— Priischer,  Cbl.  f.  Bakt.,  1906,  XL,  3.37.— 
Caj-ini.  Cbl.  f.  Bakt.,  1906,  XLII,  32n.— Nicolle  &  Adil-Bey,  C.  R.,  1906,  CXLII, 
1196.— Freger,  J.   vet.,   1906,  38.5.— Leese,  Trop.  A'et.,   1909,  I,  1. 

Pox  Vaccination  of  Man.  The  discovery  of  the  English  physician 
Edward  Jenner  (1796)  estal)lished  the  fact  that  the  inoculation  of  cow 
pox  lymph  in  man  produces  at  the  point  of  inoculation  a  mild  pox  erup- 
tion, the  recovery  from  this  producing  in  the  vaccinated  person  a  last- 
ing immunity  against  true  pox.  This  method  caused  the  abandoning 
of  the  older  procedure,  in  which  the  lymph  of  man  affected  with  pox 
was  used  for  pox  vaccination,  and  as  a  result  of  Avhich  the  vaccinated 
persons  not  infrequently  became  severely  affected  with  generalized  pox. 
Jenner  used  at  tirst  exclusively  original  animal  lymph,  but  as  it  was 
later  observed  that  this  virus  could  be  transmitted  from  man  to  man, 
in  which  case  its  character  does  not  change,  the  vaccination  with  such 
humanized  vaccine,  that  is,  Avith  the  contents  of  vesicles  from  man 
vaccinated  with  original  cow  pox  lymph,  has  latterly  attained  con- 
tinuously increasing  use. 

In  the  meantime  vai'ious  disadvantages  have  been  observed  in  this 
procedure.  In  order  to  practice  this  vaccination,  a  vaccinated  person 
in  the  proper  stage  of  the  disease  must  })e  availal)le,  which  is  often  very 
difficult.  This  condition  cannot  be  remedied  by  conserving  the  lymph 
obtained  from  vaccinated  persons,  as  in  this  manner  only  small  (|uan- 
titles  of  lymph  may  be  collected.     A  still  greater  disadvantage  lies  in 


324  Horse  Pox. 

the  proven  fact  that  occasionally  diseases  of  persons  producing  the 
lymph  (syphilis,  tii])erculosis)  are  transmitted  by  the  vaccination  to 
the  persons  being  vaccinated. 

On  account  of  this  danger,  bovine  lymph  is  used  exclusively  in 
recent  times  for  vaccination.  The  vaccinating  lymph  is  cultivated  arti- 
ficially in  state  or  private  establishments  erected  for  the  purpose.  The 
lymph  is  constantly  re-inoculated  from  calf  to  calf,  and  then  preserved 
by  a  special  method.  For  the  original  vaccine  either  original  cow  pox 
lymph,  or  lymph  of  a  calf  vaccinated  with  humanized  vaccine  is  used. 
By  employing  calf  lymph  the  danger  of  transmitting  other  diseases 
may  be  excluded  with  certainty,  by  using  young  calves  exclusively  for 
cultivation,  and  by  placing  the  collected  lymph  on  the  market  only  after 
the  health  of  the  vaccinated  animals  has  been  proven  by  an  autopsy. 

At  the  present  time  the  great  practical  value  of  pox  vaccination 
is  recognized  to  such  an  extent  that  in  most  countries  compulsory  vac- 
cination is  established  by  law,  in  spite  of  the  fact  that  here  and  there 
opposition  is  made  against  it. 

For  the  cultivation  of  the  vaccine,  weaned,  healthy  calves,  preferably  male 
animals,  are  commonly  used.  These  should  previously  be  tested  by  tuberculin  for 
the  presence  of  tuberculosis.  The  animal  is  secured  lying  on  the  side  upon  a 
suitable  table,  the  abdomen  from  the  navel  to  the  pubic-syniphysis,  or  one-half 
of  the  thorax,  is  shaved  and  thoroughly  cleaned.  Then  the  lymph  from  a  ripe 
vesicle  of  another  calf,  or  of  a  vaccinated  person,  is  inoculated  into  the  skin  of 
the  calf.  The  procedure  is  carried  out  by  puncturing  the  skin  in  100-200  points 
into  the  deeper  epithelial  layers,  or  in  such  a  manner  that  upon  the  surface  of  the 
skin  superficial  incisions  1-2  cm.  long  are  made,  and  the  lymph  is  then  rubbed  into 
the  wounds.  In  from  4  to  5  days  bluish  nodules  and  vesicles  on  a  bright  reddened 
base  develop  at  the  point  of  vaccination,  from  which  the  lymph  is  pressed  out 
with  suitable  clamp  forceps,  and  preserved  either  as  pure  lymph,  or  together  with 
epithelium,  that  is  scraped  off,  mixed  with  equal  parts  of  glycerin. 

The  lymph  is  preserved  in  glass  tubes,  or  painted  in  thin  layers  on  ivory 
plates  5  cm.  long  and  7  mm.  wide,  the  scraped  fluid  is  enclosed  between  two  small 
glass  plates  and  sealed  with  paraffin.  As  in  the  lymph  prepared  in  this  manner 
bacteria  are  destroyed  within  a  few  weeks  without  affecting  the  potency  of  the 
lymph,  only  vaccine  which  is  from  2  to  3  months  old  is  used  for  human  vaccination. 

Literature.     S.  Huguenin,  Ergebn.  d.  allg.  Path.,  1897,  IV,  246. 


(c)    Horse  Pox.  Variola  equina. 

{Sore  heels;  Pferdepocken  [German];  Variole  equine  [French]; 
Vajuolo  equino  [Italian].) 

Occurrence.  Horse  pox  wliicli  was  extensively  studied  by 
Jenner,  supposedly  existed  more  frequently  3  or  4  decades  ago, 
and  at  that  time  periodically  attained  an  epizootic  extension 
among  horses.  The  descriptions  how^ever  do  not  reveal  a  suf- 
ficiently clear  conception  regarding  the  true  nature  of  the  affec- 
tion observed,  as  English  and  French  authors  (among  them 
Bouley  and  Lafosse,  also  Nocard  &  Leclainche)  understood 
under  the  name  of  "horse  pox"  that  disease  which  since  the 
studies  of  Eggeling  and  Ellenberger  (1878)  is  otherwise  known 
as  contagious  pustular  stomatitis,  and  considered  as  an  inde- 
pendent affection  (see  p.  360).  Jenner's  horse  pox  is  at 
the  present  time  so  rare  that  some  authors,  among  them  Dieck- 
erhoff,  doubt  its  occurrence  entirely. 


Etiolofry.     Symptoms.  32.) 

Etiology.  Jeiiiier  searched  Tor  tlii'  source  of  cow  pox  in 
horse  pox,  and  did  so  in  that  form  of  the  disease  which  is  mani- 
fested as  a  vesicuhir  eruption  in  tlie  posterior  part  of  the  ))as- 
tern.  Later,  as  has  been  mentioned,  tiie  disease  was  identilied 
with  pnstnhir  stomatitis  or  dermatitis,  and  therefore  the  infec- 
tion experiments  supposedly  carried  out  witli  liorse  pox  virns 
must  be  regarded  as  indecisive. 

Loy  transmitted  horse  pox  successfully  to  man  in  seven  cases,  and  Ilertwig, 
also  Pinjjaud  observed  the  natural  transmission  of  horse  pox  to  man.  l{ecently 
Cameron  (190S)  reported  a  case  in  which  on  the  arm  of  a  driver  who  treated  a 
horse  affected  with  pustidar  stomatitis,  a  ])0x  eruption  develoi)ed.  Chauveau,  on 
the  other  hand,  ])roduced  jjeneral  pox  eruj)tions  in  older  horses,  by  injections  of 
vaccine  into  the  lymph  vessels,  and  in  younjj  animals  with  an  injection  into  the 
blood  circulation  (larije  vesicles  develojied  esjiecially  on  the  nostrils,  li|)s  and  on 
the  rump;  they  first  ai)iieared  eight  days  after  tlie  infection).  Similar  results 
were  obtained   in   triinsniissiou  experiments  by  Warleniont  and  Pfeiflfer. 

Symptoms.  At  the  present  time  the  vesico-pustuhir  exan- 
thema, in  the  flexor  region  of  the  pastern  of  young  animals,  is 
considered  as  horse  pox,  in  whicli  it  is  supposed  that  tlie  disease 
is  transmitted  to  the  skin  of  the  pastern  principally  during 
shoeing  by  the  hands  of  the  blacksmiths  and  drivers  (Fried- 
berger  »S:  Frohner).  The  sensitiveness  of  the  pastern,  and  the 
functional  disturbance  of  the  extremities  produced  bj'  this, 
sometimes  also  a  febrile  elevation  of  the  body  temperature, 
indicate  the  development  of  the  affection.  The  skin  on  the  pos- 
terior surface  of  the  pastern  is  swollen  and  reddened,  soon 
vesicles  develop  to  the  size  of  a  lentil,  which  burst  shortly  after, 
whereupon  scabs  develop  on  the  reddened,  moist  epidermis, 
under  which  new  epithelium  forms.  In  rare  cases  the  eruption 
develops  also  on  other  parts  of  the  body,  as  on  the  head,  espe- 
cially around  the  opening  of  the  mouth  and  nostrils,  exception- 
ally also  on  the  mucous  membrane  (Berger  observed  the  appear- 
ance of  pox  in  15  horses  on  the  conjunctiva). 

Diagnosis.  A  disease  which  is  manifested  with  the  above 
symptoms  could  be  considered  as  pox  and  differentiated  from 
the  common  exanthema  of  the  pastern  only  when  typical  pox 
vesicles  develop  on  the  affected  part  of  the  skin,  or  when  the 
inoculation  of  the  contents  of  the  vesicles  produces  a  typical 
eruption  of  pox  on  the  skin  of  cattle.  From  the  standpoint  of 
differential  diagnosis  the  contagious  pustular  dermatitis,  coital 
exanthema,  and  the  contagious  pustular  stomatitis  come  into 
consideration. 

Literature.  Jenner,  s.  p.  .31 S. — Bouley,  Diet,  de  nied.  vet.,  1871,  IX,  451. — 
Chauveau.  Kec,  lS6fi,  .30o  u.  625.— Hertwig,  Chirurgie,  1S74,  182  (Lit.).— Dieckerhoff, 
Spez.  Path.,  1892,  I,  999. — Xocard  &  Leclainche,  Maladies  niicrob.  des  animairx, 
1903,  I,  598.— Cameron,  Brit.  med.  J.,  1908,  I,  1292. 

(d)    Swine  Pox.   Variola  suilla. 

Occurrence.  Swdne  pox  represents  a  very  rare  disease.  In 
some  years  it  appears  to  occur  in  certain  parts  of  Southern 
Hungary  with  considerable  frequency   (in  1907  it  existed   in 


326  Swine  Pox. 

seven  counties  of  that  territory),  and  recently  it  was  also  re- 
ported from  Roumania  (Poenaru). 

Etiology.  The  susceptibility  of  hogs  for  the  pox  virus  was 
established  experimentally  a  long-  time  ago.  Chauveau  suc- 
ceeded in  several  cases  in  transmitting  cow  pox  to  hogs,  Ger- 
lach  swine  pox  to  goats,  Koch  the  same  to  calves.  Szanto  placed 
two  pigs  affected  in  the  pustular  stage  of  the  disease  among 
7  to  8  weeks  old,  healthy  pigs,  whereupon  six  developed  typical 
pox  after  an  incubation  of  four  days,  and  the  disease  was  fur- 
ther transmitted  to  healthy  pigs  by  cutaneous  inoculation.  An 
inoculation  of  lambs  always  resulted  in  a  local,  flat  swelling,  as 
well  as  an  acute  conjunctivitis  and  nasal  catarrh.  Poenaru  also 
succeeded  in  producing  the  disease  in  pigs  with  blood  and  with 
contents  of  pustules,  in  one  instance  in  the  generalized  form 
with  a  fatal  termination. 

Originally  the  disease  develops  in  pigs  through  infection 
from  cattle,  from  man  and  probably  also  with  material  origi- 
nating from  goats.  In  the  infected  piggeries  the  disease  may 
easily  spread  to  a  great  extent,  and  may  also  be  disseminated 
to  other  herds, 

Szanto  observed  64  out  of  74  pigs  affected  with  the  disease,  of  which  3 
succumbed,  while  Lovy  recorded  a  loss  of  18%  in  a  herd  of  155  pigs.  Laquerriere 
observed  swine  pox  as  a  severe  plague  with  usually  a  fatal  termination  as  early  as 
in  1864  in  Algeria.     Old  hogs  became  severely  affected  in  this  outbreak. 

Symptoms.  According  to  the  descriptions  (Spinola,  Szanto) 
the  disease  as  a  rule  affects  young  pigs,  and  is  usually  mani- 
fested in  an  exanthema  affecting  a  large  part  of  the  body.  Sev- 
eral days  after  infection  the  animals  show  symptoms  of  a  gen- 
eral disturbance,  such  as  fever  (41.5-41.8°  C),  weakness, 
loss  of  appetite,  sluggish  movement,  stiff  gait,  straightened 
tail,  chills,  bristles  standing  up  and  greasy,  on  account  of  the 
marked  evaporation  from  the  skin.  In  the  early  stages  ca- 
tarrhal symptoms,  especially  conjunctivitis,  are  often  observed. 
Soon  small  red  spots  appear  in  places  only  slightly  or  not  at 
all  covered  by  bristles,  as  on  the  snout,  eyelids  and  inner  sur- 
face of  the  thighs,  the  abdomen,  less  frequently  on  the  neck  and 
on  the  back.  These  grow  rapidly  to  sizes  like  a  ten  cent  piece, 
in  the  center  of  which  hard  nodules  develop.  After  2  to  3  days 
pea-sized  vesicles  develop,  which  at  first  contain  pure  lymph, 
later  pus.  They  dry  to  dark  brown  scabs,  and  fall  oft'  after 
several  days.  The  number  of  vesicles  varies  greatly,  and  the 
intensity  of  the  prodromal  symptoms,  also  the  course  of  the 
disease  is  not  uniform.  In  severe  cases  the  vesicles  coalesce, 
their  contents  become  bloody,  eruptions  appearing  also  on  the 
mucous  membrane  of  the  mouth,  pharynx,  in  the  trachea  and  in 
the  bronchi.  In  the  meantime  diarrhea  sets  in,  whereupon  the 
disease  terminates  in  death  from  exhaustion,  broncho-pneu- 
monia, or  from  a  general  infection.     (Lovy  also  found  on  the 


Goat.  P(.\'. 


321 


mucous  membrane  of  the  stomach,  flat  ulcers  surrounded  by 
a  red  zone,  \vc  have  also  observed  such  lesions  with  pale  yellow 
elevated  borders,  and  a  dark,  yellowish-red,  granular  base.) 

Diagnosis.  Before  establishing  a  diagnosis,  the  various 
forms  of  eczema,  granular  eruptions,  and  erysipelas-urticai-ia 
should  first  of  all  be  excluded.  If  necessary  it  could  also  be 
established  by  artificial  inoculation  of  the  contents  of  vesicles 
upon  healthy  animals. 

Immunization.  In  emergency  this  could  be  undertaken  in 
a  similar  way,  and  probably  with  the  same  results  as  in  vac- 
cination of  sheep  for  the  protection  of  the  animals  which  are 
not  yet  affected. 

Literature.  ypiiiola,  Krankheiten  d.  St'hweiiie,  1892,  204. — Koch,  O.  M., 
18S7,  57.— Szdnto,  A.  L.,  1906,  541.— Poenaru,  Arh.  vet,  1907,  67.— Lovy,  A.  L., 
1908,  103. 

(e)    Goat  Pox.   Variola  caprina. 

Occurrence.  Goat  pox  has  been  observed  principally  in 
Norway,  where  it  occurs  with  relative  frequency  in  certain 
localities  (Boeck,  Hansen);  it  was  also  established  in  Italy, 
Spain,  France,  Germany  and  Algeria,  where  the  disease  runs 
sometimes  a  very  unfavorable  course. 

Etiology.  The  virus  of  goat  pox  may  be  transmitted  to 
goats  with  the  contents  of  the  pox  eruptions,  and  also  with  the 
saliva  of  the  affected  animals  if  the  vesicles  have  appeared  in 
the  mouth.  Cutaneous  inoculation  results  in  the  development 
of  a  local  pox  eruption  at  the  point  of  inoculation,  associated 
with  very  mild,  general  symptoms.  In  some  cases  the  trans- 
mission to  sheep  was  also  successful,  however  it  only  produced 
an  incomplete  pox  exanthema  at  the  point  of  inoculation  (Bon- 
vicini,  Marcone).  Man  is  not  entirely  without  susceptibility, 
as  occasionally  persons  working  around  affected  goats  develop 
an  exanthema  with  small  vesicles  on  the  hands  and  arms  (Han- 
sen, Marcone). 

Goats  are  sometimes  infected  by  sheep  affected  with  pox,  whereupon 
they  become  affected  either  with  mild  or  severe  symptoms.  A  sulicu- 
taneous  inoculation  of  sheep  pox  virus,  when  the  transmission  is  suc- 
cessful, results  in  fever  after  the  third  day.  On  the  seventh  to  eighth 
day  a  papular  eruption  appears,  and  if  the  animals  die  nodules  are 
found  in  the  lungs  and  in  the  liver.  There  is  also  a  swelling  of  the 
intestinal  follicles,  and  of  the  mesentery  lymph  glands  (Yoigt).  Sul)- 
sequent  inoculation  of  the  fluid  from  the  lesions  at  the  place  of  injection 
into  goats  is  supposed,  according  to  Konew,  to  increase  the  virulence 
of  the  virus  for  goats,  while  for  sheep  it  l^ecomes  attenuated  (see  p. 
306).  Voigt,  on  the  other  hand,  found  that  it  later  possesses  a  lesser 
virulence,  even  for  goats. 

Natural  infection  results  from  direct  contact,  and  in  this 
manner  the  disease  spreads  rapidly  in  goat  herds,  so  that  as 


328  Groat  Pox. 

a  rule  almost  every  animal  becomes  affected  (sheep  kept  to- 
gether with  goats  usually  escape  the  infection,  or  become  only 
very  slightly  ill,  Garbuti  &  Reali).  The  disease  shows  no  ten- 
dency to  spread  over  large  territories,  but  is  mostly  confined 
to  single  flocks. 

Symptoms.  The  clinical  appearance  closely  resembles  that 
of  sheep  pox.  In  association  with  moderate,  febrile  and  ca- 
tarrhal symptoms,  various  sized  partly  coalescent  vesicles,  con- 
taining a  depression  on  top,  develop  on  various  parts  of  the 
body,  especially  however  on  the  udder,  on  the  inner  surface 
of  the  extremities,  on  the  face,  in  the  parts  surrounding  the 
lips  and  eyes.  They  form  scabs  in  the  usual  manner,  and  lieal 
wdth  radiating  scars.  In  some  cases  abscesses  develop  in  the 
tissue  of  the  udder,  when  the  milk  may  become  bloody.  In  some 
animals,  especially  in  kids,  pox  also  develop  in  the  mouth  and 
on  the  mucous  membrane  of  the  upper  air  passages,  tlieir  ap- 
pearance being  manifested  by  cough,  accelerated  respiration, 
and  purulent  nasal  discharge. 

The  course  of  the  disease  is  usually  favorable ;  although  the 
skin  may  become  gangrenous  at  the  places  where  the  vesicles 
coalesced,  the  recovery  is  however  only  retarded  therel)y,  not 
prevented.  Cases  in  which  the  disease  develops  with  severe 
symptoms  from  the  onset,  and  in  which  a  general  infection 
causes  death,  are  very  rare  (such  severe  outbreaks  were  ol)- 
served  in  Algeria). 

Diagnosis.  The  disease  can  only  be  confused  with  foot- 
and-mouth  disease,  as  the  pox  vesicles  in  goats  may  sometimes 
attain  a  size  up  to  that  of  a  hazelnut  (Conte) ;  the  character- 
istic appearance  of  the  pox  exanthema,  and  the  absence  of 
lesions  on  the  feet,  together  with  the  non-transmissibility  of  the 
disease  to  other  cloven-footed  animals,  will  prevent  errors  in 
diagnosis. 

Treatment  and  Prevention.  The  indications  which  hold  for 
the  treatment  and  prevention  of  sheep  pox  apply  also  to  this 
disease. 

Literature.  Hertwig,  Mag.,  1840,  339.— Boeck,  D.  Z.  f.  Tm.,  1879,  IX,  298.— 
Hansen,  Eef.  Eep.,  1890,  135.— Bonvicini,  II  niiovo  Ercolani,  1898,  216.— Marcone, 
La  Rif.  vet.,  1900,  387.— Garbuti  &  Reali,  Clin,  vet.,  1905,  234.— Voigt,  A.  f.  Tk., 
1909,  XXXV,  204. 

2.    Foot-and-Mouth  Disease.    Aphthae  epizooticae. 

{Maul-  uud  Klaiieuseuclie  [German^;  Fievre  aphtheuse,  Cocotte 
[French];  Fehhre  aftosa   [Italian].) 

Foot-and-mouth  disease  is  an  acute,  febrile,  contagious, 
infectious  disease  of  cloven-footed  animals,  in  the  course  of 
which  a  vesicular  exanthema  develops  on  the  mucous  mem- 
branes, and  the  skin,  especially  in  the  mouth  and  interdigital 
spaces.  The  causative  factor  is  an  ultra-microscopical  micro- 
organism. 


Foot-aiKf-^roulIi   Disease.  329 

History.  Tlio  caiiso  of  the  disoaso  was  attrilmtcil  previous  to  the 
niiiklle  of  hist  ot'iitury,  to  various  atmosplifi'ic  intluciua'S,  as  well  as  to 
spoiled  food,  altliough  Sagar  recognized  its  (-outagious  nature  during 
his  observations  in  Norway  in  1764.  In  the  second  half  of  the  last 
century,  especially  since  Bollinger  reached  his  definite  conclusions,  it 
has  been  generally  recognized  that  the  disease  develops  exclusively  as 
the  result  of  a  specific  infection,  but  its  causative  agent  is  even  at  the 
present  time  not  clearly  established.  While  various  authors  described 
certain  bactei-ia,  or  i>rotozoa,  as  the  cause  of  the  disease  (Siegel,  Scliot- 
telius,  Ivurth,  Behla  and  others),  Lciffler  &  Frosch  {1S97-1!»()()}  and 
Ilecker  (181)!))  showed  that  the  virus  passes  the  ordinary  poi-celain 
filter,  and  the  first  authors,  with  Noeard,  and  recently  also  Poels,  con- 
tributed valuable  information  relative  to  the  eradication  of  the  disease 
with  serum  inoculations. 

Occurrence.  From  time  to  time  foot-and-mouth  disease 
spreads  rai)idiy  over  extensive  territories,  as  a  severe  disease, 
affecting  principally  cattle,  in  a  lesser  degree  hogs  and  sheep. 
Its  spread  was  especially  rapid  in  former  times,  when,  spreading 
from  the  east  westward  it  s\vei)t  unchecked  during  a  period  of  2 
to  4  years,  passing  over  the  entire  European  continent,  where- 
upon a  period  of  freedom  from  the  disease  followed  its  disap- 
pearance Avhicli  lasted  for  several  years.  In  recent  times  the 
disease  usually  spreads  more  slowly,  since  its  dissemination  is 
more  or  less  controlled  by  veterinary  police  measures.  In  the 
course  of  the  various  historical  outbreaks,  recurrences  were 
repeatedly  observed,  but  uniformity  lietween  the  appearance 
of  outl)reaks,  and  the  periods  of  freedom  from  the  disease  is 
not  very  regular.  Formerly  almost  all  the  susceptible  animals 
of  large  territories  became  affected  within  a  short  time  by  th^' 
rapidly  spreading  disease,  and  therefore  the  disease  disap- 
peared of  itself,  when  there  were  no  longer  any  susceptible  ani- 
mals left,  while  in  recent  times  the  growing  young  stock  con- 
tinually affords  suitable  material  for  the  perpetuation  of  the 
virus,  so  that  infective  herds  remain,  even  after  the  apparent 
disappearance  of  the  disease,  from  which  in  a  short  time  new 
outbreaks  may  develop. 

The  disease  spreads  with  particular  rapidity  during  warm 
weather,  wliile  in  the  winter  it  does  not  occur  so  extensively. 
AVith  the  appearance  of  warm  weather,  however,  it  frequently 
gains  a  wide  prevalence,  as  a  result  of  the  greater  traffic  in 
cattle. 

The  economic  importance  of  foot-and-mouth  disease  lies 
in  the  severe  losses,  which  the  owners  sustain  from  the  long 
period  of  inactivity  of  the  affected  animals,  from  the  loss  in 
body  weight,  and  from  tlie  diminislied  milk  production,  also 
by  the  considerable  limitation  of  the  traffic  in  cattle,  and  through 
the  loss  of  calves  and  young  stock,  sometimes  also  of  mature 
cattle.  These  losses  caused  the  inaugiiration  of  measures  for 
tlie  eradication  of  the  disease  by  the  government,  and  the  efforts 
tluis  made  have  in  recent  times  brought  gratifying  results  in 
many  places. 


330  Foot-and-Mouth  Disease, 

The  last  great  epizootic  in  Europe  occurred  in  1887,  its  starting 
point  being  Russia.  The  disease  invaded  all  the  countries  of  the  conti- 
nent, and  raging  with  varying  intensity  has  not  been  eradicated  even 
up  to  the  present  time. 

In  Germany  the  disease  commenced  to  spread  rapidly  in  1888,  and  in  1892 
it  reached  its  height  (number  of  animals  in  the  newly  infected  premises:  1,504,299 
cattle,  2,193,187  sheep,  17,782  goats  and  438,262  hogs)  ;  from  that  time  on  it 
diminished,  but  in  1899  it  again  reached  a  wide  extension  (1,885,774  cattle,  1,505,830 
sheep,  59,535  goats  and  814,862  hogs)  ;  since  then  the  disease  has  rapidly  retro- 
gressed, so  that  in  November,  1905,  the  entire  Empire  was  free  from  the  infection. 
However  at  the  end  of  this  month  it  appeared  in  isolated  herds  in  western  Prussia, 
from  which  it  spread  to  the  abattoir  of  Berlin,  and  thence  to  the  Province  of 
Saxony.  At  the  end  of  the  year  1906,  55  townships  were  infected.  In  the  following 
three  years  it  again  reached  a  great  extension,  first  by  an  introiluction  from  France 
to  southern  Germany,  later  occurring  also  in  the  other  states,  and  in  the  year 
1908,  324  townships,  18,773  cattle,  19,450  sheep,  179  goats,  and  16,081  hogs 
were  affected.  In  May,  1909,  the  disease  was  entirely  suppressed,  and  only  one 
outbreak  was  afterward  established  in  December  at  Mittlefranken. 

In  France  the  disease  raged  severely  in  1893.  Soon  it  spread  rapidly,  and 
reached  its  height  in  the  years  1899  and  1900,  and  from  1901  it  gradually  retro- 
gressed, again  gaining  a  great  extension  in  1906.  In  1907  it  retrogressed,  and 
at  the  end  of  1908  only  two  premises  in  two  townships  were  affected. 

Great  Britain  was  free  from  the  disease  between  1895  and  1899.  Since  1900 
however,  several  townships  have  been  infected  annually,  in  spite  of  the  fact  that  the 
importation  of  living  cloven-footed  animals  from  the  continent  has  been  prohibited 
since  that  year.  In  each  instance,  the  outbreaks  were  localized  by  slaughtering 
the  affected  herds.  In  the  years  between  1903-1908  the  entire  territory  of  the 
Kingdom  was  free  from  the  disease^  with  the  exception  of  an  outbreak  in  the 
vicinity  of  Ipswich  in  January,  1906,  and  another  in  Edinburgh  in  1908. 

Holland  was  very  severely  infected  in  the  years  of  1897-1899  (868,206  and 
122,867  cases  of  infections).  Since  that  time  however  the  disease  has  rapidly 
diminished.  In  1907  it  gained  again  a  greater  extension  (17,816  outbreaks  with 
341,287  cases  in  11  provinces).  Since  the  second  half  of  1908  only  isolated  cases 
have  occurred. 

In  Austria  the  infection  was  very  widely  spread  in  1891  (247,946  cattle, 
32,423  sheep,  5,013  goats,  and  18,741  hogs  were  affected).  It  diminished  rapidly 
until  1894  (7,462  cattle,  617  sheep,  45  goats,  1,379  hogs).  From  that  time  on  a 
rapid  extension  up  to  1896  took  place  (305,934  cattle,  11,422  sheep,  1,032  goats, 
and  18,816  hogs),  whereupon  an  improvement  was  noted,  and  the  Empire  was 
considered  entirely  free  in  1901.  Since  that  time  it  spread  again,  and  in  the 
years  from  1904  to  1906  was  widely  spread,  especially  in  Poland  and  Bohemia.  In 
the  subsequent  two  years  it  raged  with  varying,  but  mostly  with  mild  intensity, 
and  toward  the  end  of  the  year  only  12  premises  in  seven  townships  were  infected. 

In  Hungary  the  disease  which  had  been  introduced  in  1889  from  the  southeast, 
reached  its  height  in  the  subsequent  year  (561,950  cattle,  337,566  sheep  and  goats, 
and  370,425  hogs)  ;  later  it  showed  a  diminution  up  to  1894,  but  in  1896  it  again 
attained  wide  extension  (572,809  cattle,  178,612  sheep  and  goats,  82,931  hogs). 
In  1901  the  entire  Kingdom  was  free  for  six  months;  in  the  fall  of  this  year  the 
disease  reappeared  as  the  result  of  an  introduction  from  Eoumania,  and  since 
that  time  has  again  attained  wide  extension.  In  1903,  in  2,516  townships,  434,221 
cattle,  30,533  sheep  and  goats,  and  10,951  hogs,  were  affected.  From  that  time 
on  the  condition  improved,  in  1907  however,  in  the  northwestern  part  of  Hungary, 
on  the  Polish  border  a  badly  infected  locality  was  discovered  which  radiated  all 
through  the  country,  and  in  1908,  in  108  townships,  16,988  cattle,  491  sheep  and 
goats,  and  48  hogs  were  still  affected. 

Eoumania  was  severely  affected  in  1907  (677,465  cases  of  infection).  Since 
that  time  the  disease  has  diminished  (in  1908  11,038  cases).  In  Russia  in  1907, 
596,977  cases  occurred  in  6,320  townships;  in  1908,  in  3,274  townships,  292,302 
cases.  The  disease  also  occurred  in  1908  in  Belgium,  in  11  townships,  with  147 
eases;  in  Italy,  in  47  provinces,  with  138,887  cases;  in  Switzerland,  in  96  townships, 
with  13,555  cases  (in  1909  the  disease  attained  in  the  latter  country  a  great 
extension),  while  in  Bulgaria  61  townships  were  affected;  Denmark,  Norway,  Sweden 
and  Servia  were  free  from  the  infection. 

Since  the  outbreak  of  1870  in  the  United  States,  only  a  few  limited  outbreaks 
have  occurred.  In  the  fall  of  1902  the  disease  appeared  in  the  States  of  Massa- 
chusetts Vermont,  New  Hampshire  and  Ehode  Island,  but  was  eradicated  in  a  few 
months   by   energetic  measures    (see  veterinary  police).     In  the   fall  of   1908  the 


Oecnnvticc.      Ktiolocv.  331 

disease  reappeare<l  in  the  States  of  Xow  York,  rennsylvania,  Micliigan  ami  Mary- 
laud.      (See  p.  iiilli.) 

Arjieutiiia  was  severely  all'ectetl  in   liKlO. 

In  Asia  and  Africa  the  disease  ])revails  from  time  to  time  over  larj^e  areas, 
while  Australia  is  free  from  the  infection. 

At  certain  times,  and  in  certain  localities  the  <lisease  shows  a  deviation  from 
the  normal  course,  Uy  exhibiting  a  very  severe  character,  and  in  such  instances 
many  animals  are  destroyed  l>y  it.  Thus  accordinjj  to  K'ycheiier  2,0(H)  cattle  died 
in  l.H."?SI,  in  the  Swiss  Kantons  Bern  and  Freiburg',  while  in  1H72  in  the  District 
of  Xievre  in  France  l^O.iJyt  of  calves  and  22.2%  of  hoj^s  succund;eil  to  the  disease 
inside  of  two  months.  During  the  summer  of  1S92  more  than  ;^,()(t()  animals  died 
in  Bavaria;  in  the  course  of  lS9(i,  l,.')(ll)  in  Wiirttemhery,  two  years  later  l,'MH). 
In  1901  the  disease  apjieared  in  Spain  with  such  a  maliffnant  character,  that  in 
Barcelona  50-70%  of  the  youn^  stock  succumbed,  and  these  lieavy  losses  caused 
a  susj)icion  that  the  disease  in  question  was  the  oriental  rinderpest.  In  Hungary 
the  disease  raji;ed  in  a  severe  form  in  1S90  in  certain  ])arts  of  the  counties  of  Gijinor 
and  Pest,  in  ISO!)  in  Siebenbiirgen  (in  the  counties  of  Csik,  Maros-Torda  and 
Udvarhely  of  7,498  cattle,  711  died,  amounting  to    9.4%). 

Etiology.  T.offler  »S:  Froscli,  also  ITeekcr,  and  later  Xooanl 
&  Roux  proved  that  the  vims  of  foot-aiid-inonth  disease  in  dihi- 
tioii  will  pass  the  porous  (Chamberland,  Berkefeld)  porcelain 
filters,  while  it  is  partially  retained  by  the  denser  Ivitasato 
filter.  It  has  not  yet  been  possible  to  demonstrate  the  organisms 
either  l)y  methods  of  staining-  or  cultivation.  The  virus  is  there- 
fore an  extremely  minute,  ultra-microscoi^ic  micro-organism. 

Recently  Ferni  claimed  that  the  causative  agent  is  a  protojoon  0..5  n  in  size 
(Cytoryctes  Jenneri),  which  he  succeeded  in  denionstrating  in  the  lymph  of  the 
cysts,  and  also  in  the  internal  organs  of  472  affected  cattle,  arranged  like  the 
pavement  of  a  street,  or  radiating  like  the  spokes  of  a  wheel.  A  confirmation  of 
this  finding  has  not  yet  been  made. 

The  virus  is  contained  in  the  purest  state  in  the  contents 
of  the  vesicles  which  develop  in  the  course  of  the  disease,  and 
greatly  diluted  also  in  the  blood  though  only  during  the  begin- 
ning of  the  fever.  The  saliva,  the  tears,  the  nasal  discharge,  the 
milk,  and  the  other  secretions  become  infectious  only  after  being 
contaminated  with  the  contents  of  the  ruptured  vesicles.  In 
the  later  course  of  the  disease  the  virulence  of  the  serous  fhiid 
of  the  vesicles  diminishes,  and  after  ten  days  the  saliva  of 
infected  cattle  is  no  longer  infectious  for  other  animals  (Schiitz). 

Tenacity.  A'irus  dried  at  room  temperature  and  in  daylight,  loses  its  virulence 
inside  of  24  hours,  diluted  in  jiroportion  of  1:10  an<l  kept  in  glass  tubes  closeil 
at  both  ends  by  melting,  it  remains  infective  for  3  to  4  months.  A  temperature  of 
37.5  degrees  destroys  it  in  12  to  24  hours,  one  of  50  degrees  in  15  minutes,  and 
70  degrees  in  10  minutes.  Heating  to  100  degrees  destroys  its  virulence  immediately 
(Loffler  &  Frosch).  The  action  of  a  temperature  of  — 8-9  degrees  destroys  it  in 
several  hours  (Perroneito).  Of  the  disinfectants,  milk  of  lime,  a  1%  carbolic  acid, 
2%  formalin,  3%  soda,  and  1%  hydrochloric  acid  destroy  its  virulence  in  one 
hour  (Loffler  &  Frosch).  Infectious  milk  which  has  stood  for  3  to  4  days,  becoming 
soured  and  coagulated,  is  no  longer  infectious  (Ebertz).  In  fresh  cow  and  hog 
manure  the  virus  is  destroyed  at  a  depth  of  more  than  20  cm.  within  a  short 
time   (Hecker). 

Pathogenicity.  Intravenous  injection  of  fresh  pure  lymph 
will  sometimes,  even  in  a  quantity  of  1/5000  cc,  produce  the 
disease  in  susceptible  cattle.  Depending  upon  tlie  quantity 
and  the  virulence  of  the  virus,  typical  vesicles  develop  in  from 


332  Foot-and-Mouth  Disease. 

1  to  3  days  after  the  injection,  in  the  mouth,  in  cows  also  on 
the  udder,  and  1  to  2  days  later  also  on  the  feet,  these  eruptions 
being  associated  with  febrile  manifestations.  Infection  may 
also  result  from  rubbing  the  lymph  upon  the  superficially  scari- 
fied mucous  membrane  of  the  mouth,  by  dropping  the  virus  on 
the  conjunctiva,  the  rectum  or  the  vaginal  mucous  membrane, 
and  further  by  intra-muscular,  intra-peritoneal  injections,  like- 
wise by  inoculation  of  the  milk  ducts.  Placing  woolen  threads 
dipped  in  lymph,  between  the  teeth,  and  sometimes  also  feeding 
gelatin  capsules  filled  with  virulent  lymph,  may  give  positive 
results,  while  a  subcutaneous  infection  is  uncertain.  Should 
virulent  lymph  be  injected  into  the  milk  system  of  a  fresh  milk- 
ing cow,  local  inflammation  of  the  milk  ducts  develops,  and  the 
milk  proves  virulent  for  a  period  of  eight  days  (Nocard).  The 
most  effective  is  the  lymph  of  infected  hogs,  then  that  of  cattle, 
while  the  least  efficient  is  that  from  sheep.  The  artificial  infec- 
tion of  goats  and  sheep  is  in  general  quite  difficult.  Young  dogs 
and  cats  are  very  susceptible  to  artificial  infection  (the  vesicles 
develop  in  these  animals  between  the  digits),  exceptionally 
guinea  pigs  and  rabbits  may  also  become  affected  (Heeker), 
while  mice  and  fowl,  as  well  as  older,  carnivorous  animals,  are 
resistant  to  inoculation.  Young  pigs  die  after  several  days  from 
paralysis  of  the  heart  after  an  inoculation  of  1/10  to  1/50  cc. 
of  fresh  Ijniiph.  The  autopsy  in  such  cases  reveals  a  great 
amount  of  serous  fluid  in  the  pericardium,  which  contains  the 
virus  in  pure  culture  (Loffler,  Nocard). 

Natural  infection  often  occurs  directly,  healthy  animals 
coming  in  contact  with  affected  cases,  in  the  stable,  pasture,  or 
yards,  by  means  of  which  they  receive  the  virus  upon  their 
mucous  membranes.  Infection  with  inhaled  air  has  not  yet  been 
proven,  and  could  only  occur  within  very  short  distance,  in  damp 
weather,  or  in  the  stable. 

Indirect  transmission  has  a  far  greater  importance  in  the 
spread  of  this  disease.  The  saliva,  wliich  flows  from  the  moutlis 
of  affected  animals,  and  also  the  contents  of  the  udder  or  tlie 
vesicles  which  develop  on  the  feet,  contaminate  the  food,  the 
cribs,  the  drinking  water,  the  straw,  the  stable  floor,  the  pas- 
ture, the  highways,  the  railroad  cars,  etc.,  as  w^ell  as  the  hands 
and  the  clothes  of  the  attendants.  From  such  contaminations, 
or  from  the  floor,  the  virus  reaches  the  mucous  memlirane  of 
any  body  opening,  or  with  the  food  or  drinking  water  it  enters 
the  mouth  and  stomach  of  the  healthy  animal,  from  which  points 
it  enters  the  blood  circulation.  The  virus  is  accordingly  dissem- 
inated in  the  first  place  by  affected  animals  during  driving,  rail- 
road transportation,  stabling,  by  common  drinking  places,  com- 
mon pastures,  and  yards.  In  the  second  place  food,  manure,  and 
raw  animal  products,  especially  raw  hides,  w^ool  and  milk  may 
be  considered  as  carriers  of  the  infection.  Butchers,  dealers, 
peddlers,  castrators,  and  other  persons,  first  of  all  farm  hands, 


Natural    In  IVction.  333 

and  also  animals  which  arc  not  susceptible,  comin.G,-  fi-oin  in- 
fected ])rciniscs,  may  contrihntc  to  the  transmission  of  tlic  infec- 
tion. Stock  markets  play  an  especially  important  part,  through 
trading,  further  also  changes  in  farm  hands. 

Tho  ol>s('iiio  ways  by  wliich  tlio  discaso  sniiiotimos  spreads  arc  especially  well 
illustrated  in  the  jieriodiVal  ajipearauce  of  the  affection  in  Enfjland.  Although 
the  importation  of  cloven-footed  animals  from  the  continent  into  that  co\intry  has 
been  entirely  ])rohiliited  since  lS!)li,  ami  from  other  parts  of  the  world,  permission 
was  ^n-ante-i  oidy  after  the  lai)se  of  the  perio<l  of  incubation,  yet  since  U)(tO_  the 
disease  has  appearoil  in  several  different  ]>laces  (for  the  outbreak  in  1008  it  is 
assumed  that  it  was  introduce.!  with  hay  from  Holland).  The  last  outbreak  in  the 
I'nited  States  orifjinated  from  several  calves  which  were  inoculated  with  pox  lymph 
imported  from  Japan,  and  Mohler  &  Kosenau  proved  by  experiments  that  this 
lymph  contained  the  virus  of  foot-and-mouth  disease  even  after  one  year. 

Whether  the  disease  can  lie  disseminated  l)y  blood  sucking  insects,  especially 
by  the  tabanus  bovinus,  as  sugfiested  by  IJoch  Marra  after  making  several  experi- 
ments, must  at  the  ])resent  time  be  questioned. 

Tn  recent  times  where  isolated  outbreaks  occur  more 
frequently  in  territories  which  have  been  free  from  the  infec- 
tiou  for  a  time,  and  in  which  careful  observations  have  been 
made,  the  possibility  enters  more  and  more  into  the  foreground 
that  animals  which"  pass  through  the  disease  may  harbor  the 
virus  in  their  bodies  for  a  long  time,  and  expel  it  periodically 
or  continually  (so  called  virus  carriers).  This  may  explain 
^y\lJ  it  is  that  animals  occasionally  become  affected  when  placed 
in  iierds  in  which  the  animals  have  apparently  entirely  recov- 
ered from  the  disease,  or  that  the  disease  breaks  out  on  the 
premises  where  such  animals  are  introduced  (Pr.  Vb.,  Barto- 
lucci,  Loffler,  Lourens).  Although  an  introduction  by  other 
means  cannot  be  excluded  with  certainty  in  such  cases,  and  the 
presence  of  the  virus  in  recovered  animals  has  not  yet  been 
established  experimentally,  nevertheless  the  possibility  cannot 
be  ignored  that  virus  carriers  have  been  recognized  beyond  a 
doubt  for  other  diseases  (typhoid  fever,  Asiatic  cholera,  hog 
erysipelas,  tetanus).  Therefore  in  ascertaining  the  cause  of 
new  outbreaks  this  contingency  should  be  given  due  considera- 
tion. 

According  to  Barsolucci  cattle  are  infectious  two  months,  and  according  to 
Loffler  even  six  (?)  months  after  the  disappearance  of  the  vesicles,  and  in  accord 
ance  with  the  Pr.  Vb.  for  1!K)7  a  bull  was  supposed  to  transmit  the  disease  to 
other  cattle  after  a  period  of  214  years  (?). 

Although  successful  infection  may  occur  through  the  unin- 
jured mucous  membranes,  nevertheless  it  is  favored  by_  loss 
of  substance  and  by  excoriations  in  the  mouth,  on  the  skin  of 
the  udder,  and  in  the  interdigital  space  (in  feeding  dry  food, 
also  while  pasturing  on  stu1)ble  lields,  the  disease  spreads  with 
particular  rapidity). 

The  infection  of  sucking  animals,  or  those  ^yhich  are  fed 
with  milk,  occurs  almost  invariably  through  the  milk  of  aj'fected 
animals,  or  through  the  skim  milk  from  creameries,  and  is  usu- 
ally acquired  through  the  uninjured  mucous  membrane  of  the 


334  Foot-aud-Mouth  Disease. 

digestive  tract,  wliicli  at  that  age  is  sensitive,  owing  to  its  cover- 
ing of  loose  epithelium. 

Susceptibility.  Cattle  are  most  susceptible  to  natural  in- 
fection, then  follow  hogs,  sheep  and  goats.  Differences  are 
observed  in  this  regard  in  the  various  outbreaks,  inasmuch  as 
the  last  named  species  of  animals  may  become  affected  in  the 
same  degree  as  cattle,  or  at  least  in  considerable  numl^ers.  Buffa- 
loes may  also  become  affected,  occasionally  however  they  remain 
healthy  among  affected  cattle,  while  in  other  cases  the  cattle 
may  become  affected  through  buffalo.  Wild  cloven-footed  ani- 
mals, including  boars  (Borzoni)  are  also  susceptible  to  the  dis- 
ease, and  sometimes  it  exists  among  these  animals  in  an  epi- 
zootic form.  Reindeer  and  camels  are  also  susceptible,  and 
very  exceptionally  horses,  dogs  and  cats  may  become  affected. 

Among  the  animals  of  a  certain  species  a  variation  in  susceptibility  may  be 
observed  in  the  various  breeds,  as  under  the  same  conditions  a  greater  number  of 
animals  of  common  lireeds  will  resist  the  infection,  than  of  the  finer  breeds.  While 
under  conditions  favorable  to  the  infection,  animals  of  the  western  European  breeds 
become  affected  in  the  proportion  of  95-100%,  among  the  common  breeds  only 
40-50%  contract  the  disease,  and  even  after  an  energetic,  artificial  inoculation, 
not  infrequently  20-30%  of  the  animals  remain  healthy  (Kovacsy,  Born).  According 
to  Hartenstein  hogs  of  the  Mangalicza  breeil  are  more  resistant  than  the  Polish  or 
the  German  breeds.  In  Kobanya  hogs  from  the  lower  Danube  region  became  more 
severely  affected  than  the  native  hogs. 

Recovery  from  the  disease  reduces  the  susceptibility  for 
a  certain  time.  The  immunity  thus  acquired  lasts  in  the  ma- 
jority of  cases  longer  than  a  year  (according  to  Mazzini  from 
3  to  5,  and  according  to  Schwenck  even  up  to  7  years).  Excep- 
tionally the  same  animal  may  become  re-infected  by  the  disease 
within  "a  short  time.  Strebel  observed  re-infection  by  the  disease 
in  cattle  after  6  to  10  weeks,  Makoldy  after  12  days,  while 
Kovacs  observed  a  re-occurrence  of  the  disease  in  a  herd  of 
hogs  10  days  after  the  recovery  of  the  animals.  AVarnesson 
reports  a  case  in  which  a  cow  became  aiTected  three  times  within 
a  year.  Calves  from  cows  which  recovered  from  the  disease  at 
an  advanced  stage  of  pregnancy  are  sometimes  immune  towards 
the  natural,  as  well  as  the  artificial  infection,  while  the  feeding 
of  milk  from  immune  cows  does  not  reduce  the  susceptibility 
of  the  calf  (Frohner,  Loflfler  &  Frosch). 

Pathogenesis.  Observations  that  the  disease  develops  in 
a  typical  form  after  intravenous  inoculations  of  the  virus,  that 
the  development  of  vesicles  is  preceded  by  fever,  and  that  the 
blood  is  infectious  at  the  onset  of  the  disease,  indicate  that 
the  virus,  at  least  in  some  of  the  cases,  reaches  the  tissues  pre- 
disposed for  the  development  of  the  exanthema,  by  transmission 
through  the  blood  stream.  As  such  should  be  considered  the 
deeper  epithelial  layers  of  the  mucous  membranes,  and  the  finer 
portions  of  the  skin.  The  frequent  affection  of  the  mouth, 
adder,  and  feet  may  possibly  be  associated  with  traumatic  irri- 
tation, or  with  superficial  defects  of  these  parts  of  the  body.^ 


Pathogenesis.     Anatomical   Changes.  335 

The  virus  wliicli  penetrates  between  the  epithelial  cells  of  those 
parts  of  the  body  in  all  probability  connnenees  to  multiply  im- 
mediately, later  however  it  i)asses  into  the  blood  stream,  by 
which  it  is  distributed  to  distant  i)arts  of  the  body.  The  affec- 
tion of  feet  and  udder,  which  later  becomes  associated  with  the 
affection  of  the  mouth,  may  be  of  such  metastatic  ori<?in. 

The  virus  may  l)e  transmitted  from  tiie  mother  to  the  off- 
spring, in  which  case  the  young  may  be  born  showing  manifes- 
tations of  foot-and-mouth  disease  (Mobius). 

Aceording  to  Kitt  the  development  of  the  vesicle  commences  with  hyperemia 
and  serous  infiltration  of  the  papillae  of  the  skin  or  mucons  membranes.  The 
serous  exu<late  loosens  the  epithelial  cells  from  the  mucous  layer  between  the 
papillae,  then  it  raises  the  more  resistant,  sui)erficial  layer  of  cells,  while  the  contents 
of  the  developed  vesicles  in  the  meantime  becomes  cloudy,  as  a  result  of  mifjration 
of  white  blood  corpuscles.  The  epithelial  defect  which  develops  after  the  bursting 
of  the  vesicles  becomes  covered  by  epithelial  cells  which  form  either  from  the 
remaining  part  of  the  stratum  mucosum,  or  by  a  multiplication  from  the  periphery, 
and  complete  healing  takes  place  in  this  manner,  except  that  the  papillae  become 
somewhat  smaller  than  they  were  originally. 

Besides  the  imknown  virus,  the  fluid  of  the  vesicles  may  contain 
various  other  bacteria;  such  as  Kurth's  streptococcus  involutus,  the 
staphylococcus  pyog.  aureus,  the  micrococcus  tetragenus,  sarcinae,  etc. 
(Sanfelice).  These  pus-producing  organisms  may  modify  the  later 
course  of  the  disease,  and  the  occasional  complications  which  develop 
(deep  ulcerations  and  suppurations,  purulent  inflammations  of  the  feet, 
mastitis,  pyemia,  etc.)  may  be  attril)uted  to  their  action. 

Anatomical  Changes.  Autopsies  on  animals  which  are 
slaughtered  during  the  development  of  the  disease,  or  which 
suddenly  die,  reveal  as  a  rule,  in  addition  to  the  characteristic 
exanthema,  only  an  acute  catarrhal  swelling  of  the  mucous 
membrane  of  the  mouth,  of  the  pharynx,  and  of  the  air  pas- 
sages, or  there  may  also  be  present  small  hemorrhages  on  some 
of  the  serous  membranes,  especially  on  the  visceral  layer  of 
the  pericardium.  In  some  cases  however  vesicles,  or  ulcerations 
may  be  observed  in  the  wall  of  the  pharynx,  on  the  mucous 
membrane  of  the  bronchi  and  esophagus,  in  the  stomach  (in 
ruminants  in  the  first  three  stomachs,  IJhlrich),  and  in  the 
intestinal  canal.  The  ulcerations  may  sometimes  be  covered  by 
a  tine  fibrinous  deposit. 

Animals  which  die  as  a  result  of  complications,  reveal 
severe  suppurating  processes,  especially  on  the  lower  parts 
of  the  extremities,  which  are  frequently  associated  with  caries 
of  the  neighboring  bones.  There  may  also  be  found  purulent 
or  ichorous  inflammation  of  the  joints,  or  metastatic  abscesses 
in  various  parts  of  the  body,  and  acute  degeneration  of  the 
parenchymatous  organs.  In  some  cases  a  gangrenous  pneu- 
monia is  the  immediate  cause  of  death,  which  results  from 
inhalation  of  saliva  or  food  particles. 

If  the  animal  dies  suddenly  in  the  stage  of  commencing 
recovery,  from  the  malignant  type  of  foot-and-mouth  disease, 


336  Foot-aiid-Mouth  Disease. 

the  mucous  membrane  of  the  abomasum,  and  of  tlie  intestines, 
is  found  to  be  dark  red,  covered  by  numerous  hemorrhages, 
while  in  the  rumen,  especially  in  the  vicinity  of  the  folds,  also 
in  the  leaves  of  the  third  stomach,  and  in  the  intestinal  tract, 
and  sometimes  in  the  pharynx,  erosions  and  ulcerations,  some- 
times of  the  size  of  a  silver  dollar,  may  be  observed.  The 
parenchymatous  organs  show  fatty  degeneration,  which  change 
is  sometimes  so  pronounced  in  the  muscles  of  the  heart  that  its 
cut  surface  appears  mottled,  because  of  the  yellow  spotting 
(Johne,  Nocard;  according  to  Trattner  there  is  also  hyaline 
degeneration  in  the  affected  parts).  The  spleen  is  moderately 
swollen,  dark  red  and  softened.  Hemorrhages  may  also  be 
found  on  the  mucous  membrane  of  the  respiratory  organs,  and 
in  the  serous  membranes.  Finally  in  some  cases  the  inter- 
lobular and  subpleural  connective  tissue  of  the  lungs  may  show 
an  edematous  infiltration,  and  the  contents  of  the  ventricles  of 
the  brain  may  be  increased  and  cloudy  (Willach). 

Symptoms.  After  an  intravenous  injection  of  the  virus, 
the  time  of  incubation  in  cattle  varies  from  six  hours  to  six 
days  (Loffler  &  Frosch) ;  after  inoculation  into  the  buccal  mucous 
membrane  it  is  from  48  to  60  hours  (Schiitz) ;  after  natural 
infection  the  time  is  between  2  and  7  days,  exceptionally  even 
11  days  { Siedamgrotzky,  Born).  Data  regarding  a  longer 
period  of  incubation  (according  to  Schrader,  Lies  and  Mobius 
14,  according  to  Isepponi  even  21  days)  are  doubtful. 

Without  considering  the  manner  and  method  of  the  infec- 
tion as  well  as  the  place  of  the  eruption  of  the  vesicles,  the 
disease  commences  with  fever,  which  is  quite  evident  in  young, 
strong  animals,  while  in  older  animals  it  may  sometimes  be  so 
moderate  that  it  is  not  observed  at  all.  The  body  temperature 
in  the  first  1  or  2  days  may  reach  40-41°,  but  as  soon  as  the 
vesicles  develop,  possibly  in  from  6  to  24  hours,  it  rapidly 
drops,  and  the  later  course  of  the  disease  runs  ^\'ithout  fever, 
with  the  exception  of  those  cases  in  which  inflammatory  compli- 
cations resulting  from  a  subsequent  septic  infection  become 
associated  with  the  original  disease.  The  rise  in  temperature 
is  usually  accompanied  by  a  somewhat  accelerated  pulse,  and 
diminished  appetite. 

The  other  s^nniptoms  vary  in  accordance  with  the  localiza- 
tion of  the  affection. 

The  affection  of  the  mouth  is  most  frequently  observed  in 
cattle,  while  in  sheep,  goats  and  in  hogs  it  occurs  with  consid- 
erable less  frequency.  At  the  onset  of  the  disease  a  diminished' 
appetite  and  retarded  rumination  is  observed.  The  animals 
chew  their  food  very  slowly  and  carefully,  on  account  of  the 
sensitiveness  of  the  buccal  mucous  membrane,  and  also  swallow 
the  bolus  slowly.  In  the  periods  between  feeding  times  they 
keep  the  mouth  closed,  and  only  open  it  now  and  then  with  a 


RyinptoiMS.  337 

characteristic  siiiackin^'  sound.  Later  tlicy  ^'utiicly  cease  to 
eat.  The  animals  stand  iminova])lc  with  a  stariiiiC,  ^'xpvcssion- 
Icss  look,  saliva  droppiii.c:  in  lon.i!:,  sticky  threads  front  thf»  cor- 
ners of  the  month.  Tliey  like  to  phiy  with  tlieir  montliH  in  the 
water  offered  tliem,  and  some  patients  evince  an  increased  thirst. 
The  mncons  membranes  on  tlie  inner  surface  of  the  lif*^^ 
and  on  the  ^nms  is  warm,  dry  and  reddened;  the  openino:  of  the 
moutli,  wliich  is  followed  f)y  a  flow  of  ^^reat  quantities  of 
accumulated  saliva,  reveals  a  similar  chano-e  in  the  mucous 
membrane  of  the  other  parts  of  the  mouth.     On  the  second  to 


Fig.  57.     Foot-and-mouth  disease.     Vesiclos  and  ulcerations  on  the  gum,   tlic  latter 

also  on  the  nostrils. 


third  dav  of  the  affection  smaller  and  larger  vesicles  develop 
on  the  inner  surface  of  the  lips,  and  on  the  gums  lying  opposite, 
or  on  the  toothless  part  of  the  upper  jaw,  on  the  top  and  borders 
of  the  tongue,  in  the  vicinity  of  the  frennm  of  the  tongue,  as 
well  as  on  the  inner  surface  of  the  cheeks  (Fig.  57).  These  vesi- 
cles are  in  small  animals  hardly  ever  larg(M-  tlian  the  size  of 
a  pea,  while  in  larger  ruminants  they  may  attain  the  size  of  a 
nut,  and  on  the  dorsum  of  the  tongue  may  even  reach  the  size 
of  an  egg.    The  vesicles  on  the  tongiie  (Fig.  58)  possess  a  thick 


Vol.  1—22 


Foot-and-Mouth  Disease. 


wall,  in  other  parts  however  the  walls  are  thinner.  These  con- 
tain first  a  clear,  watery,  colorless  or  yellowish  fluid,  which  later 
becomes  cloudy  and  grayish-white.  After  1  to  3  days  the  vesi- 
cles burst,  the  contents  escape,  the  wall  is  thrown  off,  and  in 
their  places  highly  reddened,  moist,  painful,  flat  erosions  with 
wide  borders  remain.  After  1  to  2  days  these  become  covered 
with  fresh  epithelium,  whereupon  for  a  certain  time  3'ellowish- 


Fig.  58.     Foot-and-mouth  disease.     Sub-  Fig.  59.     Foot-and-mouth  disease.     Ero- 

epithelial  vesicles  on  the  point  of  the  sions  on  the  dorsum  of  the  tongue  in 
tongue,  on  the  body  of  the  tongue,  and  on  stages  of  early  healing, 

the  thick  portion. 

brown  spots  remain,  which  finally  also  disappear  (Fig.  59).  As 
soon  as  the  erosions  become  covered  by  epithelium  the  animals, 
which  in  the  meanwhile  frequently  have  become  greatly  ema- 
ciated, commence  to  eat. 

In  animals  which  were  in  poor  condition  previous  to  the  affection, 
sometimes  a  lemon-colored  deposit  of  3  to  4  ram,  thickness  develops  at 


Symptoms.  qqq 

the  scat  of  the  vesicles,  and  healing'  oci-ui-s  only  after  the  shinhliii*'  of 
the  same  (Born).  Russian  veterinarians  (Kavitseh,  Korsak,  Midiai- 
low,  Sehadrin)  have  also  ohsei-ved  in  some  oiithreaks  the  appearance  of 
such  pseudo-membranous  deposits  l)ut  only  in  strong  animals,  and  in 
these  cases  vesicles  were  not  present,  or  only  in  an  abortive  development. 

Siiiuillaiieoiisly  with  tlio  affection  of  the  iniicoiis  meni1)rane, 
similar  vesicles  develo}),  in  cattle  on  the  muzzle  and  at  the  base 
of  the  horns  (rarely),  in  hogs  on  the  snout  (frequently),  which 
may  reach  the  size  of  a  nut,  and  correspond  with  the  described 
vesicles  (on  the  snout  sometimes  only  a  sin,ule  large  vesicle 
develops).  Vesicles  may  also  be  observed  in  rare  cases  on  the 
nasal  mucous  membrane,  and  on  the  conjunctiva.  The  spread- 
ing of  the  affection  to  the  pharyngeal  mucous  membrane  is  indi- 
cated by  symptoms  of  a  i)liaryngitis  (difficulty  in  swallowitig, 
cough,  regurgitation).  In  cattle  the  cornea  is  sometimes  uni- 
formly cloudy,  and  small  vesicles  may  develop  on  its  surface. 
The  ulcerations  whicli  subsequently  develop  heal  without  leav- 
ing a  trace,  or  white  cicatrices  may  remain,  which  however  later 
disappear  partly.  In  some  instances  vesicles  may  also  develop 
on  the  epiglottis,  on  the  nnicous  membrane  of  the  trachea  and 
bronchi,  in  which  cases  difficulty  in  respiration,  or  manifesta- 
tions of  edema  of  the  lungs  may  be  noticed  (Leyendecker). 

Foot  Affection.  Sheep  are  quite  frequently  and  hogs  are 
in  most  instances  affected  only  on  the  feet,  whereas  in  cattle 
affection  of  the  feet  may  occur  simultaneously  with  the  forma- 
tion of  lesions  in  the  mouth,  but  it  usually  develops  subsequent 
to  their  appearance. 

The  first  symptom,  whicli  may  be  recognized  even  from  a 
distance,  is  always  the  lameness  or  the  stitT  gait,  which  is 
caused  by  the  pain  in  the  lower  extremities,  and  is  especially 
manifested  during  walking  on  hard  ground.  If  more  than  one 
foot  is  affected  the  pain  may  be  so  severe  that  the  animals  lie 
down  continually,  and  it  is  only  with  difficulty  that  they  can 
be  made  to  rise. 

A  careful  examination  of  the  affected  feet  reveals  the  skin 
of  the  coronary  band,  the  heel  of  the  foot,  and  the  interdigital 
space  at  first  warm,  swollen,  painful,  and  in  case  it  is  not  pig- 
mented it  appears  also  highly  reddened.  After  1  to  2  days,  small 
vesicles  develop  in  these  phices,  especially  in  the  interdigital 
space,  more  rarely  also  at  the  base  of  the  dew-claws,  whicli  soon 
reach  the  size  of  a  hazelnut,  and  are  filled  first  with  a  clear, 
and  later  with  a  cloudy  fluid.  After  their  bursting,  which  at 
these  places  results  earlier  than  in  the  mouth,  owing  to  the 
continuous  friction,  the  hmph-like  fluid,  together  with  the  dirt 
from  the  ground,  dries  to  l)rown  crusts.  If  they  are  removed, 
the  underlying  surface  shows  sore  places,  which  are  desqua- 
mated of  epithelium,  highly  reddened,  moist,  and  very  sensitive. 
The  formation  of  new  epithelium  under  the  scab  progresses 


340  Foot-and-Mouth  Disease. 

very  slowly,  and  the  sensitiveness  and  swelling  of  tlie  feet  dis- 
appears completely  only  after  from  1  to  2  weeks. 

If  in  cattle  several  vesicles  develop  adjacent  to  each  other, 
along  tlie  coronary  band,  it  may  frequently  be  observed  that 
the  coronary  seam  separates  from  the  horny  border,  and  this 
may  even  become  loosened  from  the  sensitive  lamina.  In  the 
conrse  of  the  healing  process  this  crack  remains  between  the 
newly  formed  horn  and  the  old  wall,  and  it  is  only  after  several 
weeks  that  the  coronary  band  finally  becomes  covered  with  new 
horn.  (Dirt  and  sand  may  penetrate  the  horny  crack,  producing 
bruises  and  inflammation  of  the  sensitive  lamina,  as  a  result 
of  which  the  animals  remain  lame  for  a  long  time.)  In  heavy, 
fattened  hogs  the  loss  of  the  hoofs  is  often  observed. 

In  sheep  the  inflammatory  process  quite  frequently  affects 
the  biflex  gland  which  is  located  in  the  interdigital  space,  wdiere- 
upon  from  the  excretory  duct  a  great  quantity  of  muco-purulent 
material  may  be  squeezed  out  (hoof  worm). 

The  vesicular  exanthema  occurs  very  frequently  on  the 
udder  in  cattle,  simultaneously  with  the  infection  in  the  mouth 
or  hoof.  As  a  rule  vesicles  develop  on  the  teats,  sometimes 
reaching  the  size  of  a  nut.  In  such  cases  the  whole  udder  swells, 
and  appears  reddened  in  the  immediate  surroundings  of  the 
vesicles.  The  affected  parts  are  very  painful.  The  vesicles 
are  usually  broken  on  the  first  day  during  milking,  while  in 
cases  in  which  they  are  protected  from  mechanical  interference 
they  may  remain  intact  for  5  to  6  days,  until  finally  their  thin 
wall  bursts  of  its  own  accord,  and  the  resulting  loss  of  substance 
soon  yields  under  the  formed  scab.  The  sensitiveness  and  swell- 
ing, as  well  as  the  reddening  of  the  atfected  parts  of  the  skin, 
may  however  remain  for  several  days. 

With  the  exanthema  a  catarrh  of  the  milk  ducts  may  become 
associated.  In  such  cases  the  milk,  the  quantity  of  which  is 
usually  considerably  diminished  even  in  healthy  udders,  has 
a  more  or  less  colostrum-like  consistence,  and  is  therefore  of  a 
yellowish-white  color  and  acid  reaction,  coagulates  easily,  and 
can  only  with  difficulty  be  worked  into  butter  and  cheese.  In 
exceptional  cases  it  is  watery,  and  contains  white  mucous  flakes, 
which  collect  in  the  milk  ducts,  and  therefore  may  render  the 
milking  difficult.  In  the  meantime  the  milk  may  have  a  rancid, 
bitter  taste. 

The  milk  production  is  always  diminished  in  the  course  of  the  disease,  but 
the  decrease  varies  from  case  to  case.  Eelative  to  this,  Siedamgrotzky  observed 
in  a  dairy  farm  of  43  cows,  that  during  the  disease  in  two  cows  the  milk  entirely 
ceased,  in  the  others  the  shrinkage  was  the  greatest  on  the  sixth  day,  at  which 
time  the  loss  in  old  milk  cows  amounted  to  75%,  in  fresh  to  55%,  and  in  those 
which  were  about  in  the  nuddle  of  their  milking  period  it  reached  43 %„  After 
the  disappearance  of  the  disease  the  quantity  of  milk  rose  only  to  %  of  the  former 
volume.  The  entire  quantity  of  milk  dropped  at  the  height  of  the  disease  from 
745  to  364  liters,  and  after  the  disappearance  of  the  disease  came  back  to  522 
liters.  In  a  second  dairy  farm  32  cows  gave  instead  of  300,  only  30  liters  of  milk, 
and  the  quantity  remained  at  the  same  height  for  8  days.  In  a  third  place  the 
quantity  of  milk  dropped  on  the  fifth  day  from  510  to  260  liters,  it  increased  from 


Syiiiittoins.      ("oinplicatioiis.  341 

the  eighth  day  on,  but  oven  after  six  weeks  it  aniounteil  to  only  .THO  liters.  Acconling 
to  Weber  cows  in  the  period  of  tlie  highest  milk  production  give  during  the  (fourse 
of  the  disease  5-G  liters  less  milk  daily.  Born  ol)served  on  a  farm  that  the  entire 
([uantity  of  milk  eight  days  after  the  outbreak  of  the  disease  diminished  from 
75U  to  280  liters;  after  the  next  eight  days  it  rose  to  4l)()  liters,  but  failed  to 
reach  its  former  height  at  any  later  period.  The  reduction  amounted  on  a  monthly 
average,  to  3.G  liters  daily  per  cow. 

The  milk  of  affected  cows  contains  more  salts  (Lavena,  Herberger)  and 
albumen  (Kalautar),  but  less  fat  an<l  sugar  (Herberger;  according  to  Kreis  the 
l)roportion  of  fat  is  increaseil),  and  in  the  fat  the  volatile  fatty  acids  are  greatly 
diminisluMl  (Viigler);  under  the  microscope  colostral  bodies,  mucous  ei)ithelial  and 
pus  cells,  and   sometimes  also   red   corpuscles  may  be  found. 

Complications  oeeur  very  froqiioiitly  in  the  course  of  the 
disease,  and  may  greatly  nioiiit'y  the  otherwise  mikl  and  typical 
course. 

The  development  of  vesicles  on  other  parts  of  the  hody 
than  those  mentioned  is  of  relatively  slight  importance.  The 
cxanthejiia  may  sometimes  be  observed  on  any  part  of  the  body 
w  hicli  is  not,  or  only  slightly,  covered  by  hair,  especially  on  the 
vulva,  and  on  the  mucous  membrane  of  the  entrance  to  the 
vagina,  also  on  the  inner  surface  of  the  thigh,  and  on  the  skin 
of  the  chest,  or  abdomen  (Ilarns). 

More  frequent  and  of  greater  importance  are  those  com- 
plications which  develop  as  the  result  of  an  extension  of  the 
inflammatory  processes  to  the  surrounding  parts,  or  as  a  result 
of  an  infection  of  the  erosions,  or  those  which  develop  as  the 
result  of  continuous  mechanical  interference.  In  this  way  in 
the  further  course  of  the  disease,  catarrh  of  the  larynx,  tra- 
chea, and  bronchi  may  develop,  besides  pharyngitis,  and  fur- 
ther, owing  to  the  difficulty  in  sw^allowing,  saliva  or  food  may 
.  enter  the  air  passages,  and  lead  to  a  suppurative  or  gangrenous 
IDueumonia. 

The  superficial  erosions  on  the  mucous  membrane  may 
sometimes  change  to  deeper  ulcerations,  which  are  covered  with 
purulent  matter,  or  a  thick  deposit,  as  a  result  of  which  the 
surrounding  part  is  greatly  swollen,  through  inflammatory 
edema.  The  suppuration  increases,  spreading  not  only  side- 
ways, but  also  in  depth.    The  ulcers  finally  heal  by  cicatrization. 

Similar  severe  suppurating  processes  occur  much  more 
frequently  on  the  feet,  and  these  are  much  more  exposed  to 
a  subsequent  infection.  The  inflannnation  is  greatly  increased 
by  walking  on  hard,  stony,  rough  roads,  or  on  stubble.  Of  still 
more  unfavorable  influence  is  the  uncleanliness  to  which  the 
affected  extremities  are  exposed  in  the  stables,  on  dirty  floors, 
which  are  sometimes  soaked  with  ichor  or  other  filth,  as  well 
as  the  mud  to  which  they  are  exposed  in  rainy  weather.  As 
the  result  of  the  mechanical  irritation,  in  association  with  the 
local  iiiflannnatory  process,  great  swelling  of  the  coronary  cush- 
ion and  of  the  heels  develops,  as  a  result  of  which  the  lioofs 
are  spread  apart.  The  swellings  may  extend  upward  to  the 
hock  joint.  The  animals  suffer  very  severe  pain,  and  therefore 
thev  favor  the  affected  feet  in  every  possible  way,  or  they  lie 


342  Foot-and-Mouth  Disease. 

down  continually.  If  they  are  urged  to  walk  they  move  very 
slowly,  displaying  much  lameness,  while  small  animals  hop  on 
three,  or  sometimes  even  on  two  feet,  or  they  move  about  on 
their  knees. 

The  progressive  inflammation  leads  finally  to  the  formation 
of  abscesses  (panaritium),  which  are  mostly  observed  on  the 
coronary  band  above  the  affected  interdigital  space,  more 
rarely  on  the  heels  of  the  feet.  The  abscesses  break  outwardly 
provided  they  have  not  been  opened,  or  the  suppurating  process 
continues  to  burrow  into  the  deeper  parts,  This  results  in  caries 
or  necrosis  of  the  coronary  or  pedal  bone,  or  the  pus  breaks  into 
the  coronary  or  pedal  joint,  sometimes  also  into  the  sheaths 
of  the  tendons,  while  in  other  cases  the  inflammatory  process 
extends  along  the  sensitive  lamina,  resulting  in  the  formation 
of  fistulas,  partial  loosening  of  the  horny  wall  and  sometimes 
in  the  loss  of  the  hoofs. 

According  to  Lytdin  in  cattle  with  translucent  hoofs,  red  spots 
may  be  seen  in  the  sensitive  lamina  of  the  hoof,  and  the  loss  of  the 
hoofs,  as  well  as  the  changes  of  the  horny  wall,  and  the  horny  sole, 
in  cattle  and  hogs,  when  severely  affected  with  foot-and-month  disease, 
is  probably  associated  with  an  affection  of  the  matrix  of  the  hoof. 

The  affection  of  the  udder  may  lead  to  deep,  penetrating, 
abscess  formation  in  the  affected  quarter,  due  to  the  irritation 
during  milking,  and  to  possible  infection,  as  a  result  of  which 
slowly  healing  defects  develop  on  the  skin.  Sometimes  a  con- 
siderable quantity  of  the  milk  remains  in  the  udder,  and  this 
commences  to  decompose,  through  an  infection  originating  in 
the  milk  ducts,  whereupon  a  parenchymatous  inflammation  of 
the  udder  develops,  which  finally  leads  to  atrophy  of  the  affected 
quarter,  and  sometimes  also  to  obliterating  strictures  of  the 
canals  of  the  teats. 

In  severe  cases  septicemia  or  pyemia,  with  their  well-known 
symptoms  and  fatal  termination  may  result,  and  if  death  should 
not  immediately  follow  the  patient  becomes  greatly  emaciated, 
and  finally  succumbs  to  complete  exhaustion.  Such  a  termina- 
tion may  be  noticed  in  atf  ected  animals,  wdiicli  although  the  local 
process  is  not  very  malignant,  yet  have  remained  continuously 
lying,  because  of  the  pain  in  their  feet,  until  decubitus  gangrene 
has  set  in. 

In  young  animals  acute  gastro-intestinal  catarrh  is  a  very 
frequent  complication,  often  resulting  in  death.  In  such  cases 
the  feeble  and  depressed  animals  do  not  suck,  or  only  indiffer- 
ently. The  feces  are  fluid  and  fetid,  the  abdomen  is  sensitive 
to  pressure,  the  pulse  is  accelerated  and  wiry.  The  young 
patients  frequently  die  in  from  2  to  3  days,  sometimes  even  on 
the  first  day  after  the  appearance  of*  the  gastro-intestinal 
infection. 

The  gastro-intestinal  catarrh  is  without  a  doubt  produced  by  the 
pathogenic  action  of  the  virus,  which  is  swallowed  with  the  saliva  or 


ConiplicatiiHis.  343 

milk,  aiul  acts  directly  upon  the  mucous  moml)ranc  of  the  digestive 
apparatus.  In  sucking  animals  the  changed  ciicmical  consistence  of 
the  milk  of  the  atfected  mother  comes  also  into  consideration.  On  the 
other  hand  the  virus  may  also  enter  the  gastro-intestinal  ^vall  by 
way  of  the  blood  circulation,  and  this  mode  of  development  must  be 
suspected  in  those  cases  in  which  the  manifestations  of  the  gastro- 
intestinal catarrh  develop  in  the  early  stages  of  the  disease  in  animals 
which  are  not  fed  on  milk,  and  in  which  vesicles  and  erosions  develop 
in  the  mucous  nuMubraue  of  the  stomach. 

Of  the  other  complications  abortion,  internal  inflammation 
of  tlie  eyes,  inflannnation  of  the  frontal  sinuses,  which  some- 
times leads  to  tlie  dropping-  off  of  the  horns,  may  be  mentioned. 
Finally  the  disease  may  rnn  a  course  with  febrile  symptoms 
only,  and  without  a  vesicnlar  exanthema. 

Malignant  Foot-and-Mouth  Disease.  Under  this  designa- 
tion ail  those  cases  are  usually  combined  which  appear  occa- 
sionally, and  usually  only  restricted  to  certain  territories,  and 
in  wbicli  the  disease,  without  apparent  complications,  results 
in  the  death  of  the  cattle. 

In  the  cases  belonging-  to  this  group  the  disease  usually 
develops  in  a  typical  form;  but  in  the  stage  of  the  commencing 
recovery,  on  the  fifth  to  sixth  day,  a  sudden  change  to  the  w^orse 
takes  place,  without  any  apparent  cause.  The  affected  animals 
which  are  already  free  from  fever  and  commence  to  eat,  sud- 
denly become  very  feeble  and  apathetic ;  they  cease  eating  and 
ruminating,  tremble,  stagger,  grind  their  teeth,  respiration  is 
difficult,  and  they  suddenly  drop  to  the  ground,  when  death  soon 
follows.  In  some  animals,  constipation,  delayed  or  completely 
suppressed  peristalsis,  sensibility  of  the  abdomen,  and  hemor- 
rhages from  the  intestines  and  vagina  may  be  observed  (Faber), 
wdiile  others  suddenly  die  under  apoplectic  conditions  without 
any  apparent  prodromal  s^anptoms.  Those  cases  should  also 
be  included  in  this  group,  in  wdiich  in  the  course  of  the  foot-and- 
mouth  disease  a  paresis  or  complete  paralysis  of  the  hind 
quarters  develops,  and  the  s\^llptoms  of  paralysis  extend  an- 
teriorly, the  clinical  appearance  then  resembling  somewdiat  par- 
turient apoplexy;  in  such  instances  the  animals  usually  die  from 
paralysis  of  the  pharynx  (Wester). 

The  cause  of  this  malignant  type  of  foot-and-mouth  disease  has 
not  been  established  with  certainty ;  however  the  manifestations  on  the 
live  animals,  as  well  as  the  severe  changes  found  at  autopsy,  indicate 
ail  intoxication.  The  supposition  appears  very  probable  that  the 
unusually  strong  virus  attacks  also  the  nuicous  membrane  of  the  stomach 
and  intestines,  whereby  poisonous  substances  are  absorbed  into  the 
organism  from  the  ulcerations  developed  in  these  places.  Whether 
these  products  originate  from  the  virus  of  foot-and-fnouth  disease 
proper,  or  from  other  bacteria  present  in  the  digestive  tract  has  not 
yet  been  determined.  Nocard  having  shown  that  typical  foot-and-mouth 
disease   may   be   produced   by    inoculation   into   cattle   of  degenerated 


344  Foot-and-Mouth  Disease. 

parts  of  the  heart  muscle,  the  presence  of  the  virus  in  the  heart  muscles 
suggests  at  least  the  symptoms  of  the  heart  weakness.  The  malignant 
character  of  the  affection  is  not  influenced  by  outside  conditions,  espe- 
cially by  dietetic  or  hygienic  conditions,  and  Imminger  observed  in 
Bavaria  that  most  of  the  deaths  during  the  disease  occurred  in  clean, 
well  ventilated  stables. 

Course.  In  the  great  majority  of  cases  foot-and-mouth 
disease  usually  runs  a  typical  and  favorable  course.  The 
development  and  healing  of  the  vesicles  require  on  an  average 
5  to  6  days.  In  spite  of  this  however  the  disease  extends  even 
in  the  mild  cases,  from  2  to  3  weeks,  as  the  different  parts  of  the 
body  do  not  become  affected  simultaneously,  but  usually  suc- 
cessively. The  cases  in  which  the  affection  is  localized  in  the 
mucous  membrane  of  the  mouth  usually  recover  inside  of  a 
week.  Recovery  is  protracted  somewhat  longer  in  the  hoof 
affections,  on  account  of  the  delayed  healing  of  the  ulcerations. 
In  those  cases  however  in  which  the  affection  of  the  mucous 
membrane  of  the  mouth  is  associated  with  lesions  in  the  hoofs, 
a  still  longer  time  is  required  for  recovery.  After  healing 
of  the  local  changes  the  animals  usually  regain  their  former 
condition  very  rapidly. 

In  cases  running  an  unfavorable  course  with  the  exception 
of  young  animals  affected  with  gastro-intestinal  catarrh,  death 
ensues  as  a  rule  from  pyemia  or  septicemia,  as  a  result  of 
absorption  of  septic  substances  from  the  ulcers,  abscesses  or 
suppurating  wounds,  while  in  other  cases  a  gangrenous  pneu- 
monia is  the  cause  of  death.  In  the  malignant  form  of  foot-and- 
mouth  disease  toxin  poisoning,  or  paralysis  of  the  heart  may 
be  the  immediate  cause  of  death. 

In  a  certain  percentage  of  cases  various  permanent  affec- 
tions remain,  which  more  or  less  reduce  the  value  of  the  animals. 
Such  affections  are,  in  the  first  place,  chronic  disturbances  of 
the  hoofs,  which  develop  from  extensive  inflammation  of  the 
feet,  and  especially  from  the  loss  of  hoofs.  Such  conditions 
result  in  an  irregular  development  of  the  new  hoofs,  as  well 
as  in  chronic  arthritis  and  tendonitis.  In  exceptional  cases  a 
proliferation  of  granulation  tissue  is  observed,  which  originates 
from  the  ulcerations  on  the  coronary  band,  heels,  and  the  inter- 
digital  space.  In  such  instances  the  hoofs  are  forced  apart, 
and  the  lesions  consist  in  sore,  ulcerative  masses  (Schenkl). 
Of  further  importance  is  the  diminished  milk  production  which 
usually  lasts  until  the  following  parturition,  but  may  also 
remain  constant,  especially  when  the  severe  affection  of  the 
udder  has  resulted  in  atrophy  of  the  glandular  substance. 

Horvath  observed  in  the  course  of  an  acute  affection  a  marked  difficulty  in 
respiration,  and  that  the  animal  failed  to  shed  the  hair  during  the  summer.  The 
number  of  respirations  during  rest  amounted  to  60-80  per  minute,  but  after 
short  exercise  as  well  as  in  warm  weather,  it  rapidly  increased  to  120-160,  while 
the  pulse  numbered  40-60  per  minute.  In  the  meantime  the  appetite  and  the  milk 
production  were  diminished;  pregnant  animals  gave  birth  to  poorly  developed  calves, 


Course,   Diajniosis.  345 

wciphinp:  only  from  10-15  kg.  In  1<)  townships  of  tlio  alTootod  distrirt  in  Iliuigary 
a  year  jnevioiisiy  51,(»S7  cattle  were  attVcted  witli  foot  and  inoiith  disoaso,  of  which 
;Ui(l-4(Hl  manifested  the  ahove  disturbances  in  respiration.  A  similar  affection  sccpiel 
to  foot-and-mouth  disease  was  observed  by  Laszio,  also  in  llunj^'ary,  in  connection 
with  the  very  severe  outl)reak  in  which  out  of  2,;')()0  cattle  of  a  township,  8t)  (about 
LH)%  of  the  animals  I  ciufj  over  5  years  of  age)  died  suddenly  from  paralysis 
of  the  heart,  usually  while  in  the  stage  of  recovery.  In  the  other  animals  the 
symptoms  greatly  dimiiushe<l  during  tlie  cold  winter  weather;  complete  recovery 
however  was  not  observed  in  any  of  the  cases. 

Diagnosis.  While  in  typical  cases  the  disease  may  be 
easily  recognized,  or  at  least  suspected,  in  the  stai<e  of  the 
vesicular  development,  especially  when  several  animals  are 
affected  at  the  same  time,  the  correct  recognition  of  sporadic 
cases,  especially  during  tlie  beginning  or  towards  the  end  of 
the  outbreak,  fi-e(]uently  causes  considerable  dilTiculty. 

In  the  i)eracute  and  fatal  course  the  suspicion  of  hemor- 
rhagic septicemia,  anthrax,  and  the  oriental  rinderpest  may  be 
awakened,  but  these  may  be  excluded  by  the  autopsy  findings. 

With  the  infectious  mouth  disease  there  may  be  mistaken : 
Traumatic  injuries  in  the  mouth,  which  occur  most  frequently 
on  the  inner  surface  of  the  lips;  in  these  cases  however  the 
losses  of  substance  are  sharply  defined,  frequently  straight,  and 
penetrate  to  consideral)le  depth.  The  vesicular  stomatitis 
(incorrectly  also  named  as  aphthous  stomatitis)  in  cattle,  in 
which  tlie  mucous  membrane,  especially  on  the  gums,  or  on 
the  toothless  portion  of  the  upper  jaw,  discloses  small  vesicles 
and  later  thin  pseudo-membranous  deposits  form  in  their  place; 
the  development  of  this  exanthema  is  however  not  associated 
with  fever,  nor  is  the  alfection  infectious.  The  ulcerative 
stomatitis  of  hogs,  in  which  however  the  gums  become  affected 
only^  in  the  vicinity  of  the  teeth,  and  no  vesicles  develop  (similar 
is  the  mercurial  stomatitis).  In  aphthous  stomatitis  of  calves 
and  lambs,  the  vesicles  usually  appear  only  on  the  skin  of  the 
lips,  while  in  the  different  parts  of  the  mouth  white,  or  yellow- 
ish membranous  deposits  develop  on  the  mucous  membrane 
without  a  previous  vesicular  formation.  In  cattle  the  actinomy- 
cotic ulcerations  on  the  back  of  the  tongue  may  also  come  into 
consideration.  These  how^ever  are  always  located  immediately 
in  front  of  the  transverse  groove  on  the  dorsum  of  the  tongue, 
and  also  extend  to  the  papilla*  fungiformes,  whereas  in  foot- 
and-mouth  disease  these  remain  intact  even  in  the  places  of 
vesicles  or  erosions  (Leutsch).  The  stomatitis  which  is  soine- 
times  observed  after  feeding  musty,  moldy  food,  may  be  dis- 
tinguished from  foot-and-mouth  disease  by  the  absence  of  vesi- 
cles, and  by  the  diffuse  inflammation  of  the  mucous  mendjrane. 

Concerning  affections  of  the  mucous  memlirane  of  the  mouth,  which  were 
recently  described  under  various  names,  for  instance  pseudo-mouth  disease,  and 
which  may  come  into  consideration  from  the  standpoint  of  differential  diagnosis, 
sec   Chap."    "Aphthous   Stomatitis"   in    Vol.   2. 

The  affections  which  may  ])e  mistaken  for  hoof  disease,  are 
to  be  distinguished  in  general,  in  that  the  affections  on  the  lower 


346  Foot-and-Mouth  Disease. 

extremities  are  not  preceded  by  febrile  symptoms,  but  that,  if 
they  are  present,  they  follow  upon  the  appearance  of  the  lesions. 
Further  there  is  no  formation  of  vesicles,  and  the  affection 
is  confined  to  the  feet,  while  the  mucous  membrane  of  the  mouth 
is  not  simultaneously  affected  (this  fact  in  itself  of  course  does 
not  exclude  the  infectious  foot-and-mouth  disease). 

The  diseases  which  should  be  considered  in  this  regard  are : 
The  interdigital  panaritium  of  cattle,  which  occurs  especially 
in  filthy  stables,  also  in  pastures,  sometimes  in  enzootic  exten- 
sion; in  this  affection  the  skin  of  the  interdigital  space  swells 
to  a  thick  roll,  which  extends  from  the  interdigital  space  and 
over  which  the  skin  sometimes  may  even  become  gangrenous, 
resulting  in  a  discolored  ulceration,  and  in  a  separation  of  the 
interdigital  band. — A  necrotic  (malignant)  inflammation  of  the 
hoofs  in  cattle,  which  occurs  in  cows  shortly  after  parturition 
or  towards  the  termination  of  pregnancy,  exceptionally  also  in 
bulls,  and  which  is  probably  produced  by  the  bacillus  necro- 
phorus  (Bang,  Hess) ;  in  this  affection  rapid  softening  necrosis 
of  the  skin  in  the  interdigital  space  takes  place,  which  also 
penetrates  into  the  deeper  parts,  but  fever  develops  only  in 
the  later  stages  of  the  affection. — The  inflammation  of  the  inter- 
digital space  in  sheep  (Moderhinke),  from  which  many  animals 
may  suffer  at  the  same  time,  in  continuously  moist  weather.  The 
affection  consists  in  a  serous,  and  later  purulent  inflammation 
of  the  skin,  which  may  easily  lead  to  a  separation  of  the  coro- 
nary band,  and  the  horny  wall ;  the  suppuration  usually  occurs 
at  the  heels,  while  the  anterior  part  of  the  interdigital  space 
is  less  aifected.  The  so  called  hoof  worm  (inflammation  of  the 
biflex  gland)  only  occurs  sporadically,  provided  it  does  not 
develop  as  the  result  of  foot-and-mouth  disease,  and  the  inflam- 
mation is  confined  to  the  vicinity  of  the  swollen  gland,  which  is 
filled  with  smeary  material. — The  so  called  malignant  (French- 
Spanish)  disease  of  the  hoof  commences  with  an  inflammation 
of  the  hoof  proper,  which  feels  warm  to  the  touch,  while  an 
affection  of  the  interdigital  space  becomes  apparent  only  in 
the  later  stages,  frequently  after  suppuration  of  the  sensitive 
lamina  has  already  developed.  Furthermore  this  affection 
spreads  more  slowly  in  the  herd  than  is  the  case  in  foot-and- 
mouth  disease. 

To  the  latter  probably  belongs  also  the  disease  of  the  hoofs  known 
in  America  as  foot-rot  of  sheep,  in  England  as  contagious  foot-rot,  in 
France  as  pietin  contagieux,  in  which  the  inflammation  commences  on 
the  coronary  band,  whereupon  small  ulcers  with  purulent  discharge  of 
a  peculiar  odor  develop  on  the  heels.  The  process  extends  to  the  deeper 
parts,  forming  fistulas,  and  resulting  in  the  separation  of  the  horns  of 
the  hoofs,  and  sometimes  also  in  necrosis  of  the  ligaments,  tendons  and 
bones  (Mohler  and  AA^ashburn). 

Exanthema  on  the  udder  might  be  mistaken  for  pox,  but 
this  affection  remains   as   a   rule   exclusively  confined  to   the 


Diajriiosis.    Pru^ninsis.  34Y 

udder,  tlie  vosiclos  arc  only  the  size  of  a  jx'a,  the  siirroiiiidiii^ 
skin  is  elevated,  and  in  a  certain  sta^e  of  their  development 
navel-liko  depressions  form  on  tlie  vesicles. 

Indications  of  recovery  from  tlie  disease  within  a  short 
time  are  ])rofnse  salivation,  ^-reater  moistnrc  on  the  surface  of 
the  mucous  mem))ranes,  yellowish,  strai^dit  cicati-ices,  or  flat, 
yellow  spots  on  the  gums  and  on  the  toothless  portions  of  the 
upper  jaw,  small,  red  ])oints  and  depressions  on  the  uums  and 
on  the  horder  of  the  muzzle.  According'  to  Koniiiski  these 
chanues  may  be  noted  even  3  to  4  months  after  the  disappear- 
ance of  the  acute  symptoms. 

Prognosis.  Foot-and-mouth  disease  is  in  its  nature  a  mild 
affection,  death  occurring  only  very  rarely  under  normal  con- 
ditions, except  in  very  young  aninuds,  in  the  malignant  form  of 
the  disease.  Tlie  mortality  hardly  amounts  to  0.2  to  i)S)%,  and 
even  these  figures  are  principally  due  to  unfavorable  hygienic 
conditions  (filthj'  stables,  using  the  animals  for  work,  or  driving 
the  affected  animals  on  the  road,  negligence  in  the  treatment, 
etc.).  These  conditions  must  therefore  be  taken  into  consid- 
eration in  giving  a  prognosis. 

Of  the  different  species,  cattle  are  most  mildly  affected 
under  similar  conditions;  in  hogs  also  the  affection  usually 
runs  a  mild  course,  except  in  fattened  hogs,  in  wliich,  owing 
to  the  heavy  weight  of  their  bodies,  the  loss  of  hoofs  is  fre- 
quently observed,  and  therefore  complete  recovery  usually  takes 
a  longer  time.  In  sheep  the  course  of  the  disease  is  less  favor- 
able on  account  of  the  relatively  frequent  after-effects  to  the 
hoofs. 

In  very  young  animals,  especially  in  the  sucking  age,  the 
prognosis  is  unfavorable  on  account  of  the  associated  gastro- 
intestinal catarrh. 

The  deviation  of  the  course,  according  to  fox  and  age  of  cattle,  is  illus- 
trated by  Boiiley  's  reports,  which  also  correspond  with  the  observations  made  by 
others.  In  the  District  of  Nevers  in  1872,  in  the  course  of  five  weeks  of  7469 
steers  9  died  (0.12'X),  of  662.5  cows  59  succundied  (0.899^),  of  3847  calves 
781  (20.30%).  According  to  Mari  the  foot-and-mouth  disease  in  Russia  assumes 
sometimes  such  a  malignant  character  that  70  to  95%  of  the  affected  animals 
die.  Tn  this  form  the  patients  suffer  aside  from  the  characteristic  but  severe 
symptoms  of  the  disease,  from  a  pronounced  catarrh  of  eyes  and  nose,  from 
diarrhea,    and    a    severe    depression    of    the    nervous    system. 

The  prognosis  of  malignant  foot-and-mouth  disease  is  unfa- 
vorable, as  the  mortality  in  this  form  usually  amounts  to  from 
50  to  70%.  As  death  occurs  mostly  after  rather  light  symptoms 
in  the  stage  of  commencing  improvement,  it  ap])ears  advis- 
able, in  making  a  prognosis  in  instances  when  sudden  deaths 
had  been  observed  in  the  vicinity,  to  take  these  facts  into  con- 
sideration. 

Further,  in  making  a  prognosis  in  severe  affections  of  the 
hoofs,  the  possibility  of  sequelae,  and  in  the  affection  of  the 
udder,  a  lasting  shrinkage  in  the  milk  production  should  be 
given  due  regard. 


348  Foot-aud-Mouth  Disease. 

Treatment,  Eest  and  cleanliness  are  the  two  principal 
requirements  under  wliicli  mild  forms  of  the  disease  terminate 
in  recovery  within  a  short  time,  and  without  leaving  subsequent 
affections. 

In  the  mouth  affection  care  should  first  of  all  be  taken  that 
the  affected  mucous  membrane  be  protected  from  mechanical 
injury,  and  that  the  animals  are  kept  in  good  condition,  in  spite 
of  the  existing  pain  which  interferes  with  the  partaking  of  food. 
For  this  purpose  the  diet  should  be  regulated  and  the  animals 
should  be  given,  instead  of  coarse  and  rough  food,  fresh,  green 
food,  fine  hay,  or  silage.  Severely  affected  patients  should  be 
supplied  with  flour  and  bran  gruels,  while  young  animals 
should  be  given  boiled  milk. 

For  the  cleaning  of  the  buccal  cavity  the  animals  should 
frequently  be  given  pure  fresh  water,  besides  the  mouth  should 
be  syringed  out  2  to  3  times  a  day  with  pure  water  with  the 
aid  of  an  irrigator,  or  with  a  hard  rubber  syringe.  Medicines 
are  of  subordinate  importance,  and  only  serve  to  prevent  the 
decomposition  of  the  accumulated  saliva,  and  to  hasten  the 
healing  of  the  erosions.  For  this  purpose  mild  disinfectants 
and  astringents  may  be  used  for  the  irrigation,  such  as  salt 
and  vinegar  water,  alum,  copper  sulphate,  iron  sulphate,  potas- 
sium chlorate,  boracic  acid,  creolin,  carbolic  acid,  lysol  (in  2 
to  3%  solutions),  pyoctanin  (1:1000),  formalin  (0.5%),  etc. 
These  remedies  may  be  used  in  camomile-sage  or  flax-seed 
decoctions. 

In  order  that  a  possil)le  eruption  on  the  base  of  the  horns  should 
not  cause  a  severe  inflammation  of  the  horn  matrix,  and  subsequent 
loss  of  the  horns,  it  appears  indicated,  especially  in  cows,  to  tie  them 
with  chains  on  the  neck  instead  of  on  the  head. 

The  hoof  affection  is  in  greater  need  of  treatment,  as  the 
affected  feet  are  exposed  to  irritating  influences,  although  even 
this  affection  usually  heals  without  interference,  if  the  ground 
is  sufficiently  clean  and  dry,  and  the  affected  animals  keep 
quiet.  If  the  animal  is  affected  only  with  the  mouth  lesions,  it 
is  advisable  to  wash  the  healthy  feet  at  least  once  daily  with 
a  disinfecting  fluid,  or  still  better,  to  paint  them  repeatedly  with 
tar.  If  the  hoofs  are  already  affected,  care  should  be  taken  that 
the  floor  under  the  animals  is  kept  dry;  therefore  the  bedding 
should  be  changed  frequently.  For  bedding  hygroscopic  and 
antiputrefactive  material  is  recommended  (turf,  gypsum,  etc.). 

The  treatment  proper  consists  in  washing  the  affected  ex- 
tremities with  one  of  the  disinfectants  mentioned,  or  an  astrin- 
gent solution,  which  in  this  instance  may  be  used  in  a  somewhat 
concentrated  form.  Painting  with  w^ood  tar,  creolin,  or  lysol 
liniments,  in  milking  cows  with  thick  milk  of  lime,  or  sprinkling 
with  drying  powders,  will  be  found  beneficial  (powdered  copper 
sulphate  mixed  with  oak  bark,  tannoform,  wood  charcoal  mixed 


Treatiiu'iit,   Prevent  ion.  3^() 

with  corrosive  sublimate,  see  p.  -I^'J,  ixjwdered  oxide  oi"  zinc, 
etc.).  Born  recommends  placing  oakum  balls  sprinkled  with 
alum  between  the  hoofs,  Pilger  painting  the  ulcerations  on  tlie 
hoofs  with  a  10%  bacillol  ointment,  in  severe  cases  tlie  appU- 
cation  of  ))a('illol  eataphisms. 

Complications  which  result  from  inii)roper  treatment,  or 
from  unfavorable  external  influences  should  be  treated  in'  ac- 
cordance with  surgical  rules. 

In  affections  of  tlie  udder,  iirst  of  all  reguhir  milking,  if 
possible  Avith  milk  catheters,  is  necessary.  In  addition  to  this 
washing  with  hike  warm  water,  or  with  a  2%  boracic  acid 
solution,  is  sufficient.  If  the  iiiHammation  is  more  intense,  and 
the  sensitiveness  is  greatly  increased,  it  is  advisal)le  to  apply 
warm  applications  to  the  sores,  after  previously  softening  anil 
loosening  the  scabs,  also  lead  or  zinc  ointment,  lanolin,  boracic 
acid  vaseline  (20%),  or  dermatol  vaseline;  tincture  of  opium 
may  be  added  to  the  salves,  or  a  5%  cocaine  salve  may  be  used 
from  the  beginning.  Rnblnng  with  glycerin  gives  likewise  good 
results.  Parenchymatous  inflammation  of  the  udder  is  best 
treated  with  inunctions  of  green  soap,  containing  tincture  of 
iodine  (1:10),  or  camphor  ointment  (1:4),  repeated  twice  daily 
for  10  minutes  at  a  time,  and  in  order  to  prevent  the  formatioii 
of  strictures  the  udders  should  be  milked  out  every  2  to  3  hours. 
During  the  intervals  iodoform  bougies  may  be  introduced  into 
the  milk  ducts  (Born). 

In  malignant  forms  of  the  disease  it  is  advisable  to  watch 
the  activity  of  the  heart  in  the  affected  animals  carefully,  espe- 
cially from  the  fifth  to  the  ninth  day,  and  in  case  its  function 
is  disturbed,  the  threatening  heart  depression  should  be  treated 
by  stimulation.  In  case  of  severe  symptoms  the  early  slaughter 
of  the  animals  is  indicated. 

In  1901,  Baecelli  warmly  recommended  intravenous  injections  of  corrosive 
sublimate  (0.05:0.1  ^.  in  physiological  salt  solution).  According  to  later  experi- 
ences this  treatment  is  useless,  sometimes  even  dangerous.  It  has  no  favorable 
influence  on  the  local  lesions,  nor  does  it  influence  the  course  of  the  disease  favor- 
ably, and  further  poisoning  was  occasionally  observed  in  the  treated  animals,  which 
sonietiiiies  failed  to  api-ear  until  3  to  4  weeks  later  (Sacchini,  Lanzillotti-Buonsanti, 
LofHer).  The  treatment  with  intravenous  injections  of  collargol  (19f  solution), 
which  has  been  recommended  by  Winkler,  was  in  the  comparative  experin)eiits  of 
Barabas  found  to  have  no  favorable  influence  on  the  course  of  the  disease,  and 
to   be   incai)able   of   preventing   it. 

Perroncito  recommemls  his  Hiimoaphthin  for  the  treatment  of  affecte('i  cattle 
which  he  prepares  as  follows:  blood  which  is  taken  from  recovered  cattle,  that 
have  been  repeatedly  treated  with  filtered  lymph,  is  defibrinated,  filtered  through 
hydrophylic  cotton,  and  mixed  with  3  to  47f  sulphuric  ether,  and  0.75%  formol. 
After  the  injection  of  this  ])reparation  (0.5  to  1  g.  per  kg.  bo<ly  weight),  which 
keeps  for  a  long  time,  the  recovery  is  supposed  to  be  almost  instantaneous    (  ?). 

Prevention.  The  highly  contagious  character  of  foot-and- 
mouth  disease,  and  the  fact  that  the  infection  is  not  only  trans- 
mitted by  living  animals,  but  also  by  the  most  varied  objects, 
render  its  control  at  the  time  of  its  prevalence  very  difficult. 
Nevertheless  it  has  recently  been  observed  that  outbreaks  which 
have  not  yet  spread  very  extensively  may  be  eradicated  by 


350  Foot-aiul-Mouth  Disease. 

suitable  measures,  and  herds,  especially  those  on  large  farms, 
may  be  protected  from  the  infection.  The  principles  for  preven- 
tion are,  in  general,  the  same  as  those  applied  to  other  infectious 
diseases,  and  expressed  briefly  are,  that  healthy  animals 
should  be  protected  in  every  possible  way  from  coming  in 
contact  with  the  unhealthy  ones,  or  with  those  which  have  recov- 
ered within  a  short  time  (see  also  page  334),  and  also  from 
coming  in  contact  with  contaminated  utensils. 

A  quarantine  of  at  least  two  weeks  duration  for  newly 
introduced  animals  appears  to  give  good  results  in  this  respect. 
It  is  furthermore  advisable,  during  threatening  periods,  espe- 
cially in  already  infected  herds,  to  prevent  the  calves  from 
sucking  their  mothers,  but  they  should  be  given  milk  that  has 
been  heated  to  70  degrees. 

Emergency  and  protective  vaccination.  Emergency  vaccin- 
ation with  virulent  material,  and  immunization  proper,  possess 
a  marked  difference  in  their  value  and  in  their  practical  im- 
portance. 

I.  Emergency  vaccination.  This  method,  in  which  the  dis- 
ease is  produced  in  healthy  animals  by  the  inoculation  of 
virulent  material,  is  employed  to  shorten  the  disease  in  already 
infected  herds,  when  more  energetic  measures  of  eradication  are 
not  adopted. 

The  disease  usually  affects  all  of  the  susceptible  animals 
in  an  infected  herd  owing  to  its  remarkable  contagiousness, 
but  inasmuch  as  its  transmission  from  animal  to  animal 
occurs  only  successively,  a  long  time  usually  elapses  before  the 
last  animal  recovers  and  the  entire  herd  may  be  considered 
free  from  infection.  In  order  to  diminish  the  loss  due  to 
inability  of  the  animals  to  work  by  a  more  rapid  passing  of 
the  infection  through  the  herd,  and  to  reach  as  soon  as  possible 
the  removal  of  the  quarantine  period,  artificial  infection  of  all 
animals  in  the  herd  after  the  appearance  of  the  first  cases,  ap- 
pears indicated.  The  advisability  of  this  procedure  is  also  sup- 
ported by  the  experience  that  the  inoculated  disease  usually  runs 
a  milder  and  frequently  also  a  more  rapid  course  than  the 
natural  infection.  In  order  however  to  prevent  severe  losses, 
the  inoculation  should  be  undertaken  only  in  outbreaks  in  which 
the  disease  is  mild  in  character,  and  in  which  deaths  in  adult 
animals  have  not  been  observed  in  the  vicinity.  (In  the  spring 
of  1904  in  a  county  in  Hungary,  all  of  35  inoculated  cattle,  and 
39  sucking  calves  died  within  11  days.) 

Technique  of  Inoculations.  The  simplest  procedure  consists  in  rubbing  or 
superficially  scarifying  the  mucous  niembrane  of  the  mouth  lightly  with  a  clean 
coarse  piece  of  linen,  and  then  applying  the  saliva  of  affected  cattle;  or  the  animals 
are  given  coarse  food  contaminated  with  such  saliva.  The  saliva  should  be  taken 
only  from  animals  which  have  vesicles  in  their  mouths,  as  the  saliva  is  rendered 
infectious  by  their  contents  alone,  whereas  it  is  no  longer  infectious  when  the 
erosions  are  healing.  Likewise  very  simple  and  certain  is  the  method  in  which 
a  piece  of  linen  is  placed  in  the  mouth  of  the  affected  animal,  which  is  allowed 
to    chew    at   it    for    several   minutes,    then    the   well    saturated    cloth   is   introduced 


Vaccination,      Iinuiuuizatioii.  35;^ 

into  the  month  of  the  next  G  to  S  cattle,  and  they  are  also  allowed  to  chew 
upon  it.  Less  certain  is  the  procedure  in  which  threads  iniprct,nuitod  with  saliva 
of  affected  animals  are  inserted  into  the  suhcutuiu'ous  coiiucctivi'  tissue  of  the 
ear,  or  of  the  tail;  the  feedinj,'  of  affected  milk  is  less  commendable,  as  this  may 
sometimes   produce  a  severe   gastrointestinal   catarrh. 

Twenty-four  to  48  hours  after  inoculation  the  temperature  of  the  animals 
commences  to  rise,  and  2  to  3  days  later  vesicles  appear  on  the  nuicous  mcihbrane 
of  the  mouth,  excei)tionally  also  between  the  hoofs,  which  continue  to  develop  in 
the  usual  form  until  recovery  takes  place,  mostly  in  the  course  of  the  second 
week.  The  inoculated  animals  should  be  subjected  to  the  same  treatment  that 
they  would  have   received   had  they  contractetl  the   disease  by  natural  infection. 

Other  animals  than  cattle  are  usually  not  subjected  to  the  inoculation  as  it 
is  usually  less  certain  in  them,  e.  g.  in  hot,'s  (in  these  it  may  be  uudertakeu  on  the 
snout  with  the  aid  of  an  inoculation  lancet). 

II.  Immunization.  Altliongli  animals  may  easily  be  im- 
munized by  the  deliberate  production  of  the  disease,  and  the 
immunity  thus  produced  as  a  rule  lasts  for  a  long  time,  yet 
such  a  procedure  fails  to  meet  the  requirement  that  the  immun- 
ity be  produced  without  a  pronounced  affection  of  the  animals, 
especially  without  the  development  of  the  vesicular  exanthema. 
Attempts  to  work  out  a  method,  which  would  be  sufficiently  effec- 
tive, and  at  the  same  time  without  danger,  have  so  far  produced 
only  partially  satisfactory  results,  in  establishing  the  possi- 
bility and  the  nature  and  method  of  passive  immunization, 
while  the  problem  of  general  immunization  is  not  solved  at 
the  present  time. 

1.  Active  immunization.  For  this  purpose  either  pure 
lymph  or  a  mixture  of  lymph  and  immune  serum  have  been 
used,  however,  without  practical  results,  and  in  some  instances 
even  with  unfavorable  elfect. 

Nosotti  in  Northern  Italy  attempted  to  immunize  cattle,  by  injecting  them 
subcutaneously  with  pure  lymph  taken  from  closed  vesicles,  diluted  with  a(iueous 
humor  or  blood  serum,  the  results  however  were  not  satisfactory,  as  a  considerable 
proportion  of  the  inoculated  animals  became  affected  in  the  usual  way. 

According  to  LotHer  and  Frosch,  virulent  lymph  which  has  been  subjected  for 
12  hours  to  a  temperature  of  37%  may  produce  an  inununity  if  injected  into  the 
blood  in  quantities  of  0.01-0.1  cc.  As  however  this  method  is  effective  only  in 
30  to  oOr;    of  the  cases  the  procedure  has  not  been  inaugurated  in  practice. 

Loffler  and  Frosch  later  found  that  a  mixture  of  virulent  Ivmph  and  blood 
serum  from  artificially  hyper-immunized  animals  (1/50-1/40  cc.  Ivmph  plus  10-20  cc. 
blood  serum),  if  allowed  to  stand  for  a  short  time,  and  then  injeVte<I  subcutaneously 
into  cattle  and  hogs,  produces  only  a  passing  febrile  affection,'  without  the  <levelop- 
ment  of  a  vesicular  exanthema.  The  animals  however  become  immune  so  that 
in  3  or  4  weeks  they  stand  an  inoculation  with  1/50  ec.  of  virulent  virus  without 
danger. 

The  mixture  of  lymph  and  blood  serum  was  ])laced  on  the  market  at  the  end 
of  1898  under  the  name  of  "  Seraphthin,"  but  it  did  not  prove  satisfactory  in 
practice.  In  different  localities  a  large  i)ortion  of  the  inoculated  animals  became 
affected  with  tjidcal  foot-and-mouth  disease  (Flatten,  Schrader,  Schmidt,  Leonhardt, 
Lothes  and  others)  while  the  disease  produced  by  the  inoculation  was  sometimes 
malignant,  and  even  fatal  (Schindelka,  Geist).  Equally  unfavorable  results  were 
obtained  from  application  of  flecker 's  vaccine. 

In  Loffler 's  later  procedure  (1905)  the  cattle  to  be  imnuinized  received  sub- 
cutaneous injections,  first  of  0.5  cc.  of  highly  valent  cattle  serum,  and  0.03  cc.  of 
fresh  virulent  lymph.  After  24  to  26  days  they  receive,  also  subcutaneously,  0.0033 
cc.  of  lymph,  12  to  14  days  later  0.01  cc,  and  after  another  12  to  14  davs  0.04  cc. 
This  method  has  not  been  tried  in  practice  because  of  its  impracticability. 

The  most  recent  experiments  of  Loffler  show  that  in  the  inoculation  of  a 
lymph  serum  mixture,  the  quaiitity  of  serum  must  be  in  a  certain  proportion 
to  the  lymph  if  it  is  desired  to  produce  a  uniform  immunity,  and  that  the  lymph 


352  Foot-and-Moutli  Disease. 

should  be  atteBiiated  by  the  serum  only  to  the  extent  that  it  should  prevent 
its  disease  producing  action,  but  should  not  entirely  render  it  ineffective,  that  is, 
it  should  still  be  able  to  produce  a  reaction  in  the  body  for  the  establishment  of 
an  immunity.  The  difficulty  of  measuring  the  quantity  of  the  lymph  and  serum 
accurately  can  of  course  hardly  be  overcome,  and  therefore,  at  least  at  present, 
there  is  very  little  possibility  that  immunization  based  on  this  principle  will  prove 
practical. 

Ory  recommended  cow  pox  lymph  as  a  vaccine  against  foot-and-mouth  disease, 
inasmuch  as  he  supposed  that  in  the  close  relation  of  the  two  diseases  there  exists 
a  reciprocal  immunizing  relation.  He  first  inoculated  horses  with  calf  lymph,  and 
used  the  lymph  from  the  vesicles  for  the  vaccination  of  cattle.  These  are  claimed  to 
have  proven  immune  against  foot-and-mouth  disease  after  passing  through  a  mild 
inoculation  disease.  Confirmation  tests  by  Anker  and  Starcovici,  Caliuescu  and 
Sitaru  however  proved  that  it  is  not  possible  to  produce  immunity  in  this  mannerj 
and  Seibert  could  not  obtain  practical  results  from  the  use  of  original  pox 
lymph. 

The  Roumanian  authors  just  mentioned  later  modified  the  procedure,  in 
using  as  a  vaccine  a  mixture  consisting  of  two  parts  of  cow  pox  lymph,  two  parts 
salt  solution,  and  one  part  foot-and-mouth  disease  lymph.  The  practical  value  of 
this  method  is  supposed  to  be  found  in  that  the  animals  only  become  mildly  affected 
and  in  the  meanwhile  may  be  used  for  work  (the  danger  of  spreading  the  disease  is 
of  course  present  in  the  same  degree  in  this  procedure  as  in  the  emergency  inocu- 
lations). 

2.  Passive  immunization.  Blood  serum  from  animals  which 
have  passed  through  foot-and-mouth  disease,  in  quantities  from 
500  to  1,000  cc,  increases  the  resistance  of  the  susceptible  ani- 
mals; by  the  repeated  intravenous  injections  of  virulent  lyiuph 
this  resistance  may  be  increased  to  such  an  extent  that  the 
serum,  even  in  small  doses,  will  produce  a  passive  immunity. 
In  this  way  cattle  may  be  immunized  for  a  period  of  several 
weeks,  and  by  serum  inoculations  repeated  at  intervals,  the 
immunity  may  be  prolonged  even  for  several  months. 

A  single  serum  inoculation  would  then  be  indicated  only 
in  those  cases  in  Avhicli  it  is  desired  to  protect  the  animals  for 
a  period  of  about  three  weeks;  thus,  for  instance  before  they 
are  taken  to  stock  show^s  or  to  markets.  On  the  other  hand 
inoculations  repeated  two  or  three  times,  at  intervals  of  10 
days,  may  serve  beneficially  in  the  eradication  of  the  disease, 
inasmuch  as  by  such  a  treatment  of  animals  threatened  with 
infection,  its  spread  to  surrounding  herds  may  be  prevented,  and 
thereby  the  results  from  other  measures  of  eradication  and 
prevention  may  be  assured. 

Loffler's  method  of  preparing  the  immune  serum  is  as  follows:  For  the  im- 
munization of  large  animals  a  virus  propagated  in  the  body  of  pigs  weighing  15  to 
20  kg.  is  used.  The  pigs  are  inoculated  with  1/25  cc.  of  lymph,  whereupon  they 
become  ill  in  from  2  to  3  days,  and  the  lymph  is  collected  from  the  vesicles.  They 
then  receive  subcutaneously  10  cc.  of  immune  horse  serum,  which  results  in  their 
recovery.  The  lymph,  which  is  filtered  through  a  porcelain  filter,  is  inoculated 
intravenously  to  cattle  in  increasing  quantities,  and  after  such  treatment  for  2  1/2  to 
3  months  they  produce  a  sufficiently  potent  serum.  The  serum  is  suitable  for  practi- 
cal application  when  100  cc.  protects  aattle  of  200-252  kg.  weight  against  an  in- 
travenous injection  of  0.1  cc.  of  virulent  lymph,  24  hours  later.  Twenty  cc.  of 
serum  neutralizes  the  action  of  0.05  cc.  of  lymph;  as  in  the  natural  infection 
usually  only  small  quantities  of  virus  produce  the  disease,  it  is  sufficient,  except 
in  unusually  severe  cases,  to  use  20  cc.  of  serum  for  inmiunization  purposes.  In 
already  affected  animals  the  outbreak  of  the  disease  is  prevented  only  by  a  con- 
siderably greater  quantity    (100-200  cc),  and  even  then  not  with  certainty. 


Iimiiuiii/.atidii,      \'eleriii:uy  Police.  353 

The  possibility  oi  passive  imnmnizatioii  of  callle  uith  highly  potent 
serum  has  also  been  established  experimentally  by  Nocarcl,  Roux,  Carre 
&  Vallee,  and  Nocard  reeommended  it  also  for  tlie  treatment  of  atfeeted 
animals,  as  he  found  that  20  to  40  ce.  of  the  serum  reduced  the  con- 
valeseent  period,  and  that  in  severe  outbreaks  with  a  mortality  of 
10  to  20'/( ,  it  prevented  fatal  complications. 

The  utilization  of  imiiiuiu!  serum  as  an  aid  to  other  measures  of 
eradication  and  i)revention  has  been  warndy  reconnnended  by  LulHer, 
also  by  Leclainelu'  antl  Lourens. 

Veterinary  Police.  Owiiio-  to  the  severe  losses  which  agri- 
ctiltnre  sustains  from  the  foot-aiul-iuonth  disease  its  coinpnlsory 
iiotilicatioii  lias  been  inaugurated  everywhere,  and  various  s}je- 
eial  measures  have  been  adopted  for  its  eradication.  The  special 
regulations  aim  to  prevent  the  further  spread  of  the  disease, 
especially  by  the  immediate  isolation  or  destruction  of  the 
affected  aninuils,  and  consist  especially  in  the  application  of 
strict  farm  and  township  quarantine.  Strict  measures  are  also 
justified  in  the  supervision  of  cattle  markets  (prohibition  of 
such  markets  in  the  infected  towns  and  their  vicinity),  the 
transportation  and  driving  of  cattle,  as  well  as  the  control  of 
trading  by  dealers.  The  utilization  of  the  meat  of  affected 
animals  for  consumption  should  depend  on  the  decision  of  the 
veterinarian,  the  skins  should  be  disinfected  before  they  are 
worked  up,  milk  from  the  affected  dairies  or  cow  stables  should 
be  permitted  on  the  market  only  after  boiling  or  after  being- 
subjected  to  at  least  85°  of  heat.  Artificial  infection  of  animals 
which  are  directly  threatened  by  the  disease  should  be  made 
dependent  on  official  approval.  The  lifting  of  the  farm  or  town 
quarantine  appears  permissible  at  the  earliest  two  weeks  after 
the  recovery  of  all  affected  animals,  or  after  the  last  death. 

Proper  disinfection  is  of  great  importance  in  the  control  of  the  disease.  It 
is  advisaVile  to  undertake  this  immediately  after  the  appearance  of  the  first  eases, 
likewise  it  should  be  repeated  every  week,  until  after  the  suljsidinjj  of  the  disease. 
After  thorough  cleaning  of  all  parts  of  the  stables  the  disinfection  could  be  made 
"with  a  2.'/c  hot  soda  or  lye  solution;  besides  it  is  advisable  to  paint  the  wooden 
parts  with  tar,  and  the  walls  with  fresh  milk  of  lime,  and  if  possible  the  feet  of 
the  animals  should  also  be  cleansed   (with  lysol  soa[),  etc). 

It  is  advisable  to  cover  the  manure  of  cows  and  hogs  with  hori-c  manure.  It 
should  be  left  in  the  manure  pit  for  eight  days,  and  should  only  then  be  taken 
to  the  field  where  it  is  to  l)e  plowed  under  with  horse  teams.  The  virus  is  destroyed 
by  the  heat  which  develops  inside  of  the  manure  pile,  as  according  to  Hecker 's  in- 
vestigations the  temperature  in  the  inner  pai-t  of  the  manure  jtile,  at  a  depth  of 
3()-4()  cm.  rises  to  70  deg.,  in  a  greater  depth  to  4S  deg.,  and  remains  for  several 
days  at  this  height. 

If  the  disease  appears  in  regions  which  were  previously 
free  from  the  infection,  immediate  slaughter  of  the  infected 
herds  is  indicated  as  the  most  effective  and  also  as  the  most 
practical  measure.  This  may  be  greatly  supplemented  by  the 
serum  treatment  of  neighboring  herds  (see  above). 

With  the  immediate  slaughter  of  the  infected  herds  the  eradication  of  several 
local   outbreaks  was  successful!}'   acconiplishe<l   in   recent   times   in    Kngland,  and   the 
spread  of  the  infection   in  the   I'nited  States  in   l!t()2-;{  was  also  prevented,  when   in 
Vol.  1 — 23 


354  Foot-and-Mouth  Disease. 

a  period  of  seven  months  in  244  herds  4712  cattle,  360  hogs  and  229  sheep  and 
goats  were  slaughtered  representing  a  value  of  $128,908.  In  a  similar  way  Aus- 
tralia has  remained  free  from  the  infection  after  the  slaughter  in  Victoria  of 
two  herds  in  1865.  In  recent  times  Holland  and  Germany  also  adopted  the 
slaughter  of  the  infected  herds  in  sporadic  outbreaks. 

Literature.  Hertwig,  Mag.,  1842,  VIII,  389. — Haubner,  Veterinary  Police, 
1869,  359  (Lit).— Johne,  S.  B.,  1881,  62;  D.  Z.  f.  Tm.,  1884,  186.— Siedamgrotzky, 
S.  B.,  1892,  71. — Hess,  Klauenkrankh.  d.  Eindes,  1892.— Wchiitz,  A.  f.  Tk.,  1894, 
XX,  1.— Kitt,  Monh.,  1894,  V,  319  (Revue).— Mobius,  S.  B.,  1895,  75.— LofBer  & 
Frosch,  Cbl.  f.  Bakt.,  1897,  XXII,  257.— Hecker,  B.  t.  W.,  1898,  61 ;  1899,  6  u.  130.— 
Immiuger,  B.  t.  W.,  1898,  517.— Loffler,  D.  t.  W.,  1899,  317;  D.  m.  W.,  1903,  685; 
Kongr.  Haag,  1909.— Ebertz,  A.  f.  Tk.,  1900;  XXVI,  199.— Nocard,  Eev.  gen.,  1903, 
I,  369;  Acad,  de  med.,  1901. — Arb.  z.  Erforschung  d.  M.  u.  Kls.,  Denkschr.  d. 
kais.  Ges.-Amtes  1901.. — Mohler  &  Washburn,  Bureau  Animal  Industry  Bull.  Nr. 
63,  1905. — Casper,  B.  t.  W.,  1907,  399  (Lit.  on  immunization). — Ory,  Sem.  vet., 
1907.— Terni,  D.  t.  W.,  1908,   747. 

Foot-and-Mouth  Disease  in  Horses,  Carnivorous  Animals  and  in 
Fowls.  Besides  ruminants  and  hogs,  carnivorous  animals  and  the  horse 
are  also  susceptible  to  the  disease,  although  in  a  considerably  lesser 
degree,  so  that  in  these  animals  the  disease  is  observed  only  very  rarely. 

The  disease  has  been  noted  in  various  places  among  horses  simul- 
taneously with  its  occurrence  among  ruminants  and  hogs.  In  most  in- 
stances it  could  be  traced  to  direct  contact  of  the  horses  with  affected 
cattle,  to  the  drinking  of  water  contaminated  with  infectious  saliva, 
or  to  pasturing  in  fields  in  which  affected  ruminants  were  previously 
kept.  (The  transmissibility  to  horses  was  proven  experimentally  by 
Brauer  and  Woestendieck ;  Albrecht,  and  also  ourselves,  failed  in  such 
inoculation  experiments.)  From  the  affected  horses  the  disease  is 
usually  not  transmitted  to  healthy  horses. 

In  horses  the  disease  occurs  only  as  a  mouth  affection  ;  vesicles 
develop  with  febrile  symptoms,  on  the  sometimes  greatly  swollen  tongue 
and  on  the  lips,  sometimes  also  on  the  nasal  mucous  membrane,  the 
conjunctiva,  and  on  the  immediately  surrounding  skin.  The  erosions 
which  develop  in  place  of  the  ruptured  vesicles  are  for  a  time  covered 
with  yellow,  flat  deposits,  the  horses  may  sometimes  also  show  slight 
indications  of  gastro-intestinal  catarrh.  Usually  however  recovery  takes 
place  within  a  short  time  (although  Perazzi  reports  two  cases  of  death). 

By  its  clinical  manifestations  alone  the  disease  can  hardly  be  dis- 
tinguished from  the  contagious  pustular  stomatitis,  except  that  in  the 
latter  the  development  of  the  pustules  takes  place  from  nodules.  Usually 
the  establishment  of  a  diagnosis  is  only  possible  with  the  aid  of  the 
history,  and  by  determining  the  method  and  nature  of  the  infection, 
also  from  the  fact  that  pustular  stomatitis  spreads  very  rapidly  among 
horses. 

Literature.  Brauer,  S.  B.,  1876,  84.— Woestendieck,  Pr.  M.,  1883,  9.— Albrecht, 
W.  f.  Tk.,  1896,  37.— Perazzi,  Clin,  vet.,  1907,  633. 

The  disease  is  very  rarely  observed  in  carnivorous  animals ;  sporadi- 
cally it  has  been  established  in  dogs  (Adam,  Lukas,  Schaffer)  and  cats 
(Uhlich,  Esser),  which  were  kept  on  infected  premises,  or  used  for 
guarding  an  affected  herd  of  cattle.  Vesicles  develop  on  the  mucous 
membrane  of  the  mouth,  the  erosions  showing  a  tendency  to  form  deep, 
penetrating  ulcers.  The  development  of  the  disease  is  associated  with 
febrile  manifestations,  sometimes  also  with  vomiting  and  diarrhea.  If 
the  feet  are  involved  a  vesicular  exanthema  develops  on  the  balls,  be- 
tween the  toes,  and  on  the  soles,  with  which  swelling  and  lameness 
are  associated. 


Ill    Fowls  and   Man.  355 

Literature.  SchUffer,  A.  f.  Tk.,  1S94,  XX,  331.— Ilecker,  B.  t.  W.,  189S  fil  — 
Borzoui,  X.  Ere,  1907,  •292.  ' 

In  fowls  cases  of  the  disease  whicli  were  mentioned  already  by 
ypiiiola  are  exeeetlingly  rare.  Tlie  location  of  tlu;  exanthema  is  I'ither 
on  the  head  (around  tlie  nostrils,  comb,  conjunetiva,  mueous  membrane 
of  the  bills),  or  the  feet  (claws,  in  water  fowl  on  the  webs).  Sometimes 
however  the  vesieles  may  also  develop  on  other  parts  of  the  body. 
Wildner  observed  the  disease  in  two  townships  in  an  enzootic  form, 
where  it  affected  chickens  and  pigeons  severely.  The  buccal  mucous 
mem])rane  scaled  otf  in  shreds,  the  feet  swelled  up  to  the  tarsus  and  the 
skin  between  the  claws  was  covered  with  numerous  small  vesicles;  in 
some  birds  not  only  the  elaws  dropped  otf,  but  also  the  last  joints  of 
the  toes.  On  the  feet  of  the  animals  whieh  remained  alive  great  deform- 
ities developed. 

Literature.  Spinola,  Spez.  Path.,  1858,  II,  883.— Schimlelka,  Mouh.,  1892,  IV, 
125. 

Foot-and-Mouth  Disease  in  Man.  As  man  is  also  susceptible  to 
the  viru.s  of  foot-and-moutii  disease,  it  may  frecpiently  ])e  transmitted 
to  him  if  it  occurs  in  an  epizootic  form.  The  infection  is  mostly 
transmitted  by  raw,  or  insufficiently  heated  milk  from  affected  cows,  or 
by  whey  (Dieckerhoff),  cheese  and  butter  (Schneider,  Frick,  Frohlich) 
prepared  from  such  milk.  In  rare  instances  persons  engaged  in  work 
around  the  infected  animals  may  contract  the  disease  by  direct  con- 
tact with  the  affected  parts  of  the  body,  as  in  milking,  slaughtering,  or 
during  the  treatment  of  the  patients.  Bertarelli  succeeded  in  one  case 
in  transmitting  the  disease  back  to  a  calf. 

Bussenius  &  Siegel  report  16  epizootics  in  the  years  of  1878-1896,  in  the  course 
of  whieh  entire  families,  sometimes  all  inhabitants  of  certain  houses,  and  even  town- 
ships became  affected.  During  different  outbreaks  the  cases  terminated  fatally  in 
36,  23,  and   16  instances  respectively. 

The  disease  develops  in  man  usually  in  a  mild  form,  except  in 
children,  in  which  an  associated  gastro-intestinal  catarrh  may  lead  to 
death.  During  some  of  the  outlireaks  however,  adult  persons  also  be- 
came severely  affected. 

After  the  ingestion  of  raw  milk  the  symptoms  are  as  follows: 
at  first  mild  fever,  sometimes  Avith  vomiting,  soon  a  feeling  of  warmth  and 
dryness  appear  in  the  mouth,  the  mucous  membrane  of  Avhich  becomes 
reddened,  especially  on  the  lips,  gums  and  on  the  cheeks;  later  vesicles  as 
large  as  peas  develop  at  these  places,  sometimes  also  on  the  borders 
of  the  tongues,  and  even  further  back.  After  they  burst  the  lost  epi- 
thelium is  soon  replaced.  Similar  vesicles  also  develop  occasionally  on 
the  conjunctiva  and  on  the  skin  of  nose  and  face.  The  skin  exanthema 
appears  most  frequently  on  the  hands,  on  the  points  of  the  fingers,  on 
the  base  of  the  nails,  and  on  the  volar  surface  of  the  finger  tips,  more 
rarely  also  on  the  toes  or  on  other  ])arts  of  the  body.  After  the  vesicles 
burst  a  thin  scab  forms,  under  which  the  new^  formation  of  epithelium 
progresses  rapidly. 

Besides  these  local  changes  headaches  and  pains  in  the  extremities, 
dizziness,  stomach  cramps,  vomiting,  diarrhea  and  great  dullness  may 
be  observed  from  ease  to  case. 

Literature.     Koranyi,  Nothnagels  Handbuch,  1900,  V.  Bd.  I.  T. 


356  Coital  Exanthema. 

3.    Coital  Exanthema.    Exanthema  vesiculosum  coitale. 

{Vesicular    exanthema;   Bldschenausschlag    [German];    Exan- 
theme  coital   [French].) 

Coital  exanthema  is  a  disease  of  cattle  and  horses,  more 
rarely  of  sheep  and  hogs,  characterized  by  vesicular  exanthema 
of  the  external  genital  organs.  It  is  usually  transmitted  from 
animal  to  animal  during  the  act  of  coitus,  and  usually  termi- 
nates in  complete  recovery.  The  cause  of  the  disease  is  at 
present  unknown. 

Occurrence.  The  disease  occurs  more  frequently  among 
cattle  than  in  horses.  It  is  observed  annually,  especially  in 
spring  and  summer,  in  Germany,  Austria  and  Hungary,  while 
in  Denmark  and  on  the  Scandinavian  peninsula  it  also  appears 
sometimes.  However  it  is  probable  that  it  is  known  also  in 
other  countries  (in  France  it  is  considered  identical  with  pox). 
Considerable  losses  are  sustained  in  extensive  outbreaks  of  the 
disease,  because  of  the  diminished  milk  secretion  in  cows,  the 
inability  of  draught  animals  to  work,  and  from  the  prevention 
of  impregnation,  and  consequently  the  deferring  of  the  lacta- 
tion period  in  cows. 

In  Germany  in  1908,  206  horses  and  4680  cattle  were  affected  in  1194  town- 
ships, the  disease  occurring  principally  in  Wiirtteniberg,  Prussia,  Bavaria  and  Baden. 
In  Austria  during  the  period  1891-1900,  on  an  average  26  stallions,  168  mares, 
84  bulls,  and  510  cows  were  affected;  the  number  of  the  affected  townships  in  1908 
reached  51,  and  in  these  159  premises  were  infected.  In  Hungary  between  1897 
and  1908  the  affected  townships  increased  from  43  to  278,  the  number  of  affected 
horses  from  81  to  2780,  of  cattle  from  134  to  1662.  The  disease  occurs  most  frequently 
on  the  right  banks  of  the  Danube,  and  in  the  territory  lying  between  the  Danube 
and  Theiss  rivers.     In  other  countries  the  disease  is  not  recorded  officially. 

Etiology.  The  virus,  which  is  unknown  at  present,  is  con- 
tained in  the  serous  or  purulent  contents  of  the  vesicles,  and 
in  the  secretion  of  the  ulcers,  and  is  easily  transmitted  with 
these  fluids  from  the  affected  to  healthy  animals. 

The  infection  occurs  mostly  during  copulation,  in  which 
male  animals  may  infect  females  and  vice  versa;  in  large  herds 
however  the  disease  is  transmitted  mainly  by  the  males. 
Stallions  or  bulls  may  transmit  it  without  themselves  being 
affected,  after  covering  an  affected  mare  or  cow,  and  trans- 
mitting the  infectious  secretion  with  the  penis  to  the  genitals 
of  a  healthy  female.  This  method  of  infection  is  however 
only  observed  when  male  animals  repeat  the  copulation  inside 
of  a  few  hours.  The  spread  of  the  disease  is  probably 
also  facilitated  by  the  fact  that  affected  females  show  in  the 
early  stages  of  the  disease  symptoms  resembling  the  period 
of  oestrum,  and  consequently  are  taken  to  the  male. 

In  some  cases  the  disease  may  also  occur  in  advanced  stages 
of  pregnancy,  or  in  animals  which  have  not  copulated,  among 
which  it  sometimes  may  spread  extensively  (Fenner  observed 
the  disease  in  the  course  of  one  year  among  746  heifers),  and 


Etiology,  Symi)toiiis.  357 

exceptionally  Vii  to  1  year  old  colts  and  calves  and  even  steers 
may  become  affected.  In  these  cases  the  infection  develops  by 
contact  with  the  infected  animals,  being  transmitted  by  straw- 
contaminated  with  infections  secretions,  stable  floors  or  manure, 
further  by  sjioni^es  and  by  the  hands  of  the  attendants.  Affected 
mares  may  transmit  the  disease  to  the  lips  of  their  colts  during 
sucking. 

Cattle  are  most  susceptible  to  the  disease,  horses  consid- 
erably less,  and  to  a  still  slighter  degree  sheep,  goats  and  hogs. 
Recovery  from  the  disease  I'educes  the  sus('('])tihility  for  a  time; 
the  duration  of  the  innnunity  however  is  unknown,  and  excep- 
tionally the  same  animal  may  become  repeatedly  infected  at 
short  intervals  (Fenner,  Kalb). 

The  relation  of  the  affection  to  other  diseases,  whieh  are  also  asso- 
ciated with  a  vesicular  exanthema,  has  not  yet  been  estabhshed.  The 
supposition  towards  its  identity  with  foot-and-mouth  disease  (Zlamal, 
Hertwig)  or  with  dourine  (Spinola),  has  been  discarded,  but  French 
authors  (Trasbot,  Peuch,  Nocard  &  Leclainche)  consider  it,  even  in 
recent  times,  as  a  form  of  pox.  The  majority  of  authors  consider  the 
affection  as  a  disease  by  itself,  wliich  view  corresponds  with  its  inde- 
pendent occurrence,  and  its  almost  invarial)le  localization  upon  the 
genital  organs. 

It  has  likewise  not  been  definitely  esta])lished  whether  the  disease 
is  caused  by  the  same  virus  in  the  various  species  of  animals,  as  inocu- 
lation experiments  have  failed  to  give  uniform  results.  According  to 
observations  made  it  usually  spreads  among  the  animals  of  the  same 
species,  and  does  not  pass  from  horses  to  cattle,  or  vice  versa.  Neverthe- 
less the  almost  complete  resemblance  of  the  clinical  appearance  in  the 
various  species  indicates  an  identity,  or  at  least  a  very  close  relation- 
ship of  the  affections,  and  the  veterinary  police  treat  the  trouble  among 
horses  and  cattle  in  this  sense. 

Exceptionally  the  transmission  of  the  virus  to  man  has  also  been 
observed,  when  a  pustular  exanthema  appears  on  the  hands  and  on 
the  face,  and  the  aft'ected  person  infected  other  members  of  the  family. 

Symptoms.  The  time  of  incnbation  is  as  a  rule  from  3 
to  6  days,  in  exceptional  cases  the  symptoms  may  appear  even 
in  from  24  to  48  lionrs  after  the  infection,  while  in  some  in- 
stances the  period  of  incnbation  may  extend  to  10  or  11  days 
(Friedberger  &  Frohner,  Dieckerhoff). 

The  characteristic  signs  of  the  disease  develop  on  the  ex- 
ternal genital  organs.  In  female  animals  the  reddened,  and 
exceptionally  also  the  hemorrliagic  mucous  membrane  of  the 
vagina,  shows  in  from  2  to  3  days,  lentil  to  pea-sized  vesicles, 
which  are  filled  with  a  clear,  yellowish  fluid.  Tlie  vesicles  appear 
on  a  reddened  and  swollen  base,  especially  on  the  upper  commis- 
sure, and  in  the  vicinity  of  the  clitoris,  as  well  as  on  the  inner  sur- 
face of  the  vulva,  in  male  animals  on  the  glans  penis  in  the  vicinity 
of  the  urethral  opening,  in  rare  cases  also  on  the  immediately 
surrounding  skin.    Small  nodules  may  also  appear,  later  chang- 


Qgg  Coital  Exanthema. 

ing  into  vesicles,  which  at  first  contain  a  serous,  later  a  purulent 
fluid.  After  a  short  existence  the  thin  walls  of  the  vesicles 
burst,  and  in  their  place  erosions  remain,  which  show  desqua- 
mation of  epithelium,  or  deep,  penetrating  ulcerations  may 
follow,  with  reddened  bases  and  sharp  borders,  producing  a 
yellowish,  sticky,  lymphatic  or  a  more  purulent  secretion,  which 
dries  in  the  air  to  yellow  or  brownish  scabs.  The  ulcers  later 
become  covered  by  granulation  tissue,  on  which  a  new  layer  of 
epithelium  soon  forms.  In  the  place  of  the  deeper  ulcerations 
white  scars  remain,  which  later  take  on  a  yellowish-red  color, 
and  are  almost  unrecognizable. 

In  male  animals  the  glans  penis  swells,  in  severe  cases  also 
the  sheath  or  the  scrotum,  and  the  prepuce.  Vesicles  may  also 
develop  on  the  skin  of  these  parts.  The  swelling  sometimes 
peaches  such  a  degree  that  a  true  phymosis,  or  a  paraphymosis 
develops.  At  the  same  time  continuous  erections  of  the  penis 
are  frequent,  and  a  desire  for  urination  exists,  as  well  as  a 
yellowish,  mucous  or  purulent  discharge  from  the  urethra. 

In  female  animals  the  lips  of  the  vulva  are  especially 
swollen,  but  the  edematous  infiltration  extends  also  to  the  sur- 
rounding parts,  and  even  to  the  legs.  In  mares  frequent  con- 
tractions of  the  clitoris  are  observed,  while  the  vagina  dis- 
charges a  muco-purulent  material.  A  similar  discharge  occurs 
also  from  the  genitals  of  cows  and  smaller  animals. 

The  affected  animals  manifest  great  itching,  as  a  result 
of  which  the  females  rub  their  hind  parts  against  solid  objects, 
they  wag  their  tails,  arch  their  backs,  strike  at  the  abdomen, 
and  stand  frequently  in  a  position  for  urinating. 

The  lymph  glands  of  the  groin  and  of  the  vicinity  of  the 
rectum  are  usually  swollen,  elastic,  dense,  and  more  or  less 
sensitive. 

The  nervous  condition  is  hardly  affected  with  the  exception 
of  the  restlessness  produced  by  the  itching;  sometimes  slight 
digestive  disturbances,  diminished  appetite,  delayed  rumination, 
a  reduction  of  milk  secretion,  etc.,  are  observed.  In  the  presence 
of  very  numerous  pustules  these  symptoms  may  reach  a  high 
degree,  and  in  such  cases  symptoms  of  restlessness  and  strain- 
ing are  especially  severe.  Pregnant  animals  exceptionally 
abort. 

The  described  symptoms  may  become  more  aggravated  as 
a  result  of  external,  harmful  influences.  The  original  slight 
inflammatory  process  is  sometimes  considerably  increased  by 
the  continuous  severe  rubbing,  when  the  open  surfaces  of  the 
wounds  may  subsequently  become  infected  by  dirty  material. 
In  such  cases  the  ulcers  have  a  malignant  appearance,  they  are 
covered  by  yellow  crusts,  and  penetrate  into  the  deeper  parts, 
as  a  result  of  which  crater-like  depressions  develop  at  the  base 
of  the  ulcers.  The  edematous  infiltration  in  the  vicinity  of  the 
genital  organs  may  reach  a  high  degree,  and  may  extend  also 
to  the  lower  abdomen,  and  to  the  inner  surface  of  the  thighs. 


Symptoms,   Course,      Diagnosis,     Tifatint'iit.  359 

The  neighboring  lymph  glands  may  snppnratc,  loa<ling  to 
abscess  formation  in  the  vicinity  of  the  aims  and  in  the  groins; 
exceptionally  such  may  also  occur  in  the  tissue  of  the  ud(k'r. 
At  the  same  time  the  gait  is  stiff,  sensibility  is  greatly  depressed, 
the  appetite  impaired,  tlie  body  temperature  increased,  and  the 
fever  may  be  remittent.  Finally  ))yemia  or  septicemia  with 
their  usual  severe  results  may  follow  the  local  affection  through 
the  development  of  a  general  infection. 

Course.  In  the  great  nuijoritj"  of  cases  the  disease  runs  a 
course  of  2,  more  rarely  of  'S  to  4  weeks,  and  terminates  in  com- 
plete recovery.  The  severe  cases  may  always  be  traced  to  a 
subsequent  septic  infection,  or  to  traunuitic  inlluences;  in  such 
cases  the  infection  may  be  so  intense,  and  the  changes  in  the 
tissue  so  severe,  that  convalescence  may  extend  to  several 
months;  sometimes  entire  recovery  fails  to  follow  or  the  disease 
may  terminate  in  death.  Although  even  larger  wounds  may 
heal  without  scar  formation,  in  some  cases  a  chronic  vaginal 
catarrh  follows,  which  may  result  in  sterility  of  itself,  or  through 
an  extension  to  the  uterus.  In  bulls  the  deep  penetrating  abscess 
formation  may  result  in  a  deformity  of  the  penis  (Kampmaim), 
or  a  weakness  of  the  penis  remains,  which  prevents  the  animals 
from  the  act  of  coitus. 

Diagnosis.  The  thin  walled  vesicles  on  the  genital  organs 
assure  the  diagnosis,  and  disting-nish  the  disease  from  the  other 
inflammatory  local  affections.  If  ulcers  have  already  developed 
from  the  vesicles,  it  can  be  distinguished  from  traumatic  inflam- 
mation only  by  its  infectious  nature,  and  by  the  rapid  recovery. 
In  infectious  vaginitis  of  cattle,  with  which  this  disease  has 
been  frequently  confounded,  hemp-seed  size,  grayish-red  nod- 
ules on  the  mucous  membrane  are  characteristic,  which  remain 
for  a  long  time,  and  only  exceptionally  change  to  small  ulcers. 
In  horses  dourine  comes  into  consideration;  in  this  however 
there  is  also  no  vesicle  formation,  and  it  develops  with  less 
acute  s^anptoms  and  is  later  associated  with  nervous  mani- 
festations. 

Treatment.  Mild  cases  recover  without  any  treatment. 
Keeping  the  genital  organs  clean  and  washing  with  mild  disin- 
fectants and  astringents  hasten  the  recovery.  For  this  pur- 
pose alum,  sulphate  of  zinc  (M.'%)»  boracic  acid  (3%),  iron  and 
copper  sulphate  (1%),  acetate  of  lead  (1-2%),  carbolic  acid, 
creolin,  h^sol,  or  chinosol  in  2-.3%  solutions,  may  be  used,  with 
which  the  affected  parts  should  be  washed  two  or  three  times  a 
day.  In  the  presence  of  a  severe  vaginal  catarrh,  irrigations  of 
the  vagina  with  the  same  solutions  may  be  undertaken.  If  the 
ulcerations  are  unclean,  with  deep  penetrating  destruction  of 
tissues,  they  may  properly  be  cauterized  with  nitrate  of  silver, 
or  copper  sulphate.  J.  c^'  H.  Streit  recommend  the  blowing  into 
the  vagina  of  a  powder  consisting  of  four  parts  of  sulphate  of 


360  Infectious  Pustular  Stomatitis  of  Horses. 

zinc  and  one  part  of  boracic  acid  (1  teaspoonful  per  cow) ;  Gallia 
advises  the  introduction  of  bacillol  capsules  into  the  vagina. 

Veterinary  Police.  The  most  important  measures  for  the 
prevention  of  the  spread  of  the  disease  consist  in  the  exclusion 
of  the  affected  animals  from  breeding  during  their  disease.  The 
infectiousness  of  the  animals  may  be  considered  extinct  when 
all  inflammatory  manifestations  of  the  genital  organs  and  the 
discharge  have  disappeared,  and  the  mucous  membrane  has 
regained  its  former  smoothness  and  pale  red  color.  During  a 
general  prevalence  of  the  disease,  the  prohibition  of  breeding 
is  indicated  until  the  disappearance  of  the  disease  in  the  affected 
localities. 

Literature.  Hertwig,  Mag.,  1842,  VIIT,  269;  1847,  XIII,  376.— Spinola,  Spez. 
Path.,  1858,  IV,  I486.— Hamni,  D.  Z.  f.  Tm.,  1901,  XVII,  147.— Kanipmann,  O.  Ee- 
vue,  1887,  81.— Fenner,  Moiih.,  1891,  II,  196.— Ehrhardt,  Schw.,  A.,  1896,  XXXVIII, 
79.— Streit,  B.  t.  W.,   1901,  496.— Nocard  &  Leclainche,  Mai.  microb.,  1903,  I,  598. 

Infectious  Sexual  Disease  in  Rabbits  and  Hares.  Friedberger  & 
Frohner  observed  an  infectious  disease  of  the  external  genital  organs 
(vulva,  preputium)  in  a  rabbit  breeding  establishment,  which  was  char- 
acterized by  swelling  of  these  parts,  and  by  a  muco-purulent  discharge. 
Treatment  continued  for  weeks,  with  a  1  to  2%  copper  sulphate  solution, 
resulted  finally  in  recovery.     (Spez.  Path.  1908,  II,  496.) 

A  similar  disease  in  rabbits  was  noted  by  Strangeways,  only  that 
in  this  case  ulcerations  developed  on  the  genitals,  and  also  on  the  lips 
and  nostrils.  The  autopsy  revealed  abscesses  of  the  internal  organs 
(J.  of  eomp.  Path.,  1906,  XIX,  9). 


4.    Infectious  Pustular  Stomatitis  of  Horses.    Stomatitis  pusto- 
losa  contagiosa  equorum. 

Infectious  pustular  stomatitis  is  a  benign,  acute  febrile 
infectious  disease  of  horses,  which  aside  from  its  pronounced 
contagious  nature,  is  principally  characterized  by  a  pustular 
exanthema  of  the  mucous  membrane  of  the  mouth.  The  caus- 
ative factor  is  at  present  unknown. 

History.  The  disease  was  first  described  under  the  present  name 
by  Eggeling  &  Ellenberger  (1880),  as  an  independent  affection.  For- 
merly it  was  identified  with  foot-and-mouth  disease  of  the  cloven-footed 
animals  (Roll),  or  with  coital  exanthema  (Hertwig),  and  again  by  some 
authors  (Gauthier,  Silvestri,  Flemming)  was  considered  identical  with 
horse  pox.  Since  the  publications  of  the  first  mentioned  authors,  whose 
observations  were  later  confirmed  by  Friedberger,  the  independence  of 
the  disease  is  generally  recognized  except  in  France  and  England,  where 
according  to  Bouley's  conception  it  is  even  at  the  present  considered 
as  horse  pox  (see  pp.  301  and  324). 

Occurrence.  The  disease  is  observed  especially  in  younger 
horses,  and  mostly  as  a  stable  infection.  Its  economic  impor- 
tance lies  in  the  fact  that  the  affected  horses  are  incapacitated 
for  work  during  its  duration,  and  are  poorly  nourished. 


OceuiToiice,     Etiolojry,      Syniptoiiis.  3()1 

Among  the  horses  of  the  Prussiau  Army,  liom  1904-190G,  48,  113  and  3  cases 
were  obseiveil,  and  in  1908,  16  cases  were  found. 

Etiology.  The  virus  is  apparently  eontainod  in  tlie  nodules 
and  pustules  on  the  mucous  membrane  and  skin,  and  becomes 
mixed  with  their  contents,  also  with  the  secretions  of  the  mucous 
membrane,  as  well  as  with  the  saliva  of  the  infected  animals. 
Horses  may  be  infected  by  rubbing  the  infectious  saliva  into 
the  niucous  membrane  of  the  mouth  or  nose,  or  by  superficial 
scarilication  of  the  skin;  sometimes  transmission  is  also  suc- 
cessful to  cattle,  sheep,  hogs  and  chickens  (Eggeling  cV:  Ellen- 
berger,  Friedberger).  Man  is  also  susceptible  to  a  certain 
degree,  as  fel)rile  dermatitis  with  pustular  formation  with  sah- 
vation  and  difficulty  in  swallowing,  has  been  observed  on  the 
hands  and  on  the  face  of  persons  who  were  employed  around 
infected  animals  (Greswell,  Ellenberger,  Sclmltz).  Under  nat- 
ural conditions  the  disease  occurs  only  among  horses. 

The  natural  infection  is  as  a  rule  "transmitted  by  the  saliva 
and  the  nasal  discharge  froni  affected  animals,  which  reaches 
the  mucous  membrane  of  healthy  animals  with  the  drinking 
water,  food,  straw^,  or  from  the  hands  of  the  attendants.  The 
fact  that  the  disease  does  not  spread  over  large  territories,  but 
disappears  of  itself  in  a  relatively  short  time,  indicates  that  the 
virulence  of  the  virus  is  attenuated  during  its  passage  from 
animal  to  animal,  or  that  the  virus  is  soon  destroyed  in  the  outer 
world. 

Young  horses  are  much  more  susceptible  than  older  ani- 
nials,^  l)ut  variations  in  the  susceptibility  are  also  noted  in  the 
individual  animals.  In  large  stables  most  horses  usually  become 
successively  affected,  some  however  remain  healthy.  Horses 
\vhich  _  recover  from  the  disease  resist  a  new  infection  for  a 
long  time,  the  extent  of  wdiich  is  not  known. 

Symptoms.  After  a  period  of  incubation  which  in  artificial 
inoculation  is  3  to  5,  and  in  natural  infections  8  days,  the  disease 
commences  with  a  moderate  fever,  which  is  manifested  by  a  rise 
in  temperature  of  from  1  to  l^U  degrees,  as  well  as  a  moderate 
acceleration  of  the  pulse  and  debility.  The  animals  take  their 
feed  more  slowdy,  masticate  cautiously,  and  enjoy  playing  with 
the  lips  in  the  w^ater  offered  them.  At  intervals'  they  keep  the 
mouth  closed,  when  from  its  corners  pure  saliva  drips  out  in 
long  threads. 

The  mucous  membrane  of  the  mouth  at  first  has  a  higher 
temperature;  it  is  painful  and  reddened  in  spots;  soon  the  red 
spots  coalesce,  and  at  the  same  time  hemp-seed  to  lentil,  or  even 
pea-size  hard  nodules  develop  on  the  inner  surface  of  the  lips, 
on  the  gums  lying  opposite,  and  also  on  the  intervening  folds, 
further  in  the  vicinity  of  the  f remim  of  the  tono-ue,  in  the  vicinity 
of  the  commissures  of  the  mouth,  and  on  the  inner  surface  of 
the  cheeks.  Fresh  nodules  continue  to  develop  for  2  to  3  days, 
until   they   appear   in   great   numbers   upon   these   places   and 


362 


Infectious  Pustular  Stomatitis  of  Horses. 


coalesce  in  part.  In  mild  cases  liowever  tliey  only  occur  in  small 
numbers.  With  the  reduction  of  the  fever  the  nodules  change 
into  vesicles  owing  to  dissolution  of  the  cellular  elements  and 
accumulation  of  pus  cells.    Those  which  develop  from  very  small 


Fig.  60.     Nodules,  pustules  and  ulcerations  in  the  infectious  pustular  stomatitis. 

nodules  contain  clear  serum,  and  after  they  burst  very  super- 
ficial erosions  remain  which  become  covered  with  fresh  epi- 
thelium in  from  1  to  2  days.  The  large  nodules  change  into 
pustules  after  the  conical  point  turns  gray  and  later  white. 


Syiiiptcnis.  3(53 

At  their  places  somewhat  dee)),  round  ulcers  develop  later,  wiiich 
extend  to  the  siibmucosa,  and  iiardly  ever  exceed  the  size  of  a 
lentil  (Fig.  GO). 

The  center  of  the  ulcers  is  formed  l)y  easily-bleedino-  oraiui- 
lation  tissue,  while  the  periphery  appears  covered  for  a  tune 
with  a  grayish-white  deposit.  After  granulation  tissue  lills  the 
ulcers  they  heal  with  line  scar  tissue,  which  later  gradually 
becomes  pale.  Only  when  the  suppuration  penetrates  deejjer 
does  a  thicker  scab  form,  which  becomes  distinct  from  the  other 
healthy  tissue  of  the  mucous  membrane  by  its  white  color  and 
moderate  de^jression. 

In  some  cases  the  process  also  extends  to  the  nasal  mucous 
membrane,  when  nodules,  and  from  these,  pustules  develop  on 
the  inner  surface  of  the  nostrils,  more  rarely  on  the  nasal  sep- 
tum, but  always  in  the  vicinity  of  the  border  of  the  skin.  The 
highly  reddened,  and  swollen  mucous  membrane  secretes  a  muco- 
purulent discharge,  which  dries  on  the  borders  of  the  nostrils 
to  brown  crusts.  The  intiammation  sometimes  extends  to  the 
eyes  by  transmission  through  the  lachrymal  duct,  the  conjunc- 
tivae then  showing  catarrhal  swelling,  while  from  the  slit  of 
the  lids  lachrymation  is  profuse.  The  secretions  sometimes  take 
on  a  purulent  consistency,  and  sometimes  small  pustules  may 
make  their  appearance  on  the  eyelids.  (Mieckley  observed  kera- 
titis, and  iritis,  associated  with  an  affection  of  the  mucous 
membrane.)  The  exanthema  has  exceptionally  been  observed 
also  on  the  inner  surface  of  the  viilva. 

Nodules  and  pustules  develop  on  the  mucous  membranes, 
and  sometimes  on  the  skin,  which  result  in  ulcerations.  Such  are 
especially  observed  on  the  skin  of  the  lips,  the  nostrils  and  the 
cheeks ;  in  exceptional  cases  also  on  distant  parts  of  the  body,  as 
on  the  chest,  on  the  upper  arms,  on  the  thighs,  in  the  vicinity  of 
the  rectum,  and  on  the  genitals,  occasionally  also  around  the  pas- 
tern, or  over  the  entire  skin  (Rehnitz).  On  the  affected  parts 
nodules  up  to  the  size  of  a  pea  develop  in  a  similar  way  as  on 
the  mucous  membrane,  only  that  dry  secretions,  together  witli 
sticky  tufts  of  hair,  cover  the  ulcers  in  the  form  of  lirown  scabs 
the  healing  progressing  subsequently  under  these  scabs. 

Dieckerhoff  observed  repeatedly  that  the  exanthema  in  some  horses 
of  large  stables  developed  exclusively  on  the  skin,  while  the  mouth 
remained  free  from  the  infection,  although  the  origin  and  the  nature 
of  the  infection  could  not  be  donhted,  as  typical  cases  occurred  at  the 
same  time  in  other  horses  of  the  same  stahle.  On  the  other  hand  Fried- 
berger  observed  a  case  in  which  the  nasal  mucous  membrane  and  the 
bordering  skin  were  alone  affected. 

An  inflaniniation  of  the  mouth  similar  to  pustular  stomatitis  has  boon  ob- 
serverl  by  Bochberfr,  which  appeared  iu  five  horses  of  a  largfe  stable.  Tn  this  in- 
stance pustules  with  depressions  in  the  centers  developed  also  in  the  neiphborinp 
skin. 

Tn  regfard  to  an  epi70otic  stomatitis  observed  by  Theiler  in  South  Africa,  see 
under  Chap:    Stomatitis  vesiculosa  Vol.   TT. 


364  Infectious  Pustular  Stomatitis  of  Horses. 

The  lymph  glands  in  the  immediate  vicinity  of  the  affected 
part  of  the  body,  that  is  the  retro-pharyngeal  glands,  become 
more  or  less  acutely  swollen.  The  swelling  diminishes  with  the 
formation  of  the  ulcers,  and  soon  disappears  entirely.  Excep- 
tionally however  it  may  lead  to  abscess  formation  (Mariott, 
Groner).  The  lymph  vessels  leading  to  the  swollen  hmiph 
glands  are  thickened  to  distinctly  perceptible  cords  in  those  cases 
in  which  the  exanthema  develops  on  the  skin.  They  likewise 
disappear  after  the  glands  have  regained  their  normal  condi- 
tion. If  the  inflammation  of  the  mouth  extends  posteriorly  the 
clinical  manifestations  include  symptoms  of  a  mild  pharyngeal 
and  laryngeal  catarrh.  Exceptionally  the  hair  falls  out  in  the 
course  of  the  disease,  and  the  animals  become  greatly  emaciated 
(Groner). 

Course.  The  disease  lasts  as  a  rule  from  10  to  14  days, 
but  in  somewhat  more  severe  cases  it  may  extend  to  3  or  4 
weeks.  The  pustules  develop  in  from  3  to  6  days  after  the 
appearance  of  the  first  symptoms.  The  suppuration  requires 
another  4  to  6  days,  and  the  healing  of  the  ulcers  requires  about 
the  same  length  of  time.  A  longer  course  is  observed  in  cases 
in  which  the  pustules  develop  in  slower  succession,  or  the  sup- 
puration becomes  malignant,  through  a  subsequent  septic  infec- 
tion, in  which  cases  the  healing  of  the  deeper  destruction  of  tis- 
sue requires  a  longer  time. 

Very  exceptionally  the  disease  may  also  terminate  in  death. 
Poschl  observed  in  a  stud  the  deaths  of  three  colts  with  mani- 
festations of  severe  pharyngitis  and  septicemia,  in  which  tlie 
autopsy  revealed  marked  swelling  and  suppuration  of  the  folli- 
cles of  the  mucous  membrane  of  the  pharynx  and  larynx,  hem- 
orrhages in  the  serous  membrane,  the  spleen  and  the  mucous 
membrane  of  the  stomach,  also  an  acute  swelling  of  the  mesen- 
teric lymph  glands.  In  one  case  (Bayr.  Mil.  V.-B.),  the  affection 
became  complicated  later  with  a  diphtheritic  inflammation  of  the 
buccal  mucous  membrane,  later  diphtheritic  ulcerations  ap- 
peared also  on  the  skin  and  on  the  nasal  mucous  membrane, 
and  the  animal  died  from  general  septicemia.  Goldschmidt  ob- 
served the  death  of  five  affected  horses  from  similar  causes. 

Diagnosis.  Vesicular  or  follicular  stomatitis  somewhat  re- 
sembles pustular  stomatitis,  but  in  the  former  no  nodules  pre- 
cede the  development  of  vesicles,  and  the  vesicles  contain  only 
a  clear  serous  fluid.  Inflammations  resulting  from  injuries  or 
corrosions  are  distinguished  from  this  affection  by  the  history 
of  the  case,  and  by  the  deeper  penetrating  destruction  of  tissues 
in  such  conditions. 

A  mistake  is  more  readily  possible  when,  besides  the  mucous 
membrane  of  the  mouth,  that  of  the  nose  and  the  skin  is  also 
affected,  and  still  more  when  the  affection  is  exclusively  localized 
to  these  parts.    In  such  cases  the  following  diseases  enter  into 


Diagnosis,  Treatment,  Prevention.  365 

consideration:  contagions  acne;  in  this  liowcvor  tho  pustnles 
are  always  larger,  they  nsually  (Icvclo))  only  in  the  region  of  the 
withers,  and  in  its  innnediate  surronnding,  while  they  never 
occur  on  the  mucous  membranes; — the  coital  exanthema,  in 
which  however  the  vesicles  arc  confined  to  the  mucous  mem- 
brane of  the  genital  organs  and  the  neighboring  i)arts  of  the 
skin,  and  usually  develop  after  copulation; — pox,  which  usually 
occurs  only  on  the  skin,  and  around  the  flexor  region  of  the 
pastern ; — glanders,  a  suspicion  of  which  may  sometimes  be 
aroused  by  tlie  affection  of  the  mucous  membrane  and  the  neigh- 
boring parts  of  the  skin,  also  by  the  swelling  of  the  lymph 
glands.  In  this  disease  however  there  are  no  changes  in  the 
buccal  cavity,  the  ulcerations  in  the  nose  develop  fi'om  nodules, 
and  the  ulcers  of  the  skin  show  no  tendency  towards  healing; 
in  doubtful  cases  the  rapid  spread  of  the  disease  in  stables, 
and  the  rapid  and  complete  recovery  excludes  glanders. 

Treatment.  In  the  mild  form  of  the  disease  a  purely  dietetic 
treatment  is  usually  sufficient.  Less  oats  should  be  given  to  the 
horses,  and  instead  they  should  be  given  green  feed,  soft,  fine 
hay,  or  f^our  and  bran  gruels,  also  pure,  fresh  water  frequently. 
It  is  advisable  to  flush  the  mouth  3  to  4  times  daily  with  any 
mild  disinfecting  fluid  (1  to  2%  solutions  of  iron  or  copper 
sulphate,  or  potassium  cldorate,  2  to  S^o  creolin  or  lysol).  The 
ulcers  on  the  skin  should  be  treated  in  a  similar  way  or  with 
dusting  powder  (dermatol,  tannoform,  etc.).  In  conjunctivitis, 
sulphate  of  zinc  or  tannin  (i^%)  gives  good  results. 

Prevention.  Not  infrequently  the  spread  of  the  disease  in 
the  threatened  stables  may  be  checked  by  immediate  isolation 
of  the  horse  first  affected.  For  this  purpose  it  is  sufficient  to 
separate  the  affected  animal  together  with  its  neighbor  by 
an  empty  stall  from  the  other  animals,  only  they  must  be  at- 
tended by  special  persons,  and  separate  utensils,  special  pails 
and  sponges  must  be  used  in  their  care. 

If  several  horses  are  already  affected  in  a  stable,  and  if  a 
spread  of  the  disease  is  expected  by  the  existing  conditions,  it 
is  advisable  to  undertake  emergency  inoculation  of  the  healthy 
animals  in  order  to  shorten  the  duration  of  the  disease.  The 
inoculation  is  readily  accomplished  by  rubbing  saliva  from  the 
affected  horses  on  the  inner  surface  of  the  lips,  which  have  been 
previously  rubbed  with  a  coarse  linen  cloth. 

After  the  disappearance  of  the  disease  the  stalls  of  the 
affected  horses  and  all  stable  utensils  should  be  washed  with 
a  hot  solution  of  lye. 

Literature.  Hertwig.  Ma<j.,  1841,  VITT,  305. — Boiiley,  Diet,  de  med.  vet.,  1871, 
IX,  451.— Eggeling  &  Ellenberger,  A.  f.  Tk.,  1878,  IV,  .i34.— Friclberger,  D.  Z.  f. 
Tm..  1879,  V.  26-5;  Mlinchn,  Jhb.,  18S2-8.3,  6(5;  188fi-S7,  50;  1^89-90,  141.— Diecker- 
hoflf,  Spez.  Path.,  1892,  I,  391.— Schultz,  Miineh.  m.  W.,  1S94.  201.— Groner,  Vet. 
Jhb.,  1895,  97.— Poschl,  A.  L.,   1904,  681.— Kehnitz,  S.  B.,  1906,  176. 


Group  III. 

ACUTE  INFECTIOUS  DISEASES  WITH  LOCALIZATION 
IN  CERTAIN  ORGANS 

1.    Strangles.    Adenitis  equorum, 

{Coryza  contagiosa   equorum;   distemper;  Druse  der  Pferde, 
[German];  Gourme  [French];  Adenite  equia  [Italian].) 

Strangles  is  an  acute,  contagious,  infectious  disease  of 
horses,  in  the  course  of  which  catarrhal  symptoms  of  the  upper 
air  passages  develop  in  association  with  suppurative  inflamma- 
tions in  the  adjoining  lymph  glands,  and  sometimes  in  a 
metastatic  form  in  more  distant  lymph  glands.  The  strepto- 
coccus equi  is  considered  at  the  present  time  as  the  cause  of 
the  disease. 

History.  The  disease,  which  is  very  prevalent  among  horses,  and 
especially  among  colts,  has  long  been  considered  as  a  specific  affection  of 
the  young,  which  was  supposed  to  be  essential  to  the  normal  develop- 
ment of  the  animal,  while  similar  affections  of  older  animals  were  con- 
sidered as  an  entirely  different  disease  (Solleysel,  Vitet,  Lafosse).  It 
was  also  supposed  (Spinola),  that  it  might  sometimes  lead  to  glanders 
(Traeger  [1886]  was  the  first  to  take  a  stand  against  this  view). 

Bowinghausen  recognized  the  contagious  nature  of  the  disease 
towards  the  end  of  the  eighteenth  century,  while  Viborg  demonstrated 
the  infectiousness  of  the  nasal  discharge  of  the  infected  horses  by  inocu- 
lation experiments  at  the  beginning  of  the  last  century.  Schiitz  in 
1888,  and  independently  of  him,  Jensen  &  Sand,  as  well  as  Poels,  estab- 
lished the  etiological  importance  of  the  streptococci  which  are  present 
in  the  nasal  discharge  and  in  the  pus  of  the  glands. 

Occurrence.  Strangles  occurs  almost  annually  in  studs  and 
sale  depots,  when  it  usually  affects  practically  all  the  young 
foals  in  a  varying  degree.  In  later  ages  it  is  rarely  observed, 
and  almost  exclusively  in  horses  which  have  not  passed  through 
the  disease  while  young.  It  occurs  almost  everyivhere  (Ireland 
and  Argentine  are  supposed  to  be  free  of  the  infection),  and 
although  its  course  is  usually  favorable,  yet  it  may  cause  con- 
siderable loss  to  the  horse  owner  through  frequent  disturbances 
in  the  development  of  the  colts,  and  also  by  occasional  deaths. 

In  the  years  1899-1908,  1753  horses  were  affected  with  strangles  in  the  Prus- 
sian   Army,    of   which    43    died,   and   49%    of   the    affections   occurred   in    the    last 

366 


Oceiirreiu-c.      Ktinl()"\-. 


367 


quarter  of  the  year.      In  the  Frem-li  Army  in  the  years   I'.hki  an.l    I'.tdl,   is, Id.")  ca-ses 
with  283  deaths  oecurred  among  about  100,000  horses. 

Etiology.  Streptococci  (Streptococcus  equi  Scliiitz)  are  in- 
variably present  in  the  lymph  glands  and  in  the  nasal  discharge 
of  alTected  horses,  formed  by  cocci  arranged  in  tiie  manner  of 
a  string  of  pearls;  these  are  not  always  uniform  in  size  and 
are  frequently  split  transversely.  The  rounded  chains  consist 
of  50  to  60,  and  even  more  segments,  but  much  shorter  chains, 
and  also  diplococci  and  single  cocci  may  occur.  They  stain  well 
with  aqueous  aniline  dves,  as  well  as  bv  Gram's  method  (Fig. 
61). 

Cultivation.  The  streptococcus  ecjui  may  he  cultivated  aerobically 
and  anaerohically,  at  room  as  well  as  body  temperature.  On  gelatin 
very  fine  white  jioints  develop  alotig  the 
inoculation  streak,  on  agar  the  colonies 
have  hardly  tlie  size  of  a  poppy  seed  :  they 
are  grayisli-wliite,  not  transparent,  not 
coalescing,  and  clo.sely  adhering  to  the 
medium.  On  coagulated  blood  serum 
glassy  transparent,  yellowish-gray  droplets 
develop,  which  later  may  coalesce  forming 
a  tenacious  layer.  In  the  water  of  con- 
densation a  fine  precipitation  results, 
which  consists  of  very  long  chains.  In 
bouillon  the  organisms  grow  in  fine  flakes, 
wliicli  accumulate  on  the  l)ottom  of  the 
tube  and  over  which  the  fluid  remains 
clear;  the  growth  is  favored  hy  the  addi- 
tion of  blood  serum.  No  growth  results  on 
potatoes.  Milk  is  coagulated ;  dextrose  is 
not  fermented. 


Fig.   61.      Htrrptococciis   equi. 
Pus  from  ghind  ;  f uchsin  stain- 
ing. 


The  relation  of  streptococci  from  different  derivations  to  each  other  has  not 
yet  been  sufficiently  established.  While  Schiitz  considers  his  streptococcus  as  an 
independent  species,  Foth  believed  it  identical  with  Schiitz 's  diplococcus  of  influenza, 
and  also  with  the  streptococcus  pyogenus  of  man.  Lignieres  considers  the  identity 
of  streptococcus  of  strangles  and  that  of  influenza  proven  beyond  a  doul)t.  while 
he  believes  that  Eosenbach  "s  jiyogenic  streptococcus,  which  among  other  <liseases 
plays  a  part  in  purpura  hemorrhagica  of  horses,  is  an  independent  species.  This 
conception  is  supported  also  by  the  experience  that  blood  serum  from  animals  immu- 
nized with  1  of  the  2  al>ove  mentioned  streptococci  immunizes  only  against  the  respec- 
tive varieties  (Lignieres),  and  the  serum  from  a  horse  treated  with  the  strepto- 
coccus of  strangles  agglutinates  this  streptococcus  in  the  proportion  of  1:100,  while 
other  p.vogenic  streptococci  from  animals  are  agglutinated  only  at  1:25,  and  the 
human,  on  the  other  hand,  have  only  a  very  slight  or  no  agglutinating  jjowers  (Pior- 
kowski).  Similar  results  were  also  observed  by  Angelici.  He  found  that  the  sertini 
of  a  horse  hyper-imnuinizeil  with  strangles  streptococci  had  an  agglutinating  value 
of  1:10000-20000,  whereas  streptococci  cultivated  from  wounds  and  intestinal  con- 
tents agglutinated  in  nuieh  lower  dilutions.  Marmorck  consi<lers  the  two  forms  of 
streptococci  as  not  identical,  based  on  his  observation  that  horse  streptococci  thrive 
in  filtrates  of  cultures  of  the  streptococcus  of  man.  Besides  this  Ludwig  found  some 
differences  in  inoculation  of  cultures  on  Loffler's  serum,  which  were  manifested  by 
the  fact  that  the  streptococcus  of  strangles  produced  larger  colonies  than  the 
streptococcus  of  man,  or  the  streptococcus  of  mastoitidis.  The  identity  of  the 
streptococci  of  different  origin  is  still  an  unsettled  question,  the  solution  of  which 
is  surrounded  by  great  difficulties  inasmuch  as  in  animal  experiments  one  and  the 
same  streptococcus  may  produce  various  disease  processes   (erysipelas,  suppuration). 

Baruchello  found"  streptococci  92  times  in  97  samples  of  feces  from  S7  horses, 


368  Strangles. 

which  he  considers  as  harmless  habitants  of  the  intestinal  tract,  l>ut  which  may 
become  harmful  under  certain  conditions,  alone  or  in  connection  with  colon  ba,- 
cilli. 

Tenacity.  Streptococci  belong  to  the  more  resistant  bacteria.  They  resist 
drying,  especially  in  pus  or  blood,  for  several  weeks.  A  temperature  of  70-75  de- 
grees destroys  them  in  1  hour,  while  frozen  bouillon  cultures  are  still  active  after 
two  days.  They  are  destroyed  inside  of  15  minutes  by  sulphuric  acitl  1:150,  sodium 
hydrate  1:85,  corrosive  sublimate  1:1500,  iron  sulphate  1:125,  carbolic  acid  or 
lysol   1:200,  and  creolin   1:S0    (Lingelsheim). 

Pathogenicity.  Subcutaneous  inoculations  of  a  pure  cul- 
ture,, or  pus  from  a  gland  produces  in  mice  a  purulent  inflam- 
mation of  the  subcutaneous  connective  tissue  and  lymph  glands, 
also  metastatic  abscesses  in  the  internal  organs.  Eabbits  are 
less  susceptible,  and  guinea  pigs  to  a  still  lesser  degree.  Intra- 
peritoneal inoculations,  however,  are  fatal  to  rabbits  (Ludwig), 
while  cutaneous  inoculations  into  the  ears  produces  erysipelas 
(Jensen  &  Sand).  A  subcutaneous  injection  in  horses  causes  a 
purulent  inflammation  at  the  point  of  inoculation,  with  partial 
necrosis  of  the  tissues;  an  injection  of  pure  culture  into  the 
nasal  cavity,  especially  if  the  mucous  membranes  have  been  pre- 
viously rul)bed,  develops  an  acute  nasal  catarrh,  and  suppura- 
tion of  the  submaxillary  lymph  glands;  therefore  the  typical 
clinical  manifestation  of  strangles  (Schiitz),  Rubbing  pus  con- 
taining streptococci  upon  the  scarified  skin  produces  a  felirile 
vesicular  dermatitis,  which  heals  within  a  short  time.  The  infec- 
tion of  cattle  is  sometimes  successful  (Jolly  &  Leclainche). 

Natural  Infection.  The  results  of  the  experiments  just 
alluded  to  indicate  that  the  causative  factor  of  strangles,  wdien 
reaching  the  nasal  cavities,  produces  there  a  purulent  or  muco- 
purulent inflammation  of  the  mucous  membrane ;  but  there  exists 
also  a  possibility  that  the  virus  may  primarily  attack  the  tissues 
from  other  organs,  especially  from  the  pharynx  and  the  intes- 
tines. Schiitz  based  the  belief  on  his  microscopical  examinations 
of  liver  sections  from  mice,  that  streptococci  penetrate  the  walls 
of  the  blood  capillaries,  and  that  therefore  the  infection  may 
take  place  through  the  uninjured  mucous  membranes.  As  strep- 
tococci may  easily  colonize  in  the  numerous  recesses  of  the  nasal 
cavities,  where  they  may  continue  to  multiply,  the  nasal  secre- 
tion of  infected  animals  may  transmit  the  disease  to  a  healthy 
horse  when  it  reaches  its  nasal  cavities. 

Under  natural  conditions  the  infection  occurs  usually 
through  the  nasal  secretion  or  pus  from  affected  animals  enter- 
ing, directly  or  by  transmission  with  contaminated  substances 
(food,  drinking  water),  the  upper  air  passages  of  a  healthy  horse 
(nasal  cavities,  buccal  cavities),  where  it  adheres  to  the  mucous 
membrane.  It  is  also  very  possible  that  infection  takes  place 
through  the  uninjured  mucous  membrane,  where  the  bacteria 
very  likely  penetrate  the  excretory  ducts  of  the  mucous  glands. 
The  disease  which  usually  attacks  all  the  colts  in  a  stable,  could 
hardly  be  explained  otherwise ;  on  the  other  hand  the  infection 
is  favored  by  conditions  of  the  mucous  membranes  in  which 


Xatural   liiiectioii.  3gC) 

there  is  a  (k'squainatioii  of  t'i)itlioliuiii,  or  Ity  (lcc[)  pciietratiii"- 
injuries. 

Tiie  disease  occurs  usually  when  alleetcd  or  not  entirely 
recovered  animals  are  introduced  into  the  stable.  The  outbreak 
of  the  disease  in  the  studs  of  Mezohei-yes  is  usually  associated 
with  the  introduction  of  colts  purchased  from  different  parts, 
and  from  similar  causes  the  disease  frequently  develops  in  colts 
at  remount  depots.  Accordin^^  to  the  investi.p^ations  of  Joliv  & 
Jieclainche  scabs  from  an  exanthema  of  the  skin  of  colts  affected 
with  strangles  may  also  disseminate  the  infection. 

The  air  evidently  plays  an  important  part  in  the  transmis- 
sion of  the  infection,  inasmuch  as  in  the  warm  and  moist  stable 
air  the  virus  expelled  durin.i;-  coughing-  and  blowing  may  float 
for  a  considerable  time  attaclied  to  the  di'oplets,  and  later  enter 
the  upper  air  passages  of  healthy  animals.  This  form  of  trans- 
mission through  the  air  is  k'ss  dominant  out  of  doors,  first 
on  account  of  the  smaller  quantity  of  moisture,  and  second  on 
account  of  its  more  rapid  movement,  which  re>sults  in  the  rapid 
dilution  of  the  expelled  virus. 

Through  contamination  with  nasal  discharge  and  pus  from 
the  glands  the  most  varied  objects  may  become  carriers  of  the 
infection,  such  as  cribs,  drinking  utensils,  the  food,  the  drinking 
water,  straw,  walls,  floor  of  the  stables,  the  grass  in  the  pasture, 
further  the  hands  and  clothes  of  the  attendaiits.  The  fresher  the 
secretion  the  greater  its  virulence;  drying  however  does  not 
wholly  destroy  its  infectiousness.  The  disease  usually  occurs 
annually  almost  at  the  same  time  of  the  year  in  stablesof  colts, 
if  they  have  not  in  the  meantime  been  cleaned  and  disinfected. 
It  usually  appears  in  the  spring,  and  it  is  not  possible  in  all 
instances  to  prove  a  fresh  introduction  from  the  outside.  In 
such  cases  it  must  be  assumed  that  the  virus  remained  in  the 
stable  after  the  disappearance  of  the  disease,  and  w^as  there 
dormant  for  months  until  it  again  attacked  the  susceptible  indi- 
viduals of  the  new^  generation  of  colts,  and  tliereby  caused  a  new 
outbreak  of  the  disease. 

The  infection  probably  enters  from  the  digestive  tract, 
and  especially  through  the  intestinal  mucous  membranes  in 
those  cases  in  which  it  affects  primarily  or  exclusively,  the 
lymph  glands  of  the  mesentery.  However  up  to  tlie  present 
time  it  has  not  been  possible  to  produce  this  form  of  the  disease 
by  feeding  infected  food. 

In  copulation  an  infected  stallion  may  transmit  the  disease 
to  mares,  and  in  such  cases  there  appear  symptoms  of  a  vaginal 
catarrh,  while  the  lymph  glands  in  the  vicinity  of  the  external 
genital  organs  and  of  the  rectum,  as  well  as  in  exceptional 
cases  also  the  udder,  become  affected  (van  Leeuwen,  Preuss. 
y.-B.,  Bierstedt).  Affected  colts  may  infect  their  mothers  dur- 
ing sucking  and  cause  an  inflamnuition  of  the  udder  and  the 
neigliboring  lymph  vessels  (Bermbach;  in  one  case  necrosis  of 
one  half  of  the  udder  and  later  a  fatal  septicemia  resulted). 

Vol.  1—24 


370  Strangles, 

There  is  another  possibility  which  has  been  emphasized 
by  Schiitz,  that  among  other  streptococci  which  are  very  widely 
distributed  in  nature  the  strejDtococci  of  strangles  may  live 
outside  of  the  animal  bodies  as  saprophytes,  and  under  favor- 
able conditions  may  attack  the  colts,  especially  when  the 
animals  are  weakened  by  outside  influences.  In  this  manner 
those  cases  can  be  explained  in  which  the  disease  appears  in 
localities  after  years  of  absence,  without  any  demonstrable  in- 
troduction. 

Solipeds  are  exclusively  susceptible  to  the  disease,  and  they 
become  infected  at  the  age  of  i/o  to  5  years,  mostly  however 
while  they  are  colts.  In  rare  cases  the  disease  may  occur  at 
the  age  of  1  to  2  months  and  also  in  animals  over  five  years 
of  age.  The  greater  susceptibility  of  young  animals  is  as- 
sociated with  the  lesser  resistance  of  their  mucous  membranes. 
The  greater  resistance  of  older  animals  is  however  probably 
the  result  of  their  having  already  passed  through  an  attack 
of  the  disease.  According  to  common  experience  it  usually 
attacks  animals  only  once  during  their  lives,  and  the  immunity 
resulting  from  one  attack  may  be  proven  experimentally 
(Toggia).  In  exceptional  cases  the  acquired  immunity  does 
not  last  through  the  entire  life,  as  some  horses  may  become 
affected  repeatedly,  but  in  such  cases  the  attacks  are  usually 
separated  by  intervals  of  several  years,  while  cases  in  which 
an  animal  becomes  repeatedly  infected  in  one  year  (Holterback) 
are  exceptionally  rare. 

According  to  Viborg  and  Hertwig  out  of  100  horses  affected  with  strangles 
70  were  less  than  5  years  old,  20  more  than  5  years,  ami  10  over  15  years.  Accord- 
ing to  Humbert's  observations  covering  four  years  in  the  vicinity  of  Snippes 
(France),  of  all  horses  over  two  years  of  age  2195  were  affected  once,  543  twice, 
i21  three  times,  and  1641  animals  did  not  contract  the  disease. 

Outside  influences  which  reduce  the  natural  resistance  of 
the  animals,  especially  colds,  favor  the  infection,  by  causing 
a  catarrh  of  the  mucous  membrane  of  the  air  passages,  as  a 
result  of  which  the  epithelia  become  loosened,  and  thereby  the 
bacteria  colonize  more  readily  in  the  profusely  accumulated 
secretion,  from  which  place  they  may  penetrate  the  tissue  of 
the  mucous  membrane. 

Usually  weakened  and  poorly  nourished  colts  are  particu- 
larly susceptible  to  the  disease.  In  this  regard,  stabling  in 
poorly  ventilated  excessively  warm  stables,  insufficient  feeding, 
sudden  changes  of  w^eather,  fatigue  during  transportation,  also 
pre-existing  illness  have  a  modifying  effect  on  the  individual 
susceptibility.  The  cases  in  older  horses  usually  have  a  direct 
connection  with  such  factors.  On  the  other  hand  the  resistance 
is  increased  by  work,  acclimation  to  the  changeable  outside  in- 
fluences and  hardening.  Other  accessory  conditions,  such  as 
temperament,  teething,  etc.,  have  no  influence  on  the  suscejD- 
tibility. 

Peterson  observed  an  instance  in  which  all  the  colts  of  a  stud  became  affected 
with  strangles  after  standing  for  half  an  hour  in  a  pond,  and  later  being  exposed  on 


Natural   Iiifectiuii.    Pathogenesis.  371 

a  liigh  elevation  to  cohl  winds,  and  being  further  provided  with  coM  water  to  drink. 
According  to  Cagnj'  the  disease  occurs  in  certain  localities  ot"  France  less  fre- 
quently and  runs  a  milder  course  since  the  colts  are  driven  home  from  the  pas- 
tures  in   the   month   of   September. 

Pathogenesis.  The  streptococci  which  roach  the  surface  of 
the  nasal  inueous  iiiembraiie,  colonize  in  the  numerous  side 
cavities  of  the  upper  air  }nissages,  and  after  multiplying  there 
they  penetrate  the  mucous  glands,  from  which  they  pass  into 
the  lymph  spaces  of  the  tissue  of  the  mucous  membranes,  along 
which  they  gain  entrance  to  the  submaxillary  lym])li  glands.  In 
case  of  an  infection  from  the  mucous  meml)rane  of  the  i)harynx, 
intestines,  or  vagina,  they  are  held  up  in  the  neighboring  lynii)li 
glands. 

Under  the  local  influence  of  the  penetrating  bacteria 
hyperemia  and  serous  inliltration  of  the  tissues  develop,  also 
in  some  places  necrosis  of  the  superficial  epithelial  layer  of 
the  mucous  membrane.  Serous  fluid  oozes  from  the  surface, 
and  at  the  same  time  the  secretion  of  the  mucous  glands  is 
increased.  In  the  h^npll  glands  a  migration  of  the  leucocjies 
commences  under  the  positive  chemotactic  action  of  the  strep- 
tococci or  their  toxins,  and  probably  also  because  of  an  increase 
of  l\nnpliocytes.  The  glandular  tissue  proper  however  becomes 
partly  dissolved,  probably  under  the  influence  of  a  peptonizing 
ferment.  In  this  manner  large  suppurative  areas  develop  in 
the  lymph  glands,  the  tissues  surrounding  them  showing  usually 
a  marked  swelling,  due  to  inflammatory  edema. 

Superficial  abscesses  usually  open  through  the  outer  skin, 
in  which  case  the  body  rids  itself  of  the  infective  substance. 
From  the  first  affected  hmiph  glands,  however,  the  bacteria 
may  pass  along  the  lymph  vessels  to  the  neighboring,  as  well 
as  distant  lymph  glands  in  the  body,  in  which  they  cause  similar 
inflammatory  processes.  Besides  this  the  streptococci  may 
enter  the  blood  stream  by  their  power  to  penetrate  the  waifs 
of  the  vessels,  and  may  thus  be  carried  to  all  parts  of  the  body, 
producing  metastatic  abscesses  in  various  organs  aside  from 
the  h^llph  glands,  or  they  may  cause  a  general  septicemia. 

The  acute  inflammatory  character  of  the  local  disease  process,  and 
the  associating  febrile  manifestations  indicate  that  the  streptococci 
exert  their  pathogenic  action  through  toxins.  As  a  matter  of  fact  the 
experiments  conducted  with  Rosenbach's  streptococcus  gave  positive 
results  Qlarmorek,  Baginsky  &  Sommerfeld.  ^Marmier  and  others),  and 
the  pathogenic  action  of  the  toxin  of  this  streptococcus  manifested  itself 
in  local  acute  inflammation,  fever,  and  diarrhea.  In  less  severe  intoxi- 
cations, emaciation  and  sometimes  paralysis  resulted.  Some  strains 
produce  toxins  which  possess  hemolytic  properties  (Besredka,  Xeisser 
&  Wechsherg  and  others). 

In  exceptional  cases  foals  may  be  born  with  the  affection 
(Nocard,  Choisy).  The  ability  of  the  streptococci  to  penetrate 
the  walls  of  the  vessels  explains  the  occurrence  of  intrauterine 
infection.     In  such  cases  pharyngitis  and  suppuration  of  the 


372  Strangles. 

submaxillary  lymph  glands  were  repeatedly  observed  in  preg- 
nant mares  (Trelut). 

Anatomical  Changes.  In  addition  to  inflammatory  changes 
in  the  superficial  lymph  glands,  frequently  the  size  of  a  fist, 
autopsy  exceptionally  reveals  abscesses  the  size  of  a  child's 
head  in  the  mediastinum  and  in  the  vicinity  of  the  bronchi. 
They  are  filled  with  white,  creamy  pus  containing  streptococci, 
and  are  frequently  divided  into  several  sections  by  connective 
tissue  walls.  By  their  presence  the  trachea  or  the  neighboring 
bronchus  may  be  pushed  to  one  side  and  may  also  become 
compressed.  At  the  same  time  there  may  be  present  a  purulent 
inflammation  of  the  pleura  and  pericardium.  In  the  lungs  there 
is  sometimes  only  hyperemia  and  acute  edema,  at  other  times 
a  catarrhal  pneumonia,  or  in  its  tissue  various  sized  abscesses 
may  be  imbedded,  which  are  sometimes  very  numerous.  The 
mucous  membrane  of  the  bronchi  and  trachea,  also  of  the 
pharynx  is  always  hyperemic,  loosened  and  sprinkled  with 
ecchymoses,  and  covered  with  considerable  quantities  of  mucous 
or  purulent  secretions.  There  is  frequently  a  gelatinous  in- 
filtration of  aryteno-epiglottic  ligaments. 

The  Ijanph  glands  of  the  mesentery  frequently  change  to 
large  suppurating  masses,  when  the  peritoneum  shows  marked 
injection,  and  the  abdominal  cavity  contains  larger  or  smaller 
quantities  of  purulent  exudate.  Animals  which  die  after  long 
illness  are  sometimes  found  to  be  affected  with  one  or  more 
large  abscesses  with  thick,  purulent  or  caseous  contents  and 
adhesions  of  the  neighboring  loops  of  intestines  by  dense  con- 
nective tissue.  Abscesses  may  also  be  present  in  the  kidneys, 
liver,  spleen  (this  is  sometimes  greatly  enlarged  and  contains 
numerous  suppurative  areas,  Lesage;  fatal  bleeding  may  take 
place  into  the  cavity  of  a  large  abscess,  Berton),  pancreas  and 
in  the  psoas  muscle,  further  in  the  brain  and  in  the  spinal 
cord,  in  which  they  are  usually  associated  with  purulent  in- 
flammation of  the  meninges.  They  may  also  be  present  in  the 
muscles  of  the  neck,  and  in  the  axillary  region,  in  the  inguinal 
region,  in  the  tissue  surrounding  the  anus,  in  the  different 
joints,  testicles,  the  udder,  thymus  gland,  heart  muscle,  etc.  In 
exceptional  cases  the  mucous  membrane  of  the  stomach  may  be 
separated  from  the  muscular  coat  by  a  flat,  diffused  layer  of 
pus  several  millimeters  in  thickness. 

The  autopsy  may  sometimes  reveal  degenerative  changes 
in  the  parenchymatous  organs  indicating  pyemic  or  septicemic 
infection. 

Symptoms.  After  a  period  of  incubation  of  4  to  8  days, 
which  possibly  may  last  only  1  to  2  days,  especially  after 
colds,  exhaustion,  etc.,  the  disease  commences  with  symptoms 
of  an  acute  febrile  affection,  such  as  debility,  diminished  ap- 
petite, and  increased  body  temperature.  Almost  at  the  same 
time,  or  not  later  than  after  1  to  2  days,  symptoms  of  acute 


Symptoms. 


373 


nasal  catarrh  appear.  The  mucous  membrane  of  the  nose  is 
first  liighly  re(UkMied,  warm,  and  dry,  soon  the  secretion  becomes 
profuse,  consisting-  at  first  of  a  clear  or  only  slightly  tuibid 
fluid,  Jater  it  is  teiuicious,  after  3  to  4  days  it  is  niuco-i)urul('iit, 
and  finally  })ni-ukMit  (rhinitis  blenorrhoica).  At  this  stage  the 
discharge  is  profuse,  and  flows  in  great  quantities  from  the 
nasal  openings  over  the  upper  lips.  In  colts  the  discharge 
is  usually  crumbly,  loss  sticky,  and  the  patients  expel  it  in  great 
balls  during  coughing  or  blowing.  The  animals  cough  much, 
and  frequently  manifest  more  or  less  pronounced  symptoms 
of  an  initial  pharyngitis;  in  this  stage  an  acute  catarrh  of  the 
buccal  mucous  membrane  and  the  conjunctiva  may  also  be  ob- 
served. 

In  rare  cases  the  mucous  glands  of  the  nasal  mucous  membrane 
are  swollen  to  hemp-seed  sized  hard  nodules,  or  small  vesicles  develop 
on  the  membrane,  which  later  siipiJurale   (on  tlic  Itasis  of  sncli  exi)eri- 


t 


JL 


Fig.  62.     Strangles.     Commencing  swelling  of  the  submaxillary  lymph  glands. 

ences  Trasbot  incorrectly  considered  strangles  as  a  disease  identical 
with,  or  at  least  related  to  pox).  Still  less  frecpiently  the  mucous  mem- 
brane may  reveal  urticaria-like,  flat  pla(iues,  which  are  the  result  of 
serous  infiltrations  of  the  suhmucous  connective  tissue.  According  to 
Rabe  the  sti-eptococcus  may  also  cause  an  extensive,  ulcerating  intTam- 
mation  of  the  nasal  nuicous  meml)rane,  which  can  only  be  distinguished 
from  ulcers  of  glanders  hy  their  vivid,  reddened  borders,  and  similarly 
ri-ddened  base,  also  by  the  numerous  streptococci  which  are  found  in 
the  discharge.  Peters  ohserved  in  a  colt  a  necrosis  of  the  bony  parts 
of  the  nose  as  the  result  of  an  infection  with  strangles. 

In  the  great  majority  of  cases  an  acute  swelling  of  the 
submaxillary  lymph  glands  may  be  noted  with  the  first  appear- 
ance of  the  catarrhal  symptonis  (Fig.  02).     The  lobular  struc- 


374  Strangles. 

ture  is  still  markedly  perceptible  at  this  time,  but  the  individual 
lobules  are  larger,  firmer,  and  painful  on  pressure.  They  soon 
coalesce,  forming  a  uniformly  hard  growth,  which  rapidly  in- 
creases in  size,  fills  up  the  intermaxillary  space,  later  also  the 
throat  and  parotid  regions,  and  may  extend  also  to  the 
lower  border  of  the  cheeks.  It  is  not  sharply  circumscribed, 
but  is  firm,  taut,  w^arm  and  painful,  and  the  animals  hold  their 
heads  stiffly  extended.  After  the  swelling  reaches  a  certain 
size  it  remains  apparently  unchanged  for  several  days;  finally 
however  a  distinct  fluctuation  api^ears  in  one  or  more  places, 
while  in  other  parts  it  remains  hard  and  tense.  The  hair  falls 
out,  over  the  affected  places,  and  from  these  hairless  surfaces 
a  yellowish  sticky  fluid  oozes  out,  the  skin  proper  becomes 
thin,  and  at  certain  points  a  dark  brown  discoloration,  and 
finally  a  conical  prominence  appears,  which  soon  bursts,  where- 
upon from  the  resulting  opening  white  or  slightly  yellowish, 
creamy  pus  is  evacuated  in  profuse  quantities.  If  the  abscess 
is  opened  the  pus  squirts  out.  If  several  fluctuating  places  form 
on  the  surface  of  the  swelling  ruptures  may  occur  at  several 
places,  usually  following  each  other  in  rapid  succession.  Ad- 
joining abscesses  may  coalesce  by  the  breaking  down  of  the  sepa- 
rating walls,  and  evacuate  their  pus  from  a  single  opening;  or 
after  the  bursting  of  an  abscess  the  contents  of  the  adjacent 
abscess  may  break  into  the  first  evacuated  cavity  through  the 
sudden  relaxation  of  pressure. 

After  the  evacuation  of  the  pus  the  inflammatory  edema 
of  the  surrounding  parts  diminishes  rapidly,  and  the  swelling 
subsides  in  1  to  2  days.  Prom  the  opening  however  pus  and 
later  a  lymph-like  fluid  oozes  out  for  several  days,  until  finally 
the  cavity  fills  up  with  granulation  tissue,  the  borders  of  the 
opening  close,  the  swelling  disappears  entirely,  and  recovery 
takes  place. 

The  microscopical  examination  of  the  nasal  discharge  discloses  loosened  pave- 
ment and  cylindrical  epithelial  cells,  fatty  degenerated  cells,  and  leucocytes.  The 
discharge  from  the  abscesses  contains  pus  cells,  sometimes  intermixed  with  granular, 
broken-down  tissue  elements.  Cover  glass  preparations  stained  with  aqueous  aniline 
dyes  or  after  Gram's  method,  show  long,  curved  chains  of  cocci  in  the  pus  (see  fig. 
61,  p.  367),  while  in  the  nasal  discharge  the  chains  are  shorter,  and  other  forms  of 
bacteria  are  present.  According  to  Bermbach  and  Baruchello  the  nasal  discharge 
and  in  the  early  stages  also  the  pus  of  the  glands  contain  pyogenic  staphylococci, 
which  aid  the  streptococci  in  the  execution  of  their  pathogenic  action.  The  pus 
of  the  pharyngeal  or  mesenteric  abscesses  may  also  contain  other  bacteria,  (Cuille 
found  in  them  a  Gram-positive,  thread-forming  anaerobic  bacillus),  which  evidently 
gained  entrance  by  subsequent  migration. 

The  respiration  is  accelerated  even  in  the  milder  cases, 
but  it  is  of  a  normal  type  if  there  is  no  severe  pharyngitis 
and  laryngitis  present.  When  the  inflammatory  process  extends 
to  the  larynx,  a  moist,  painful  and  spasmodic  cough  is  observed, 
which,  together  with  the  sensitiveness  of  the  larynx  persists 
for  1  to  2  v/eeks  after  the  abscesses  break.  If  there  is  a  pro- 
nounced swelling  of  the  aryteno-epiglottic  ligaments  the  respira- 
tion becomes  rattling,  whistling  and  very  labored. 


Symptoms.  375 

At  the  onset  oi'  the  disease  the  heart's  action  is  onlj^ 
slightly  accelerated;  with  the  advance  of  the  snppurating 
process  however  the  nnniher  of  heart  beats  may  double,  but 
the  i)ulse  remains  even  tiien  full  and  tense. 

The  body  temperature  reaches  a  high  degree  even  on  the 
first  day  (40^-41^).  On  the  following  days  it  drops  slightly, 
but  on  the  appearance  of  supi)uration  a  new  rise  is  observed, 
and  then  the  fever  remains  at  a  comparatively  uniform  heigiit, 
until  the  termination  of  the  suppurating  process,  or  until  the 
bursting  of  the  abscesses.  From  this  stage  on  the  temperature 
diminishes  rapidly,  and  becomes  normal  after  1  to  2  days. 

The  nutrition  is  disturbed  in  all  cases,  not  only  on  account 
of  the  difficult  mastication  caused  by  the  swelling  of  the  sub- 
maxillary tissue,  but  also  because  of  the  difficult  deglutition 
brought  on  by  the  pharyngitis.  The  appetite  is  diminished  from 
the  onset  of  the  disease,  and  the  patients  take,  at  best,  only 
small  quantities  of  hay  or  green  feed. 

Defecation  is  at  first  retarded,  and  later  an  intestinal 
catarrh  sets  in  not  infrecpiently  with  the  well-known  symptoms. 

Tlie_  urine  is  passed  in  diminished  amount,  its  specific 
gravity  is  increased,  and  in  the  later  stages  it  often  contains 
considerable  quantities  of  albumen.  With  the  ripening  of  the 
abscesses  the  quantity  of  indican  is  considerably  increased, 
but  drops  to  normal  after  the  evacuation  of  the  pus ;  during  con- 
valescence pohiTria  lasting  for  several  days  is  occasionally  ob- 
served. 

During  the  beginning  or  the  termination  of  the  disease, 
the  skin  shows  not  infrequently  an  extensive  urticaria,  lasting 
only  for  a  short  time,  or  small  vesicles  may  develop  rapidly, 
which  are  filled  with  clear  serous  fluid.  Thin  scabs  form  later 
at  these  places,  and  finally  fine  white  scars  remain  (according 
to  AVoronzow  such  a  skin  eruption  may  precede  the  character- 
istic symptoms  of  strangles).  Places  of  predilection  for  the 
eruptions  are  the  cheeks,  the  parts  around  the  nose  and  mouth, 
the  neck,  the  sides  of  the  chest,  and  the  flexor  sides  of  the 
joints. 

Atypical  Forms.  In  every  outbreak  there  occur  cases  in 
which  the  manifestations  deviate  considerably  from  the  de- 
scribed symptoms,  and  accordingly  the  course  of  the  disease 
appears  varied. 

In  this  category  belong  undoubtedly  those  catarrhal  affec- 
tions of  the  upper  air  passages  and  the  pharynx,  which  are 
observed  during  the  disease  in  a  smaller  or  greater  number 
of  animals  of  the  same  stable,  without  the  development  of  the 
characteristic  suppurative  inflammation  of  the  lymph  glands, 
or  without  their  having  any  participation  in  the  disease  process. 
These  catarrhs  also  develop  apparently  as  a  result  of  the 
specific  streptococcus  infection,  but  inasmuch  as  the  bacteria 
do  not  penetrate  to  the  lymph  glands,  these  remain  intact  or 
show  only  an  insignificant  swelling.    The  catarrh  of  the  atfected 


376  Strangles. 

mucous  membranes  is  manifested  by  the  ordinary  sjTuptoms; 
the  nasal  catarrh  is  sometimes  very  mild,  but  the  mucous 
membrane  maj  secrete  a  profuse  purulent  discharge,  while 
suppurative  inflammation  of  the  lymph  glands  does  not  take 
place. 

The  inflammation  of  the  lymph  glands  does  not  in  all  cases 
lead  to  suppuration  and  abscess  formation.  Especially  in  older 
horses  the  swelling  of  the  Ijanph  glands  may  come  to  a  stop 
at  a  certain  time,  whereupon  it  gradually  retrogresses,  and 
finally  disappears  entirely,  only  a  slight  thickening  remaining 
in  some  cases. 

More  important  are  those  complications  which  result  from 
the  extension  of  the  inflammatory  process  to  the  immediate 
surroundings,  or  to  metastatic  processes. 

The  inflammatory  process  extends  most  frequently  to  the 
region  of  the  pharynx,  which  then,  together  with  the  subparotid 
glands,  and  the  laryngeal  region,  swells  to  a  high  degree.  The 
swelling  is  usually  caused  by  an  inflammatory  edema  of  the 
subcutaneous  connective  tissue,  which  results  from  severe  in- 
flammation of  the  submaxillary  lymph  glands. 

Unfavorable  significance  attaches  to  cases  in  which  pharyn- 
gitis becomes  associated  with  purulent  inflammation  of  the 
retropharyngeal  lymph  glands.  In  such  instances  the  swelling 
alwaj^s  attains  a  very  high  degree,  and  is  either  uniformly 
distributed  on  both  sides,  or  more  marked  on  one  side.  At 
the  same  time  symptoms  of  severe  pharyngitis  are  present. 
Excluding  the  regurgitation  caused  by  the  serous  infiltration 
of  the  pharyngeal  muscles,  swallowing  is  rendered  difficult  or 
even  impossible,  by  a  marked  extension  of  the  posterior  wall 
of  the  pharynx.  Besides  this,  the  larynx  may  be  forced  down- 
wards and  forwards  by  the  swelling  and  thereby  cause  inspira- 
tory dyspnea  and  stenosis.  Finally  the  suppurating  abscesses 
in  the  pharjmgeal  wall  may  burst  in  any  direction.  This  occurs 
most  easily  into  the  pharyngeal  cavity,  especially  when  the 
mucous  membrane  is  necrotic  in  places.  In  such  cases  a  great 
quantity  of  pus  is  suddenly  evacuated  by  the  mouth  and  nose, 
and  then  it  is  always  possible  that  the  suddenly  eliminated  pus 
may  be  aspirated  through  the  laryngeal  opening  into  the  deeper 
air  passages.  In  other  cases  the  suppurative  process  pene- 
trates to  the  outside,  and  finally  reaches  the  lower  parotid 
region,  or  the  vicinity  of  the  larynx  under  the  skin ;  after  the 
perforation  of  this  part  the  pus  is  evacuated  outside.  Ex- 
ceptionally the  perforation  may  take  place  both  to  the  outside 
and  inside,  which  leads  to  the  formation  of  a  pharyngeal  fistula, 
the  healing  of  which  usually  requires  a  long  time.  The  condition 
becomes  still  more  aggravated  in  case  the  inflammation  extends 
to  the  soft  palate,  or  downwards  and  forwards  to  the  muscles 
of  the  hyoid  bone  (muse,  omohyoideus  and  muse,  hyoideus),  in 
which  cases  swallowing  is  impossible  and  the  danger  of  an 
inhalation  pneumonia  becomes   greater.     The  catarrh  of  the 


Atypical  Forms  3yy 

nasal  cavities  may  also  extend  to  lli^^hniore's  cavity,  and  load 
to  necrosis  ol"  the  l)ony  walls,  and  to  cerebral  meningitis  (Nagy). 
This  may  also  develop  by  the  suppnrating  process  progressing- 
along  the  nerve  trunks  into  the  cranial  cavity  (Augustin).  The 
abscess  may  also  burst  into  the  vertebral  canal,  whereuj)()n 
paralysis  of  the  fore  parts  develops  suddenly;  with  this  symp- 
toms of  general  spinal  meningitis  become  rapidly  associated 
(Frohner). 

An  affection  of  the  subi)ar()tid  lymi)h  glands  results  also 
in  marked  swelling  of  one  or  both  of  the  lower  regions,  but  the 
abscesses  burst  either  into  the  laryngeal  cavity  or  the  pus  sinks 
downwards  along  the  jugular  groove  until  it  finally  finds  its  way 
out  in  the  middle  of  the  neck  or  immediately  anterior  to  the 
entrance  into  the  thorax.  The  inflanunatory  process  may  fur- 
ther extend  to  one  or  both  guttural  pouches,  which  in  such 
cases  become  filled  with  pus,  and  the  swelling  thus  produced 
may  reach  the  size  of  a  child's  head  (in  such' cases  a  marked 
dyspnea  is  always  present).  In  rare  cases  the  subparotid  ab- 
scesses burst  into  the  guttural  pouches,  from  which  the  pus 
is  discharged  by  the  nose  through  the  existing  openings  of 
connnunication;  a  portion  however  may  remain  in  the  guttural 
pouch  and  change  into  a  caseous,  or  later  a  mortar-like  mass. 

If  the  abscess  develops  in  the  deeper  layers  of  the  larvngeal 
region,  directly  under  the  floor  of  the  buccal  cavity,  painful, 
hard,  later  fluctuating  swellings  develop  in  the  vicinity  of  the 
frenum  of  the  tongue,  by  which  the  veins  and  lymph  vessels 
of  this  region  are  compressed,  and  a  serous  infiltration  of  the 
tongue  results.  This  organ  is  then  considerably  enlarged,  and 
the  tip  protrudes  between  the  teeth,  while  saliva' flows  profuselv 
from  the  mouth.  The  abscess  usually  opens  into  the  buccal 
cavity,  whereupon  the  swelling  of  the  surrounding  parts  and 
the  tongue  diminishes  promptly,  and  the  abscess  cavity  rapidly 
fills  with  granulation  tissue. 

The  affection  of  the  submaxillary  hinph  glands  is  some- 
times associated  with  an  inflammation  of  the  superficial  lymph 
vessels  of  the  head.  In  such  cases  the  Ijinph  vessels  leading 
from  the  eyes,  cheeks,  nose  and  lips  swell  to  painful  cords, 
the  thickness  of  a  pencil,  while  the  surrounding  connective 
tissue  appears  diffusely  infiltrated.  Later  small  nodules  ap- 
pear along  the  lymph  vessels,  which  develop  into  abscesses. 
At  the  same  time  the  swelling  of  the  surrounding  tissues  reaches 
a  very  high  degree,  and  the  nostrils,  cheeks  and  lips  becoine 
greatly  thickened  (formerly  known  as  'Mienign  farcy").  There 
may  also  be  associated  a  diffuse  purulent  inflammation  of  the 
subcutaneous  connective  tissue  of  the  head  and  neck.  In  such 
cases  the  affected  parts  of  the  body  are  greatly  deformed,  at 
the  same  time  high  fever  is  present,  and  the  respiration  be- 
cause of  the  swelling  around  the  nasal  openings  is  very  difficult. 
If  the  inflammatory  process  reaches  such  a  high  degree  it  almost 
invariably  results  in  fatal  septicemia  or  pyemia. 


378  Strangles. 

The  spread  of  the  inflammation  to  the  lymph  glands  of  the 
neck  results  in  inflammatory  swellings  of  one  or  both  sides  of 
the  neck,  which  later  open  to  the  outside.  More  dangerous  are 
those  abscesses  which  develop  from  the  retrotracheal  connec- 
tive tissue.  In  these  cases  bursting  not  infrequently  takes  place 
both  to  the  inside  and  outside,  and  the  resulting  fistulae  usually 
heal  very  slowly  or  not  at  all.  Abscesses  developing  in  this  part 
may  also  cause  severe  dyspnea  and  difficulty  in  swallowing 
by  pressing  on  trachea  and  esophagus.  If  inferior  cervical 
glands  in  front  of  the  chest  are  involved,  a  marked  swelling 
results,  which  may  gradually  extend  to  the  lower  two  thirds 
of  the  neck.  The  fascia  of  the  neck  affords  usually  a  sufficient 
guard  against  the  pus  breaking  into  the  thoracic  cavity;  but 
sometimes  the  swelling  exerts  such  a  pressure  on  the  trachea 
and  the  large  blood  vessels  that  the  animals  finally  die  from 
asphyxiation.  In  rare  cases  the  inflammation  may  extend  also 
to  the  organs  of  the  thoracic  cavity,  and  in  such  instances  there 
exists  danger  of  general  fatal  infection. 

The  inflammation  of  the  axillary,  inguinal,  popliteal  and 
precrural  lymph  glands  is  not  dangerous  in  itself  on  account  of 
the  superficial  location  of  these  glands.  Their  involvement 
is  indicated  by  the  inflammatory  swelling  of  the  affected  parts 
and  by  the  disturbance  of  locomotion,  which  how^ever  disappears 
rapidly  after  the  abscesses  burst.  Suppuration  in  the  perianal 
glands,  which  also  usually  burst  to  the  outside,  may  cause  an 
obstruction  of  the  feces,  sometimes  also  symptoms  of  inflam- 
mation of  the  rectum;  there  may  be  added  an  involvement  of 
the  pelvic  lymph  glands  with  extensive  abscess  formation. 
An  affection  of  the  mammary  lymph  glands  is  usually  asso- 
ciated with  severe  inflammatory  swelling  of  one  or  both  halves 
of  the  udder. 

The  inflammation  of  certain  joints,  which  sometimes  de- 
velops in  association  with  the  disease,  causes  painful,  hot  swell- 
ings and  marked  lameness.  The  knee,  pastern  and  coronary 
joints  become  affected  relatively  most  frequently,  and  the  in- 
flammation occurs  in  one  alone  or  in  several  joints  at  the  same 
time.  In  some  cases  a  phlegmonous  inflammation  of  the  sub- 
cutaneous tissue  develops,  which  later  results  in  necrosis  of 
the  skin  and  inflammation  of  the  adjacent  tendon  sheaths,  espe- 
cially in  the  pastern  and  the  fetlock  joints. 

The  mediastinal  and  the  mesenteric  lymph  glands  are 
among  the  internal  lymph  glands  most  frequently  affected.  An 
involvement  of  the  mediastinal  lymph  glands  can  be  established 
in  the  living  animals  only  with  very  great  difficulty.  Under 
febrile  symptoms  severe  disturbances  in  respiration  develop 
gradually  without  it  being  possible  to  establish  an  affection  of 
the  thoracic  organs  by  percussion  or  auscultation.  The  contrast 
between  the  striking  disturbance  in  respiration  and  the  nega- 
tive results  of  the  physical  examination  points  to  an  affection 
of  the  diaphragm  if  there  is  a  suspicion  of  infection.     This 


Atyptiful   Fdniis.  Ji'TQ 

may  infroqiicntly  lead  to  ra])i(]  dcalli  I'l-om  i)iinil('iit  pleurisy, 
tliroii.nh  an  extension  of  tlie  intiaiiiniation  to  tlio  pleura  or  the 
bursting  oi'  an  abscess  between  the  layers  of  the  pleura.  In 
the  meantime  catarrhal  or  purulent  pneumonia  may  develop 
with  invariably  fatal  results.  In  affections  of  the  peribronchial 
glands  Chaussee  observed  in  one  case  a  venous  pulse  on  the 
neck  and  nuirinurs  of  stenosis. 

The  affection  of  the  mesenteric  lymph  glands  which  some- 
times develops  primarily,  more  frequently  however  in  the  later 
course  of  typical  strangles,  and  after  tlie  healing  of  the  sub- 
maxillary ^lesions,  is  very  diflicult  to  recognize  in  the  living 
animal.  Usually  only  disturbances  of  digestion  lasting  for  sev- 
eral weeks  are  observed,  indicated  by  constipation  alternating 
with  diarrhea,  nioderate  colicky  symptoms,  and  persistent  fever, 
as  well  as  rapid  emaciation,  until  tinally  the  animals  die  from 
exhaustion,  or  a  purulent  peritonitis  sets  in  suddenly  which  then 
rapidly  results  in  death.  In  rare  cases  abscesses  in  the  mesen- 
tery may  open  into  the  intestines,  whereupon  recovery  takes 
place,  while  the  development  of  abscesses  iji  the  gastric  region 
may  result  in  a  rupture  of  the  stomach  (Bolz). 

The  primary  affection  of  the  mesenteric  lymph  glands  is,  according 
to  the  o])servation  of  Szollos,  inaugurated  by  a  sudden  illness,  with 
symptoms  of  acute  gastro-intestinal  catarrh,  Avhich  either  leads  to' death 
in  a  short  time,  or  disappears  almost  entirely  in  a  period  varying  fi-om 
several  days  to  1  to  2  weeks.  The  symptoms  reappear  after  a  certain 
time,  and  then  in  a  more  severe  form.  In  these  cases  frequent  stretching 
of  the  hind  legs,  arching  of  the  hack  and  grunting  are  observed,  while 
in  the  region  posterior  to  the  xiphoid  cartilage  palpation  causes  pain. 
Defecation  and  urination  are  associated  with  symptoms  of  restlessness. 
After  this  condition  has  continued  for  a  time,  or  in  some  cases  suddenly, 
an  aggravation  is  observed,  which  leads  to  death  from  purulent  peri- 
tonitis in  from  6  to  48  hours. 

Abscesses  which  develop  in  the  pelvic  cavity,  and  which  may  some- 
times he  found  by  manual  examination  through  the  rectum,  exceptionally 
penetrate  towards  the  perineum,  or  under  the  skin  of  the  tail,  where 
they  finally  break  on  the  outside  (Altmann).  Sometimes  they  compress 
certain  nerves  (for  instance  the  N.  ohturatorius),  or  an  inflammation 
results  in  certain  nerves  with  subsequent  atrophy  of  the  corresponding 
groups  of  muscles  (Labat)  ;  in  both  of  the  latter  eases  the  locomotion 
of  one  or  both  hind  extremities  is  greatly  interfered  with. 

If  metastatic  abscesses  in  the  internal  organs  (brain,  lungs, 
liver,  spleen,  kidneys,  thyroid  glands,  etc.)  are  in  the  course  of 
development,  high  fever,  rapid  weakening  of  the  heart's  action, 
great  debility  and  depression  of  the  sensil)ility  as  well  as  rapid 
emaciation  are  observed,  which  usually  result  in  death  in  the 
course  of  a  few  days.  Extension  of  *  a  brain  abscess  to  the 
meninges  is  sometimes  indicated  by  sudden  staggering,  where- 
upon the  animals  drop  to  the  ground  and  die.  (According  to 
Kofler  an  inflammation  of  the  uveal  tract  of  the  eyes  is  also 
a  frequent  complication  of  strangles.) 


380  Strangles. 

Course  and  Prognosis.  The  instances  in  which  the  symp- 
toms represent  typical  cases,  the  inflammatory  process  being 
confined  to  the  submaxillary  lymph  glands  and  the  nasal  mucous 
membrane,  are  favorable  indications  of  the  disease,  while  the 
deviations  from  this  type  render  the  prognosis*  more  unfavor- 
able. In  the  typical  cases  the  disease  lasts  two  to  four  weeks, 
and  terminates  in  complete  recovery.  Localization  of  the  in- 
flammatory swellings  in  the  submaxillary  space,  rapid  pro- 
gress towards  abscess  formation,  and  correspondingly  high 
fever  indicate  a  favorable  course,  while  in  less  pronounced 
inflammatory  symptoms  the  disease  may  persist  for  a  longer 
time.  The  extension  of  the  processes  to  the  mucous  membrane 
of  the  pharynx,  or  to  the  superficial  lymph  glands  of  other 
parts  always  lengthens  the  course,  but  even  in  these  cases 
recovery  takes  place  in  most  instances.  This  is  likewise  the 
case  in  affections  of  the  retropharyngeal  h^npll  glands,  but  in 
these  instances  there  is  always  danger  of  an  inhalation  pneu- 
monia, and  therefore  the  prognosis  should  be  cautious.  Symp- 
toms indicating  an  affection  of  the  intrathoracic  or  intra- 
abdominal lymph  glands,  and  metastasis  in  the  internal  organs, 
have  always  an  unfavorable  significance. 

Sometimes  the  course  is  very  prolonged,  inasmuch  as  after 
the  healing  of  one  abscess  others  appear  in  other  parts  of  the 
body,  and  this  may  repeat  itself  (wandering  strangles).  Finally 
however  healing  may  take  place,  or  the  animals  may  die  from 
exhaustion  or  from  the  involvement  of  internal  organs  leading 
to  chronic  pyemia. 

The  course  depends  considerably  on  the  age  and  strength 
of  the  patients.  While  in  horses  over  one  year  old  the  disease 
almost  always  runs  a  favorable  course,  very  young  or  poorly 
developed  and  badly  nourished  animals,  or  foals  which  have 
already  been  weakened  by  other  diseases,  do  not  stand  the 
disease  as  well. 

Accordingly  the  mortality  varies  greatly.  While  ordi- 
narily it  amounts  to  only  1-3%,  it  may  be  considerably  higher 
under  unfavorable  hygienic  conditions. 

The  course  also  depends  on  the  character  of  the  outbreak, 
inasmuch  as  in  some  years,  or  in  some  localities,  the  suppurating 
process,  with  or  without  participation  of  the  submaxillary 
h^nph  glands,  attacks  the  abdominal  and  thoracic  l^nnph  glands 
with  remarkable  frequency. 

Szollos  observed  in  1906  130  cases  in  a  small  territory  with  severe  manifes- 
tations, of  which  37  terminated  fatall.y.  At  this  time  the  disease  frequently  affected 
older  horses.  Prussian  official  veterinarians  likewise  report  severe  outbreaks,  es- 
pecially Bernt  in   1904,  which  occurred  in  the  District  of  Gumbinnen. 

In  the  Hungarian  Government  studs,  1711  colts  were  affected  between  the 
years  1886-9,  almost  all  under  the  age  of  one  year,  of  which  48  (2.8%)  died.  In 
the  same  perioil  the  disease  had  been  observed  in  the  government  stallion  depots, 
among  118  stallions,  and  in  only  one  instance  was  the  course  so  severe  that  it  be- 
came necessary  to  destroy  the  affected  animal.  Among  the  horses  of  the  Prussian 
cavalry,  in  the  years  1900-190.S,  out  of  39.54  affected  remount  and  service  horses 
82   (2.1%)   died   (the  loss  varied  in  the  different  years  between  0.0  and  3.4%).     In 


Course  ami  Pnijinosis.  3g^ 

the  French  army,  in  the  period  between  1SS.S-1S07,  0(l,.".si  liorses  were  affeeteil  with 
strangles,  of  which  i»t)li  (I.I'a)  succiunlied.  In  tlie  Italian  army  colt  depots  the 
number  of  cases  in  the  years  from  IttO.'MitoT  varied  between  i>4')  and  IHliii,  amonij 
5000-0000   colts,   the   number  of  deaths   varying   between    Id   and   30. 

After  the  subsidence  of  the  acute  affection,  various  se(|uels 
occasioiialiy  develo});  thus  tile  inllainniation  of  the  inesenteriu 
glands  may  come  to  a  stop  in  case  no  acute  peritonitis  or 
pyemia  result.  But  the  nutrition  of  the  animals  usually  re- 
mains more  or  less  affected  through  suppuration  in  the  glands, 
through  new  formation  of  connective  tissue  and  the  resulting 
thickening  of  the  mesentery  and  sometimes  also  through  a  con- 
striction of  the  intestinal  lumen.  Consequently  a  severe  cachexia 
gradually  develo])s  (tabes  mesaraica).  The  inflammation  of 
the  guttural  pouches,  and  of  llighmore's  cavities,  which  is  at 
tirst  acute,  may  sometimes  change  in  its  further  course  and  be- 
come chronic,  while  contracted  tendons,  which  may  result  from 
the  disease  on  the  extremities,  produce  lasting  lameness.  In 
some  animals  symptoms  of  hydrocephalus  develo])  gra<hially  as 
a  result  of  encapsulated  abscesses  in  the  brain  (Koiler  found  in 
12  out  of  40  horses  which  were  slaughtered  on  account  of  hydro- 
cephalus, softened  areas  in  the  brain,  with  streptococci  in  the 
contents  of  the  abscesses).  Further  purpura  hemorrhagica  may 
develop  in  liorses  recovered  from  strangles,  while  roaring  is  a 
frequent  sequel  and  is  due  to  paralysis  of  the  recnrrent  laryn- 
geal nerves  (according  to  Wiart  out  of  100  colts  affected  with 
strangles  25  later  became  roarers,  while  according  to  Nocard,  in 
Argentine,  where  strangles  does  not  occur,  roaring  is  supposed 
to  be  unknown). 

-  Diagnosis.  In  those  cases  in  which  the  infection  of  stran- 
gles is  indicated  only  by  acute  nasal  catarrh  or  pharyngitis, 
without  suppuration  of  the  lymph  glands,  the  specific  nature 
can  only  be  established  with  more  or  less  probability,  by  the 
condition  of  other  horses  in  the  same  stable  in  which  attacks 
with  characteristic  spnptoms  of  strangles  might  be  present. 
A  demonstration  of  streptococci  in  the  nasal  discharge  would 
have  to  be  considered  with  caution  as  streptococci  may  be  pres- 
ent in  the  discharge  without  true  strangles. 

In  affections  of  the  lymph  glands  in  the  pharyngeal  region 
strangles  may  be  confounded  with  pharyngitis  resulting  from 
other  causes,  or  with  inflammation  of  the  parotid  gland.  If  tlie 
disease  process  is  exclusively  localized  in  the  region  of  the 
throat,  only  the  further  course  of  the  disease  will  reveal  the 
true  nature  of  the  affection,  wdiile  previous  to  that  the  diag- 
nosis can  be  based  only  on  the  mode  of  infection,  or  upon  the 
fact  that  in  strangles  the  symptoms  of  pharyngitis  usually 
reach  a  very  high  intensity.  In  cases  of  inflammation  of  the 
parotid  gland  the  inflammatory  swelling  is  less  diffuse,  at  least 
at  the  beginning,  but  is  more  or  less  sharply  circumscribed  fol- 
lowing the  borders  of  the  glands  or  its  lol)ules. 

In  the  cases  in  wliicli  the  affection  is  <\\clusivelv  confined 


382  Strangles. 

to  the  lympli  glands  of  the  body  cavities  the  diagnosis  can  be 
established  correctly  only  with  sufficient  information  regarding 
the  development  and  the  presence  of  the  infection,  as  the  symp- 
toms proper  usually  only  indicate  disturbances  of  the  functions 
in  the  neighboring  organs.  Nevertheless  a  repeated  examina- 
tion of  the  urine  for  the  presence  of  indican  may  be  beneficial 
in  such  cases,  as  its  considerable  increase  points  with  a  degree 
of  certainty  to  a  suppurative  process. 

The  differentiation  of  strangles  from  glanders  and  the  so 
called  suspected  strangles  will  be  discussed  fully  in  the  diag- 
nosis of  glanders. 

Treatment.  Not  much  can  be  expected  from  abortive  treat- 
ment; yet  as  in  some  cases  the  symptoms  diminish,  and  the 
swelling  of  the  lymph  glands  retrogresses  after  antiphlogistic 
treatment,  it  is  advisable  to  attempt  such  treatment  if  it  can 
be  done  at  the  commencement  of  the  disease  (cold  applications, 
inunctions  with  gray  mercurial  ointment).  If  however  there 
is  no  improvement  perceptible  after  a  few  days,  it  appears 
practical  to  discontinue  this  treatment,  and  allow  the  suppur- 
ative process  a  free  course. 

If  expectant  treatment  has  been  decided  upon,  suitable 
regulation  of  the  care  and  nursing,  as  well  as  of  the  diet,  should 
first  be  carried  out.  The  animals  should  be  placed  in  clean, 
and  uniforndy  warm  stables,  or  in  warm  weather  they  may 
during  the  day  be  kept  out  of  doors  in  shady  places  free  of 
dust.  It  is  advisable  to  feed  the  animals,  in  addition  to  good 
hay  and  some  oats  a  few  beets,  or  during  the  summer  fresh 
grass,  clover  or  alfalfa;  if  swallowing  is  difficult,  bran  slop  is 
advisable.  Sucking  foals  should  be  taken  to  their  mother  at 
regular  intervals,  and  during  sucking  they  should  be  supported ; 
if  however  there  is  great  difficulty  in  swallowing,  artificial  feed- 
ing through  the  rectum  must  be  considered  (see  Vol.  II). 

Great  care  should  also  be  exercised  in  maintaining  the 
greatest  possi])le  cleanliness,  for  which  purpose  the  straw 
should  be  removed  frequently,  the  cribs  washed  during  the  day, 
and  the  purulent  excretion  should  be  frequently  removed  from 
the  nasal  openings  and  the  eyes,  ^\ath  clean  sponges  or  cotton 
swabs,  dipped  in  luke  warm  water  containing  boracic  acid.  Peri- 
odical rubbing  of  the  body  with  alcohol  has  a  beneficial  effect 
on  the  general  condition  of  the  patient. 

Swelling  of  the  glands  may  be  left  without  interference, 
or  if  the  progress  of  suppuration  is  too  slow  it  may  be  stimu- 
lated with  warm  or  moist  warm  poultices.  Counter  irritants, 
which  are  frequently  applied  in  such  cases  (cantharides  oint- 
ment, mustard  dough,  etc.)  have  a  doubtful  value,  and  may 
easily  cause  severe  inflammatory  swellings,  especially  if  they 
are  applied  in  the  region  of  the  throat.  If  fluctuation  is  percep- 
tible at  any  part  of  the  swelling  which  is  indicated  by  the  soften- 
ing, the  abscess  should  be  opened  without  delay.  Although  the 
pus  ultimately  works  its  way  to  the  outside  of  its  own  accord,  the 


Treatment.  3g3 

destruction  of  tissue  in  these  cases  becomes  very  extensive; 
iuul  there  is  increased  (huii-er  of  brealvin^-  on  tlie  inside,  when 
healing  will  require  longer  time. 

The  abscess  cavities  should  always  be  opened  with  a  long 
incision.  If  the  opening  is  too  small  it  should  be  enlarged  after 
the  i)artial  evacuation  of  the  pus,  and  subsequently  the  cavity 
should  be  thoroughly  cleansed  with  a  disinfectant  (boracic 
acid,  carbolic  acid,  creolin,  Burow's  solution),  whereupon  the 
wound  should  be  treated  in  accordance  with  the  requirements 
of  surgery.  After  evacuation  of  the  pus  the  condition  of  the 
patient  improves  immediately;  the  temperature  drops  to  nor- 
mal inside  of  12  to  24  hours,  the  quantity  of  indican  in  the 
urine  is  diminished,  the  swelling  of  the  abscess  reduces  rapidly, 
rendering  the  movements  of  the  head  and  mastication  easier. 

If  the  swelling  persists  after  the  opening  of  the  abscess  or 
should  it  even  increase  and  at  the  same  time  the  body  tem- 
perature continue  to  remain  high,  it  is  an  indication  of  the 
presence  or  development  of  other  abscesses  in  the  vicinity  of 
the  one  which  has  l^een  opened.  In  such  cases  the  separating 
wall  may  successfully  be  broken  by  the  finger  introduced  into 
the  open  abscess  cavity,  whereby  a  passage  into  the  open  cavity 
is  provided  for  the  pus;  in  other  cases  the  abscesses  must  be 
opened  individually. 

If  the  pharyngeal  region  is  affected,  the  necessity  for  feed- 
ing the  animals  with  easily  swallowed  food  (gruels,  sloppy 
food)  becomes  still  more  imperative.  At  the  same  time  the 
existing  pharyngitis  requires  special  treatment,  for  which  the 
administration  of  potassium  chlorate  (8-10  g.  to  a  pail  of 
water),  or  the  application  of  Priesznitz's  poultices  is  appro- 
priate. _  The  opening  of  the  superficial  al)scesses  causes  no 
difficulties;  if  however  abscess  formations  are  present  in  the 
deeper  parts,  between  the  parotid  glands  and  the  lower  jaw,  or 
in  the  retropharyngeal  tissue,  their  opening  requires  special 
care.  These  abscesses  should  be  opened  as  early  as  possible 
on  account  of  the  threatening  danger  from  asphyxiation.  On 
account  of  the  nerves  and  blood  vessels  h^ng  in  these  parts, 
which  may  be  displaced  from  their  normal  position,  it  is  advis- 
able only  to  split  the  skin  with  a  knife  at  the  most  prominent 
place  of  the  swelling,  and  then  to  spread  apart  the  nerves  and 
vessels  by  boring  movements  with  the  index  finger,  and  if  possi- 
ble by  this  means  to  pierce  the  wall  of  the  abscess  cavity.  In 
this  way  not  only  subparotid,  but  also  retropharvngeal  ab- 
scesses may  be  opened.  Sometimes  this  procedure  may  not  im- 
mediately lead  to  results,  but  in  the  course  of  1  to  2  days  the 
pus  penetrates  without  aid  in  the  direction  of  the  canal  whicli  has 
been  bored  as  this  constitutes  the  place  of  least  resistance,  and 
therefore  ultimately  it  breaks  through  at  this  point. 

For  the  local  treatment  of  the  mucous  membrane  Kagel  introduces  a  thiek- 
Tvalled  rubber  tube  60  cm.  long  in  cases  of  pharyngitis  through  the  nose  into  the 
pharyngeal  cavity,  and  injects  a  disinfecting  fluid  (0.5'/,  salt  solution,  1:1000  sub- 
limate,  or   0.3 Oc    of   a   potassium   permanganate   solution).      Frick   employs   for   this 


384  Strangles. 

purpose  a  tube  perforated  in  several  places  at  the  end,  with  the  aid  of  which 
the  affected  nasal  and  pharyngeal  mucous  membrane  is  irrigated,  while  Payrou 
injects  the  pharynx  with  a  thin  urinary  catheter  40-42  cm,  in^  length.  He  injects 
10-15  g.  of  a  fluid  consisting  of  Guaiacol,  Acid,  carbol.  eryst.  aa  15.0,  Menthol  40.0, 
01.  oliv.  100.0.  Bringard  uses  a  stiff  sound  40  cm.  in  length,  to  the  end  of  which 
is  tied  a  wad  of  cotton  dipped  in  eucalyptus  vaseline  (1:15),  with  which  the  soft 
palate  and  the  pharyngeal  walls  are  swabbed.  This  treatment  is  supposed  to  shorten 
the  duration  of  the  disease  considerably  (in  40  hortes  treated  in  this  manner  the 
time  was  reduced  from  1112  days  to  470  days).  None  of  these  methods  are  with- 
out danger  in  lively  animals,  and  especially  if  difficulty  in  swallowing  exists. 

Poschl  recommends  to  open  the  submaxillary  swelling  before  the  appearance 
of  suppuration.  According  to  his  observations  recovery  is  more  rapid  after  such  a 
procedure  and  takes  place  without  abscess  formation,  and  without  much  destruc- 
tion of  tissues.  Szollos  also  obtained  favorable  results  in  many  cases  by  this  treat- 
ment, but  nevertheless  abscesses  not  infrequently  developed  in  distant  lymph  glands, 
especially  in  older  horses. 

If  the  difficulty  of  respiration  has  reached  a  high  degree 
because  of  much  swelling  in  the  throat  region,  and  the  threaten- 
ing danger  of  asph^^xiation  cannot  be  eliminated  by  artificial 
evacuation  of  pus,  tracheotomy  should  be  performed,  in  Avhich 
case  the  tube  should  be  allowed  to  remain  in  the  wound  until  the 
conclusion  of  the  suppurating  process,  or  until  the  complete  dis- 
appearance of  the  threatening  symptoms. 

The  affection  of  the  guttural  pouches  also  demands  surgical 
treatment  in  order  to  remove  the  pus  which  has  accumulated 
therein;  further  abscesses  formed  in  the  superficial  lymph 
glands  or  in  other  parts,  as  well  as  the  lymphangioitis  and 
phlegmons  which  become  sometimes  associated,  also  require 
surgical  interference. 

Internal  treatment  is  only  indicated  in  the  presence  of 
digestive  disturbances.  If  constipation  exists  it  is  advisable  to 
mix  tablespoonful  doses  of  artificial  Carlsbad  salt  with  the  food. 
Beside  the  administration  of  antimony  preparations,  and  of 
mucilaginous  substances  which  are  still  given  extensively,  sali- 
cylic acid  and  sodium  salicylate  (8-10  g.  per  day)  may  be  given 
advantageously  (Hardon). 

Inhalations  of  steam  vapors  may  be  used  as  a  remedy  for 
the  catarrh  of  the  nose,  throat  and  "the  upper  air  passages;  it 
being  advisable  to  add  to  the  boiling  water  salt,  carbolic  acid, 
or  oil  of  turpentine.  In  such  cases  intralaryngeal  or  intra- 
tracheal injections  of  mild  solutions  of  astringents  (subnitrate 
of  bismuth  5%,  alum,  iron  sulphate  or  tannin  1-2%,  Lugol's 
solution  1:5:100),  or  according  to  Levis'  suggestion  antipyrin 
(2-4.0  g.)  may  also  be  used. 

The  fever  requires  special  treatment  only  when  it  exceeds 
41  degrees,  and  then  the  usual  antipyretics,  in  doses  adapted 
to  the  age  of  the  patients,  are  indicated.  In  the  presence  of 
a  weak  heart  cardiac  stimulants  should  be  administered  (for 
instance  caffein  5-6  g.). 

Metastases  in  the  internal  organs  are  excluded  from  direct 
treatment ;  in  such  cases  and  also  when  s^miptoms  of  severe 
general  infection  are  present  only  stimulating  treatment  comes 
into  consideration. 


Tii'atiiH'iit,      I'rcveiilidii.  385 

Dieckerliolf  ret'onunciuls  in  ])i()tr<u'tod  cases,  as  well  as  in  phleg- 
monous inliainniations  and  septic  i'ever,  intravenous  injections  oi"  Argm- 
tuni  coUoideale  or  Kollargol  (40  cc.  of  a  I'/v  solution  repeated  for 
several  days)  but  Baunigart,  Kegel  and  AVerner  failed  to  obtain  favor- 
able results  from  this  treatment.  ]\loretti  employs  corrosive  sublimate 
(for  5  days  ;}U-60  cc.  of  a  1:1000  solution  intravenously),  Franz  ad- 
ministers lodipin  (50  g.  of  a  25%  solution  su])cutaneously),  with  sup- 
posedly favoral)le  i-esults.  Lindner  however  found  lodipin  without  ell'eet. 
Bass  recommends  Ichthargan  (50  cc.  of  a  1%  solution  intravenously, 
or  1.5  to  8  g.  in  a  ii'/v  solution  intratracheally),  Kettner  however  ob- 
served in  two  cases  no  benetieial  results  from  this  treatment.  The  yeast 
treatment  recommended  by  Ludwig  and  Petersen  (100  g.  of  a  mixture 
of  brewer-yeast  cells  and  flour  of  starch,  which  is  marketed  as  Anti- 
gourmine  and  Furonculine,  dusted  2  to  3  times  daily  on  the  food ;  the 
healthy  horses  receive  as  a  prophylactic,  thin,  sour-dough  soup),  failed 
to  give  results  according  to  Ilausmann,  Zerler,  Schultz  and  Mitrowitsch, 
also  in  the  Prussian  remount  depots,  Feuerhack  (only  Diercks  and  Deich 
express  approval  of  this  treatment). 

In  recent  times  the  treatment  with  antistreptococcus  serum  has 
been  extensivelv  used,  but  its  value  cannot  vet  be  exactly  established 
(seep.  386). 

Prevention.  This  consists  in  keeping  healthy  horses,  and 
especially  colts,  from  affected  animals,  as  well  as  from  stables 
and  stands  occupied  by  the  latter.  In  this  way  it  is  frequently 
possible  to  protect  the  animals  from  infection  through  their 
early  years  and  if  they  should  later  contract  the  disease  it  will 
run  a  milder  course.  The  colts  born  upon  certain  premises 
should  be  kept  as  much  as  possible  separate  from  strange  colts. 
If  the  disease  appears  in  spite  of  it,  it  may  be  checked  by  trans- 
porting the  healthy  animals  as  early  as  possible  to  localities 
free  of  the  disease;  in  such  instances  the  animals  should  be 
giiarded  especially  against  cold,  which  would  reduce  their  resist- 
ance. After  the  extinction  of  the  disease  thorough  disinfection 
of  the  stables  and  the  stable  utensils  is  very  desirable,  as  other- 
wise it  reappears  annually  in  the  infected  establishments.  Re- 
peated disinfections  will  prevent  the  reappearance  of  the  dis- 
ease still  more  efficiently. 

Immunization  and  Serum  Treatment.  As  one  attack  of  the 
disease  as  a  rule  affords  an  immunity  which  lasts  for  several 
years,  the  possibility  of  an  artificially  produced  immunity  is 
evident.  Even  in  former  times  experiments  were  made  in  this 
direction,  always  liowever  for  the  purpose  of  artificially  pro- 
ducing a  mild  affection  in  the  animals,  thereby  protecting  them 
from  the  natural,  usually  more  severe  form  which  may  occur 
during  an  unfavorable  time  of  the  year. 

Viborg  and  Toggia  in  the  beginning  of  the  last  century  rn1)be(t  the  nasal  dis- 
charge of  affected  animals  into  the  noses  of  healthy  horses,  while  Tatray  injected 
suljcutaneously  in  the  neck  near  the  thorax  the  lymph-like  fluid  oozing  from  the 
broken  abscesses.  The  aftection  produced  in  this  manner  is  usually  mild,  and  as 
the  peripharyngeal  lymph  glands  are  spared,  no  dangerous  symptoms  appear.  Jolly 
&  Leclainche  injected  scabs  taken  from  sick  animals  and  emulsified  in  water  sub- 
cutaneously  into  healthy  horses  and  thus  always  produced  a  mild  attack  of  the 
disease. 

Vol.  1—25 


386  Strangles. 

1.  Active  Immunization.  At  first  experiments  were  made 
with  living  cultures  of  the  strangles  streptococcus,  but  inasmuch 
as  this  procedure  proved  dangerous,  dead  cultures  have  recently 
been  used  for  this  purpose.  As  a  matter  of  fact  however  there 
is  at  present  no  immunization  method  at  our  command  which 
has  been  tried  out  sufficiently  in  practice. 

After  the  discovery  of  the  strangles  streptoeoeeus,  Jensen  &  Sand  observed  that 
intravenous  injections  of  pure  cultures  do  not  produce  strangles,  but  only  an  inflam- 
mation of  the  vein,  after  the  healing  of  which  the  horses  resist  an  intranasal  in- 
fection. This  method  however  could  not  be  utilized  in  practice  on  account  of  the 
severity  of  the  local  inflammation. 

Kitt  treated  two  colts  which  had  not  been  affected  with  strangles,  in  the 
course  of  two  months  with  repeated  intravenous  injections  of  5-10  cc.  of  strangles 
streptococcus  serum  bouillon  cultures  killed  at  53-55  degrees,  and  found  later 
that  these  animals  resisted  an  artificial  infection  through  the  nasal  cavities  and  in- 
testinal  canal. 

Gabritsehewsky  used  a  bouillon  culture  concentrated  to  1/10  of  its  volume, 
and  killed  with  0.5%  carbolic  acid,  of  which  he  injected  subcutaneously  six  colts 
with  60  cc,  in  1,  2,  or  3  injections.  The  animals  resisted  an  infection  from  rub- 
bing a  virulent  culture  on  the  nasal  mucous  membrane,  and  displayed  also  a  higher 
resistance  against  subcutaneous  injections  of  1.5-2  cc.  of  virulent  culture  than  did 
the  control  animals.  Cultures  of  virulent  streptococci  also  killed  by  0.5%  carbolic 
acid  but  not  concentrated,  are  according  to  Umeno  used  in  Japan  against  strangles 
of  horses  which  is  prevalent  there. 

Baruchello  used  as  vaccine  a  mixture  of  dense  streptococci  culture,  and  pleural 
exudate  (aggressin)  of  artificially  infected  horses  or  donkeys  (1:8)  which  had 
been  previously  sterilized  with  toluol  (3%),  and  preserved  with  ether  (2%),  The 
results   in   practice    are   claimed   to   have   been   satisfactory. 

Wiedenmann  immunized  rabbits  by  treating  them  with  cultures  which  had 
been  shaken  for  3i^  days  with  25%  uric  acid  at  37°,  and  then  concentrated  by 
evaporation.  Ealdrey  recommends  vaccine  prepared  from  24  hour  agar  or  bouillon 
cultures,  according  to  Wright's  method,  by  washing  them  off  with  salt  solution,  and 
heating  to  60°.     These  however  proved  unreliable  even  in  experiments  on  rabbits. 

Concerning  "strangles  extract"  (shake-extracts  of  cultures  of  strangles  strep- 
tococci?) of  Jess  &  Piorkowski,  Otto  obtained  very  satisfactory  results  from 
their  use  in  his  experience  with  694  horses.  All  healthy  animals  which  had  been 
vaccinated  by  these  methods  showed  no  affection  with  strangles  for  a  period  of 
eight  months. 

2.  Passive  Immunization.  Blood  serum  of  horses  artifi- 
cially immunized  against  streptococcus  infections  in  man,  is 
recently  being  used  more  extensively,  and  this  method  appears 
to  be  giving  satisfactory  results  when  utilized  against  strangles 
in  horses.  According  to  numerous  laboratory  experiments  it 
is  possible  to  actively  immunize  animals  with  artificially  attenu- 
ated streptococci,  as  well  as  with  toxins,  and  such  animals  later 
hyperimmunized  with  fully  virulent  material,  produce  a  blood 
serum  which  confers  a  passive  immunity  upon  other  animals, 
but  as  a  rule  only  against  that  strain  of  streptococci  with  which 
the  serum-producing  animals  have  been  treated.  Therefore 
Marmorek  injected  his  horses  with  various  strains  of  strepto- 
cocci of  man,  and  the  polyvalent  serums  obtained  thereb}^  have 
also  given  better  results  in  human  medicine. 

Marmorek 's  polwalent  anti-streptococcus  serum  has  also 
been  used  by  French  veterinarians  (Jacoulet,  Drouin  and 
others)  against  strangles  of  horses,  since  this  is  a  disease  also 
produced  by  streptococcus  infection.  However  the  results  were 
not  promising.     As  these  more  or  less  unsatisfactory  results 


Passive  liiiimiiiizatioii.  3g7 

indicate  that  the  streptococcus  of  strangles,  in  spite  of  its 
morphological  similarity,  is  different  from  the  pyogenic  strep- 
tococci of  man,  the  innnnnization  of  horses  has  lately  been 
undertaken  witli  the  specilic  streptococci  of  horses.  The  treat- 
ment with  serum  obtained  from  horses  treated  by  the  various 
strains  of  pyogenic  and  strangles  streptococci  consequently 
gave  better  results. 

According  to  Rohr's  ol)sorvations,  the  scrum  injection  of  horses 
atTected  with  strangles  diniinislics  the  quantity  of  the  profuse  purulent 
nasal  discharge,  tlie  fever  is  reduced,  and  not  infrerjuently  the  treatment 
results  in  the  absorption  of  the  abscesses  already  in  tlie  stage  of  devel- 
opment (the  serum  was  subcutaneously  injected  in  doses  of  10  cc.  three 
times  on  the  first  day,  and  once  on  the  secoiul  and  third  day).  The 
results  of  Jacoulet's  experience  with  this  treatment  on  'SO  horses  were 
also  favora])le;  since  the  fever  in  this  mode  of  treatment  was  of  short 
duration,  complications  and  relapses  were  more  rare,  and  the  recovery 
of  the  patient  was  hastened.  (The  daily  dose  amounted  to  from  20  to 
30  cc. ;  80  to  100  cc.  brought  the  development  of  the  disease  process  to 
a  standstill). 

Dassonville  &  Vissocq  produced  a  serum  by  treating  horses  with 
virulent  streptococci  cultures,  of  which  20  to  .30  cc.  was  supposed  to 
protect  healthy  horses  against  natural  contact  infection.  By  following 
the  serum  injection  with  a  su])cutaneous  injection  of  3  to  5  cc.  of  viru- 
lent cultures,  it  should  be  possible  to  convert  the  passive  into  an  active 
immunity.  French  veterinarians  (Desoubry,  Breton,  Argoud  and 
others)  o])tained  favorable  results  with  this  method  of  immunization, 
and  partly  also  with  the  serum  alone. 

Jess  &  Piorkowski  produced  a  strangles  serum  from  horses  by 
treating  them  with  cultures  made  from  growing  various  strains  of 
strangles  streptococci  directly  from  the  abscesses  on  strongly  alkaline 
media,  of  which  0.0005  cc.  is  said  to  protect  mice  against  double  the  fatal 
dose  of  virnlent  culture,  and  to  agglutinate  these  cultures  in  dilutions  of 
at  least  1 :100.  The  single  dose  in  practice  is  10  cc.  or  even  more,  which 
if  necessary  may  be  repeated  2  to  3  times. 

The  reports  regarding  the  protective  and  curative  action  of  this  serum  vary. 
"VThile  Aronson  in  his  laboratory  experiments,  Angerstein,  Eeimers,  Feuerbach  and 
also  Prussian  district  veterinarians  in  practice  found  it  without  effect,  according  to 
Stramnitzer  it  is  supposed  to  be  beneficial  at  the  beginning  of  pure  strangles,  and 
also  to  improve  the  general  condition  in  advanced  cases  in  50  cc.  doses.  A  favor- 
able influence  on  the  course  of  the  disease  was  also  observed  by  Brandt,  Pflanz, 
Franz  and  Otto  (in  124  horses),  in  Hungary  by  Demeny  &-  Szende ;  after  the  serum 
inoculations  the  fever  dropped  and  the  inflammatory  swelling  disappeared  rapidlv, 
mostly  however  after  the  opening  of  the  abscesses.  "  Likewise  favorable  are  the  Re- 
ports of  Cederberg  on  the  serum  treatment  of  horses  affected  with  strangles  in  the 
Danish  army;  the  preventive  inoculations  however  failed  in  several  cases,  and 
the  experiments  of  Wucherer  and  Wagenheuser  gave  similar  results. 

Ruppel's  strangles  serum  (Gurmin)  is  derived  from  horses  which 
have  been  treated  with  a  mixture  of  strains  from  strangles,  together 
with  a  streptococcus  culture  made  highly  virulent  by  passages  through 
animals.  It  is  supposed  to  protect  mice  in  doses  of  0.005  to  0.00025  cc. 
against  10  to  100  times  the  fatal  dose  of  virulent  culture.  In  36  out  of 
44  horses  affected  with  strangles  it  is  supposed  to  have  given  a  pro- 
nounced curative  result,  in  daily  doses  of  20  to  50  cc,  wliile  in  healthy 
horses  it  afforded  a  protective  action. 


388  Strangles. 

Recently  a  strangles  serum,  which  is  prepared  in  Rome  according 
to  Vicchi  and  Gatti,  was  used  quite  extensively  in  Italy  with  satisfactory 
results. 

Finally  Delvos  uses  a  serum  from  horses  which  have  recently  passed 
through  an  attack  of  strangles  for  protection  of  healthy  and  treatment 
of  affected  animals.  Of  this  serum  previously  heated  to  70°,  and 
mixed  with  i/^%  carbolic  acid,  the  dose  amounts  to  20  cc,  the  curative 
dose  from  30  to  40  cc.  (if  necessary  to  be  repeated).  The  results  are 
said  to  have  been  satisfactory  in  the  treatment  of  94  horses. 

Literature.  Haubner,  Mag.,  1843,  227.— Bonlev,  Eec,  1849,  89;  1855,  537.— 
Hering,  Spez.  Path.,  1858,  83,  (Lit).— Schiitz,  A.  f.'Tk.,  1888,  XIV,  172.— Sand  & 
Jensen,  D.  Z.  f.  Tm.  1888,  XIII,  437.— Poels,  P.  d.  M.,  1888,  VI,  4.— Nocard, 
Bull.,  1888,  22;  1890,  187.— Foth,  Z.  f.  Vk.,  1891,  III,  192.— Lignieres,  Bull.,  1895, 
369;  1896,  173.— Marniorek,  A.  P.,  1902,  172.— Jess,  B.  t.  W.,  1902,  171;  1905, 
242.— Piorkowski,  Ibid.,  1902,  p.  1124.— Jolly  &  Leclainche,  Eev.  vet.,  1893,  289 
(Lit.).— Sclmiirer,  Z.  f.  Tm.,  1903,  VII,  286  (Literature  on  Immunity).— Lingel- 
sheim,  Hb.  d.  p.  M.,  1903,  III,  303;  1904,  IV,  1185  (Literature  on  Streptococcus 
and  streptococcus  immunity). — Stramnitzer,  A.  f.  Tk.,  1904,  XXX,  519. — Dassonville 
&  Vissocq,  Bull.,  1905,  176.— Feuerbach,  Z.  f.  Vk.,  1905,  XVI,  12.— Mitrovitseh, 
B.  t.  W.,  1905,  77.— Ludwig,  Monh.,  1906,  XVII,  289.  (Literature  on  Immuniza- 
tion).—Gabritschewsky,  Cbl.  f.  Bakt.,  1906,  XLI,  719.— Baruchello,  Eev.  gen.,  1908, 
XI,  497.— Otto,  B.  t.  W.,  1909,  921. 

Strangles  in  Cattle.  Nagy  observed  in  two  mature  cattle  marked 
and  painful  swellings  of  the  submaxillary  lymph  glands,  which  devel- 
oped with  symptoms  of  high  fever,  and  purulent  nasal  catarrh,  and  led 
in  a  few  days  to  abscess  formation.  After  opening  the  abscesses  and 
evacuating  the  creamlike  pus,  recovery  soon  resulted  (the  pus  was  not 
examined  bacteriologically ;  according  to  Kuennemann  the  bacillus  pyo- 
genes bovis  is  most  frequently  found  in  the  pus  from  cattle,  and  is 
considered  by  Glage  identical  with  the  bac.  pyog.  suis,  see  p.  144 ; 
streptococci  and  staphylococci  occur  in  pus  of  cattle  only  very  rarely). 
Peschke  also  observed  multiple  abscess  formation  in  the  glands  on  the 
heads  of  calves.  (Peschke,  A.  f.  Tk.,  1896,  XXII,  346.— Nagy,  Vet., 
1897,  580.) 

Strangles  in  Hogs.  Starcovici  observed  in  Roumania  (1898)  an 
affection  in  young  hogs  in  the  course  of  which  the  submaxillary  and  sub- 
parotid  lymph  glands  developed  an  inflammatory  swelling  and  later 
suppurated.  The  animals  also  showed  debility,  capricious  appetite  and 
fever.  During  the  disease,  which  lasted  several  weeks,  they  became 
greatly  emaciated,  as  the  condition  prevented  them  from  taking  nour- 
ishment. Finally  however,  with  a  few  exceptions,  all  recovered.  In 
the  pus  from  the  abscess  bipolar  bacilli  and  streptococci  were  found, 
which  were  pathogenic  for  rabbits,  guinea  pigs  and  mice.  The  treatment 
consisted  in  opening  and  subsequent  washing  of  the  abscesses.  (Revista, 
1902,  11,  H.) 

Dog  Strangles.  Frohner  describes  under  this  name  a  rare  affection 
of  dogs  in  the  course  of  which  the  lips,  cheeks  and  the  region  of  the 
pharynx  become  greatly  sw^ollen  without  a  febrile  rise  in  the  tempera- 
ture. On  the  skin  of  these  places  lentil-sized  pustules  develop,  filled 
with  bloody  pus.  Later  the  submaxillary  and  the  parotid  lymph  glands 
swell  to  the  size  of  a  pigeon  egg,  and  form  abscesses  (purulent  lymphan- 
gioitis  and  lymphadenitis).  Following  surgical  treatment  recovery  takes 
place  in  most  instances ;  sometimes  however  metastatic  suppurations  may 
develop  in  the  internal  organs,  when  the  animals  succumb  to  pyemia. 
The  purulent  inflammation  appears  to  commence  in  the  hair  follicles 


Contagious  Pleuro-pueuuionia.  389 

of  the  lips,  with  which  an  inflammation  of  tlic  subcutaneous  connective 
tissue,  lymph  vessels  and  the  lymph  glands  becomes  associated.  Treat- 
ment consists  in  opening  the  suppurative  formations,  while  in  high  fever 
ami  in  the  later  course  the  administration  of  quinine  and  camphor  is 
indicated  (Monh.,  1894,  V,  301). 


2.     Contagious  Pleuro-pneumonia.     Pleuropneumonia 
contagiosa  bovum. 

{Lung  i)hi(/uc;  Lungenseuche  der  R'wder  [German];  Polpncu- 

monie  coufagieiise   [Freiich];  Polmonc.ya,  Plcuro- 

polmonite  essudativa  [Italicni].) 

Contagious  pleuro-pneumonia  is  as  a  rule  an  acute  or  sul)- 
acute,  but  soniotinies  chronic  contagious  disease  of  cattle,  which 
is  characterized  by  an  exudative  inflammation  of  the  inter- 
lobular hmiph  vessels,  and  of  the  alveolar  tissue  of  the  lungs, 
with  a  simultaneous,  sero-fibrinous  pleurisy.  It  is  caused  by 
a  filterable  virus. 

History.  Since  the  disease  was  described  in  detail  by  Bourgelat 
(1765),  and  Haller  (1773),  it  was  according  to  the  changes  in  medical 
views  considered  at  one  time  as  a  severe  typhus  affection,  and  again 
as  a  paralysis  of  the  lungs,  and  the  possibility  of  its  spontaneous  devel- 
opment was  generally  accepted.  Chaberts  (1794)  insisted  upon  its  con- 
tagiousness, which  was  since  recognized  by  the  majority  of  authors.  This 
view  has  been  substantiated  by  the  investigations  of  commissions  ap- 
pointed in  the  middle  of  the  last  century  in  France,  Germany,  and 
in  other  parts,  for  the  study  of  the  disease.  In  the  meantime  "Willems 
(1850-1852)  succeeded  in  proving  that  cattle  may  be  effectively  im- 
munized with  fluid  from  the  lungs  of  affected  animals.  The  causative 
factor  was  discovered  by  Nocard  &  Roux  in  1898,  and  by  the  use  of 
pure  cultures  a  new  method  of  immunization  has  been  worked  out. 

Occurrence.  Contagious  pleuro-pneumonia  was  extensively 
prevalent  in  Europe  prior  to  the  last  but  one  decade  of  the 
last  century,  and  caused  great  losses  among  the  cattle  herds 
by  its  severity.  Through  the  energetic  measures  which  were 
inaugurated  at  that  time  the  disease  was  successfully  eradicated 
in  a  great  part  of  the  continent  and  also  in  Great  Britain,  so 
that  it  exists  at  present  only  in  Eussia  and  Spain ;  it  also  pre- 
vails in  Africa,  Australia  and  Asia. 

Contagious  pleuro-pnounionia  was  known  as  early  as  the  emi  of  the  17th  cen- 
tury in  Switzerland,  as  well  as  in  the  neighboring  mountainous  regions  of  German.'? 
and  France.  At  the  beginning  of  the  last  century  it  caused  great  losses  among 
cattle  herds  in  Belgium  and  Holland.  "With  the  expansion  of  animal  traffic  about  the 
middle  of  last  century  it  rapidly  extended  over  large  territories,  and  was  spread 
especially  by  breeding  stock  from  Switzerland  and  Holland,  which  was  at  that 
time  preferred  for  breeding  and  crossing  purposes,  to  the  east  and  also  to  distant 
parts  of  the  world.  In  this  manner  it  was  carried  to  Austria,  in  1841  with  Dutch 
cattle  to  England  fin  this  country  however,  it  had,  according  to  Barker,  been  ob- 
served already  in  17.36),  and  in  18.54  it  was  imported  to  South  Africa  supposedly  with 
a  Friesland  bull.  Further  the  disease  was  in  184^  spread  from  England,  also  with 
breeding  stock,  to  Sweden  and  North  America,  and  in   18.58   to   Australia. 


390  Contagious  Pleuro-piieuuiouia. 

In  Belgium  in  the  period  between  1882  and  1887,  5,152  affected  and  451 
suspected  cattle  were  slaughtered  representing  a  value  of  2,165,938  francs.  In 
1890-1896  the  disease  was  decreasing  (from  893  to  3  cases),  since  1897  the  country 
has  been  free  from  it. 

In  Germany  the  formerly  wide-spread  disease  has  in  later  times  confined 
itself  to  the  Prussian  provinces  of  Brandenberg,  Posen,  and  Saxony,  also  to  the 
States  of  Saxony-Weimar  and  Anhalt.  While  in  1896,  as  many  as  1608  cases  were 
still  diagnosed,  the  number  diminished  since  that  time  to  such  an  extent  that  at  the 
beginning  of  1904  the  disease  was  considered  to  be  eradicated.  After  1}<>  years 
one  case  was  discovered  in  Saxony  and  after  this  the  entire  Empire  remained  free 
from  the  affection  for  ly^  years.  Since  July,  1907,  however  new  outbreaks  occurred 
first  in  Prussia,  then  also  in  Saxony  and  Saxony-Koburg-Gotha,  and  in  the  year 
1908,  448  cases   (with  28  deaths)  were  recorded  in  24  townships. 

In  France  4762  animals  became  affected  during  the  period  from  1893  to 
1903,  the  disease  being  most  virulent  in  the  northern  part  of  the  country,  as  well 
as  in  the  Department  of  the  Seine.  Since  1890  the  number  of  cases  diminished  with 
some  fluctuations,  in  1905  only  14  cases  were  recorded,  in  1906  and  since  that  time 
no  outbreaks  were  recorded  offtcially. 

Contagious  pleuro-pneumonia  had  raged  in  former  times  in  Great  Britain  with 
such  severity  that  in  1860  for  instance,  187,000  animals,  with  a  value  of  19  million 
pounds  sterling,  fell  victim  to  the  disease.  From  1870  to  1890,  63,333  affected  cattle 
were  slaughtered,  and  7,110  died;   since  1891  the  disease  has  rapidly  <lecreased;   in 

1898  it  was  diagnosed  only  in  one  single  case,  and  since  that  time  the  entire  King- 
dom has  been  free  from  the  affection. 

In  Holland  in  the  period  between  1833  to  1850,  64,989,  and  between  1851-1869, 
37,706  cattle  died;  from  1881  to  1887,  22,183  affected  and  12,783  suspected  cattle 
were  slaughtered,  by  which  measure  the   disease  was  entirely   suppressed. 

Formerly  the  disease  raged  in  Austria,  most  extensively  in  Moravia,  Bohemia, 
Southern  Austria,  and  Silesia.  In  1890,  1857  cases  were  recorded,  and  up  to  1S92  the 
number  increased  to  2,524.  As  a  result  of  the  eradication  measures  inaugurated  in  that 
year,  it  has  rapidly  decreased,  so  that  in  1897  only  one  ease  was  observed  in  Silesia. 
Since  that  time  the  entire  empire  has  remained  free  from  the  disease. 

In  Eussia   the   disease  has   become  widely  spread   during   the   last  decade;   in 

1899  five  government  districts  were  officially  recorded  with  7,728  cases;  in  1906, 
19  government  districts  and  389  townships  with  2964  cases;  in  1908,  18  government 
districts  and  965  townships  with  4,971  cases. 

In  Hungary  contagious  pleuro-pneumonia  was  introduced,  in  all  probability, 
in  the  middle  of  last  century  from  the  west  and  spread  extensively  later  to  the 
northwestern  part  of  the  country,  (in  1893  2,352  cases  occurred  in  351  townships  of 
17  counties).  As  a  result  of  the  measures  inaugurated  in  1892  the  infected  terri- 
tory was  more  and  more  limited;  in  1901  only  1  case  was  recorded,  and  since  1902 
the  entire  territory  has  been  free. 

Spain  appears  to  be  badly  infected,  as  even  in  recent  times  the  disease  was 
introduced  from  that  country  into  France,  while  in  Italy  no  cases  have  been  recorded 
since  1889. 

The  northern  countries,  Denmark,  Norway  and  Sweden,  have  been  free  from  the 
affection  for  a  long  time,  and  in  the  countries  of  the  Balkans  it  does  not  appear 
to  occur. 

In  Asia  the  disease  appears  especially  wide-spread  in  the  Eussian  territories, 
(in  1908  14,115  cases  in  857  townships),  as  well  as  in  India;  it  occurs  likewise  fre- 
quently in  Central  and  South  Africa  (in  Capeland  alone  9,062  cases  were  recorded  in 
the  period  of  1897-1S98,  and  in  Egypt  five  cases  were  officially  established  in 
1908),  in  Australia  (Loin  estimates  the  loss  in  1889  at  16  million  francs),  and 
also  in  South  America.  The  United  States  of  North  America,  where  in  1886,  10,000 
cattle  were  affected  in  the  State  of  Illinois  alone,  has  been  free  from  the  disease 
since  1892. 

Etiology.  Contagious  pleuro-pneumonia  is  caused  by  an 
extraordinarily  small,  polymorphic  micro-organism,  wliicli 
passes  through  the  Berkefeld  filter,  and  also  through  the 
Chamberland  F-candle.  In  cultures  under  the  microscope  it  is 
perceptible  at  a  magnification  of  about  1500  and  with  strong 
illumination,  in  the  form  of  extremely  small,  refracting  dots, 
fine  vibrios,  and  very  short  spirillae,  as  well  as  of  branching 
and  asteroid  bodies. 


Etiolog}',     Pathogenicity.  391 

Lipschiitz  describes  the  bodies  of  contagious  pleuro-pneunionia  as  roundish 
protoplasmic  chimps  almost  ViM  i"  size  which  occur  single  or  in  pairs,  or, 
thou^^i  rarely,  in  numerous  cliains  containing  3-4  segments,  lying  close  to  each  other. 
Plump  forms  with  angular  borders  may  be  also  found   (degenerated  elements?). 

According  to  Bordet  spirocha'tes  resembling  the  organism  of  syphilis  develop 
on  blood-jiotato  agar,  and  also  in  transfers  to  alkaline  jieptone  bouillon  contain- 
ing rabbit  serum,  they  are  however  much  shorter  and  finer  spirillae.  Borrel  oli- 
servcd  in  preparations  obtained  according  to  Liltller's  mordant  method,  a  pronounced 
pleomorjdiic  appearance  of  the  virus.  According  to  his  and  his  co-workers'  findings, 
pure  cultures  consist  of  cocci,  streptococci,  and  morulashaped  bodies,  further  short, 
spiral  threads,  which  show  fork-shaped  branchings,  and  asteroid  figures  as  well  as 
mycelioiil  moulds,  and  are  always  surrounded  by  fine,  mucin  coverings.  On  account 
of  its  last-named  properties  he  called  it  asterococcus  mykoides. 

Staining.  In  bouillon  cultures  the  bodies  may  be  stained  with 
aqueous,  and  still  better  with  aniline  dyes  containing  carbolic  acid; 
also  with  Liifflers  flagella  stain,  and  according  to  Gienisa's  method, 
while  they  cannot  be  stained  by  Gram's  method. 

Cultivation.  Nocard  &  Roux  cultivated  the  virus  by  placing  a 
mixture  of  bouillon  and  a  small  (juantity  of  lymph  from  the  lungs  in 
collodion  sacks  and  sewing  these  into  the  abdominal  cavity  of  rabbits. 
By  such  a  procedure  the  bacteria  are  protected  from  the  phagocytes, 
and  the  bouillon  is  rendered  more  suitable  for  the  propagation  of  the 
virus  by  osmosis  between  it  and  the  peritoneal  fluid.  After  15  to  20 
days  the  fluid  became  cloudy  and  opalescent,  and  the  above  mentioned 
small  granules  were,  on  microscopical  examination,  found  present  in 
great  numbers. 

Later  the  cultivation  succeeded  by  a  similar  procedure  in  the 
abdominal  cavity  of  cattle  (not  in  guinea  pigs)  also  in  Martin's  bouil- 
lon, to  which  had  been  added  blood  serum  from  cattle  or  rabbits  (6  to 
8%).  Outside  of  the  animal  body  they  may  be  cultivated  on  agar  pre- 
pared with  such  bouillon,  the  surface  of  which  has  been  moistened  with 
a  few  drops  of  serum  (Dujardin-Beaumetz)  as  well  as  in  Lofifler's 
bouillon  containing  25%  cattle  blood  serum  (Schmidt).  In  bouillon 
the  culture  is  noticeable  after  2  to  3  days  by  a  very  delicate  turbidity 
of  the  fluid,  Avhile  on  agar  the  colonies  form  very  fine  transparent,  later 
whitish  points  adherent  to  the  surface  of  the  medium.  The  optimum 
temperature  is  37°  to  38°  ;  below  30°  the  growth  ceases. 

Tenacity.  Cultures  kept  in  the  thermostat  and  transferred  every  two  weeks, 
retain  their  unattenuated  virulence  not  longer  than  6  to  8  days,  while  in  glass  tubes 
closed  by  melting  at  the  en<ls,  and  kept  at  a  temperature  not  exceeding  12°,  they 
retain  their  virulence  for  almost  a  year  (Nocard,  Eoux  &  Beaunietz). 

The  fluid  from  the  lungs  remains  virulent  for  eight  days  if  kept  in  a  cool 
place;  after  a  month  the  virulence  has  become  attenuated,  in  the  air  and  in  sun- 
light, however,  the  attenuation  occurs  much  earlier.  A  temperature  of  58°  destroys 
the  virus,  while  frozen  pieces  of  lungs  kept  at  a  temperature  of  — .5°  to  — 6° 
contain  virulent  lymph  even  after  three  months  (Laquerriere).  The  virulence  is  not 
influenced  by  concentrated  glycerin,  nor  by  0.5%  carbolic  acid  (Schiitz  &  Steffen, 
Nocard). 

Pathogenicity.  After  the  subcutaneous  inoculation  of  a  few 
drops  to  10  cc.  of  pure  culture  into  the  subcutaneous  connective 
tissue  of  the  rump  or  neck  of  cattle,  the  temperature  commences 
to  rise  after  6  to  27  days.  Soon  an  edematous  swelling  develops 
starting  at  the  point  of  inoculation,  and  finally  the  animal  dies, 
when  the  autopsy  reveals  a  pronounced  serous  infiltration  of 
the  subcutaneous  and  intramuscular  connective  tissue;  or  the 
swelling  disappears  after  1  to  2  weeks  and  the  animal  recovers. 


392  Contagious  Pleuro-pneumonia. 

Inoculation  of  a  culture  into  tlie  pleural  cavity  produces,  after 
a  similar  period  of  incubation,  sero-fibrinous  pleurisy  and  peri- 
tonitis, serous  infiltration  of  the  lung  tissue  and  acute  swelling 
of  the  mediastinal  lymph  glands.  Inhalation  of  a  virulent  cul- 
ture may  result  in  fever  and  symptoms  of  bronchial  catarrh, 
which  however  disappear  after  1  to  2  wrecks,  while  animals 
which  are  slaughtered  in  the  meantime  show  serous  infiltration 
of  the  interstitial  connective  tissue  of  the  lungs.  The  feeding 
of  cultures  is  without  effect,  likewise  intravenous  or  intra- 
tracheal injections,  provided  that  none  of  the  culture  enters  the 
subcutaneous  connective  tissue.  Intracerebral  injections  of  a 
few  drops  of  pure  culture  results  in  6  to  14  daj'^s  in  fever, 
symptoms  of  cerebral  irritation,  later  apathy  and  drowsiness, 
and  invariably  in  inflammation  of  the  joints  (experiments  of 
Nocard,  Eoux  &  Dujardin-Beaumetz). 

The  fluid  of  the  lungs  and  the  pleural  exudate  of  affected 
cattle  possesses  a  similar  pathogenic  action,  according  to  the 
older  investigations  of  Willems.  The  reactive  inflammation 
however  is  much  less  pronounced  when  the  Ijniipli  is  not  injected 
into  the  rump  or  the  neck,  but  in  the  connective  tissue  at  the 
point  of  the  tail,  which  is  more  tense  and  has  a  lower  temperature 
(such  inoculations  in  sucking  calves  frequently  result  in  serous 
or  fibrinous  inflammations  of  the  joints,  and  Dschunkowski  ob- 
served similar  manifestations  from  injections  into  the  rump  of 
reindeer).  Injections  of  lung  juice  into  the  milk  cistern  of  a  cow 
produces  a  severe  mammitis,  which  results  in  recovery  after 
four  weeks,  but  the  pus-like,  tenacious  milk  contains  the  virus 
even  after  two  months,  and  its  virulence  has  in  the  meantime 
been  increased  (Nocard). 

Cattle  which  have  recovered  from  an  inoculation  disease 
later  resist  subcutaneous  or  intrapleural  inoculations  without 
reaction,  while  by  feeding  and  also  by  intravenous  or  intra- 
ocular inoculations  no  immunity  can  be  produced. 

Besides  cattle  and  closely  related  species  (buffalo,  reindeer, 
camel,  yak,  bison)  other  animals  and  man  are  not  susceptible 
to  either  artificial  or  natural  infections. 

Dujardin-Beaimietz  obtained  cultures  bv  cultivating'  the  virus  on  media  pre- 
pared from  mutton  and  from  sheep  serum,  or  from  goat  meat  and  goat  serum, 
which  produced  a  tj'pical  action  in  cattle,  and  similarly  also  in  sheep  and  goats. 
The  lesions  produced  in  cattle,  however,  were  no  longer  virulent  for  the  last  named 
species  of  animals. 

The  channels  for  the  natural  infection  are  not  yet  clearly 
known.  In  addition  to  lieing  found  in  the  affected  lung  tissue, 
the  pleural  exudate  and  the  hmiph  glands  of  the  thoracic  cavity, 
the  virus  is  also  present  in  the  bronchial  secretions  and  in  the 
nasal  discharge,  probably  also  in  the  moist  exhaled  air,  and  is 
possibly  introduced  into  the  ])odies  of  healthy  animals  with  the 
inhaled  air.  Up  to  the  present  however  it  has  not  been  possible 
to  produce  artificially,  by  inhalation  of  infectious  exudate  and 
secretions  or  in  other  ways  a  disease  which  completely  corre- 


Natural    In  I'celiun.  393 

spends  to  contagious  plouro-pnenmonia.  The  possibility  of 
infection  by  moans  of  inhalod  air  is  proven  to  some  extent  by 
tlie  successful  experiments  of  Nocard  t^  Koux,  as  well  as  by  an 
older  experiment  of  Cliauveau,  in  wliicli  a  cow  that  inhaled  air 
from  an  affected  animal  through  a  sack  passed  over  the  heads 
of  both  animals,  became  affected  with  contagious  pleuro-pneu- 
monia. 

As  was  shown  by  experience,  the  disease  spreads  l)y  direct 
contact  of  healthy  with  affected  animals,  while  the  transmission 
of  the  virus  by  intermediate  hosts  has  not  yet  been  positively 
established.  The  contagion  appears  to  remain  virulent  in  in- 
fected stables  for  a  long  time,  and  infects  animals  which  are 
subsequently  placed  in  such  stables.  On  the  occasion  of  out- 
breaks careful  investigation  usually  reveals  the  fact  that  at 
some  time  previously  one  or  more  affected  animals  had  been 
introduced  into  the  affected  herd.  At  the  same  time  the  disease 
spreads  preferably  among  cattle  which  are  stabled  closely 
for  a  long  time,  but  sometimes  a  rapid  spread  may  also  be 
observed  during  the  pasturing  season. 

Affected  animals  may  transmit  the  disease  in  all  stages  to 
healthy  individuals,  the  transmission  being  however  easiest  and 
most  effective  during  the  acute  s^^nptoms.  The  virus  may  re- 
main effective  in  the  affected  lungs  for  years,  and  may  even 
retain  its  virulence  in  the  sequestrated  and  later  encapsulated, 
necrotic  parts  of  the  lungs.  If  an  entirely  closed  connective 
tissue  capsule  forms  around  such  a  sequestrum  and  other  parts 
of  the  lungs  remain  healthy,  the  infectiousness  of  the  animal 
is  suppressed  for  a  time;  however  as  soon  as  a  communication 
opens  between  the  cavity  and  a  bronchus,  some  parts  of  the 
sequestrum  and  with  it  micro-organisms  enter  the  air  passages, 
whereupon  the  animal  may  again  infect  others.  The  disappear- 
ance of  the  acute  s\auptoms  and  improvement  or  apparent 
recovery  does  not  therefore  mean  that  the  animal  is  no  longer 
infectious. 

Ac'eor<liug  to  Walle%'  the  virus  may  remain  active  in  the  encapsulate<l  cavities 
for  15  months;  according  to  other  anthors  the  infectiousness  may  last  even  con- 
si<]erably  longer.  Minette  traced  outbreaks  in  herds  to  cows  purchasetl  two  ami 
three  years  previously. 

The  susceptibility  of  cattle  to  tlie  disease  varies  greatly 
in  accordance  witli  the  breed  and  method  of  living,  and  also 
with  the  individuals.  The  more  hardened  range  cattle  resist 
natural  infection  far  more  than  the  more  highly  bred  stable 
cattle.  The  less  frequent  occurrence  of  the  disease  among  range 
cattle  may  also  be  explained  by  the  fact  tluit  such  animals  live 
more  out  of  doors,  and  are  therefore  less  exposed  to  an  inten- 
sive infection  than  milk  cows  or  fattening  cattle  kept  standing 
closely  in  stables.  Sometimes  in  herds  of  one  and  tlie  same 
breed  some  animals  may  withstand  the  disease  in  spite  of  favor- 
able conditions  for  infection. 


394  Contagious  Pleuro-pueumonia. 

A  commission  (Commission  Dumas),  appointed  in  1850  for  the  study  of  the 
disease  under  the  presidency  of  Bouley,  found  that  out  of  100  cattle  32  resisted 
infection.  According  to  Lutz  on  three  premises  in  the  County  Bars  (Hungary)  out 
of  246  Hungarian  fattened  steers  four  (1.63%)  became  affected,  out  of  174  fattened 
steers  of  higher  breeds  22  (17.32%),  of  32  cows  of  the  same  breed  5  (15.63%),  of 
15  similarly  bred  young  stock  9  (60%)  were  attacked  by  the  disease,  although  all 
animals  were  kept  under  the  same  conditions  and  were  kept  together  in  the  stables. 

Pathogenesis.  Tlie  virus  which  in  all  probability  enters  the 
lungs  with  the  inhaled  air,  appears  to  propagate  lirst  in  the 
lymph  spaces  of  the  interlobular  connective  tissue,  where  it 
causes  an  inflammatory  process,  as  a  result  of  which  the  spaces 
become  filled  with  serous  exudate  and  therefore  distended. 
With  this  a  serous  inflammation  of  the  surrounding  connective 
tissue  soon  becomes  associated,  and  the  inflammation  spreads 
to  the  neighboring  lobules,  wdiicli  from  their  periphery  towards 
the  center  become  filled  with  a  serous,  cellular,  later  coagulating 
exudate,  containing  also  a  few  red  blood  corpuscles.  The  in- 
flammation gradually  involves  an  increasingly  larger  part  of 
the  lungs,  producing  inflammatory  infiltration  of  the  alveoli, 
while  the  exudate  contained  in  the  previously  affected  parts 
of  the  alveoli  undergoes  fatty  degeneration.  The  virus  also 
reaches  the  pleural  tissue,  as  well  as  the  connective  tissue  of  the 
mediastinum,  and  there  produces  serous  infiltration,  while  acute 
swelling  occurs  in  the  neighboring  IjTiiph  glands. 

As  the  inflammation  extends  to  the  l>anph  spaces  of  the 
walls  of  the  vessels,  it  causes  coagulation  of  the  blood  in  parts 
of  these  vessels,  by  which  a  smaller  or  larger  part  of  the  lungs 
is  excluded  from  the  blood  circulation,  and  therefore  becomes 
necrotic  (ischemic  necrosis).  This  affected  part  of  the  lungs 
separates  later  from  the  still  sufficiently  nourished  surround- 
ings, and  a  connective  tissue  capsule  forms  around  it,  in  the 
cavity  of  which  the  necrotic  piece  of  lung  lies  free  as  a  so- 
called  sequestrum. 

The  sequestration  represents  essentially  a  healing  process, 
and  as  a  matter  of  fact  when  only  a  small  part  of  the  lung 
becomes  necrotic,  it  is  occasionally  later  absorbed,  and  actual 
recovery  may  take  place.  Mostly  however  the  sequestrum  and 
the  virus  contained  therein  remain  unchanged  for  a  long  time, 
until  the  capsule  breaks,  for  instance  by  a  severe  coughing 
spell,  whereupon  the  virus  penetrates  the  surrounding  lung  tis- 
sue, causing  acute  inflammatory  changes.  Sometimes  the  pri- 
mary inflammatory  process  may  come  to  a  standstill  in  the 
tissue  which  is  not  necrotic,  wliereupon  the  enclosed  lobules  of 
the  lungs  become  atrophied  through  shrinking  of  the  inter- 
lobular connective  tissue.  If  the  inflammation  was  confined 
only  to  a  small  area,  the  process  may  entirely  heal  in  this 
manner  by  the  formation  of  cicatricial  tissue. 

The  circulating  blood  does  not  appear  to  be  favorable  for 
the  propagation  of  the  virus,  as  blood  from  affected  animals 
is  usually  not  infectious,  and  the  injection  of  virulent  lymph 
into  the  blood  circulation  is  also  ineffective.  Exceptionally 
however  the  blood  may  contain  the  virus  and  disseminate  it 


Pathogenesis,  Anatumical  Changes. 


395 


throiift'li  tlio  body;  this  is  substantiated  by  tlie  experienco  tliat 
ill  sucking-  calves  inflammations  of  the  joints  develop  sometitncs 
l)y  way  of  metastasis,  and  that  in  some  cases  changes  chai-ac- 
teristic  of  contagious  pleuro-})neumonia  are  found  in  tlie  limits 
of  fetuses  of  diseased  pregnant  animals. 


The  virus  evidently  exerts  its  pathogenic  action  tlirouKli  toxins. 
This  coneoption  is  supi)ort(*(l  l)y  tlie  character  of  the  infiaiiiinalory  pioc- 
ossos  and  tlu^  fcvei", 
also  hy  the  fact  that 
ral)l)its,  in  the  ahdomi- 
nal  cavity  of  which  the; 
virus  propagates  for  a 
time  inside  of  collo- 
dion sacks,  die  months 
afti'i-wards  from  ca- 
chexia, although  the 
virus  pi'oper  has  ap- 
parently not  passed 
into  the  circulation  of 
the  body.  According 
to  Arloing  the  exudati^ 
contains  <».  toxic  sub- 
stance, which  may  be 
precipitated  by  alco- 
liol,  does  not  lose  its 
activity  when  heated 
to  80°,  but  produces  a 
very  severe  intoxica- 
tion if  inoculated  even 
in  very  small  quanti- 
ties into  the  blood  of 
cattle  and  goats. 

Anatomical 
Changes.  In  acute 
cases  a  smaller  or 
larger  part  of  the 
lungs  is  found  liep- 
atized,  free  from  air 
and  not  elastic;  on 
incision  a  clear 
serous,  yellow  fluid 
oozes  from  the  cut 
surface  in  great 
quantities  and  later 
coagulates  to  a  gela- 
tinous mass.  The 
cut  surface  discloses 

a  pale  yellow  network,  formed  by  an  increase  of  the  interlobular 
connective  tissue,  which  separates  the  hepatized  lung  into 
various  sized  islands,  and  according  to  the  stage  of  hepatization 


Fig.  63.  Cut  surface  of  Ihe  Junfi  in  contof/ious  pJcuro- 
pueninonia:  (a)  norniallung  tissue;  (b)  rod  licpati- 
zatioii ;  (c)  gray  hoi)atizatioii ;   (tl)  incipient  necrosis  ; 

(e)  interalveolar  se|)tuni  with  dilated  lymph  spaces: 

(f)  blood  vessels  Avitli  11iroiiil)Us;  (f,0  bronchi.  (After 
a  preparation  of  the  ))atliologic  anatomical  collection.) 


396  Contagious  Pleuro-pneiimonia. 

they  appear  gray,  pale  red,  or  dark  brownish-red  in  color 
(variegated,  marble-like  cut  surface;  Fig.  63).  In  the  broader 
beams  of  the  network  the  dilated  lymph  spaces  are  found  as 
round,  oval  or  fissured  depressions,  filled  with  yellow  lymph  or 
more  fibrinous  exudate,  while  the  immediately  adjoining  con- 
nective tissue  appears  uniformly  gelatinously  infiltrated.  The 
enclosed  airless  foci  are  pale  red  and  firm  especially  at  the 
border  of  the  hepatized  lung  portion,  sometimes  on  the  periph- 
ery, while  the  center  is  still  dark  red  and  elastic.  The  walls 
of  the  bronchi  in  the  affected  parts  of  the  lungs  also  show 
serous  infiltration  and  are  dilated,  while  their  lumen  contains 
much  fibrinous  exudate.  The  peribronchial  and  mediastinal 
lymph  glands  are  swollen  and  filled  with  fluid. 

The  pleura  over  the  affected  parts  of  the  lungs  is  sometimes 
lusterless,  injected  and  covered  with  a  very  fine,  veil-like  fibrin- 
ous membrane.  Usually  however  friable  deposits  1-2  cm.  thick, 
pale  yellowy  are  found  on  its  surface,  under  which  the  pleura 
appears  thickened,  and  the  underlying  connective  tissue  is  fre- 
quently serously  infiltrated.  In  the  majority  of  cases  the 
pleural  cavity  contains  at  the  same  time  more  or  less  (some- 
times up  to  15  to  20  liters)  clear  yellow,  or  turbid,  yellowish- 
gray  exudate  mixed  with  fibrin-flakes,  and  in  rare  cases,  the 
mediastinal  connective  tissue  is  also  saturated  by  a  similar 
exudate. 

In  more  chronic  cases  the  connective  tissue  streaks  on 
the  cut  surface  of  the  lungs  consist  of  white,  firm  connective 
tissue,  while  the  lobules  lying  between  them  are  uniformly  hepa- 
tized and  necrotic,  sometimes  even  calcified.  In  such  cases 
so  called  sequesters  are  found  frequently  in  one  or  both  lungs, 
that  is  one  or  rarely  several  necrotic  lung  portions  which  are 
from  nut  to  fist  size  or  even  larger.  Their  surface  is  knobbed, 
the  outside  layers  mushy  and  softened,  while  the  inside  is  still 
firm,  and  the  cut  surface  is  diffusely  mottled.  The  necrotic  por- 
tions are  enclosed  in  thick  connective  tissue  capsules,  to  which 
they  are  sometimes  still  partly  adherent,  and  their  inner  sur- 
face is  covered  with  a  gray,  smeary  mass.  The  capsule  may  be 
closed  or  may  communicate  with  the  neighboring  bronchus 
(Arloing  found  a  sequester  enclosed  in  a  connective  tissue  cap- 
sule as  early  as  the  fiftieth  day).  Exceptionally  even  in  the 
lung  tissue  proper,  dull  yellow  areas  may  be  found,  which  are 
only  partly  separated  from  the  surrounding  parts  and  show 
evidences  of  acute  inflammation,  while  in  other  cases  evidences 
of  fresh  pneumonia  may  be  observed  in  the  vicinity  of  an  old, 
encapsulated  sequester.  In  the  chronic  cases  the  pleura  is  usu- 
ally much  thickened,  but  the  surface  may  still  be  covered  with 
loose  pseudo-membranes,  or  the  pleural  membranes  may  adhere. 

In  some  cases  the  autopsy  may  further  reveal  serous  or 
fibrinous  pericarditis,  similar  inflammation  on  the  peritoneum, 
on  the  diaphragm,  and  in  the  portal  portion  of  the  liver;  in 
young  calves  sero-fibrinous  inflammation  may  exist  in  different 


Anatomical   Cliaii}>c's.     Syniptoius.  397 

joints  and  their  surroundings,  further  gohitinous  inliltration 
of  the  subcutaneous  connective  tissue  in  the  dowhii),  on  the 
chest,  and  sometimes  also  on  other  parts  of  the  ])ody. 

Symptoms.  The  period  of  incubation,  after  subcutaneous 
injection  of  the  virus,  in  tiiis  disease  is  (i  to  27  ihiys,  after  in- 
liahition  12  to  IG  (hiys  (Nocard  t^c  l^oux),  and  it  is  probably 
not  much  longer  under  natural  conditions.  The  reports  of  a 
very  long  time  of  incul)ation  may  probal)ly  be  traced  to  tlie  fact 
that  tlie  disease  may  be  obscured  for  a  time  even  after  tlie  initial 
rise  of  temperature,  and  symptoms  of  lung  aifection  are  only 
later  perceptible. 

As  the  first  sjanptom  of  the  affection  a  rise  in  temperature 
of  1/^.  to  1  degree  is  observed,  which  may  ))ecome  even  higher 
during  the  following  days. 

The  accurate  observation  of  the  body  temperature  in  suspected 
cases  is  of  special  importance.  According  to  L^'dtin,  Fleming  and 
Brown  animals  in  which  the  temperature  is  over  39.5°,  and  according 
to  Dele  those  in  which  it  goes  to  over  40°,  may  l)e  suspected  of  the  disease 
even  if  they  fail  to  manifest  other  abnormalities. 

Simultaneously  with  the  rise  in  temperature  the  animals 
manifest  more  or  less  pronounced  symptoms  of  general  illness, 
depending  on  the  more  acute  or  more  chronic  character  of  the 
disease  (debility,  capricious  appetite,  delayed  rumination, 
diminished  milk  secretion,  etc. ;  according  to  Berndt,  an  edema 
of  the  region  of  the  throat  appears  at  the  beginning  of  the  affec- 
tion, which  however  soon  disappears  again).  Almost  at  the 
same  time  there  is  a  short  dry  painful  cough,  which  appears 
especially  in  the  morning  after  the  animals  rise  at  the  opening 
of  the  stable  door,  or  on  leaving  the  stable,  and  while  drinking. 
This  may  also  be  brought  on  ])y  percussion  of  the  thoracic  wall. 
Later  the  cough  becomes  more  frequent,  although  without  reso- 
nance, moist  and  painful.  In  some  animals  there  occurs  a  mod- 
erate muco-jiurulent  nasal  discharge. 

This  still  indefinite  clinical  picture  changes  only  slightly 
for  a  time,  gradually  however  s^nnptoms  of  difficult  respiration 
become  more  emphatic.  About  2  to  4  weeks  after  the  appear- 
ance of  the  first  symptoms  the  respiration  becomes  accelerated 
(30  to  40  per  minute)  and  labored;  the  stronger  extension  of 
the  thoracic  wall  is  followed  mostly  by  double  contraction  of  the 
abdominal  muscles,  with  a  simultaneous  trembling  of  the  rump. 
During  inspiration  the  intercostal  spaces  sink  in,  the  nostrils 
are  opened  wide,  while  the  expiration  is  carried  out  with 
grunting  (later  the  respiration  may  become  superficial  and  very 
much  accelerated).  At  the  same  time  the  animals  turn  their 
elbows  outward,  they  utilize  the  accessor}-  muscles  of  respira- 
tion, and  also  show  the  want  of  air  by  an  anxious  expression. 
On  pressure  on  the  vertebral  column  this  is  bent  laterally. 

Percussion  reveals,  in  accordance  with  the  extension  of  the 
pneumonia,  on  one  or  both  sides,  behind  the  shoulder  blade 


398  Contagious  Pleuro-piieumonia. 

and  up  to  a  certain  height,  a  partly  or  entirely  dull  sound,  which 
is  limited  above  by  a  horizontal  or  slightly  convex  line.  During 
percussion,  as  well  as  on  pressure  of  the  intercostal  spaces  the 
animals  manifest  severe  pain,  and  attempt  to  avoid  the  pres- 
sure. Auscultation  at  lirst  shows  a  weakened,  vesicular  breath- 
ing and  some  crepitation  in  the  anterior  and  lower  portions 
(Trinchera) ;  later  in  the  region  of  the  partially  or  entirely  dull 
area  no  vesicular  breathing  or  bronchial  breathing  may  be 
heard,  but  this  is  usually  perceptible  around  the  borders  of  the 
affected  area,  while  near  the  spinal  column  and,  if  the  affection 
is  confined  to  only  one  lung,  over  that  entire  side  the  vesicular 
breathing  is  increased,  and  frequently  associated  with  moist 
rales.  In  severe  cases  expiration  is  accompanied  by  grunting, 
which  covers  up  the  respiratory  sounds.  The  heart  sounds  are 
either  clear  and  strong,  or  can  be  heard  only  slightly  on  both 
sides  (in  cases  of  serous  pleural  exudate).  Friction  sounds  may 
sometimes  be  heard  in  the  early  stages  of  the  disease,  over  ar^as 
in  which  the  dullness  has  not  yet  completely  developed. 

With  the  progression  of  the  lung  affection  the  skin  loses 
its  elasticity,  the  hair  its  smoothness  and  luster.  The  appetite 
becomes  worse  and  worse,  the  patients  rest  frequently  in  the 
pasture,  and  separate  themselves  from  the  healthy  animals. 
Rumination  is  also  delayed  and  sometimes  entirely  absent. 
Later  the  patients  fail  to  take  any  food,  they  pull  away  from  the 
crib,  or  remain  apathetically  in  one  place  in  the  pasture.  At  tho 
same  time  rumination  ceases,  and  instead  they  occasionally 
eructate.  The  animals  enjoy  taking  water,  especially  if  it  is 
pure  and  fresh.  Peristalsis  is  diminished,  the  flanks  are  sunken 
in,  constipation  alternates  with  diarrhea,  so  that  the  animals 
pass  either  dry,  solid  and  dark  brown,  or  fluid  and  fetid  feces, 
usually  with  straining. 

Urine  is  passed  at  long  intervals  and  very  sparingly.  It 
is  dark  yellow  in  color  and  acid  in  reaction,  the  specific  gravity 
is  as  high  as  1.022-1.036,  the  amount  of  phosphoric  acid  is  con- 
siderably increased,  up  to  0.30%,  while  chlorin  can  only  be 
demonstrated  in  certain  localities  (Bugarszky). 

The  milk  production,  as  already  mentioned,  diminishes  even 
in  the  earlier  stages  of  the  disease,  and  in  the  later  course  good 
milking  cows  give  hardly  1  to  2  deciliter  of  milk  which  contains 
a  considerably  reduced  quantity  of  fat  and  sugar,  while  the 
casein  and  albumen  are  increased. 

The  body  temperature  rises  in  the  further  course  of  the 
disease  up  to  41°  to  42°,  and  the  fever  curve  corresponds  to  a 
"febris  continua."  The  body  heat  is  distributed  unevenly  over 
the  surface  of  the  body,  the  ears  and  horns  feel  sometimes  warm, 
at  other  times  cold,  the  extremities  are  cold.  The  muzzle  is 
dry  and  warm,  later  its  surface  is  chapped  and  covered  with 
dried  nasal  secretion.  The  heart  beat  is  correspondingly  in- 
creased during  the  height  of  the  fever  (80-100-120  beats  per 
minute),  in  the  later  course  it  is  throbbing,  the  pulse  is  weak. 


Syiuptoius,     Course.  399 

In  fatal  cases  the  animals  become  greatly  emaciated  while 
the  described  symptoms  become  aggravated,  they  lie  with  ex- 
tended neck  and  extremities  on  the  ground,  they  breathe  with 
groans  and  with  open  montlis,  and  finally  die  of  exhaustion. 
Toward  the  termination  of  the  disease  a  subcutaneous  edem- 
atous infiltration  develops  on  the  lower  chest,  lower  abdomen, 
and  on  tlie  neck,  and  in  other  cases  a  serous  inHannnation  of  tlie 
joints  may  follow\  Cows  usuallj'^  abort  in  the  course  of  the 
disease. 

Course.  The  disease  commences  as  a  rule  in  a  latent  form, 
and  2  to  4  and  even  more  weeks  may  pass  before  it  is  distinctly 
perceptible.  From  this  on  the  process  progresses  rapidly  in 
about  one  half  of  the  cases,  and  death  ensues  inside  of  2  to  3 
.  weeks  more.  Exceptionally  the  disease  may  have  an  acute 
onset  with  severe  symptoms,  the  pneumonia  develops  wdth  a 
sharp  rise  in  temperature  in  from  2  to  3  days,  and  death  ensues 
even  in  the  course  of  the  first  week.  In  other  cases  the  affection 
develops  in  the  described  manner,  but  before  reaching  an  intense 
degree  the  animal  suddenly  dies  (paralysis  of  the  heart  due  to 
an  inflammation  of  the  pericardium  and  of  the  mediastinal  con- 
nective tissue?). 

With  the  exception  of  these  peracute  cases  the  disease  may 
come  to  a  standstill  at  any  stage,  whereupon  the  sjniptoms 
gradually  subside,  the  temperature  drops,  the  cough  becomes 
stronger,  the  difficulty  of  respiration  subsides,  the  appetite, 
rumination  and  milk  secretion  returns,  the  skin  becomes  elastic, 
and  the  animal  is  more  lively  in  general  and  improves  in  nutri- 
tion. The  shorter  the  duration  of  the  disease  and  the  milder 
the  s>nnptoms,  the  more  complete  is  the  improvement,  and  some 
animals  may  appear  entirely  recovered  after  a  certain  time. 
This  condition  may  be  permanent,  especially  in  cases  in  which 
the  sjTiiptoms  were  less  intense  from  the  beginning,  and  no  pro- 
nounced dullness  of  the  lungs  could  be  found.  Usually  however 
the  recovery  is  only  apparent,  as  after  a  shorter  or  longer  time 
the  disease  breaks  out  anew%  and  takes  on  a  severe  form,  or  it 
is  possible  even  later  to  ascertain  a  dullness  in  the  lungs,  with 
the  other  manifestations  of  a  constricted  respiratory  area  in 
the  improved  animals,  which  meanw^hile  may  even  increase  in 
body  weight.  If  in  severe  cases  improvement  occurs  at  all  it 
usually  requires  months,  until  at  least  the  digestive  functions 
are  again  performed  normally.  Notw^ithstanding  this  the  respi- 
ration may  even  later  remain  more  or  less  difficult,  a  slight 
cough  may  be  noted  periodically,  and  the  animals  are  easily 
fatigued.  Such  patients  become  again  emaciated  after  a  while, 
and  finally  die  from  exhaustion,  or  the  disease  again  assumes 
an  acute  form  and  leads  to  rapid  death. 

The^  outcome  of  the  disease  can  hardly  be  prognosticated 
during  its  development.  At  present  the  progiiosis  is  of  no 
importance,  as  the_  diagnosis  of  the  disease,  or  its  suspicion 
requires  the  immediate  slaughter  of  the  animal. 


400  Contagious  Pleuro-pneuniouia. 

As  an  epizootic  contagious  pleuro-pneumonia  nsnally  runs 
a  slow  course.  After  the  first  introduction  the  suspicion  of 
a  general  outbreak,  because  of  its  occurrence  in  several  animals, 
is  aroused  only  after  about  4  to  6  weeks.  In  stables  the  imme- 
diate neighbors  of  the  affected  animal  become  first  affected,  and 
the  number  of  cases  increases  only  from  week  to  week,  so  that 
in  large  herds  it  requires  several  months  before  all  susceptible 
animals  are  affected.  If  the  dead  or  emergency  slaughtered 
animals  are  replaced  by  new  ones,  as  for  instance  in  fattening 
establishments,  the  disease  may  exist  with  varying  intensity  for 
years,  and  it  may  also  be  propagated  for  years  among  animals 
in  a  township  when  kept  upon  public  pastures. 

Diagnosis.  In  the  living  animals  a  positive  diagnosis  can 
only  rarely  be  made  with  sufficient  assurance.  Physical  exam- 
ination shows  only  that  the  animal  is  affected  with  pneumonia, 
or  pleuro-pneumonia,  the  nature  of  which  however  can  be  estab- 
lished accurately  only  by  reliable  historical  data.  If  there  is 
a  suspicion  of  infection  every  disease  of  the  lungs  which  shows 
a  latent  development  and  which  gradually  becomes  more  inten- 
sive is  a  suspicious  indication  of  the  disease,  especially  when 
several  cattle  become  affected  successively  under  similar  mani- 
festations. Under  such  conditions  the  diagnosis  of  contagious 
pleuro-pneumonia  may  be  established  with  great  probability, 
especially  when  the  disease  becomes  more  advanced,  and  the 
symptoms  become  more  pronounced.  Absolute  certainty  how- 
ever is  even  in  such  cases  revealed  only  by  the  autopsy. 

From  the  standpoint  of  differential  diagnosis,  the  subacute 
pectoral  form  of  hemorrhagic  septicemia  comes  into  consider- 
ation in  the  first  place.  Although  in  most  cases  it  is  distin- 
guished from  pleuro-pneumonia  by  the  sudden  onset,  the  acute 
course,  the  severe  intestinal  inflammation  which  is  commonly 
present,  as  well  as  the  simultaneous  affection  of  several  animals, 
isolated  cases  of  the  disease  which  run  a  slower  course  may  be 
easily  mistaken  for  the  acute  stage  of  pleuro-pneumonia.  The 
diagnosis  is  sometimes  difficult  even  on  postmortem  examin- 
ation ;  although  in  hemorrhagic  septicemia  a  larger  part  of  the 
lung  is  usually  uniformly  affected  and  the  cut  surface  shows  no 
marbled  appearance,  yet  the  changes  in  the  lungs  may  entirely 
simulate  those  of  acute  pleuro-pneumonia.  Numerous  hemor- 
rhages in  the  pleural  tissue  and  in  the  mucous  membrane  of 
the  air  passages  are  indications  of  hemorrhagic  septicemia, 
nevertheless  even  in  such  cases  the  diagnosis  can  be  established 
with  certainty  only  by  bacteriological  examination.  In  this 
respect  the  difference  is  that  in  pleuro-pneumonia  the  exudate 
of  the  lungs  reveals  no  bacteria  under  the  microscope,  further 
the  inoculation  of  the  fluid  from  the  lungs  has  no  effect  on  test 
animals,  and  in  calves  the  subcutaneous  injection  is  followed 
after  one  week  at  the  earliest  by  an  edematous  swelling,  while 
in  hemorrhagic  septicemia  the  exudate  of  the  lungs  contains 
small,  polar  stained  bacilli ;  the  inoculation  of  the  fluid  from  the 


Diaiiiui.sis. 


401 


lungs  kills  giiinoa  pigs,  rabbits,  and  as  a  rule  also  calvos  in 
1  to  2  days.  Nevertheless  the  diagnosis  may  prove  diHicidt 
even  by  tliis  method  of  examination,  as  in  some  subacute  cases 
of  hemorrhagic  sei)ticemia  the  lung  tissne  may  contain  only  a 
few  ovoid  bacteria,  Avhich  are  only  slightly  virulent  for  rabbits. 

Tho  charat'tcristies  given  above  hold  also  foi-  llic  (litfci-ciiliatioii  of 
septic  pleuro-pneuinonia  of  calves  caused  by  bipolar  bacilH.  Ironi  i)lcuro- 
pneunioiiia. 

Tuberculosis  may  be  mistaken  both  for  the  early  stage  and 
for  the  chronic  form  of  pleuro-pneumonia.  The  severe  cough, 
the  absence  of  extensive  dullness,  bronchial  breathing  and  sensi- 
tiveness of  the  thorax,  further  the  normal  temperature  or  only 
moderate  and  sometimes  remittent  fever  and  the  very  slow 
evolution  suggest  the  probability  of  tuberculosis.  The  differ- 
entiation nuiy  sometimes  be  difficult,  as  tuberculosis  may  take 
on  an  acute  character,  and  in  pleuro-pneumonia  the  course  may 
become  chronic  after  the  disappearance  of  the  acute  symptoms. 
Moreover  the  establishment  of  tuberculosis,  for  instance  l)v 
microscopical  examination  of  the  discharges,  does  not  exclude 
pleuro-pneumonia,  as  both  affections  may  exist  simultaneously 
in  one  and  the  same  animal. 

Traumatic  pericarditis  has  in  common  with  pleuro-pneu- 
monia the  sensitiveness  of  the  thorax,  the  dullness  on  per- 
cussion and  the  difficulty  in  breathing.  The  sensitiveness  how- 
ever is  mostly  confined  to  the  region  of  the  heart,  the  dullness 
IS  bordered  by  a  concave  line  running  downwards  and  forwards, 
the  heart's  action  is  quite  easily  disturbed,  and  besides  a  venous 
pulse  is  sometimes  perceptible  in  the  neck,  while  on  the  lower 
chest  an  edematous  swelling  is  present.  If  however  the  lung 
is  simultaneously  affected,  the  differentiation  of  the  aifection 
from  pleuro-pneumonia  is  impossible. 

A  genuine  croupous  pneumonia  in  which  the  fullv  devel- 
oped clinical  ])icture  entirely  corresponds  with  the  s^onptoms 
of  pleuro-pneumonia,  could  only  be  suspected  when  the  possi- 
bility of  contagious  pleuro-pneumonia  appears  to  be  excluded, 
and  when  the  disease  takes  a  typical  course  and  disappears  com- 
pletely within  a  short  time  after  a  rapid  dissolution  of  the 
lung  infiltration.  On  autopsy  the  slight  affection  of  the  pleura, 
and  the  entirely  uniform  color  of  the  hepatized  portion  of  tlie 
lung  are  indications  of  a  genuine  pneumonia  (the  cut  surface 
is  sometimes^ mar1)led  even  in  these  cases  but  not  variegated). 
Finally  in  infected  territories  chronic  bronchial  catarrh! 
catarrhal  pneumonia,  verminous  bronchitis,  pneumomycosis^ 
(nasal^  discharge!),  the  echinococcus  disease  (good  nutritive 
condition,  no  sensitiveness  of  tlie  pleura),  as  well  as  other  affec- 
tions of  the  lungs,  may  give  rise  to  suspicion  of  pleuro-pneu- 
monia. 

According'   to   Nocar.l    tin-    diagnosis    of   plouro  i)iR'uinonia   luav   lie    iiiado   with 
certainty  in  a  short  time  l>y  the  examination  of  small  portions  of  the  lnn<?s  or  of 

Vol.  1—26 


402  Cuutayious  Pleuro-pneumonia , 

the  exudate  in  the  following  way :  The  exudate  from  the  lung  is  diluted  with 
Martin's  bouillon  60-80  times  and  filtered  through  a  Chamberland 's  F-candle  or 
through  a  Berkefeld  filter.  The  filtrate  is  collected  in  a  sterilized  flask,  on  the 
bottom  of  which  cattle  blood  serum  has  been  placed  in  an  amount  corresponding 
to  6-8%  of  exudate.  Then  the  flask  containing  the  filtrate  is  placed  in  a  thermostat, 
and  shoulil  the  fluid  become  opalescent  in  3  to  4  days  without  the  microscopical 
examination  demonstrating  therein  distinguishable  bacteria,  the  diagnosis  of  pleuro- 
pneumonia may  be  considered  as  established. 

Immunization.  Immunization  against  plenro-pnenmonia 
has  been  employed  to  a  considerable  extent  since  the  stand  taken 
by  Willems  in  1850,  as  a  procedure  by  which  healthy  animals 
may  be  protected  against  natural  infection.  Since  that  time 
it  has  been  employed  widely,  especially  in  Holland,  Belgium, 
Great  Britain,  France,  and  Germany,  in  recent  times  also  in 
Africa  and  Australia,  while  in  England,  Austria  and  Hungary 
it  has  not  met  with  favor. 

I.  Immunization  with  Fluid  from  the  Lungs.  This  method 
of  immunization,  the  principle  of  which  consists  in  the  injection 
of  the  living  virus  into  the  stretched  subcutaneous  connective 
tissue  of  the  point  of  the  tail,  which  has  a  low  temperature, 
affords,  as  proved  convincingly  by  Willems  and  later  also  by 
other  observers,  the  animals  an  immunity  lasting  over  one  year. 
This  can  easily  be  proved  by  injections  of  virulent  lymph  into 
the  loose  connective  tissue  of  the  dewlap  or  rump.^  While  it 
produces  an  extensive  inflammatory  edema  in  non-immunized 
cattle  which  sometimes  results  in  the  death  of  the  animal,  in 
cattle  which  have  been  immunized  a  swelling  not  exceeding  the 
size  of  a  nut  results  at  the  point  of  inoculation,  and  an  injection 
of  virulent  lymph  directly  into  the  tissue  of  the  lung  does  not  in 
any  way  affect  their  health.  Practical  experience  coincides  with 
these  results,  it  having  been  observed  that  immunized  animals 
liecome  much  more  rarely  affected  through  natural  infection 
than  cattle  which  have  not  been  immunized. 

In  Willems'  experiments  108  immunized  cattle  remained  healthy  after  being 
exposed  to  the  natural  infection,  while  out  of  50  animals  which  were  not  immunized, 
17  became  affected  under  the  same  conditions.  Thiernesse  &  Degive  injected  96 
immunized  cattle  with  virulent  lymph  into  the  loose  connective  tissue  of  the  rump, 
whereupon  they  became  affected  only  mildly  or  not  at  all,  while  of  33  animals 
which  were  not  immunized  and  subjected  to  the  same  infection,  all  contracted  the 
disease.  Schiitz  &  Stefifen  inoculated  31  animals  partly  with  warm,  partly  with 
cooled  lymph  from  the  lungs;  12  were  later  placed  among  infected  animals,  but 
remained  healthy,  while  of  four  control  animals  three  died.  The  remaining  19  head 
received  later  virulent  lymph  injected  either  into  the  connective  tissue  of  the 
dewlap  or  into  the  lungs,  whereupon  they  contracted  the  disease  only  in  a  mild 
form  or  not  at  all,  while  all  of  the  six  control  animals  became  severely  affected 
and  three  of  them  died. 

Under  certain  conditions  the  immunization  may  prove  an 
effective  method  of  controlling  the  disease,  especially  when  it 
is  very  widely  spread  in  a  country,  and  the  general  obligatory 
slaughter  of  the  suspected  animals  cannot  be  carried  out  for 
some  reason,  and  where  the  danger  of  subsequent  exposure 
must  continue  to  threaten  the  animals  (in  case  of  infection 
involving  large  herds,  public  herds,  valuable  large  dairy  herds, 
industrial  fattening  establishments). 


Iiiiimuiizalioii.  403 

As  a  matter  of  fact  the  procedure  was  mostly  disapproved 
of  in  the  past,  and  played  only  a  subordinate  ])ait  in  the 
attempts  to  eradicate  the'disease.  This  may  be  explained  prin- 
cipally by  the  fact  that  in  innnunizing  large  herds  those  animals 
are  of  course  also  inoculated  which,  although  ai)parently  healtliy 
nevertheless  are  already  infected.  In  these  aninuils  the  already 
existing  inHammatory  process  continues  to  develo])  in  the  usual 
manner  in  spite  of"  the  inoculation  and  thus  these  animals, 
which  are  believed  to  be  no  longer  susceptible,  continue  to 
s])read  the  disease  among  those  which  liave  not  been  innnunize<l. 
A  further  disadvantage  exists  also  in  the  frequent  loss  of  the 
tail  as  well  as  in  the  occasional  fatal  results  of  the  method. 

Tniniunijation  was  introducdl  in  the  Sitoplinger  District  of  Hollantl  in  1^74, 
as  this  territory  had  been  so  badly  infected  that  the  slaughter  of  animals  coidd 
not  be  carried  out,  and  as  a  result  of  this  procedure  up  to  1884  the  annual  loss 
was  reduced  from  1:20S  to  i:5')  cattle.  According:  to  Degive  2.7%  out  of  6,7nG  imnui- 
nized  animals  acquire<l  the  disease  between  1850  and  1883  in  the  various  countries, 
while  out  of  2,4.53  animals,  which  were  not  immunized,  26.97o  became  later  affected 
■with  pleuro-pneumonia.  In  the  German  Empire,  according  to  official  reports,  out 
of  3,868  immunized  animals  151  (3.9%)  became  affected  in  the  period  of  189_1-19()() 
in  previously  immunized  herds,  while  out  of  546  not  immunized  animals  73  (13.4%) 
became  ill.  "  In  herds  which  were  immunised  only  after  the  outbreak  of  the  disease, 
out  of  3,287  immunized  animals  394  (11.9%) 'became  subsequently  affected  with 
pleuro-pneumonia. 

Results  of  the  Immunization.  After  the  inoculation  of  fresh,  pure 
lymph,  a  hard,  painful  and  warm  swelling  in  size  like  a  nut  to  an 
egg  develops  in  about  90%  of  the  animals,  at  the  point  of  inoculation ; 
the  animals  keep  the  tail  quiet  and  slightly  bent  upward,  and  at  the 
sajue  time  showing  marked  febrile  symptoms.  In  favorable  cases  the 
swelling  disappears  together  with  the  febrile  symptoms  inside  of  1  to 
2  weeks;  not  infreciuently  however  the  swelling  increases  in  size  and 
suppuration  or  even  necrosis  of  the  tip  of  the  tail  sets  in.  _  Occasionally 
the  inflammation  may  extend  even  to  the  root  of  the  tail  and  to  the 
part  around  the  anus,  as  well  as  to  the  connective  tissue  of  the  pelvis, 
whereupon  the  animal  dies  from  peritonitis  which  may  be  associated 
with  it,  or  from  pyemia  or  septicemia.  The  cause  of  these  dangerous 
complications  may  almost  invarialily  be  attributed  to  the  fact  that  the 
vaccine  originally  contained  foreign  pathogenic  bacteria,^  or  that  such 
organisms  entered  it  during  its  preparation  and  preservation,  or  during 
the  inoculation.  The  number  of  deaths  and  losses  of  tails  varies  accord- 
ingly from  case  to  case.  On  an  average  1  to  3%  of  the  immunized 
animals  die,  and  5  to  15  7f  lose  their  tails. 

According  to  Haubner  the  deaths  amount  on  an  average  to  1-2%  (at  the 
highest  10%),  the  losses  of  tails  to  5-10%.  In  Holland,  in  the  Spoelinger  District, 
out  of  147,971  immunized  animals  1,285  (0.94%)  died  in  the  years  1878-1887,  while 
in  Hasselt,  the  home  of  Willems,  the  mortality  among  184,275  immunized  animals 
did  not  exceed  1%.  In  Germany  out  of  17,520  immunized  animals  141  (0.8%) 
died  as  a  result  of  the  inoculation  between  1891-1901.  In  some  cases,  however,  the 
losses  were  considerably  greater.  Thus  Hildebrandt  observed  among  365  inoculated 
animals  69  (18.9%)  deaths,  while  on  another  occasion  49%  of  the  animals  remaining 
alive  lost  their  tails.     Similar  unfavorable  results  are  reported  by  Omler. 

Technique  of  Inoculation.  In  the  oldest  method  recommended  by  Willems,  the 
material  which  is  used  for  the  immunization  consists  of  fluids  from  the  lungs  of  an 
animal  affected  with  the  acute  form  of  pleuro-pneumonia,  which  had  been  slaughtered 
immediatelv  before  the  immunization.  The  hepatized  part  of  the  lung  is  incised 
by  a  knife  sterilize<l  in  a  flame,  whereupon  the  lymph  accumulates  in  the  depth  of 


404  Contagious  Pleuro-pneumonia. 

the  incision.  The  inoculation  is  carried  out  by  dii^i^ing  a  grooved  vaccinating  needle 
into  the  Ij'mph,  and  sticking  the  same  about  10  crn.  from  the  point  of  the  tail  into 
the  subcutis,  or  the  lymph  may  be  allowed  to  coagulate  in  a  glass  vessel  and  1-2 
drops  of  the  serum  are  subcutaneously  injected  into  the  same  place  by  means  of  a 
Pravaz  syringe. 

In  procuring  the  virus  special  care  should  lie  taken  that  the  lungs  are  only 
affected  with  characteristic  acute  changes  of  pleuro-pneumonia,  and  that  the  lymph 
is  very  clear  and  light  yellow.  Lungs  in  which  necrotic  centers  are  already  present 
must  not  be  used  for  this  purpose,  as  they  frecjuently  contain  pyogenic  or  gangrene 
producing  bacteria.  Some  filter  the  collected  lymph  through  pure  linen  and  inoculate 
the  filtrate.  If  pure  serous  exudate  is  present  between  the  layers  of  the  pleura, 
this  may  also  be  utilized  for  the  inoculation. 

The  described  procedure  has  repeatedly  been  modified;  thus  Martin  introduces 
under  the  skin  of  the  end  of  the  tail,  immediately  under  the  last  caudal  vertebra  a 
hair  cord  three  mm.  broad  and  8-10  cm.  long  saturated  with  lymph.  This  is  allowed 
to  remain  in  place  for  8  to  12  days  and  is  in  the  meantime  repeatedly  moistened  witli 
lymph.  A  similar  method  is  practiced  by  the  Boers  in  South  Africa,  in  which 
they  saturate  raw,  woolen  threads  with  lymph  and  introduce  them  under  the  skin 
at  the  point  of  the  tail.  Defays,  Bouley,  Thiernesse  and  Degive  injected  2  cc.  of 
virus  directly  into  a  superficial  vein,  for  instance  into  the  jugular. 

Others  again,  among  them  Willems,  utilize  the  serous  fluid  of  the  swelling  at 
the  point  of  inoculation  as  vaccine,  whereas  in  Australia,  in  accordance  with 
Pasteur 's  suggestion,  the  fluid  of  the  lung  is  first  inoculated  subcutaneously  into 
the  dewlap,  or  behind  the  shoulder  of  a  calf  two  or  three  months  old,  and  from  the 
resulting  swelling  after  the  death  of  the  animal  the  lymph,  which  sometimes  amounts 
to  several  liters,  is  collected  in  glass  tubes,  the  ends  of  which  are  closed  by  melting. 
The  lymph  thus  obtained  is  supposed  to  remain  unchanged  and  effective  for  six 
to  eight  weeks  if  kept  in  a  cool  place  (according  to  Schmidt  adult  cattle  are  still 
better  adapted  for  lymph  production  than  calves). 

Laquerriere  allows  the  lung  to  freeze  at  5°  to  6°  below  zero,  and  then  places 
small  pieces  of  it  in  sterilized  glass  vessels.  The  lymph  which  oozes  out  has  the 
same  effectiveness  after  one  year  as  when  taken  out  from  the  fresh  lung.  Schiitz 
&  Steften  grind  the  fresh  lung  juice  in  a  mortar  with  glycerin  and  then  place  it  in 
a  cool  place.  This  substance  remains  effective  for  at  least  eight  days,  as  coagulation 
is  prevented  by  the  glycerin.  Koeard  incises  the  hepatized  lungs,  which  have  been 
washed  in  hot  water,  deeply,  and  covers  the  incision  with  a  plate.  The  collected 
lymph  is  drawn  off  with  a  sterilized  pipette,  mixed  with  water  containing  carbolic 
acid  and  glycerin  (1  part  lymph,  14  part  of  a  !,{;%  solution  carbolic  acid,  %  part 
pure  neutral  glycerin).  This  is  filtered  through  paper  and  kept  in  glass  tubes  in 
cool  dark  places.  Such  lymph  remains  unchanged  for  months.  The  natives 
of  Senegambia  for  a  long  time  employed  the  method  of  taking  the  point  of  a  knife 
or  dagger,  dipping  it  first  into  the  aft'ected  lungs,  and  then  sticking  it  under  the 
pkin  of  the  back  of  the  neck  of  the  animal  which  was  to  be  inoculated. 

Besides  the  methods  described  Theiler  recommends  the  administration  of  viru- 
lent material  (fluid  of  the  lung  or  culture)  per  os,  (6  oz.  diluted  with  water),  as 
has  been  practiced  for  a  long  time  in  South  Africa.  The  immunity  is  supposed  to 
last  for  18  months. 

II.  Immunization  with  Pure  Cultures.  In  France  immun- 
ization with  pure  cultures  has  been  carried  out  since  1899  ac- 
cording to  the  suggestion  of  Nocard  &  Roux,  and  the  results 
have  in  general  been  more  favorable  than  with  the  old  method. 
An  eight-day  old  culture  of  the  virus  in  Martin's  bouillon  serves 
as  vaccine,  of  which  cattle  receive  %  to  i/>  cc.  subcutaneously, 
inoculated  into  the  tip  of  the  tail.  The  immunity  thus  pro- 
duced lasts  for  at  least  two  years,  as  immunized  animals,  which 
have  distinctly  reacted  to  the  inoculation,  withstand  after  two 
years  a  subcutaneous  injection  of  0.5  cc.  of  pure  culture  without 
any  reaction  (Constant  &  Mesnard). 

In  the  beginning  of  1901,  2,359  cattle  were  immunized  by  this  method  in 
Southern  Prance,  on  597  premises;  of  these  3  (0.12%)  died,  18  head  (0.7%)  lost 
their  tails.  All  of  these  losses  occurred  in  one  township,  where  a  veterinarian  had 
not  carried  out  the  inoculation  in  accordance  with   the  requirements;    otherwise  no 


Imiminizatioii.  40,") 

losses  were  observed  (Xoeanl).  During  1902,  out  of  1,955  iiiimuuized  animals  nine  died, 
while  257  lost  their  tails  (the  inoculations  wore  made  in  this  instance  (iurinf:j  unfavor- 
al)le  weatiier).  in  UKi.'i  and  l!in4  attonuati'il  cultures  were  used  for  the  inuuunization, 
and  on  this  occasion  out  of  5,554  animals  only  one  die<i,  and  only  SS  cattle  lost 
their  tails. 

According  to  Yohowsky's  report  immunization  with  pure  cultures  also  gave 
f'atisfactory  results  in  liussia,  only  he  emphasizes  the  fact  that  cattle  which  had  not 
reacted  to  the  inoculation  should  be  inoculated  the  second  time  after  20  to  25  days. 
Very  favorable  results  are  likewise  reported  from  Kussia  and  Siberia  by  Dorofeew, 
Mnkarewsky  and  Stahl. 

Cattle  may  also  be  immunized  effectively  by  intraocular  injections  of  pure 
cultures  (Xocard  &  Koux). 

III.  Serum  Inoculation.  Altliouij:h  the  serum  of  healthy 
cattle  and  those  which  have  recovered  from  tlie  disease,  pos- 
sesses no  inmiuiiizing-  properties,  animals  which  become  affected 
as  a  result  of  subcutaneous  injections  of  a  small  quantity  of 
pure  culture  and  have  again  recovered,  and  which  have  sub- 
se(iuently  received  during  several  months  subcutaneous  injec- 
tions of  up  to  over  6  liters  of  culture,  produce  a  potent  serum, 
although  it  has  no  agglutinating  or  bactericidal  properties. 
A  subcutaneous  injection  of  40  cc.  of  such  serum  produces  an 
immunity  lasting  from  8  to  10  days,  while  40-00  cc.  checks  the 
further  develojunent  of  an  inoculation-swelling  produced  by 
a  virulent  injection.  After  the  appearance  of  the  fever  re- 
peated injections  of  100-200  cc.  of  serum  are  required  to  exert 
a  curative  action;  at  still  later  stages  it  is  not  possible,  even 
by  very  large  injections,  to  check  the  process  in  the  lungs 
(Xocard). 

-  Veterinary  Police.  As  the  treatment  of  affected  animals 
does  not  promise  results,  the  complete  eradication  of  the  disease 
by  veterinary  police  measures  is  of  special  importance.  As 
the  virus  remains  virulent  in  the  body  of  affected  animals  for 
a  long  time,  even  in  cases  showing  improvement,  it  can  only 
l)e  destroyed  by  the  slaughter  of  all  cattle  which  are  supposed 
to  harbor  it  in  their  bodies.  In  this  regard,  besides  the  affected 
and  exposed  animals  even  those  should  be  considered  which 
are  suspected  of  having  been  atfected,  as  suspicious  symptoms 
of  the  disease  appear  only  relatively  long  after  the  infection 
in  a  perceptible  manner. 

This  attitude  has  been  assumed  by  the  legislative  bodies 
of  those  countries  which  earnestly  desired  the  complete  eradica- 
tion of  contagious  pleuro-pneumonia,  and  by  an  energetic  prac- 
tical execution  of  this  principle,  and  by  satisfactory  compensa- 
tion of  the  owners,  the  desired  end  has  been  achieved.  However 
the  killing  of  all  the  suspected  animals  in  localities  where  the 
disease  is  widely  spread,  especially  in  large  dairy  herds,  fatten- 
ing establishments,  and  public  cattle  herds,  is  hardly  possible 
of  execution  without  great  danger  to  the  stock  industry.  There- 
fore in  such  herds  the  isolation  or  quarantining  of  the  suspected 
animals  for  a  period  of  at  least  six  months  should  be  considered, 
and  further,  in  order  to  reduce  the  individual  susceptibility  the 
application  of  occasional  immunization,  particularly  since  by 


406  Contagious  Pleuro-pueiimouia. 

the  utilization  of  pure  cultures  for  immunization,  the  danger 
has  been  greatly  lessened  as  compared  with  former  times. 
Further  a  thorough  disinfection  of  the  infected  stables,  as  well 
as  the  most  thorough  airing  possible  of  the  evacuated  buildings, 
aid  greatly  in  obtaining  the  desired  result. 

The  law  of  1880  concerning  the  infectious  diseases  of  the  German  Empire 
ordered  only  the  slaughter  of  the  affected  animals;  in  1895,  however,  this  measure 
was  extended  also  to  suspected  animals,  and  the  authorities  were  further  authorized 
to  destroy  cattle  which  were  suspected  of  having  been  infected.  In  the  period  of 
1S90-1903  11,975  cattle  were  slaughtered  by  authoritative  order,  and  the  government- 
indemnity  to  the  owners  amounted  to  2,987,795  marks. 

In  Great  Britain  the  measure  of  1888  did  not  have  satisfactory  results  in 
spite  of  the  fact  that  over  30,000  cattle  were  slaughtered,  as  the  slaughter  of  the  affected 
and  suspected  animals  and  the  compensation  of  the  owners  had  to  be  carried  by 
the  local  funds;  therefore  by  the  Act  of  July  4,  1890,  the  government  was  entrusted 
with  the  execution  of  the  eradicatio7i.  Since  that  time  the  situation  has  improved 
rapidly,  so  that  in  1898  the  entire  country  was  free  from  the  disease  (the  cost  of 
eradication  amounted  to  over  14  million  pounds  sterling). 

In  accordance  with  the  contagious  pleuro-pneumonia  law  of  August  17,  1892, 
the  eradication  was  carried  out  in  Austria  until  the  suppression  of  the  disease  in 
1897,  during  which  time  21,013  cattle  were  slaughtered,  at  a  valuation  of  3,555,886 
crowns;  of  this  amount  the  State  paid  an  indemnity  of  2,711,651  crowns. 

In  Hungary,  according  to  the  law  of  1893,  the  slaughter  of  the  affected  and 
suspected  animals  was  ordered,  eventually  also  of  those  which  were  suspected  of 
being  affected,  and  the  time  of  observation  for  the  latter  was  extended  to  six  months. 
The  owners  were  assured  of  an  indemnity  by  the  State,  which  in  accordance  with  the 
law  of  1897,  included  for  healthy  animals  the  full  value,  and  for  affected  cattle 
90%  of  the  appraised  value.  Until  the  eradication  of  the  disease  in  1901,  56,238 
cattle  were  slaughtered  in  accordance  with  this  law,  with  a  total  indemnity  amounting 
to  3,651,905  crowns.  In  a  similar  way,  by  obligatory  slaughter  of  the  affected  and 
suspected  animals,  with  indemnity  from  the  State,  the  disease  has  been  eradicated  in 
Holland   (1884-1888),  in  Denmark   (1849-1856),  and  in  North  America  (1887-1892). 

Literature.  Willems,  Eec,  1852,  401;  1887,  11.— Magendie  &  Bouley,  Ibid., 
1854,  161.— Sussdorf,  D.  Z.  f.  Tm.,  1879,  V,  353.— Thiernesse  &  Degive,  Ann.,  1882, 
620.— Schlitz  &  Steffen,  A.  f.  Tk.,  1889,  XV,  217;  1890,  XVI,  29;  1891,  XVII,  290.— 
Mac  Fadyean,  J.  of  comp.  Path.,  1892,  V.— Nocard,  Bull.,  1892,  158,  203  u.  317.— 
Eoeckl,  Ber.  liber  d.  Kongr  in  Bern,  1894,  11. — Thomassen,  Ibid.,  1S94,  51. — Nocard 
&  Eoux,  A.  P.,  1898,  XII,  240;  1901,  416.— Nocard,  Eoux  &  Duiardin-Beaumetz, 
Bull.,  1899,  430.— Schmidt,  B.  t.  W.,  1898,  159;  D.  t.  W.,  1899,  265.— Techn. 
Dep.  f.  d.  Vet.-Wesen,  A.  f.  Tk.,  1899,  XXV,  312.— Theiler,  Schw.  A.,  1899,  XLI,  57. 
—Constant  &  Mesnard,  Eec,  1903,  436;  1904,  552.— Dujardin-Beaumetz,  A.  P.,  1906, 
XX,  449. — Bordet,  A.  P.,  1910,  XXIV,  161.— Borrel,  Dujardin-Beaumetz,  Jeantet  & 
Jouan,  Ibid.,  168. 

Infectious  Pleuro-pneumonia  of  Goats.  In  the  years  of  1894  and 
1895  a  severe  pneumonia  developed  in  various  localities  of  Germany, 
especially  in  Saxony  in  the  vicinity  of  Dresden  (Pusch)  and  in  Thurin- 
gia  (Storch,  Holzendorff),  among  the  bucks  imported  to  this  locality 
from  the  Swiss  Simmental  shortly  after  their  arrival,  which  later  spread 
also  to  the  native  goats.  At  the  same  time  the  disease  was  ol)served  by 
Leclainche  in  the  Pyrenees,  two  years  later  l)y  Mazzini  in  Italy,  and  the 
first  mentioned  author  established  the  fact  that  the  disease  is  identical 
with  the  affection  of  goats  in  Algeria  known  there  as  "boufrida,"  and 
which  occurs  there  in  some  years  in  an  epizootic  form  causing  great 
losses. 

The  disease  appears  to  affect  goats  exclusively;  the  transmission  to 
other  animals,  even  to  sheep,  has  not  yet  been  observed.  According  to 
recorded  observations  the  disease  is  prevalent  only  in  mountainous 
regions,  where  it  usually  runs  a  mild  course.  If  however  the  affected 
animals  are  brought  to  other  localities  the  disease  attains,  under  the 
influence  of  the  transportation  and  the  changed  climatic  conditions,  a 
severe  form,  and  causes  severe  losses  even  among  the  native  goats. 


SyiHptonis.  iny 

Symptoms.  The  disease  connucnees  after  a  period  of  incubation  of 
8  to  10  days  (Puseh)  with  fever  and  catarrh  of  the  air  passages  (cougli, 
nasal  discharge,  increased  vesicular  breatliing).  After  3  to  5  days  tlie 
respiration  becomes  very  la])orious  and  on  piiysical  examination  of  tlie 
thorax  exudative  ])leurisy  or  hepatization  in  a  portion  of  the  lung  may 
be  established,  uhicli  as  a  rule  is  contined  to  one  side.  Subse(iuently  the 
condition  becomes  aggravated  sometimes  rapidly,  other  times  only 
gradually,  and  as  a  rule  about  one  half  of  the  affected  animals  die. 
In  some  auinuds  a  herpes-like  eruption  is  observed  on  the  lii)s,  some- 
times also  on  the  udder,  Avhich  as  a  rule  heals  without  interference. 

The  course  is  at  times  so  rapid  that  tlie  hepatization  of  the  lungs 
develops  in  a  few  hours  and  death  ensues  in  from  12  to  46  hours ;  mosth- 
however  the  disease  lasts,  even  in  severe  eases,  from  3  to  4  weeks,  while 
in  other  animals  it  runs  a  more  chronic  course,  and  the  animals,  which 
in  the  meantime  become  greatly  emaciated,  iinally  recover. 

Tlie  autopsy  sometimes  reveals  only  hepatization  of  a  small  or 
larger  area  of  the  lung  in  wliich  there  is  at  the  same  time  an  infiltration 
of  the  interstitial  connective  tissue.  The  cut  surface  therefore  resemliles 
somewhat  that  of  the  lungs  in  contagious  pleuro-pneumonia.  In  other 
cases,  which  are  more  fre(iueut,  there  is  also  a  sero-fibrinous  pleurisy 
with  profuse  exudate  in  the  thorax.  At  the  same  time  the  peri])ronchial 
lymph  glands,  and  the  spleen  show  acute  swelling,  while  the  other 
organs  show  no  special  changes. 

Bacteriological  examinations  have  failed  to  reveal,  up  to  the  present 
time  the  presence  of  micro-organisms,  either  in  the  affected  lungs  or  in 
the  pleural  exudate.  Inoculation  of  material  from  the  lesions  into 
goats,  and  also  into  other  animals  was  entirely  negative.  This  condition 
differentiates  the  disease  from  contagious  pleuro-pneumonia  of  goats 
(see  p.  124),  and  also  excludes  a  relationship  with  that  disease.  Never- 
theless the  infectiousness  of  the  disease  cannot  be  denied,  especially  in 
consideration  of  the  experiences  in  Germany,  and  therefore  quarantine 
measures,  isolation,  and  early  slaughter  of  the  aft'ected  animals,  disin- 
fection of  the  stal)les,  etc.,  are  fully  justified  on  its  appearance. 

Literature.  Pusch,  D.  t.  W.,  1894,  403.— Storch,  B.  t.  W.,  1896,  567.— Holzen- 
(lorff,  A.  f.  Tk.,  1896,  XXII,  346.— Ledaiiiehe,  Eev.  vet.,  1897,  1.  (Lit.).— Mazzini, 
Giorn.,  1898,  3:10.— Castelet,  Progr.  vet.,  1906,  324. 

Chronic  Pneumonia  of  Sheep.  According  to  Robertson  (1904),  a 
disease  occurs  in  South  Africa  among  sheep,  known  there  as  Jagziekte 
(hunting-disease),  or  Hartslagziekte,  which  is  usually  observed  during 
the  winter  months  in  the  higher  altitudes  in  the  Cape  Colonies,  and  is 
manifested  by  difficulty  in  respiration,  M'ith  flank  breathing.  The 
autopsy  reveals  a  chronic  catarrhal  pneumonia,  without  tendency  to 
degeneration,  caseation  or  suppuration ;  the  sharply  circumscribed,  hepa- 
tized  areas  have  the  appearance  of  bacon,  and  are  greasy  to  the  touch ; 
in  older  lesions  the  connective  tissue  is  increased  to  such  an  extent,  and 
is  so  tough,  that  it  cuts  like  cartilage.  In  the  later  stages  the  adjoining 
pleura  also  appears  thickened  and  adheres  to  the  costal  pleura.  The 
affected  lung  tissue  contains  half-moon  shaped,  centrally  well-stained, 
and  also  cylindrical  bodies  (supposed  to  be  protozoa?).  Attempts  to 
transmit  the  disease  artificially  to  healthy  sheep  failed  to  give  positive 
results.     (J.  of  comp.  Path.,  1904,  XVIT,  221.) 


408  Malignant  Catarrhal  Fever  of  Cattle. 

3.    Malignant  Catarrhal  Fever  of  Cattle.     Coryza  gangraenosa 

bovum. 

{Rhinitis  gangraenosa,  Bosartiges  Katarrlial-fieher  der  Rinder 
[German];  Coryza  gangrmeux,  mal  de  tete  de  con- 
tagion [French];  Febbre  catarrale  infettiva 
[Italian].) 

Malignant  catarrhal  fever  is  an  acnte,  non-contagions,  in- 
fections disease  of  cattle  and  bnffalo,  which  is  characterized 
especially  by  an  inflammation  of  the  mucous  membrane  of  the 
head,  with  a  tendency  to  formation  of  membranes  and  ulcera- 
tions, with  a  simultaneous  affection  of  the  eyes  and  severe  ner- 
vous symptoms. 

History.  The  disease  has  been  observed  and  described  repeatedly 
since  the  end  of  the  eighteenth  century;  its  nature  however  was,  even 
up  to  the  present  time,  not  sufficiently  established.  Anker  (1832)  de- 
scribes it  as  typhus  of  cattle,  he  as  well  as  Spinola  were  of  the  opinion 
that  the  benign  nasal  catarrh  may  change  to  the  malignant  type  under 
certain  conditions.  Haubner  and  Roll,  later  also  Lucet,  laid  particular 
stress  on  the  diphtheritic  affection  of  the  mucous  membranes,  the  disease 
however  was  not  considered  as  a  specific  infection  of  cattle  until  Bugnion 
(1877)  classified  it  as  such,  his  view  being  at  present  generally  accepted. 
Transmission  experiments  were  carried  out  by  Brusasco  (1887)  and 
Lucet  (1892),  with  negative  results,  while  Leclainche  (1898)  added  fur- 
ther contributions  to  the  etiology  of  the  disease. 

Occurrence.  The  disease  is  observed  either  sporadically 
or  as  a  stable  infection.  In  some  localities,  and  especially  in 
stables  of  poor  cattle  owners  it  is  more  frequent  than  under 
more  favorable  hygienic  conditions. 

In  Europe  the  disease  occurs  everywhere,  most  frequently,  however,  in  northern 
parts,  on  the  Scandinavian  peninsula  (in  1904,  599  cases  occurred  in  Norway),  and 
in  Denmark.  Severe  outbreaks  have  repeatedly  been  reporteil  from  Russia,  but  it 
cannot  be  asserted  with  certainty  that  it  was  not  mistaken  for  rinderpest  or  a 
mixed  infection.  In  Hungary  most  cases  were  observed  in  the  mountainous  region 
of  Northern  Hungary  and  Siebenbiirgen.  The  disease  is  also  known  in  South  Africa 
(in  Transvaal  as  "  Snottziekte, "   Theiler). 

The  disease  has  been  observed  among  buffaloes  in  the  Netherland-Iudies,  and 
on  the  island  of  Java   (Pascola,  Paszotta). 

Etiology.  The  etiology  of  the  disease  is  not  j^et  entirely 
clear.  This  can  only  be  accepted  with  great  probability,  that 
the  supposed  infective  micro-organism  produces  through  its 
toxic  products  a  general  intoxication  of  the  organism,  in  the 
course  of  which  the  resistance  of  the  tissues,  and  especially 
of  the  mucous  membranes  is  diminished,  so  that  under  the  in- 
fluence of  other  bacteria  which  subsequently  reach  these  parts, 
inflammatory  processes  develop  on  the  mucous  membrane  with 
the  formation  of  fibrinous  membranes,  and  later  necrosis  of 
the  tissue. 

Various  authors  (Ow,  Semmer,  Franck,  Lucet  and  others)  found 
different  bacteria  in  the  deposits  of  the  mucous  membrane;  their  part 


Etiolofo^.  409 

in  the  etiology  of  the  disease  has  however  not  been  definitelj^  estab- 
lished. Noeard  I'uund  in  \hv  p.SL'iulo-ineinl)raiu'8  of  the  larynx  and  the 
nasal  cavity,  bacilli  resembling  the  bacteria  of  hemorrhagic  septicemia. 

The  etiology  has  been  more  closely  stndied  by  Leclainche,  and  the 
ri'snlts  of  ills  investigations  may  be  summed  up  as  follows:  A  virulent 
variety  of  the  colon  bacillus  nuiy  be  demonstrated  in  the  intestinal  canal, 
in  the  lymph  glands  of  the  mesentery,  sometimes  also  on  the  nasal  mu(;ous 
meml)rane,  in  the  horn  core  and  in  the  sub-lingual  glands.  This  organ- 
ism produces  very  poisonous  toxins  in  bouillon  culture,  especially  for 
young  cattle.  Two  cc.  of  a  l-l-day  old  bouillon  culture  injected  intra- 
vc'nou.sl\'  or  10  cc.  injected  subcutaneously  into  a  calf  about  nine  monliis 
old,  pi'oduces  after  a  few  minutes  severe  symptoms  of  poisoning  (restless- 
ness, trembling,  rising  temperature,  colic,  serous  discharge  from  the  nose, 
and  lachrymation),  which  after  24  to  48  hours  gradually  disappears. 
Intravenous  injection  of  10  to  40  cc.  of  a  one-day  old  culture  produces 
diarrhea,  nasal  discharge,  and  salivation,  Avhereupon  the  aniiiud  dies 
in  from  5  to  6  hours,  and  on  autopsy  all  mucous  membranes  are  found 
markedly  )-eddened.  Feeding  of  one  liter  of  the  culture  causes  only 
a  passing  diarrhea. 

Leclainche  considers  these  symptoms  and  changes  as  identical  with 
those  which  are  observed  in  the  early  stages  of  the  disease,  and  believes 
that  the  bacteria  which  multiply  rapidly  in  the  intestinal  canal  migrate 
into  the  neighboring  lymph  glands  and  produce  toxins,  which  after 
absorption  produce  a  general  intoxication  and  catarrhal  hyperemia  of 
the  nuicous  membranes,  whereupon  streptococci  and  other  pyogenic  bac- 
teria sulisetjuently  cause  suppuration  and  necrosis  in  these  tissues.  In- 
asmuch however  as  Leclainche  did  not  succeed  in  producing  the  disease 
in  its  typical  form,  and  as  the  observed  symptoms  of  intoxication  may 
be  Itrought  on  in  a  very  similar  manner  by  the  inoculation  of  cultures 
of  other  pathogenic  bacteria,  and  as  the  virulent  coli  bacteria  may  also 
multiply  subsequently  in  the  intestinal  canal  and  later  migrate  into 
the  lymph  glands,  the  conclusions  drawn  from  the  above  investigation 
must  for  the  present  be  accepted  with  reservations. 

The  nature  and  method  of  the  natural  infection  is  not  yet 
known  accurately.  The  experience  that  the  disease  occurs 
mostly,  although  not  exclusively,  in  poorly  constructed,  low 
and  dark,  badly  ventilated  stables,  with  unclean  floors,  appears 
to  indicate  that  the  virus  propagates  on  the  contaminated 
floors  of  such  stables,  and  probably  also  in  stable  filth.  From 
such  places  it  reaches  the  digestive  tract  of  the  animal  with 
the  food  or  drinking  water.  In  rare  instances  animals  in  pas- 
ture may  also  become  affected,  these  cases  however,  are  fre- 
quently associated  with  bad,  polluted  drinking  water. 

The  disease  appears  to  ])e  non-contagious.  Experiments 
of  transmitting  the  disease  by  inoculation  with  the  nasal  secre- 
tions of  affected  animals  were  without  results  (Brusasco,  Esser, 
Lotzer).  Furthermore,  animals  which  stand  next  to  the  af- 
fected cattle  do  not  become  affected  in  spite  of  the  very  close 
contact.  If  the  disease  spreads  in  a  stable,  or  if  it  appears 
at  the  same  time  in  various  places  in  a  towmship  or  locality, 
this  cannot  be  attributed  to  its  contagiousness,  but  rather  to 
the  sinuiltaneotis  influences  of  a  common  local  cause.  Instances 
are  recorded  in  wliicli  the  disease  appears  annually  in  certain 


^]^Q  Malignant  Catarrhal  Fever  of  Cattle. 

stables,  wMcli  also  indicates  the  influence  of  a  local  cause,  and 
likewise  proves  that  this  may  continue  to  exist  for  a  long  time 
in  one  place. 

Frentzling  observed  in  the  course  of  a  year  and  a  half  in  one  stable  32 
eases  of  the  disease,  while  Dieekerhoff  &  Junkers  saw  in  a  herd  of  15  cattle,  eight 
fatal  affections  within  17  days.  According  to  Isepponi  the  disease  occurs  en- 
jootically  among  the  cattle  and  goats  in  the  mountains  of  the  Swiss  Canton  Grau- 
biinden,  especially  in  the  spring,  for  instance  in  the  period  of  1889-1892,  of  a  total 
number  of  45,000  cattle,  407  became  affected,  while  in  the  Canton  Zurich,  out  of 
94,738  cattle  only  three  fell  victims  to  the  disease  in  1900.  In  the  fall  of  1893 
Kramarew  observed  the  disease  in  an  epizootic  form  among  pastured  animals  in 
four  townships  in  Southern  Eussia.  Of  1,244  cattle  322  became  affected,  139  (4j)%) 
of  which  died  (the  mortality  varied  in  the  different  townships  between  34-67%). 
The  disease  was  supposed  to  have  resulted  from  polluted  river  water. 

Unfavorable  outside  influences,  such  as  sudden  change  in 
the  outside  temperature  or  moist  cold  weather  and  colds  caused 
by  such,  further  fatigue  during  work,  etc.,  appear  to  be  not 
infrequently  accessory  causes  in  the  appearance  of  the  disease. 
If  it  could  be  proved  that  the  disease  is  caused  by  a  variety 
of  the  colon  bacillus  its  development  could  be  explained  in  that 
the  otherwise  harmless  habitant  of  the  intestinal  canal  some- 
times multiplies  rapidly  under  the  above  mentioned  weakening 
influences  and  at  the  same  time  attains  an  increased  virulence 
as  a  result  of  which  it  produces  an  intoxication  of  the  organism. 

The  disease  occurs  frequently  in  certain  localities,  especially 
in  swampy  places,  while  in  others  it  is  unknown  in  spite  of  other- 
wise similar  local  conditions.  It  is  usually  observed  in  spring 
and  fall,  more  rarely  in  summer,  and  very  exceptionally  in 
winter.  (Mehrdorf  has  known  a  farm  on  which  the  disease 
existed  uninterruptedly  for  several  years  as  a  stable  infection.) 
Young  animals  are  affected  mostly;  according  to  Ow  only  up 
to  the  third  year,  while  calves  under  one  year  show  but  very 
slight  susceptibility;  steers  appear  to  be  more  susceptible_ tlian 
cows.  A  recovery  from  the  disease  does  not  protect  the  animals 
from  a  new  attack,  as  sometimes  recovered  animals  become  re- 
infected after  several  weeks  or  months,  and  then  usually  with 
more  severe  symptoms  than  the  first  time  (Nagy). 

Similar  affections  were  observed  in  other  species  of  animals  than 
cattle.  Thus  Hable  has  seen  a  similar  disease  in  two  horses,  Schloss- 
leitner  in  two  hogs.  In  these  cases  the  symptoms  were  fever,  severe 
nasal  catarrh,  conjunctivitis  and  keratitis,  while  the  horses  also  showed 
pharyngitis.  According  to  Isepponi's  observations  the  disease  may  occur 
frequently  in  goats. 

Anatomical  Changes.  The  most  constant  findings  at 
autopsy  are  the  inflammatory  changes  on  the  mucous  membrane 
of  the  upper  air  passages.  The  mucous  membranes  of  the 
nose,  and  those  of  Highmore's  and  the  frontal  sinuses,  which 
contain  various  quantities  of  a  thick,  fetid  pus,  are  markedly 
reddened  or  cyanotic,  swollen,  and  sprinkled  with  small  hemor- 
rhages.    Its  surface  is  covered  with  purulent  secretion,  and 


AiiaU'inical  Clianjii's.      Sytiii)toius.  411 

in  places  with  loose,  croupous,  easily  detacliable,  fiat  deposits, 
under  wiiich  tlie  epithelium  is  desquamated,  sometimes  also 
ulcerated.  The  ulcers  may  also  extend  into  the  deeper  layers, 
so  that  their  base  is  formed  by  the  periosteum;  indeed,  the 
necrosis  and  the  i;angrene  may  even  involve  the  bones  especially 
the  ethmoid,  or  the  turbinates.  The  inllammation  sometimes 
involves  the  cores  of  the  horns,  also  the  meat  platelettes  of 
the  horns,  as  a  result  of  which  they  appear  reddened  and  juicy, 
provided  that  the  horns  have  not  dropped  off  during  life,  or 
are  only  loosely  attached  to  the  skin.  The  hemorrhagic  or 
sometimes  also  croupous  inflammation  may  occur  in  the  larynx 
and  in  the  trachea  and  in  rare  cases  in  the  bronchi.  Excep- 
tionally a  catarrhal  ])neumonia,  and  sero-fibrinous  plouritis  may 
be  present. 

The  buccal  mucous  membrane  is  bright  red  in  color  and 
shows  catarrhal  swelling;  the  gums,  the  inner  surface  of  the 
lips,  as  well  as  the  palate  may  contain  round,  flat  deposits,  with 
underlying  erosions.  Similar  changes  are  frequently  present 
in  the  greatly  swollen  mucous  membrane  of  the  pharynx,  which 
shows  a  gelatinous  infiltration  of  its  deeper  layers. 

The  ej^es  manifest  the  changes  which  are  recognizable  in  the 
living  animal  (see  p.  412).  The  cerebral  meninges  are 
hyperemic,  and  saturated  with  a  serous  fluid;  the  ventricles 
contain  a  profuse  yellowish,  slightly  turbid  or  reddish  exudate. 

Among  other  changes  there  is  frequently  an  acute  catarrh 
of  the  mucous  membrane  of  the  stomach  and  intestinal  canal, 
with  small  superficial  hemorrhages,  in  rare  cases  covered  with 
fiijrinous  pseudo-membranes,  and  necrosis  of  the  superficial 
layers,  especially  on  the  Peyer's  patches.  The  liquid  contents 
of  the  intestinal  canal  are  frequently  mixed  with  blood,  some- 
times also  with  fibrinous  shreds. 

The  spleen  shows  a  moderately  acute  swelling,  the  liver 
and  the  kidneys  cloudy  swelling;  the  mucous  membrane  of  the 
urethra  shows  an  inflammatory  reddening  in  its  entire  length, 
and  is  sometimes  sprinkled  with  punctiform  hemorrhages  and 
covered  with  fine  pseudo-membranes.  The  lungs  are  h^q^eremic, 
and  show  acute  edema,  sometimes  also  interstitial  emphysema 
and  infarcts.  The  lymph  glands,  especially  in  the  mesentery 
are  acutely  swollen;  further  fresh  hemorrhages  may  be  seen 
in  some  cases  in  the  subcutaneous  and  subserous  connective 
tissues,  as  well  as  in  the  muscles. 

Symptoms.  Older  authors  (Bugnion,  Franck)  estimated 
the  time  of  incubation  of  the  disease  as  from  .'>  to  4  weeks;  it 
extends  however  very  probably  only  to  several  days  (according 
to  Lucet  it  is  not  more  than  12  hours). 

The  disease  commences  usually  with  rapidly  progressing 
febrile  s}inptoms.  "Within  a  few  hours  the  temperature  reaches 
40°-42° ;  the  heat  on  the  body  surface  is  unevenly  distributed, 
and  the  skin  feels  hot,  especially  at  the  base  of  the  horns,  and 
over  the  cranium.    The  muzzle  is  warm  and  drv,  the  hair  rough- 


412  Malignant  Catarrhal  Fever  of  Cattle. 

ened,  the  skin  tight  and  dry.  The  animals  manifest  at  the 
same  time  great  debility,  and  dullness  of  the  sensorium,  they 
stand  with  staring  look  and  drooped  head  or  support  the  head 
on  the  crib,  or  they  lie  down  much  of  the  time  with  extended 
neck.  If  urged  to  rise  they  stand  up  only  with  difficulty,  stagger 
on  their  legs,  and  arch  their  backs.  Some  patients  grind  their 
teeth  from  time  to  time,  bellow,  stand  in  the  manger,  and  even 
attack  objects  standing  before  them.  In  the  meantime  trembling 
is  observed  in  some  of  the  groups  of  muscles,  especially  on 
the  neck,  shoulders  and  abdomen,  which,  under  the  influence  of 
outside  irritation,  for  instance  sunlight,  may  extend  to  all 
muscles  and  even  increase  to  epileptic  convulsions  (Anker). 
The  animals  show  great  thirst,  while  appetite  and  rumination 
are  suppressed.  The  milk  secretion  diminishes  and  constipa- 
tion is  present.  Exceptionally  the  disease  may  commence  with- 
out fever  or  conspicuous  dullness,  but  the  manifestations  are 
indicated  in  digestive  disturbances  and  salivation  (Balog). 

On  the  first,  and  not  later  than  on  the  second  day  of  the 
disease  inflammation  of  the  conjunctiva,  as  well  as  of  the  nasal 
and  buccal  mucous  membranes  develops. 

The  eyelids  swell  and  are  continuously  kept  closed  on  ac- 
count of  photophobia,  at  the  same  time  tears  run  profusely  over 
the  cheek  from  the  inner  canthus  of  the  eye.  After  18  to  24 
hours  the  cornea  commences  to  show  a  smoky  cloudiness,  which 
starts  at  the  periphery,  and  the  entire  surface  gradually  be- 
comes opaque.  In  the  meantime  in  some  of  the  cases  a  serous 
exudate  is  eliminated  from  the  inflamed  areas  and  the  ciliary 
body,  which  fills  the  anterior  chamber  of  the  eye,  either  partly 
or  entirely  giving  the  still  transparent  cornea  a  yellowish  hue. 
Exceptionally  the  cornea  remains  transparent  in  spite  of  the 
internal  inflammation  of  the  eye  (Bugnion,  Dieckerhoff, 
Isepponi).  At  the  same  time  a  purulent  secretion  accumulates 
under  the  eyelids,  the  vessels  of  the  sclera  are  extended,  and 
a  fine  wreath  of  vessels  may  appear  on  the  border  of  the  cornea. 

A  nasal  discharge  becomes  noticeable;  the  secretion  is  at 
first  mucoid,  yellowish,  but  soon  becomes  purulent,  fetid,  and 
mixed  with  fibrinous  shreds,  occasionally  also  with  blood,  and 
dries  on  the  nostrils  into  brown  crusts  so  that  it  chaps  the 
skin.  The  nasal  mucous  membrane  is  highly  reddened  and 
covered  with  dirty  gray,  loose  pseudo-membranes  which  are 
easily  detachable  leaving  an  ulcerated  surface. 

The  inflammatory  process  always  extends  from  the  nose 
to  the  neighboring  Highmore's  and  frontal  sinuses,  which  is 
evident  by  the  conspicuous  dullness,  as  well  as  by  the  increased 
heat  and  swelling  of  the  corresponding  parts.  Sometimes  it  ex- 
tends from  the  wall  of  the  frontal  sinuses  to  the  bony  wall  of 
the  matrix  of  the  horns  and  in  consequence  the  horns  loosen 
from  their  cores,  and  drop  off  either  spontaneously,  or  as  the 
result  of  a  blow. 

Respiration  becomes  snuffled  as  a  result  of  the  swelling  of 


Syiiiptoius.  413 

the  nasal  cavities  sometimes  also  oi'  tlie  larynx,  later  rattling 
and  snoring  are  observed.  It  is  always  accelerated  and  labored; 
in  some  cases  the  dililicuit}  in  respiration  increases  to  symptoms 
of  asphyxiation,  which  may  liiially  canse  the  death  of  the  animal. 
Increased  vesicular  breathing-  may  be  heard  over  the  chest  walls, 
sometimes  together  with  moist  rales.  The  heart's  action  is 
excited  from  the  beginning,  tlie  pulse  is  at  lirst  full  and  hard, 
later  small  and  soft. 

The  mucous  membrane  of  the  mouth  appears  reddened,  hot 
and  dry  (especially  striking  on  the  dorsum  of  the  tongue) ; 
soon  gray  or  yellowish  pseudo-membranes  develop  in  some 
l)arts  of  its  surface,  especially  on  the  gum,  on  the  inner  surface 
of  tlie  lips,  and  on  the  hard  palate,  which  later  are  thrown  off, 
leaving  superlicial  granulating  ulcers.  Exceptionally  vesicles 
lying  in  close  proximity  appear  on  the  skin  near  the  corners 
of  the  mouth,  and  on  the  muzzle  (Wahl),  which  soon  leave 
ulcers  in  their  places.  Still  more  readily  the  inflammation 
extends  to  the  pharynx,  as  a  result  of  which  difficulty  in  swal- 
lowing appears  or  swallowing  becomes  entirely  impossible.  At 
the  same  time  the  earlier  salivation  becomes  still  more  profuse, 
and  the  saliva  itself  shows  a  dirty  discoloration,  mixed  with 
membranous  shreds,  and  is  fetid,  as  is  also  the  exhaled  air 
(Pascolo  and  Paszotta  in  a  buffalo  observed  trismus).  In  rare 
cases  croupous  membranes  and  ulcerations  develop  also  in  the 
rectum  and  in  the  vagina.  The  feces  which  are  at  first  dry 
become  softer,  soon  fluid,  at  the  same  time  may  be  mixed  with 
blood  and  fibrinous  shreds,  and  are  passed  under  great 
straining. 

The  urine  has  an  acid  reaction  (Franck),  is  cloudy,  con- 
tains considerable  albumen,  and  sometimes  also  blood;  under 
the  microscope  renal  epithelia  and  cylinders  are  found. 

The  body  temperature,  which  usually  reaches  its  height 
on  the  second  day,  drops  later  l°-2°,  fluctuates  then  between 
^9''A0°,  and  at  the  approach  of  death  it  drops  below  normal 
(Lucet). 

In  some  cases  a  papular  or  vesicular  exanthema  may  de- 
velop on  the  skin  of  the  entire  body  or  only  in  some  places, 
such  as  the  neck,  back,  udder  and  interdigital  space,  resulting 
in  the  formation  of  lirown  scabs,  which  on  dropping  off  remove 
also  the  hair,  while  on  the  udder  the  thin  skin  bursts  in  places, 
and  subsequently  a  parenchymatous  mastitis  may  develop. 
Later  profuse  scaling  of  the  epidermis  is  observed  on  the  hair- 
less parts.  Finally  a  diffuse  inflanmiation  of  the  skin  of  the 
interdigital  space  may  result  in  exceptional  cases.  (According 
to  Franck  in  this  form  the  horns,  as  well  as  the  hoofs  are  most 
frequently  thrown  off.) 

During  the  disease  the  animals  become  greatly  emaciated, 
they  lie  continually  on  the  ground,  and  finally  die  from  exhaus- 
tion, usually  with  convulsions. 

The  enumerated  symptoms  are  observed  in  the  majority  of  cases 


414  Malignant   Catarrhal  Fever  of  Cattle. 

in  quite  a  uniform  development  in  the  respiratory  and  digestive  appa- 
ratus ;  sometimes  however  the  respiratory  organs  are  only  slightly  af- 
fected in  spite  of  the  severe  affection  of  the  digestive  tract  (intestinal 
form). 

According  to  Isepponi  the  disease  occasionally  shows  an  atypical 
course,  inasmuch  as  in  the  presence  of  a  high  fever,  but  almost  normal 
respiration  and  heart  action,  the  patients  suddenly  pass  thin,  fetid, 
sometimes  also  bloody  feces,  whereupon  death  ensues  in  2  to  3  days. 
The  cornea  in  such  cases  is  not  clouded. 

Lucet  also  described  a  form  of  the  disease  in  which  a  catarrhal 
croupous  pleuro-pneumonia  becomes  associated  with  the  inflammation 
of  the  upper  air  passages  after  a  short  time.  According  to  his  observa- 
tions, in  this  always  very  rapid  type  of  the  disease  the  affection  of  the 
eyes  is  only  slightly  pronounced,  and  especially  on  the  cornea  hardly 
any  changes  are  noticeable.  He  considers  the  croupous  inflammation 
of  the  pharynx,  larynx,  bronchi,  and  of  the  lungs  as  different  forms  of 
a  special  disease,  the  diphtheria  of  cattle  ( ?). 

Lichtenheld  reports  on  a  malignant  catarrh  of  cattle  in  German 
East  Africa,  which  with  otherwise  similar  symptoms  is  differentiated 
from  the  catarrhal  fever  occurring  in  Europe,  by  its  epizootic  form, 
with  losses  up  to  75%,  further  by  the  marked  predominance  of  the 
affection  of  the  intestines,  and  the  usually  hemorrhagic  character  of  the 
mucous  membranes. 

Course  and  Prognosis.  The  disease  runs  with  few  excep- 
tions an  acute  course.  The  clinical  picture  is  usually  fully 
developed  in  3  to  4  days,  and  death  follows  in  4  to  12  days. 
In  some  of  the  cases  the  symptoms  diminish  after  the  disease 
has  rapidly  developed,  and  the  animals  commence  to  eat,  al- 
though they  still  have  fever  and  continue  to  emaciate;  a  little 
later  the  condition  again  becomes  aggravated,  and  the  animals 
finally  die  in  2  to  3  weeks. 

The  prognosis  is  quite  unfavorable,  as  the  mortality  varies 
between  50-90%.  Severe  nervous  sjanptoms  and  a  great  exten- 
sion of  the  inflammatory  process  should  be  considered  as  un- 
favorable indications.  The  body  temperature  deserves  special 
attention,  as  from  the  third  day  on  a  new  rise  (indication  of 
an  associating  pneumonia  or  septic  infection),  or  as  a  rapid 
drop  have  a  very  unfavorable  significance. 

In  the  case  of  a  favorable  termination  the  local  changes 
are  not  so  marked,  and  the  necrotic  processes  are  either  absent, 
or  they  do  not  penetrate  deeply.  After  a  certain  time  lachryma- 
tion  ceases,  the  nasal  discharge  becomes  again  mucous,  and 
loses  its  fetid  odor,  the  respiration  is  no  longer  rattling,  the 
appetite  and  rumination  return,  and  the  animals  become 
brighter,  while  the  temperature  gradually  returns  to  normal. 

Recovery,  whicli  is  usually  preceded  by  a  convalescence 
lasting  for  several  weeks,  is  rarely  complete,  as  the  animal 
frequently  remains  blind  in  one  or  both  eyes,  or  a  chronic 
catarrh  of  the  nose  and  its  sinuses,  and  sometimes  lasting 
digestive  disturbances  remain. 

Diagnosis.     Besides  the  rapid  development  of  the  clinical 


Dia.niitisis.     Ti-oatiiieii(.  415 

symptoms,  tlio  inliammatioii  of  the  o\*es  (cornea),  and  the  nasal 
mucous  menibranc,  the  marked  depression  of  the  sensoriuni 
are  characteristic  of  the  a  flection.  From  these  signs  the  dis- 
ease is  easily  recognized  when  it  occurs  sporadically  and  no 
intensive  affections  of  other  organs  are  associated.  If  how- 
ever several  cases  follow  each  other  rapidly,  or  if  the  intestinal 
canal  and  the  genital  organs  are  severely  affected,  and  the 
course  is  very  rapid,  a  differentiation  from  other  similar  dis- 
eases requires  great  care,  and  very  accurate  observation. 

The  greatest  similarity  exists  Avitli  rinderpest,  especially 
when  at  the  same  time  there  exists  a  severe  inflammation  of 
the  intestinal  and  vaginal  mucous  meml)ranes.  However  in 
malignant  catarrh  the  symptoms  of  the  affections  of  the  eye 
(diffuse  keratitis,  which  may  exceptionally  be  absent),  and 
sinuses  of  the  head,  as  well  as  the  severe  nervous  symptoms, 
are  in  the  foreground  of  the  clinical  picture,  and  besides  the 
disease  is  not  contagious,  which  condition  may  in  emergency 
be  established  by  subcutaneous  inoculations  of  blood  (in  rinder- 
pest in  4  to  5  days  after  such  inoculation  fever  and  a  severe 
catarrh  of  the  nnicous  membrani^s  develops). 

The  fibrinous  rhinitis  (croup  of  cattle),  which  sometimes 
also  occurs  in  an  infectious  character  and  manifests  quite 
similar  s^nnptoms,  usually  attacks  cows  shortly  after  parturi- 
tion, and  at  the  same  time  nervous  symptoms  as  well  as  indica- 
tions of  an  eye  affection  are  absent  (Grunth).  By  the  affection 
of  the  nose  and  its  sinuses,  as  well  as  by  the  great  dullness, 
the  disease  is  distinguished  from  foot-and-mouth  disease,  and 
from  the  various  forms  of  intestinal  inflammation  (scours, 
mycotic  and  toxic  enteritis).  The  croupous  character  of  the 
mucous  membrane  distinguishes  it  from  the  non-infectious  nasal 
catarrh,  while  in  infectious  keratitis  the  process  is  confined 
exclusively  to  the  eyes.  Finally  tuberculous  meningitis  may 
enter  into  consideration  on  account  of  the  great  apathy,  in 
which  however  inflammatory  changes  of  the  nmcous  membranes 
are  absent,  and  instead  paralysis  of  certain  nerves  of  the  head 
is  observed. 

Treatment.  xVt  present  the  treatment  is  purely  symp- 
tomatic. To  alleviate  the  acute  inflammation  of  the  mucous 
membranes  of  the  head  energetic  cold  applications,  or  cold 
ii-rigation  of  the  head  are  indicated  first  of  all.  The  accumula- 
tion of  discharges  should  be  prevented  by  repeatedly  washing 
the  conjunctiva,  as  well  as  the  nasal  and  buccal  mucous  mem- 
branes with  mild  astringents  and  disinfectants  (boracic  acid, 
alum,  copper  sulphate,  creolin,  lysol,  in  1-2%  solutions),  fur- 
ther by  inlialation  of  water  vapors,  and  if  possible  by  manual 
removal  of  the  necrotic  tissue.  In  attacks  of  asphyxiation 
tracheotomy  must  be  performed,  and  it  is  advisable  to  retain 
the  tube  in  the  opening  of  the  trachea  for  a  time,  even  after 
the  respiratory  difficulties  diminish. 

If  a  great  quantity  of  exudate  accumulates  in  tlie  frontal 


416  Malignant  Catarrlial  Fever  of  Cattle. 

sinuses  or  in  the  cavities  of  the  bony  extensions  of  the  horns, 
this  may  be  removed  artificially  by  trephining,  or  if  this  does 
not  produce  results,  if  necessary  one  or  both  horns  may  be 
sawed  off,  whereupon  the  cavities  should  be  washed  2  to  3 
times  daily  as  long  as  they  contain  the  discharge.  The  exudate 
accumulating  in  the  submaxillary  sinuses  usually  discharges 
through  the  natural  channels  from  the  nose. 

If  the  apathy  is  very  pronounced  alcoholic  rubs,  and  the 
addition  of  coffee  or  alcohol  to  the  drinking  w^ater  are  indicated. 
Very  high  fever  is  subdued  by  antipyretics. 

The  constipation  which  exists  at  first,  and  later  the  diar- 
rhea, are  treated  in  the  usual  manner  (see  vol.  II,  Acute  Intes- 
tinal Catarrh).  Suitable  feeding  during  the  disease,  as  well 
as  during  convalescence  must  be  especially  provided  for. 

The  derivative  treatment,  which  is  still  greatly  in  favor  with 
French  veterinarians,  and  which  consists  in  the  application  of  counter 
irritants  to  the  frontal  part  of  the  head  and  the  neck,  is  hardly  ever 
used  elsewhere.  Eggeling  and  Esser  obtained  good  results  in  some 
cases  from  intratracheal  injections  of  Lugol's  solution  (15  to  20  g.  1 
to  2  times  daily),  while  Lotzer  observed  rapid  recovery  from  the  admin- 
istration of  large  doses  of  iron  sulphate.  Tennebring,  Meissner,  Peter, 
Werner  and  others  recommend  the  colloid-silver  preparations  (Collargol, 
Protargol ;  40  to  50  g.  twice  daily  intravenously,  of  a  i/o  to  1  '/o  solution, 
for  2  to  3  days)  ;  in  severe  cases  however  even  this  treatment  fails, 
or  produces  at  best  only  a  temporary  fall  in  temperature  (Schloss- 
leitner,  Hohmann,  Burgles).  Perigaud  obtained  good  results  from  sub- 
cutaneous injections  of  a  0.75%  salt  solution  (7  recovered  out  of  11 
cases),  and  this  procedure  is  also  recommended  by  Moussu,  as  well  as 
recently  })y  Schlotte;  of  the  luke-warm  solution  4  to  6  liters  must  be 
injected  daily  subcutaneously  until  improvement  is  noticed,  and  later  1 
liter  for  several  days.  Isepponi  recommends  profuse  bleeding  at  the 
onset  of  the  disease ;  if  no  improvement  is  noticed  after  24  hours  the 
animal  should  be  slaughtered  as  incurable. 

As  the  convalescence  lasts  for  weeks,  even  in  the  favorable 
course,  and  not  infrequently  blindness  results,  it  is  advisable 
from  an  economic  standpoint  at  the  appearance  of  severe  symp- 
toms, to  slaughter  animals  of  little  value  rather  than  to  pursue 
the  unpromising  treatment.  (Ingestion  of  the  meat  is  not 
harmful  for  man  according  to  investigations  of  Esser.) 

Prevention.  According  to  our  present  knowledge  of  the 
etiology  of  the  disease,  cleanliness  and  satisfactory  ventilation 
of  the  stables,  as  well  as  feeding  good,  unspoiled  food,  should 
receive  first  consideration. 

Literature.— Anker,  Sehw.  A.,  1832,  VI,  81.— Bugiiion,  D.  Z.  f.  Tm.,  1877,  III, 
63  (Lit.).— Senimer,  Ibid.,  1885,  XI,  77.— Fraiick,  Ibid.,  137. — Brusaseo,  II,  med.  vet., 
1886,  145.— Lucet,  Eec,  1892,  481.— Kramarew,  A.  f.  Vm.,  1893,  I,  53.— Pascola, 
B.  t.  W.,  1893,  562.— Paszotta,  Tji.  bl.  f.  Niederl.  Indien,  1894,  VIII,  16.— Theiler, 
Schw.  A.,  1895,  XXXVII,  1.— Keleti,  Vet.,  1895,  167.— Nagy,  Ibid.,  231.— Mehrdorf 
&  Pesehke,  A.  f.  Tk.,  1897,  XXIII,  194.— Leclainche,  Eev.  vet.,  1898,  69.— Pericaiid, 
Bull.,  1902,  388.— Isepponi,  Schw.  A.,  1904,  XLVI,  1.— Liehtenheld,  Z.  f.  Infkr., 
1910,  VII,  290. 


Cioup  of  (  jittle.  41  7 

Croup  of  Cattle.  (Jniiitli  dcscrilifs  iiiulcr  this  name  a  disease  which 
in  a(kliti()ii  to  (listurhaiiees  of  the  ^enei-al  eoiiditiou  is  associated  with 
croui)ous  infianiiiiation  oi'  the  nasal  mucous  mend)i'ane,  in  which  the 
local  alt'ections  do  not  result  from  local  irritation,  neither  do  they  belong? 
to  the  clinical  manifestations  of  rinderpest,  malignant  catarrh,  or  to 
croupous  inflammation  of  tlu;  intestines.  Bang  however  considers  the 
affection  as  closely  related   to  the   malignant  catarrh  of  cattle. 

The  disease  appears  to  prevail  chiefly  in  Demnark,  and  especially 
in  Copenhagen  and  vicinity,  whei-e  it  was  first  observed  by  Sand,  later 
by  Hansen,  Kaufmann,  Olsen,  Bang  and  Jensen.  Grunth  made  a  carc;- 
ful  study  of  it.  The  tihi-iiious  rhinitis  observed  by  Berndt  in  Germany 
ma}'  also  belong  here. 

Etiology.  According  to  Grunth  the  disease  is  produced  by  an  un- 
known infectious  substance,  which  weakens  the  resistance  of  the  body, 
therel)y  rendering  the  mucous  membrane  susceptible  to  secondary  in- 
fections. Accorilingly  all  complications,  and  ])r()bal)ly  also  the  crou])ous 
inflannuation  of  the  nasal  mucous  membrane  should  be  considered  as 
secondary  manifestations. 

Cows  which  have  recently  calved  are  especially  susceptible,  but  in 
rare  cases  the  disease  may  appear  shortly  before  or  several  months  after 
parturition,  if  the  animals  have  meanwhile  been  otherwise  weakened. 
Other  cattle  than  cows  are  only  exceptionally  affected  by  the  disease  in 
infected  herds. 

Symptoms.  As  a  rule  the  animals  become  affected  suddenly  by  high 
fever  intermittent  in  character.  The  pulse  and  respiration  are  acceler- 
ated, appetite  and  rumination  are  disturbed,  the  milk  secretion  ceases. 

By  sufficiently  illuminating  the  nose  the  nasal  mucous  membrane 
appears  more  or  less  reddened,  and  sometimes  covered  with  petechiae. 
On  the  nasal  septum  or  on  the  nostrils,  more  rarely  in  the  other  parts 
of  the  nasal  cavity,  white  or  yellowish,  loosely  adherent  croupous  mem- 
brane's of  various  extension  may  be  observed  attached  to  the  mucous 
membrane.  Only  exceptionally  do  they  attain  the  thickness  of  several 
millimeters,  sometimes  however  they  may  even  be  diphtheritic  in  nature, 
in  which  case  even  perforations  of  the  nasal  septum  may  result.  There 
is  always  a  nasal  discharge,  first  serous,  later  becoming  muco-purulent 
and  containing  croupous  membranes,  sometimes  also  streaks  of  blood. 
Here  and  there  snuffling  or  wheezing  respiration  may  be  observed  with 
head  extended  and  the  mouth  wide  open. 

Complications  occur  very  fre(juently  (according  to  Grunth  in  70% 
of  the  cases).  Very  often  a  broncho-pneumonia  sets  in  (Grunth  ol)- 
served  it  in  42%  of  the  cases)  which  sometimes  may  also  give  rise  to 
an  interstitial  lung  emphysema,  in  Avhich  the  air  nuiy  pass  under  the 
skin,  or  into  the  subperitoneal  connective  ti.ssue.  Sinuiltaneously  with 
the  broncho-pneumonia  a  croupous  inflammation  of  the  larynx,  trachea 
and  the  bronchi  frequently  develops. 

The  genital  passages  are  also  affected  in  some  cases  (according  to 
Grunth  in  27%).  These  affections  take  the  form  of  a  croupous,  diph- 
theritic or  hemorrhagic  inflammation  of  the  mucous  membranes  of 
vagina  and  uterus,  and  in  some  cases  a  parametritis  and  peritonitis,  or 
an  affection  of  the  mucous  membrane  of  the  urinary  organs  is  asso- 
ciated with  it. 

Likewise  a  profuse,  fetid  diarrhea  is  frequently  observed,  in  which 
the  feces  may  be  mixed  with  coagulated  l)lood  or  croupous  membraiies. 
In  conjunctivitis,  which  is  by  no  means  rare,  the  eyelids  swell,  and  there 
is  usually  serous  lachrymation,  which  may  become  purulent.  An  accumu- 

Vol.  1 — 27' 


418  Catarrhal  Fever  of  Sheep. 

latiou  of  blood  in  the  anterior  chamber  of  the  eye,  as  well  as  kera- 
titis has  also  been  observed.  Here  and  there  fibrinous  deposits  may 
form  on  the  buccal  mucous  membrane. 

The  course  is  acute,  and  its  duration  averages  nine  days.  It  fluc- 
tuates however  in  the  different  cases  between  one  and  thirty  days.  The 
convalescent  stage  is  always  protracted. 

The  prognosis  appears  to  be  unfavorable,  as  according  to  Grunth 
45%  of  the  patients  die  from  the  disease,  or  must  be  slaughtered.  In 
the  recovered  animals  a  permanent  shrinkage  in  the  secretion  of  milk 
may  result. 

In  croup  without  complications  Grunth  observed  33.3%  deaths,  while  in  the 
cases  coniplieateil  with  broncho-pneumonia  the  mortality  was  42.8%,  in  those  which 
are  associated  with  diarrhea  48%,  in  complications  with  metritis  52.9%,  and  in  the 
cases  showing  a  simultaneous  affection  with  broncho-pneumonia  and  metritis  78.6%. 

Differentiation  from  malignant  catarrh  should  be  based  on  the  facts 
that  in  the  primary  nasal  croup  there  usually  exists  no  keratitis,  the 
affection  runs  a  more  favorable  course  when  compared  with  catarrhal 
fever,  it  principally  affects  cows,  and  produces  no  cerebral  disturbances. 
If  the  pseudo-membranes  developing  in  the  nose  are  obscured,  the  disease 
may  be  confused  with  broncho-pneumonia,  metritis,  or  croupous 
enteritis. 

The  treatment  is  purely  symptomatic.  The  same  remedies  which 
come  into  consideration  in  other  inflammations  of  the  nasal  mucous 
membrane  or  in  broncho-pneumonia,  enteritis,  metritis,  etc.,  are  adapted. 
At  the  same  time  it  is  advisable  to  separate  the  affected  animals  from 
those  which  are  healthy. 

Literature.     Grunth,  Z.  f.  Tm.,  1905,  IX,  232. 

Catarrhal  Fever  of  Sheep.  (Malarial  catarrhal  fever,  Geel  dikkop, 
Bekziekte,  Ouil  bek,  Blaw  tong.) 

Under  this  name  a  disease  of  sheep  and  goats  is  known  in  South 
Africa,  which  occurs  there  under  similar  local  and  periodical  conditions 
as  horse  sickness  (see  p.  285)  and  which  in  some  years  causes  great 
losses,  especially  among  sheep  herds.  It  was  first  described  Ijy  Hutcheon 
and  Spreull,  then  by  Paine,  and  recently  by  Theiler. 

The  symptoms  which  develop  from  artificial  infection,  after  an 
incubation  period  averaging  four  days,  consist  in  diminished  appetite, 
dullness  and  fever  (up  to  42.5°),  severe  hemorrhagic  stomatitis,  with 
shedding  of  great  shreds  of  epithelium ;  further  a  marked  edematous 
swelling  of  the  forehead  and  the  laryngeal  region,  and  a  cyanotic  dis- 
coloration of  the  tongue.  Later  the  swollen  parts  become  hard  and  wrin- 
kled, sometimes  ulcerative  keratitis  and  panophthalmitis,  as  well  as 
diarrhea  and  icterus  set  in,  whereupon  in  about  40%  of  the  cases  death 
follows.  In  some  animals  an  inflammation  of  the  coriuni  of  the  hoofs 
develops  in  the  meanwhile.  In  favorable  cases  the  duration  of  the 
disease  until  recovery  is  about  three  weeks.  Quinine  and  calomel,  also 
scarifications  of  the  tongue  are  supposed  to  be  beneficial  in  action. 

The  autopsy  reveals,  aside  from  the  local  changes  on  the  head,  only 
a  general  blood  infection,  and  in  protracted  eases  anemia.  The  spleen 
is,  even  in  acute  cases,  only  moderately  swollen. 

Although  the  disease  is  not  directly  contagious,  Spreull  succeeded 
in  transmitting  it  with  filtered  blood  to  sheep  but  not  to  goats,  and 
the  natural  infection  appears  to  be  transmitted  by  insects.  Sheep  recov- 
ered from  the  disease  are  immune  against  later  infections,  their  blood 
however  proves  virulent  sometimes  even  after  50  days. 


Calf  Diphtheria. 


419 


SiiuultaiH'ous  inoeulalioiis  Avith  serum  of  highly  immunizod  sheep 
(4  cc),  and  Avith  virulent  blood  (2  cc),  gave  very  favorable  results  in 
a  herd  of  21)5  merino  sheep,  A  mixture  of  serum  and  virus  (2:1)  is  also 
suitable  for  immunization.  Theiler  observed  that  in  serial  inoculations 
of  sheep  the  virulence  diminishes  gradually  and  finally  from  the  tenth 
operation,  and  from  then  on,  a  harndess  vaccine  is  obtained. 

Literature.  Spreull,  J.  of  conip.  Path.,  1005,  XVTII,  321.— Paine.  Ibi.l.,  1906, 
XIX,  ;-).— Theiler,  Schw.  A.,  1895,  XXXVll,  1;  Bull.  P.,  1905,  III,  G17;  Z.  f.  Tm., 
1907,  XI,  301. 


4.    Calf  Diphtheria.    Diphtheria  vitulorum. 

{Angina  diphtheritica  vitulorum.) 

Calf  diphtheria  is  an  acute  infectious  disease  of  sucking 
calves,  in  the  course  of  which  croupous  diphtheritic  pseudo- 
membranes  form  on  the  mucous  membrane  of  the  mouth  and 
the  pharynx,  and  which,  as  a  result  of  a  general  septic  infec- 
tion usually  results  in  death.  The  causative  factor  of  the  dis- 
ease is  the  bacillus  necrophorus,  which  was  closely  described 
by  Bang. 

History.  The  disease  was  first  described  in  1877  by  Dammann, 
who  observed  it  in  enzootic  extension  in  two  consecutive  years  on  an 
estate  near  the  East  Sea.  He  established  its  contagious  and  transmissible 
nature  and  considered  it  identical  with  diphtheria  of  man.  Later 
Blazekovie  and  Toilers  observed  similar  affections,  while  Lciffler  (1884) 
proved  by  histological  examinations  that  the  affection  differed  from 
human  diphtheria,  and  was  prol^alily  caused  by  long  rods,  which  were 
present  at  the  border  of  the  necrotic  tissue.  Later  Bang  (1890)  estab- 
hshed  the  identity  of  the  Loffler  's  bacillus  with  his  bacillus  necrophorus. 

Occurrence.  According  to  the  observations  made  up  to 
the  present  time  the  disease  occurs  but  rarely;  in  some  localities 
however  it  occurs  as  a  stable  disease 
among  the  sucking  calves  and  causes 
by  its  malignant  course  material  loss. 
Thus  in  Dammann 's  case  all  calves 
born  in  the  winter  and  spring  became 
affected,  and  with  a  few  exceptions 
they  died  of  the  affection. 


Etiology.  The  bacillus  necro- 
phorus. Bang,  Mdiich  is  considered  to 
be  the  cause  of  the  disease,  appears  as 
a  thin  slender  rod,  which  in  the  tis- 
sues as  well  as  in  artificial  cultures, 
grows  into  long  threads,  the  plasma  of 
which  is  eitlier  liomogeneous  or  at 
uniform  distances  contains  dark,  fine 
granules  (Fig.  64).    The  bacillus  shows  no  motility. 

Staining.  The  bacillus  stains  only  slightly  and  uniformly  with 
aqueous  solutions  of  aniline  dyes,  stains  well  with  carbol-fuchsin,  but  not 
with  Gram. 


FifT.  64.      Bacillus   necrophorus 

linncj.     Agar  culture:    staining 

with  methylene  blue. 


420  Calf  Diphtheria. 

Cultivation.  The  bacillus  develops  only  at  body  temperature,  and 
only  anaerobically.  Artificial  cultivation  succeeds  on  blood  serum,  agar 
containing  blood  serum,  bouillon,  and  in  milk.  On  serum  agar,  colonies 
2  to  3  mm.  in  diameter  develop  with  striped  surface  and  consisting  of 
felt-like  braided  threads.  At  the  same  time  indol  and  gas  are  produced, 
which  have  an  unpleasant  cheesy  odor  (Jensen,  Ernst).  Bouillon  is 
uniformly  clouded  in  a  few  days,  liquid  blood  serum  is  coagulated.  No 
growth  results  on  potatoes. 

Pathogenicity.  Inoculation  of  pns  containing  bacilli  or  of 
a  pure  culture  into  or  under  the  skin  of  a  rabbit  causes  pro- 
gressive necrosis  of  the  skin  (see  p.  102).  Inoculation  into 
mice  produces  also  skin  necrosis,  while  guinea  pigs,  dogs,  cats 
and  chickens  are  not  susceptible  to  the  infection.  A  sub- 
cutaneous injection  in  cattle,  hogs  and  pigeons  causes  only 
local  necrosis  of  the  skin,  in  horses  cold  abscesses.  (According 
to  L.  Roux  the  experimental  necrosis  develops  especially  after 
adding  other  bacteria  to  the  pure  culture,  whereas  alone  it 
frequently  causes  only  cold  abscess.)  The  introduction  of 
pseudo-membranes  of  affected  calves  into  the  nose  and  into 
tlie  mouth  of  lambs  only  several  days  old,  produces  a  diph- 
theritic stomatitis,  while  if  sewed  in  under  the  eyelids  a  severe 
conjunctivitis  with  keratitis  results.  Feeding  experiments  al- 
ways give  negative  results. 

The  bacillus  necrophorus,  as  has  l)een  proven  by  Bang  and  later  l)y 
Jensen,  plays  an  important  part  in  various  diseases  of  animals,  in  which, 
during  their  course  necrotic  and  gangrenous  processes  develop  as  com- 
plications. Thus  the  necrotic  and  croupous  diphtheritic  processes  of 
the  mucous  membranes  in  general,  especially  however  of  the  mucous 
membranes  of  the  pharynx  and  the  intestines  (among  others  in  hog 
cholera),  in  sheep,  on  the  lips  and  on  the  borders  of  the  nostrils,  or 
on  the  external  genital  organs  (see  Vol.  II),  further  in  gangrene  of 
the  hoofs  and  the  teats,  in  necrotic  dermatitis,  etc.,  are  frequently  pro- 
duced by  this  bacillus.  In  addition  to  these  the  occasional  necrotic  areas 
in  the  liver,  kidneys,  lungs,  etc.,  may  be  attributed  to  this  cause. 

In  the  great  majority  of  cases  the  bacillus  necrophorus  attacks 
only  tissue  that  is  already  affected.  Successful  infection  experiments,  as 
well  as  metastatic  necrotic  areas,  proved  however  that  under  specially 
favorable  conditions  it  may  attack  even  healthy  tissues.  Its  character- 
istic location  at  the  border  of  the  necrotic  and  the  living  tissue,  proves 
that  it  exerts  its  pathogenic  action,  the  necrosis  of  the  tissue  elements, 
by  the  elimination  of  toxic  products. 

The  bacillus  necrophorus  is  described  in  literature  under  various  names  and 
is  identical  with  the:  Bacillus  necrophorus,  Fliigge;  Bacillus  diphtheriae  vitulorum, 
Loeffler ;  Bacillus  necroseos,  Salonionsen ;  Bacillus  filif  ormis,  Schiitz ;  Bazillus  des 
Kalbernoma,  Bitter;  Streptothrix  cuniculi,  Schniorl ;  Actinomyces  cuniculi,  Gasperini; 
Actinomyces  necrophorus,  Neukirch,  and  Streptothrix  necrophora,  Ernst   (L.  Eoux). 

Natural  infection  may  probably  be  explained  by  stating  that 
tbe  bacillus  necrophorus,  which  is  very  extensively  distributed 
in  nature,  is  among  others  frequently  contained  in  the  feces 
of  herbivorous  animals,  and  owing  to  its  anaerobic  character 


Nadiral    In  IVction,  Aiiatiiiiiii-nl    Cliaii.iifs,  401 

remains  alive  for  a  lono-  time  on  tlie  dirtj^  floors  of  damp  stables, 
in  musty  food  and  straw,  and  from  there  reaches  the  buccal 
cavity  of  youn^  animals.  Healthy  animals  may  become  in- 
fected by  contact  with  affected  ones,  by  licking  them,  thereby 
introducing'  diseased  products  (shreds  of  pseudo-membranes 
hanging  from  the  mouth,  nasal  secretions)  into  their  mouths. 
The  easy  transmissibility  of  the  disease  has  been  fully  estab- 
lished by  Danmiann,  since  he  watched  a  healthy  calf  which  was 
placed  in  a  stable  between  two  affected  calves,  become  affected 
in  five  days. 

The  disease  attacks  young  sucking  calves  exclusively,  which 
sometimes  become  affected  as  early  as  on  the  third  day  after 
their  birth.  The  great  susceptil)ility  of  the  young  can  probably 
be  explained  by  the  loose  and  delicate  consistency  of  the 
epithelia  of  the  mucous  membrane.  The  susceptibility  of  the 
newly  born  may  also  be  increased  by  any  other  physical  weak- 
nesses, the  residue  of  the  milk  remaining  in  the  mouth  of  such 
aninials  being  especially  adapted  for  the  localization  and  propa- 
gation of  the  virus.  Injuries  of  the  buccal  mucous  membrane, 
such  as  the  eruption  of  the  milk  teeth,  may  constitute  the  prin- 
cipal entrance  for  the  infective  agent. 

Anatomical  Changes.  The  autopsy  reveals  on  the  mucous 
membrane  of  the  month  and  pharynx,  various  sized  and  coalesc- 
ing croupous  membranes,  which  extend  higher  than  the  eleva- 
tion of  the  surrounding  tissue.  They  are  several  centimeters 
thick,  sharply  circumscribed,  dirty  gray  or  brown  in  color, 
ragged  on  the  surface,  and  firmly  adherent  to  the  underlying 
tissues.  Ulcerations  also  occur  with  thickened  borders  and 
ragged  bases;  between  these  lesions  the  mucous  membrane  is 
greatly  swollen,  reddened,  the  submucosa  shows  serous  infiltra- 
tion. Preferred  places  for  the  formation  of  these  pseudo- 
membranes  are,  the  inner  surface  of  the  cheeks,  the  hard  palate, 
the  borders  of  the  tongue,  the  parts  surrounding  the  frenum 
of  the  tongue,  the  gimis,  the  soft  palate  and  the  pharynx.  In 
some  cases  the  mucous  membrane  over  a  considerable  area  and 
in  its  entire  thickness  changes  to  a  yellowish-gray,  brittle,  fetid 
mushy  mass.  The  muscles  of  the  tongue  may  also  be  necrotic 
under  the  affected  parts  of  the  mucous  membrane  to  a  greater 
or  lesser  depth,  the  destructive  process  on  the  hard  palate 
may  even  extend  to  the  bone  producing  caries,  and  changing 
it  to  a  soft  mushy  mass.  Similar  changes  occur  also  on  the 
lower  parts  of  the  nasal  cavity,  on  the  larynx  and  in  the  trachea, 
where  they  may  affect  the  cartilage. 

The  lungs  usually  contain  either  dry  or  purulent,  softened, 
necrotic  areas,  which  are  surrounded  by  zones  of  catarrhal 
pneumonia,  and  sometimes  also  a  purulent  pleurisy  may  be  pres- 
ent as  a  result  of  perforation  of  such  superficial,  necrotic  areas. 
The  small  intestines  reveal  acute  catarrh,  whereas  posterior  to 
the  cecum  sometimes  pea-sized  dirty  yellow,  dry  deposits  may  be 


422  Calf  Diphtheria. 

found.    The  spleen  is  not  enlarged  and  the  lymph  glands  show 
a  moderately  acute  swelling. 

Symptoms.  The  disease  commences  on  about  the  fifth  day 
after  the  infection  with  marked  weakness  and  diminished  appe- 
tite, as  well  as  a  slight  rise  in  temperature.  On  the  second  to 
third  day  salivation  appears,  and  at  the  same  time  on  one  or 
both  cheeks  a  hard  painful  swelling  is  noted.  With  a  finger 
introduced  into  the  buccal  cavity,  rough  deposits  may  be  felt 
on  the  mucous  membrane  in  the  corresponding  places.  On 
inspection  of  the  mouth  however,  on  these  as  well  as  on  other 
places,  especially  on  the  hard  palate  and  on  the  swollen  tongue, 
yellowish  deposits  are  found,  which  in  part  show  a  ragged 
surface. 

In  the  meantime  there  is  a  yellowish  discharge  from  the 
nose,  and  the  nostrils  fill  with  dirty  yellow,  brittle  masses,  on 
account  of  which  the  respiration  appears  snuffling.  At  the  same 
time  the  animals  become  greatly  emaciated,  and  are  able  to 
take,  only  from  time  to  time,  and  with  difficulty,  small  quantities 
of  water.  In  some  cases  cough,  and  a  very  labored,  rattling 
respiration,  indicate  an  affection  of  the  larynx  and  the  lungsj 
while  diarrhea  points  to  an  involvement  of  the  intestines. 
(Dammann  observed  in  one  case  a  necrosis  of  the  skin  and 
of  the  subcutis  in  the  interdigital  space  in  both  forelegs.) 
Exceptionally  swelling  and  a  suppuration  of  all  glands  of  the 
head  have  also  been  observed. 

Eggeling  found  repeatedly  that  the  disease  commenced  in  calves 
with  high  fever,  difficulty  in  respiration,  and  inability  to  swallow.  At 
the  same  time  cows  which  had  recently  calved  showed  a  diphtheritic 
vaginal  and  uterine  involvement. 

Course.  The  disease  terminates  in  the  majority  of  cases 
in  death  after  4  to  5  days,  in  other  cases  again  in  about  three 
weeks,  pneumonia  being  usually  the  immediate  cause.  In  the 
rare  cases  with  favoral3le  termination  the  convalescence  lasts 
several  weeks,  as  the  defects  on  the  mucous  membrane  after 
the  shedding  of  the  necrotic  deposits  heal  reluctantly,  and  the 
strength  of  the  affected  animals  is  regained  very  slowly. 

Diagnosis.  The  thick  deposits  on  the  lesions,  consisting 
principally  of  necrotic  tissue  of  the  mucous  membrane,  dis- 
tinguish the  affection  from  foot-and-mouth  disease,  in  wdiich 
the  erosions  are  at  the  worst  only  covered  with  fine,  loose, 
readily  removable  pseudo-membranes.  In  aphthous  stomatitis 
and  in  thrush  only  superficial,  readily  removable  deposits  form 
on  the  only  very  slightly  swollen  mucous  membrane. 

Treatment.  After  removing  the  deposits,  which  are  not 
very  firmly  adherent,  it  is  advisable  to  paint  the  ulcerating 
surfaces,   as   well  as   the   firmly  adhering  pseudo-membranes 


Pharyngeal  Diphtheria.  423 

1  to  2  times  daily  with  a  paste  consisting  of  water  and  salicylic 
acid  (Damniann),  Lug-ol  solution  (Dieckerhoff),  tincture  of 
iodine,  10%  citric  acid  (Pools),  or  with  a  5%  solution  of  per- 
manganate of  potash.  Besides  it  is  advisable  to  wash  the  mouth 
repeatedly  with  lukewarm  water.  Salicylic  acid  (1-2  g.)  or 
potassium  chlorate  (2  g.)  may  be  administered  internally.  At 
the  same  time  the  attempt  should  be  made  to  keep  tiie  animals 
in  good  strength  by  supplying  them  with  nutritious  food 
(milk,  eggs). 

Careful  ventilation  and  disinfection  of  the  stables  is  in- 
dicated for  the  prevention  of  the  spread  of  the  disease. 

Literature.  Dammann,  D.  Z  f.  Tni.,  1877,  III,  1.— Blazekovic,  Rec,  1878,  64. 
— Vollors,  W.  f.  Tk.,  1879,  432.— Loeffler,  Mitt.  d.  G.-A.,  1884,  HI,  401.— Bang, 
Maanedsskr.,  1S90,  II;  1892,  IV.— Jensen,  lib.  d.  p.  M.,  1903,  II,  693.— Eggeling, 
Pr.  Mt.,  1903,  11,  17.— L.  Ronx,  Cbl.  f.  Bakt.,  1905,  XXXIX,  531. 

Pharyngeal  Diphtheria  of  Other  Mammals.  As  the  bacillus  necro- 
phoriis  has  been  demonstrated  in  \ho  diphtheritic  processes  of  various 
species  of  animals,  it  appears  proba])le  that  a  diphtheria  analogous 
to  the  affection  in  calves  may  also  occur  in  other  animals  as  an  inde- 
pendent afifection.  In  the  cases  however  which  have  been  observed  the 
bacillus  necrophorus  as  a  rule  attacked  the  l)uccal  mucous  membranes 
only  after  the  animals  had  become  sick  from  other  causes. 

IMayr  observed  a  diphtheritic  inflammation  of  the  pharynx  in  three 
head  of  cattle,  while  Strebel  observed  it  in  five  head.  Tlie  symptoms 
consisted  in  salivation,  dyspnea,  difficulty  in  swallowing,  nasal  dis- 
charge, sensitiveness  and  swelling  of  the  throat  region.  The  autopsy 
revealed  diphtheritic  deposits,  and  ulcerations  on  the  palate,  in  the 
pharynx  and  larynx,  as  well  as  along  the  esophagus.  In  some  cases  ulcers 
were  found  on  the  muzzle  and  in  the  interdigital  space,  with  necrotic 
deposits  as  large  as  a  quarter  on  the  mucous  membrane  which  w^as 
without  papillae,  in  the  pillars  of  the  rumen,  membranous  inflammation 
of  the  small  intestines,  etc.  In  these  cases  the  disease  had  probably 
developed  as  a  complication  to  a  septicemic  infection,  which  is  appar- 
ently also  the  case  in  the  affection  of  horses  (Cobbett,  Pr.  Mil.-Vb.) 
occurring  as  a  diphtheritic  process  in  the  mouth,  in  which  case  it  is 
proliably  a  complication  of  an  influenza  infection. 

Roche-Lubine  observed  a  disease  among  lambs  which  was  manifested 
in  difficult  respiration,  salivation,  laryngeal  and  bronchial  catarrh.  The 
autopsy  revealed  extensive  pseudo-membranes  on  the  mucous  membrane 
of  the  upper  air  passages.  Diem  reports  a  similar  affection  which 
occurred  as  a  local  enzootic,  wliile  Hasenkamp  observed  an  outl)reak  of 
panaritium  of  sheep  caused  by  the  bacillus  necrophorus,  in  the  course 
of  which  diphtheritic  processes  developed  on  the  mucous  membrane  of 
the  pharynx  and  mouth,  in  some  of  the  animals. 

In  hogs  the  so  called  angina  represents  a  freqnent  symptom  of 
hog  cholera,  in  which  the  flat  deposits  on  the  mucous  membrane  of  the 
pharynx  and  larynx  contain  the  bacillus  necrophorus,  together  with 
the  bacillus  suipestifer.  This  is  likewise  the  case  in  the  inflammations 
of  the  pharynx,  which  are  frequently  observed  as  a  symptom  of  sAvine 
plague,  especially  on  premises  where  hemorrhagic  septicemia  exists 
among  cattle. 

According  to  Johne  and  Kitt  the  pharyngeal  diphtheria  may  also 
occur  among  hogs  as  an  independent  disease.     In  such  cases  the  crj'pts 


424  Avian  Diphtheria  and  Chicken  Pox. 

of  the  greatly  swollen  tonsils  are  tilled  with  yellowish,  brittle  masses, 
and  the  mucous  membrane  of  the  surrounding  part  is  covered  with 
numerous  yellowish  deposits  which  may  reach  the  size  of  a  pea,  or  the 
diffuse,  swollen  and  reddened,  buccal  and  pharyngeal  mucous  membrane 
appears  to  be  covered  with  caseous  deposits. 

A  severe  pharyngitis,  with  the  formation  of  pseudo-membranes,  has 
also  been  observed  in  dogs  and  cats  (Gray,  Symes,  Bell),  and  Brandt 
reports  a  case  in  which  a  Scotch  collie  became  affected  with  a  diphtheritic 
inflammation  of  the  throat,  and  from  which  he  isolated  bacteria  which 
microscopically,  culturally,  and  biologically  appeared  identical  with 
diphtheria  bacilli  (several  days  later  a  girl  who  attended  the  dog  be- 
came affected  with  diphtheria,  and  Si/o  weeks  later  still  another  girl). 
During  the  course  of  canine  distemper,  and  still  more  frequently  in 
typhus  of  dogs,  necrotic  processes  occur  on  the  buccal  mucous  membrane, 
which  are  also  caused  by  the  bacillus  necrophorus  (Jensen),  while  in 
one  case  showing  also  symptoms  of  albuminuria  and  hemorrhages.  Ball 
found  only  streptococci. 

Literature.  Wayr,  Bavr.  W.,  1902,  1S5.— Strebel,  Sehw.  A.,  1899,  173.— 
Cobbett,  Cbl.  f.  Bakt.,"  1900,  XXVIII,  631.— Diem,  W.  f.  Tk.,  1900,  339.— Johue,  S. 
Jhb.,  1893,  61.— Kitt,  Much.  Jhb.,  1893-94,  SI.— Ball,  J.  vet.,  1906,  449.— Gray,  J.  of 
comp.  Path.  1896,  IX.,  46.— Symes,  Brit.  med.  Journ.,  1896,  I,  1385.— Bell,  Amer. 
Bev.  1901,  XXV,  115.— Brandt,  J.  of  the  Americ.  med.  Assoc,  1908,  L,  15. — Hasen- 
kamp,  D.  t.  W.,  1909,  237. 


5.  Avian  diphtheria  and  chicken  pox.  Diphtheria  et  epithelioma 

contagiosum  avium. 

Until  very  recently  avian  diplitlieria  was  considered  to 
be  a  contagious,  epizootic  disease  of  domesticated  fowls,  char- 
acterized by  croupous  and  diphtheritic  pseudo-membranes  on 
the  mucous  membranes  of  the  head,  while  cliicken  pox  was 
held  to  be  a  contagious,  epizootic  disease  in  which  hyperplastic, 
epithelial  nodules  of  the  skin  occurred  especially  on  the  comb 
and  wattles,  but  in  addition  to  which  croupous-diphtheritic 
deposits  frequently  developed  on  the  mucous  membranes  of  the 
head.  The  two  diseases  were  considered  as  independent;  more 
recent  research,  however,  indicates  that  they  are  produced  by 
the  same  organism,  and  they  will  here  be  treated  accordingly. 

History.  In  avian  diphtheria  as  well  as  in  chicken  pox  investigators 
were  inclined,  since  the  experiments  of  Rivolta  and  Silvestrini  (1873 
and  1878),  to  consider  protozoa  as  the  etiological  factors  (in  diphtheria 
the  flagellate,  Cercomonas  gallinae ;  in  pox  gregarines,  hence  the  former 
name  Gregarinosis).  Later  bacteriological  experiments,  particularly 
those  of  Loefifler  (1884)  on  pigeon  diphtheria,  seemed  to  indicate  tliat 
the  diphtheria  was  due  to  a  rod-like  bacterium  which  he  called  Bac. 
diphtheriae  columbarum.  Furthermore  other  observers,  as  Krajewski, 
Moore  and  Galli-A^alerio  found  the  same  organism  in  the  diphtheritic 
membranes  of  sick  chickens,  while  subsequently  Guerin  demonstrated 
its  identity  wdth  the  ovoid  bacillus  described  by  Haushalter  and  Loir 
&  Ducloux.  Streit  insisted  on  the  etiological  importance  of  his  roup 
bacillus  for  the  disease  called  roup  in  America,  and  Miiller  was  of 
the  opinion  that  the  virus  of  chicken  diphtheria  was  a  corynebacillus, 


llislniy,  l*iv\  ak'iicf.  Ill  iolntiy.  425 

au  organism  similar  to  liu'  Iniiiiaii  liiplillicria  organism,  lint  these 
and  other  simihir  iindings  intiueneed  but  slightly  the  view  that  bird 
diphthei'ia  is  a  baeillary  infectious  disease,  and  were  explained  })y  the 
assumption  that  various  baeteria  participate  in  dilferent  eases  in  the 
diphtheritic  diseased  processes,  a  view  which  indicated  a  degree  of  un- 
certainty as  to  any  positive  knowledge  in  this  regard. 

The  etiology  of  chicken  pox  was  elucidated  acceptably  when  ]\Iarx 
and  Sticker  (1J)02)  brought  proof  that  the  pock  virus  will  pass  through 
a  porcelain  filter  and  therefore  belongs  to  the  filterable  infectious  sub- 
stances. This  has  since  been  conlirmed  by  .Juliusberg,  Borrel,  Loewen- 
thal,  Burnet  and  others. 

Experiments  following  this  discovery  have  led  to  results  which 
completely  shattered  the  existing  view  that  the  etiological  factor  of 
the  two  diseases  diffci-ed.  It  is  true  that  Roell  (1867)  suspected  that 
the  changes  in  the  oral  mucosa  and  skin  were  due  to  the  same  causative 
agent,  and  this  view  is  also  expressed  in  the  work  of  Rivolta  &  Delprato 
(1880)  as  well  as  Pfeitfer  (1889)  and  Kinsley  (1907).  :\Ioreover 
from  a  practical  point  of  view,  considering  the  difficulty  in  diiferential 
diagnosis,  this  did  not  seem  unlikely,  but  experimental  support  was 
not  obtained  until  Carnwath  (1908)  succeeded  in  producing  a  diph- 
theritic disease  of  the  mucous  membranes  from  pure  pox  material,  and 
with  diphtheritic  material  produced  chicken  pox.  These  experimental 
results,  doubted  by  Bordet  &  Fally  and  also  by  Jowett,  were  confirmed 
by  Schmid,  Uhleidiuth  &  Manteufel,  and  also  by  Ratz,  and  further 
experiments  directed  towards  the  solution  of  some  contested  details 
such  as  virulence  of  the  blood  in  pure  diphtheria,  role  of  the  bacteria 
present  in  the  pseudo-membranes,  etc.,  will  no  doubt  soon  establish  the 
etiological  identity  of  the  two  forms  of  disease  definitely. 

Prevalence.  Both  forms  of  disease  occur  particularly  in 
fowls  (chickens,  turkeys,  pheasants,  peacocks),  also  in  pigeons, 
and  mnch  less  commonly  in  water  fowls.  In  the  southern 
regions  (Italy,  Tunis)  the  diphtheritic  form  rages  with  greater 
virulence  and  sometimes  presents  a  septicemic  character,  hut 
in  northern  regions  the  losses,  especially  in  pedigreed  fowl 
farms,  are  heavy  on  account  of  the  frequent  severe  invasion 
of  the  disease  and  high  mortality. 

Etiology.  The  experiments  of  Marx  &  Sticker  have  sho^vn 
that  the  fluid  obtained  by  maceration  of  epithelial  nodules  in 
physiological  salt  solution  is  infectious  after  passing  throiigli 
a  Berkefeld  filter,  since  after  the  inoculation  of  the  filtrate  into 
the  skin  of  chickens  the  characteristic  epithelioma  developed, 
which  could  he  inoculated  from  one  animal  to  another. 

Borrel,  Lipsehiitz,  as  well  as  Prowafek,  are  iiielinefl  to  consider  as  etiological 
agents,  very  minute,  hardly  0.25  ix  f^ized,  sjiherical  or  biseuitform  organisms, 
found  in  large  quantities  in  virus-emulsions,  and  -which  can  be  demonstrated  by 
Giemsa's  as  well  as  by  Loefller's  flagellum  stain.  By  penetrating  into  cells  they 
may  cause  the  development  of  the  frequently  mentioned  "inclusions"  in  the  epi- 
thelial cells,  as  products  of  reaction.  Prowayek  named  them,  as  well  as  similar 
formations  in  vaccinia,  rabies,  etc.,  Chlamydo7oa,  since  they  caused  vacuoloid  reac- 
tion products  in  the  infected  cells. 

Tenacity.  The  pox  virus  is  rather  resistant  to  external  influences.  Enclosed  in 
?pithelial  masses  it  is  not  destroyed  by  complete  drying  or  exposure  to  diffuse  day- 
light for  several  weeks;  heating  to  60°C.  for  three  hours,  cooling  to  minus  12°C.  for 


426  Avian  Diphtheria  and  Chicken  Pox, 

five  weeks,  and  one  per  cent  carbolic  acid  solution  for  half  an  hour  also  failed  to 
destroy  it.  Portions  of  the  nodules  preserved  in  glycerin  for  several  weeks  still 
produced  the  typical  disease  (Marx  and  Sticker).  The  virus  further  resists  the 
effect  of  10%  atoxyl  and  1%  saponin  solutions,  as  well  as  a  10%  solution  of 
sodium  taurocholate  (Lipschiitz).  AVhen  the  tumor  masses  are  finely  pulverized  it  is 
killed  at  60°C.  in  8  minutes  (Burnet),  by  1%  potassium  hydrate  solution,  1%  acetic 
acid  or  1:1,000  corrosive  sublimate  in  5  minutes  (Sanfelice). 

Culture.  Bordet  reported  successful  cultivations  from  diphtheria 
material  on  his  blood-glycerin-potato-agar,  minute  colonies  developing 
on  the  surface,  composed  of  granules  staining  by  Giemsa's  method 
and  having  a  dimension  of  barely  0.2  m.  "With  such  cultures  he 
succeeded  in  producing  diphtheritic  membranes  on  the  oral  mucosa 
of  chickens,  but  not  epithelioma  on  the  skin.  Similar  attempts  at  culture 
by  Lipschiitz  and  by  Uhlenhuth  &  Manteufel  with  pox  material  gave 
no  positive  results. 

Pathogenicity.  When  finely  pulverized  epithelial  nodes  are 
rubbed  into  the  skin  of  the  comb,  wattles  or  eyelids  of  chickens 
there  occur  after  5  or  6  days  swelling  and  pallor  of  the  affected 
parts  of  the  skin,  and  on  the  following  day  a  nodule  as  large 
as  a  millet  seed  appears  on  its  surface.  After  three  or  four 
more  days  hemorrhages  suddenly  appear  over  the  affected  re- 
gion; later  the  blood  dries  forming  thick  scabs,  beneath  which 
the  papillae  enlarge  considerably  and  become  covered  with  a 
turbid,  gray  exudate.  Beneath  this  bloody  scab  healing  takes 
place  after  a  shorter  or  longer  period  of  time;  but  when  the 
diseased  portions  are  exposed  to  traumatic  influences  (rubbing, 
scratching)  there  develop  extensive  papillary  proliferations 
which  delay  healing.  The  result  from  inoculation  of  the  filtrate 
is  similar,  only  the  incubation  period  is  from  8  to  10  days  on 
account  of  the  dilution  or  attenuation  of  the  infectious  sub- 
stance (Marx  &  Sticker).  Juliusberg,  who  demonstrated  the 
filterability  of  the  infectious  virus  of  pigeon  pox,  observed  an 
incubation  period  of  14  days  after  inoculation  of  the  filtrate 
into  pigeons. 

When  pox  material  is  rubbed  into  the  scarified  oral  mucosa 
or  injected  into  the  submucosa,  there  either  arises  a  local  re- 
action in  the  form  of  a  light  yellow  membrane,  or  there  develops 
a  characteristic  croupous-diphtheritic  inflammation,  which  may 
extend  from  the  oral  mucosa  to  the  nasal  cavities  and  their 
sinuses  (Loewenthal,  Schmid,  Uhlenhuth  &  Manteufel).  Con- 
iunctival  inoculation  produces  a  diphtheritic  conjunctival  in- 
flammation, which  eventually  causes  a  panophthalmia. 

The  results  are  similar  when  diphtheria  material  is  em- 
ployed for  inoculation  on  the  skin  and  mucous  meinbrane  only 
here  negative  results  are  more  common  than  after  inoculation 
with  pox  material  (Schmid,  Uhlenhuth  &  Manteufel). 

Loewenthal  and  Burnet  produced  pox  on  the  skin  by  in- 
travenous injection  of  pox  material.  Uhlenhuth  &  Manteufel 
used  intravenous  injections  of  pox  and  diphtheria  material  and 
produced  severe  diphtheritic  symptoms  on  the  mucosa  of  the 
mouth  and  on  the  conjunctivae. 


Pathoiivnicity.  427 

Botli  pox  and  <liplitlieria  aro  oasily  transmitted  from 
chickens  to  chickens  and  from  pigeons  to  cliickens,  whereas 
tlie  transfer  of  pox  material  from  chickens  to  pigeons  is  ac- 
coniplislied  Avitli  difticulty,  and  transmission  of  diphtlieria  ma- 
terial lias  tlm.v  ^^ar  l)een  nnsuceessfnl.  The  infective  vims  trans- 
ferred from  the  pigeon  to  the  chicken  ai)pears  to  undergo  an 
attenuation  even  in  the  first  generation;  but  also  in  the  pigeon 
the  virus  becomes  attenuated  by  successive  passages  even  to 
avirulency  (.lulinsbcrg). 

Aside  from  its  presence  in  the  epithelial  nodules  and 
mucous  membranes  the  virus  is  also  found  in  the  blood,  at 
least  in  the  beginning  of  the  disease,  for  it  was  repeatedly 
found  possible  to  produce  the  characteristic  changes  on  skin 
and  mucous  membrane,  especially  with  liver  substance  (Loewen- 
thal,  Burnet,  Schmid,  Uldenhuth  &  Manteufel). 

The  above  mentioned  experimental  results  permit  the  con- 
clusions, that  epithelial  nodes  and  diphtheritic  pseudo-mem- 
l)ranes  contain  the  same  virus  which  produces  pox  on  the  skin 
and  diphtheritic  processes  on  mucous  membranes,  and  therefore 
chicken  pox  and  avian  diphtheria  form  an  etiological  entity. 
This  view  is  supported  by  an  experimental  result  obtained  by 
Uhlenhuth  »!t  ^lanteufel,  according  to  which  recovery  from  the 
affection  of  the  mucous  membrane  produced  vritli  diphtheria 
material  gives  immunity  against  a  subsequent  artificial  skin 
infection  with  virulent  pox  virus. 

In  consideration  of  the  present  viewpoint  the  question  arises  what 
significance  attaches  to  the  more  or  less  pathogenic  bacteria  found  by 
different  authors  in  the  diphtheritic  pseudo-nienibranes  and  considered 
by  them  as  causes  of  the  disease  on  account  of  the  partly  successful 
experiments  of  transmission.    The  following  come  under  consideration : 

1.  The  bacillus  diphtheriae  eohnnhaniiii  obtained  in  pure  culture  l\v  Loefflcr 
from  a  case  of  pigeon  diphtheria.  This  bacillus,  which  takes  a  bipolar  stain,  is  similar 
to  the  organism  causing  rabbit  septicemia,  but  slightly  longer  and  more  slender; 
Its  pure  cultures,  after  subcutaneous  inoculation,  produce  in  pigeons  a  necrotic 
inflammation  of  the  skin,  while  after  injection  into  the  oral  mucosa  of  chickens 
circumscribed  pseudo-membranes  form.  Loir  &  Ducloux  no  doubt  found  the  same 
bacillus  in  diphtheritic  chickens  in  Tunis,  only  this  organism  was  characterized  by  a 
marked  virulence,  while  its  cultures  after  subcutaneous  inoculation  soon  produced  a 
rapidly  fatal  septicemia,  or  heavy  deposits  in  the  throat  and  in  the  larynx  in  addi- 
tion to  general  septic  symptoms. 

2.  The  "Eoupbacillus,"  an  organism  in  many  ways  similar  to  the  bacillus 
pyocyaneus,  described  by  Streit  as  the  causative  factor  of  American  ' '  roup, ' '  a 
disease  clinically  identical  with  chicken  diphtheria.  He  found  it  in  abundance 
in  the  disease  products  of  sick  birds  and  made  with  his  pure  cultures  experiments  of 
transmission  to  chickens  and  pigeons,  which  were  in  i)art  successful. 

3.  The  "Chickendiphtheriabacillus"  of  R.  Miiller,  which  he  describes  as 
related  to  the  human  diphtheria  organism  or  Loeffler's  bacillus,  although  a  smaller 
corvnebacillus.  He  obtained  pure  cultures  which  ui)on  inoctdation  in  mucous  mem- 
branes or  injection  into  the  submucosa  in  pigeons  produced  a  diphtheritic  inflam- 
mation. 

4.  A  colon-like  bacillus,  which  Hausser  was  enabled  to  constantly  demonstrate 
in  s|iontaneous  diphtheria  in  the  deposits,  and  with  whose  pure  cultures  he  succeeded 
several  times  in  producing  a  diphtheritic  inflammation  in  chickens  and  pigeons. 

Finally  there  may  be  found  in  the  diphtheritic  deposits  in  some  cases  the 
bacillus  pyocyaneus,  streptococci,  chicken  cholera  bacteria,  necrosis  bacilli  and  some- 
times swine  erysipelas  bacilli. 


428  Avian  Diijlitheria  and   Chicken  Pox. 

These  variable  results  of  the  several  observers  preclude  any  specific 
role  of  the  bacteria  found;  on  the  other  hand,  however,  in  view  of 
the  positive  inoculation  results  obtained  with  pure  cultures  the  possi- 
bility is  by  no  means  excluded  that  under  certain  conditions,  especially 
when  the  requirements  for  their  propagation  in  the  body  of  the  fowl 
are  for  any  reason  favorable,  local  diphtheritic  inflammatory  processes 
may  be  caused  or  already  existing  processes  be  aggravated.  When  it  is 
considered  that  the  disease  of  the  mucous  membrane  may  also  be  produced 
by  filtrates  of  disease  products  and  by  intravenous  injection  of  such 
filtrates  the  assumption  or  supposition  can  hardly  be  rejected  that  avian 
diphtheria,  as  well  as  chicken  pox,  is  primarily  produced  by  the  same 
filterable  virus,  whereupon  facultative  pathogenic  bacteria  subseciuently 
settle  on  the  mucous  membranes  and  on  their  own  part  participate  more 
or  less  in  the  development  of  the  clinical  picture  of  the  disease. 

According  to  Bollinger  and  Csokor  the  epithelioma  contagiosnni  of  man  is 
identical  with  the  epithelioma  of  birds,  for  material  from  the  former,  when  inoculated 
into  the  comb  of  birds,  gave  rise  to  a  disease  identical  with  chicken  pox.  The  close 
relationship  is  indicated  further  by  the  fact  that  the  virus  of  the  disease  is  also 
filterable    (Juliusberg,  Casagrandi,  Serra,  and  others). 

Natural  infection  probably  occurs  in  most  cases  by  tlie 
intermediation  of  exfoliated  epithelial  material  or  of  exudate 
discharged  by  the  diseased  animals  while  sneezing  or  cough- 
ing, or  otherwise.  These,  or  the  intestinal  contents  or 
portions  of  internal  organs  of  diseased  or  dead  animals,  may 
come  in  contact  with  superficial  abrasions  on  the  skin  or 
mucous  membranes.  It  is  possible  that  infection  may  occur 
also  through  the  unimpaired  mucosa,  which  is  favored,  no 
doubt,  by  a  preceding  injury,  and  the  frequent  disease  of  the 
eyes'may  be  associated  with  the  habit  chickens  have  of  rubbing 
the  vicinity  of  the  orbit  with  their  feet  (according  to  Megnin 
older  pigeons,  which  frequently  show  small  caseated  nodules 
in  the  esophagus,  may  infect  their  young  wdiile  feeding  them). 

Healthy  fowls  are  usually  infected  by  sick  animals,  con- 
taminated drinking  water,  food,  etc.,  serving  as  media  of  in- 
fection. The  disease  is  spread  mostly  through  transportation 
of  fowls  to  markets  and  poultry  exhibits ;  but  free-flying  birds 
(pigeons,  sparrows,  etc.)  may  carry  the  infection  for  long  dis- 
tances to  healthy  poultry  farms. 

Pigeons  are  most  susceptible  to  the  disease,  chickens  less 
so,  and  water  fowls  to  a  considerable  degree  less.  The  sus- 
ceptibility to  infection  is  in  general  greater  in  young  than  in 
older  animals. 

An  attack  of  the  disease,  no  matter  whether  skin  changes 
or  diphtheria  of  the  mucous  membranes  was  manifested,  confers 
immunity  against  subsequent  infection,  for  chickens  which  have 
recovered  from  the  artificially  produced  disease,  can  not  be  re- 
infected after  two  weeks.  The  immunity  so  acquired  is,  how- 
ever, sometimes,  only  of  short  duration  (Loewenthal). 

Anatomical  changes.  These  may  be  confined  to  the  skin, 
or  to  the  mucosa  of  the  mouth  and  nose,  but  in  the  animals 


Aiiatoiiiical   Cliaiiycs,  Sviuplouis.  4'^9 

which  have  died  from  tlio  disoaso  tlic  vast  majority  of  cases 
•will  sliow  tiio  skill  as  well  as  the  mucous  membranes  seriously 
affected. 

In  addition  to  the  epithelial  nodes  of  the  skin  one  finds 
croupous-diphtheritic  deposits  on  the  mucosa  of  the  mouth  and 
throat,  the  nose  and  accessory  cavities,  sometimes  also  in  the 
larynx,  trachea  and  bronchi  as  well  as  in  the  intestinal  mucosa. 
The  membranes  in  the  mouth  are  dark  gray  or  brown,  at  other 
points  yellowish-gray,  usually  croupous,  sometimes  softened 
and  cheesy,  while  the  subjacent  mucosa  is  denuded  of  epithelium, 
finely  granular  and  occasionally  appears  necrotic  to  a  certain 
depth.  In  individual  cases  a  erou})Ous-caseous  exudate  is  found 
in  the  bronchi  and  in  the  cella  infraorbitalis  in  such  quantities 
as  to  fill  the  canals  and  cavities  involved  completely. 

The  intestinal  mucosa  also  shows  similar  inflammatory 
changes  and  small  extravasations  of  blood.  Occasionally  the 
epithelium  is  removed  for  a  considerable  extent,  and  here  and 
there  shallow  ulcers  may  form,  while  on  other  areas,  especially 
in  the  caeca  firm  dry  nodes  composed  of  proliferated  epithelium 
and  detritus  may  adhere  to  the  inner  surface  of  the  intestine. 

In  tlie  more  acute  cases,  in  addition  to  the  above  changes 
on  the  mucous  membrane  which  may  be  very  indefinite,  a  large 
splenic  tumor  may  be  found,  fine  yellowish  points  or  spots  in 
the  liver,  acute  edema  of  the  lungs,  hemorrhages  and  occa- 
sionally fibrinous  membranes  on  the  serous  coats,  and  finally 
a  serous  exudate  in  some  joints. 

The  microscopic  examination  of  the  epithelioma  of  the  skin  shows,  according  to 
Polowinkin,  the  epithelial  layers  thickened  and  the  epithelial  papillae  elongated  in- 
ward;  in  the  papillary  layer  the  vessels  are  dilated  and,  like  those  of  the  subcutis, 
surrounded  by  migrating  leucocytes;  in  addition  there  are  small  hemorrhages  into  the 
tissue  of  the  papillary  layer.  Cell-inclusions  are  found  in  the  swollen  epithelium, 
similar  to  Guarnieri 's  pox  bodies  (Loewenthal,  Burnet;  s.  p.  293).  In  a  general  way 
the  characteristic  features  of  the  efflorescences  are  composed  of  a  more  or  less  pro- 
nounced hyperplasia  and  proliferation  of  the  cell  elements  of  the  skin,  which  sooner 
or  later  succumb  to  degeneration.  This  is  associated  with  the  extension  of  the  process 
to  the  external  skin  and  there  follows  a  condition  which,  according  to  Eeischauer,  is 
similar  to  true  pox;  the  difference  lies  mainly  in  the  fact  that  in  bird  pox  the  more 
chronir-  character  of  the  disease  causes  the  nodular  and  tumor  formation  *to  pre- 
dominate. 

Microscopic  examination  of  the  diseased  mucous  membrane  shows  a  fibrin- 
ous network  in  the  superficial  layers,  in  the  folds  of  which  lie  irregularly  formed 
flakes  and  granular  detritus,  while  in  the  mucous  tissue  are  seen  cellular  infiltrations 
and  occasionally  necrosis  of  the  tissue  elements.  The  exudate  may  also  show  various 
bacteria  and  occasionally  protozoondike  organisms,  Imt  their  significance  has  thus  far 
not  been  ascertained.  Eivolta  found  a  flagellated,  spherical  or  ovoid  protozoon,  the 
Ccrcomnnns  gaJIinarum,  in  the  membranes  of  the  oral  mucosa,  while  Pfeiffor  found 
in  mendiranous  inflammation  of  the  trachea  and  tlie  intestines,  flagellates  in  large 
numbers  with  three,  more  rarely  with  two  or  four  flagellae,  wliii-h  he  believed  to  be 
Trichomonads,  and  both  observers  were  inclined  to  associate  their  findings  etiologically 
with  the  pathological  conditions.  Babes  &  Puscariu  consider  the  flagellates  as  harm- 
less and  only  accidentally  present  in  the  air  passages  and  in  the  intestinal  canal, 
because  they  never  succeeded  in  producing  a  disease  of  the  mucous  membranes  with 
them. 

Symptoms.  The  clinical  picture  of  the  disease  depends 
upon  whothor  there  is  an  affection  of  the  skin  or  the  mucous 
membranes  or  if  both  these  tissues  are  involved,  and  whether 


430 


Avian  Diphtheria  and  Chicken  Pox. 


the  disease  runs  an  acute  or  chronic  course.     Thus  there  are 
several  clinical  forms  of  disease  to  be  differentiated. 

In  one  form,  which  has  always  been  designated  as  chicken 
pox,  morbid  changes  develop  in  the  skin,  and  in  the  majority 
of  cases  the  skin  of  the  head  is  first  affected.    On  comb,  ears 


Fig.  65.     Chicken  pox.     Epithelial  proliferations  on  the  comh,  on  the  wattles,  and  in 
the  vicinity  of  the  corners  of  the  mouth. 

and  wattles,  in  the  vicinity  of  the  natural  openings  and  es- 
pecially on  the  parts  of  the  body  which  are  slightly  covered 
or  totally  devoid  of  feathers  there  arises  at  first  a  fine,  bran- 
like, gray  deposit,  which  is  soon  followed  by  little  nodules,  at 
first  reddish-gray  in  color  and  with  a  mother-of-pearl  luster. 


Syiuptom-s.  431 

but  which  later  assume  a  more  ^-rayisli-j-ellow  color,  and  are 
composed  of  horny  or  fatty  degenerated  epithelial  cells.  By 
gradual  enlargement  these  develop  to  pea-sized,  yellow  or  dark- 
brown  nodes  whose  surfaces  are  warty,  dry  and  firm,  the  in- 
terior contents  being  composed  of  a  yellow,  fatty  paste  (Fig.  65). 
Sometimes  they  are  so  ahniidant  tlint  they  touch  and  even 
coalesce  with  the  result  that  the  highly  reddened  and  easily 
bleeding  skin  forms  thick  cohesive  scabs.  The  comb  and  wattles 
are  in  consequence  much  thickened  and  deformed.  The  margins 
of  the  nasal  orifices  and  still  more  those  of  the  eyelids  also 
become  thickened  so  that  eventually  the  eyes  are  completely 
closed.  Should  the  inflammatory  process  spread  to  the  con- 
junctival tissue  much  caseous  and  purulent  secretion  accumu- 
lates in  the  conjunctival  sac  which  gradually  effects  a  pressure 
atrophy  of  the  eyes,  or  a  corneal  inflammation  develops,  which 
may  become  complicated  with  a  purulent  panophthalmitis. 

Xodules  and  nodes  similar  to  those  on  the  head  develop 
in  some  cases  on  other  portions  of  the  body,  especially  in  the 
vicinity  of  the  cloaca,  on  the  under  surface  of  the  wings,  on 
the  neck,  on  the  rump,  particularly  on  unfeathered  areas.  Here 
they  sometimes  attain  the  size  of  a  hazelnut  and  may  even  de- 
velop into  horny  or  callous  growths.  Such  large  growths  which 
have  an  irregular  surface,  may,  ])y  the  exercise  of  considerable 
force,  be  removed  or  broken  off  from  the  skin,  which  will  expose 
the  interior  cavity  filled  with  a  thick  cheesy  mass,  while  vertical 
sections  show  wavy  layers  running  more  or  less  parallel  with 
the  skin  surface. 

As  long  as  the  disease  is  confined  to  the  skin  the  general 
condition  usually  remains  undisturbed;  only  when  it  is  widely 
distributed  over  the  surface  of  the  skin  marked  emaciation 
is  likely  to  occur. 

In  warmer  countries  a  virulent  diffuse  form  of  the  disease  occurs 
whereby  the  skin  shows  no  tumor  formation  hut  a  flat  papular  thicken- 
ing and  the  affected  areas  become  in  a  few  days  covered  with  dry  crusts. 
Febrile  symptoms  may  also  occur,  not  follo-\ved  by  nodules  but  by 
reddish-violet  pustules,  which  turn  later  white  and  finally  yellow,  and 
which  eventually  dry  up  and  form  brownish  crusts,  or  death  follows 
after  4  to  5  days  of  the  disease  (Reischauer).  A  malignant  course 
Avas  also  observed  by  Klee  on  a  chicken  farm  where  a  diffuse  inflamma- 
tion developed  over  the  body  associated  with  seborrhoea  and  warty 
growths.     All  hens  so  diseased  died  within  4  to  5  days. 

The  second  form  which  lias  hitherto  been  considered  ex- 
clusively as  avian  diphtheria,  begins,  also  without  any  marked 
disturbance  of  the  general  condition,  with  a  local  affection  of 
one  of  the  mucous  membranes  of  the  head,  usually  the  mouth. 
In  some  cases  there  develop  on  the  otherwise  smooth  surface 
which  is  at  times  only  slightly  reddened,  small  spherical  or 
oval  yellowish-white  spots,  which  gradually  spread  and  finally 
form  extensive  membranes.  In  other  cases  the  mucous  mem- 
brane assumes  a  dark  red  color,  soon  followed  by  a  gray  deposit 


432  Avian  Diphtheria  and   Chicken  Pox. 

on  its  surface,  wliicli  gradually  becomes  thicker  and  forms  dense 
deposits,  at  first  gray  or  yellowish,  later  brownish-gray  and 
dark  brown  on  the  parts  exposed  to  the  air;  when  dry,  the 
surface  becomes  rough  and  fissured.  The  membranes  are 
usually  adherent  to  the  subjacent  tissue.  When  they  are  re- 
moved they  leave  red,  uneven,  slightly  depressed  and  bleeding 
surfaces,  or  the  mucosa  is  covered  with  cheesy  easily  removable 
masses  of  exudate,  and  beneath  these  the  surface  is  only  red- 
dened and  finely  granulated,  but  not  eroded  (usual  appearance 
in  pigeons). 

The  adjoining  tissue  which  is  not  covered  with  membranes, 
is  edematous,  but  here  also  oftimes  exudative  masses  occur  in 
the  later  stages;  these  gradually  become  confluent  and  finally 
completely  cover  the  affected  cavity.  Such  abundant  deposits 
may  occur  within. the  first  or  second  day,  and  after  their  removal 
new  ones  form;  sometimes,  however,  the  ulcerative  process  ex- 
tends deeper  leading  to  extensive  destruction.  If  the  animal 
survives  the  membranes  are  in  the  course  of  time  loosened  spon- 
taneously, and  the  loss  of  substance  is  replaced. 

Such  croupous-diphtheritic  membranes  develop  most  com- 
monly on  the  oral  mucosa,  especially  on  the  gums  near  the  longi- 
tudinal cleft,  on  the  borders  and  the  under  surface  of  tongue, 
the  corners  of  the  mouth  and  cheeks,  as  well  as  on  the  pharyngeal 
Avail  and  in  the  vicinity  of  the  larynx.  The  inflammatory  process 
not  infrequently  extends  to  the  larynx  and  from  here  to  the 
trachea  and  bronchi;  on  the  other  hand  it  may  extend  from 
the  pharynx  to  the  mucosa  of  the  esophagus  and  crop.  As 
the  inflammation  progresses  respiration  and  deglutition  become 
more  and  more  difficult;  the  bird  keeps  its  neck  constantly 
extended  and  the  beak  always  open  or  opens  it  every  few 
moments  snapping  for  air,  whereby  the  in-rush  of  air  is  ac- 
companied by  whistling  or  rattling  noises.  In  the  meantime 
the  desire  for  food,  at  first  unimpaired,  grows  less  and  less,  and 
as  deglutition  is  more  difficult  or  impossible,  the  bird  ceases 
to  eat  altogether. 

The  affection  of  the  nasal  cavity  is  at  first  manifested  by  a 
serous  nasal  discharge,  which  soon  becomes  muco-purulent  and 
later  dirty-gray  in  color.  It  is  discharged  in  considerable  quan- 
tity on  pressure  over  the  dorsum  of  the  nose ;  otherwise  it  dries 
in  the  nasal  orifices,  closing  these  in  part  or  entirely  and  oc- 
casionally raising  the  upper  nasal  wall.  In  the  meantime  the 
birds  breathe  heavily,  show  a  desire  to  sneeze  and  shake  their 
heads  thus  hurling  out  masses  of  pus  and  single  flecks  of  thick- 
ened pus  and  bits  of  membranous  shreds.  From  the  nasal  cavity 
the  inflammation  extends  to  the  lachrymal  canal,  which  as  a  re- 
sult becomes  occluded ;  it  also  progresses  quite  frequently  on  one 
or  both  sides  to  the  cella  infraorbitalis  which  now  becomes  filled 
with  exudate  and  bulges  under  the  internal  angle  of  the  eye  in 
the  form  of  a  growth,  which  on  pressure  discharges  a  muco- 
purulent fluid  from  the  nasal  orifice  on  the  affected  side.    The 


Syiiij))oiiis. 


4'a:] 


¥iiX.  66. 


tumor  is  hot,  painful  and  in  the  later  stages  sliows  on  palpation 
a  harder  nnelens  {Fig.  06). 

The  constantly  increasing  swelling  forces  the  orbit  up- 
wards and  backwards  while  the  corresponding  wing  of  the 
palate  is  arched  against  the  oral  cavity  and  later  is  entirely 
destroyed,  so  that  the  cavity  ai)pears  to  be  surrounded  only 
by  mucous  membrane  or  by  a  dense  pseudo-membrane.  This 
produces  a  marked  dis- 
ligurement  of  the  head 
while  the  movements  of 
the  head  or  beak  are 
greatly  interfered  with  by 
the  tnmoi'.  On  incision  the 
growth  discharges  a  yel- 
lowish-white, cheesy  or 
caseated  mass,  or  dry  and 
brittle  lumps  may  be  re- 
moved from  its  cavity. 

AVhen  the  eyes  are  in- 
volved the  first  indications 
are  acute  catarrhal  symp- 
toms of  the  conjunctiva 
with  edematous,  swollen, 
painful  lids  beneath  whicli 
there  accumulates  much 
muco-purulent  exudate 
filled  with  air  bubbles, 
sealing  the  eyes  over  night.  If  the  eye  slit  is  not  opened  at  reg- 
ular intervals  the  exudate  dries,  forming  thick,  yellowish-white, 
caseated  masses,  which  cause  a  protrusion  of  the  lids  and  force 
the  eye  backwards,  forming  on  the  surface  of  the  cornea  club- 
shaped  formations  whose  dry  brownish-yellow  ends  project  be- 
tween the  compressed  lids.  These  masses  are  easily  removed 
from  the  conjunctival  sac,  but  form  again  rapidly.  In  other  cases 
diphtheritic  membranes  develop  on  tlie  conjunctiva ;  the  inflam- 
mation may  also  extend  to  the  conjunctival  sclera  and  from  here 
to  the  cornea,  which  becomes  opaque  or  ulcerated,  and  finally 
a  general  inflammation  of  the  internal  eye  results. 

Involvement  of  the  intestinal  tract  occurs  only  in  the  later 
stages  of  the  disease  and  is  manifested  by  profuse  diarrhea 
with  frequent  discharge  of  creamy  or  fluid  feces,  sometimes 
mixed  with  pus  or  blood,  and  causing  a  rapid  w^eakening  of  the 
animal. 

The  general  condition  of  the  patients  is  at  first  not  dis- 
turbed, but  later  the  condition  changes  markedly.  Unable  to 
eat  and  gasping  for  air  they  sit  around  tired  and  depressed, 
Avith  neck  drawn  in,  wings  hanging  down,  feathers  ruffled,  and 
do  not  resist  attempts  to  catch  them.  The  1)ody  temperature 
is  raised  only  in  the  late  stages,  while  towards  the  end  it  falls 
below"  normal.     The  comb  and  wattles  are  at  first  bluish-red. 

Vol.  1—28 


Swelling  of  tlie  t'clla  iufraorbitalis  in 
chicken  pox. 


434  Avian  Diphtheria  and   Chicken  Pox. 

later  joale  and  cold  to  the  touch.  1  he  discharge  emanating  from 
the  mouth  and  nasal  orifices  soils  the  breast  and  emits  an 
unpleasant  odor.  The  animals  emaciate  considerably,  until  they 
finally  die  from  exhaustion  due  to  the  associated  diarrhea. 

Those  cases  in  which  the  disease  affects  both  the  skin  and 
mucous  membranes  of  the  head,  although  not  necessarily  at 
the  same  time,  may  be  designated  as  mixed  form.  In  the 
majority  of  cases  the  skin  of  the  head  is  first  affected,  and  the 
inflammatory  process  usually  spreads  from  the  corners  of  the 
mouth,  later,  to  the  oral  mucosa  and  from  here  to  the  neighbor- 
ing cavities ;  the  reverse  order  is  much  less  commonly  observed. 
No  matter  in  what  direction  the  process  progresses  the  two 
forms  coalesce  in  such  a  variety  of  clinical  pictures  that  in 
the  lethal  cases  one  usually  finds  the  signs  of  pox  and  of  diph- 
theria simultaneously,  although  developed  to  different  degrees. 
However,  cases  in  which  the  mucous  membranes  alone  are 
affected  are  not  rare. 

The  acute  form  of  the  disease  as  it  has  been  almost  ex- 
clusively observed  in  southern  countries  (Algeria,  Cuba), 
l)egins  with  marked  symptoms  of  a  general  infection  (marked 
lassitude,  loss  of  appetite,  difficulty  of  breathing,  etc.),  followed 
on  the  second  or  third  day  by  small  yellowish-brown  pseudo- 
membranes  on  the  inflamed  oral  mucosa,  which  in  a  very  short 
period  of  time  develop  to  extensive  deposits.  Although  the 
process  mostly  affects  the  nasal  cavities  and  conjunctivae, 
deglutition  and  respiration  are  markedly  impaired,  and  in- 
testinal inflammation  occurs  causing  rapid  exhaustion,  and 
ending  fatally  within  a  few  days. 

Course  and  prognosis.  Cases  in  which  the  disease  is  con- 
fined to  the  skin  run  a  favorable  course  in  the  majority  of 
instances.  The  skin  disease  ceases  to  progress  after  a  certain 
time  when  the  nodules  have  become  dry  and  have  been  shed, 
and  spontaneous  cure  follows  after  3  to  5  weeks.  In  this  manner 
even  large  nodes  may  fall  off  spontaneously;  in  other  cases 
there  occur  fresh  nodules  on  other  parts  of  the  body,  and  in 
these  instances  the  disease  runs  over  several  months. 

Less  favorable  is  the  course  of  the  diphtheritic  disease  of 
the  mucous  membranes.  In  a  goodly  number  of  cases  spon- 
taneous arrest  and  cure  follows  in  these  instances,  but  as  the 
process  is  easily  carried  to  the  larynx  and  bronchi  and  often 
involves  the  intestinal  mucosa  the  mortality  is  much  higher 
on  account  of  exhaustion  or  dyspnea.  The  disease  usually 
lasts  2  to  3  weeks,  sometimes  1  to  2  months,  and  with  transitory 
improvement  the  time  may  be  even  more  prolonged.  Accord- 
ing to  Friedberger  the  mortality  is  50-70%,  and  is  much  higher 
in  young  birds,  especially  in  those  of  highly  bred  varieties. 


Course  and  Pro,i;iu)sis,  Diagnosis,  Ticadiicut.  4o5 

The  acute  form  so  eonimoii  in  .southern  countries  usuall>- 
ends  fatally  in  4  to  8  days. 

Diagnosis.  The  earlier  differential  synii)toins  between  avian 
dil)litlieria  and  chicken  ])ox  have  lost  their  sig'nilicanee  since  the 
discovery  of  an  identical  etioloi^y  for  both  diseases. 

The  contai;ious  catarrli  of  the  nose  (coryza  contagiosa) 
is  confined  exclusively  to  the  nasal  cavity,  runs  a  course  with- 
out any  development  of  pseudo-membranes  and  is  therefore  not 
associated  witli  as  severe  symptoms  as  diplitheria. — "Pips" 
which  mii>lit  be  mistaken  for  the  l)e,ninning  of  diphtheria,  is 
confined  to  the  tongue,  the  discoloration  occurring  by  simple 
drying  of  the  epithelium,  acute  inflanmiatory  symptoms  being 
absent. — In  mycosis  aspergillina  the  deposits  on  the  palate  and 
nose  are  dryer  and  sometimes  of  a  greenish  color ;  the  fungi 
are  easily  demonstrated  with  the  aid  of  the  microscope. 

Treatment.  So  long  as  the  disease  is  confined  to  the  skin 
proper  treatment  will  usually  effect  a  cure,  and  the  aifection  of 
the  nnicous  membranes  may  sometimes  be  arrested  in  its  in- 
cipiency  and  a  cure  effected.  The  nodules  and  nodes  on  the 
skin  are  softened  with  ointments,  oil  or  soda  solution  and 
removed;  the  mucous  membrane  deposits  are  caught  with 
forceps  and  carefully  stripped  off  or  removed  with  a  piece 
of  cotton  on  the  end  of  a  stick  or  other  object.  The  exposed 
surface  is  painted  once  or  twice  a  day  with  1%  silver  nitrate 
solution  (if  in  the  mouth  apply  an  after  treatment  of  saline 
solution),  1%  corrosive  sublimate  solution  (after  treatment  with 
soda  solution),  with  lactic  acid,  lemon  juice,  2%  creolin  or  lysol 
solution,  tincture  of  iodine  (with  Tinct.  gallarum  aa),  or  the 
skin  is  painted  with  concentrated  glycerin. 

The  secretion  which  accumulates  in  the  eyes  is  washed  out 
with  warm  water  and  the  eye  is  subsequently  treated  with  2% 
boric  acid,  tannin  or  creolin.  Tumors  below  the  eyes  are  to 
be  opened  early  and  after  thorough  evacuation  of  the  cavities 
these  should  be  thoroughly  cleansed. 

For  the  difficult  respiration  inhalations  of  turpentine  and 
tar  vapors  may  be  tried  while  against  intestinal  catarrh  tannin 
or  sulphate  of  iron  (1%  solution  in  drinking  water),  red  wine 
(spoonful  doses)  or  other  astringents  (in  geese,  glycerin)  may 
be  employed,  but  in  most  cases  treatment  is  here  of  little  avail. 

Local  treatment  must  be  continued  until  the  cleansed  skin 
or  mucous  membrane  shows  no  new  nodules  or  deposits.  In 
those  instances  where  proper  treatment  is  not  available  or 
impractical,  or  where  the  birds  are  of  little  value,  it  will 
prove  more  practicable  to  suppress  the  disease  by  killing  the 
diseased  animals  or  even  destroying  the  entire  number  of  fowls 
on  the  farm,  and  instituting  thorough  disinfection  of  the  coops. 

Prevention.  The  general  prophylactic  measures,  such  as 
isolation  of  the  diseased  and  removal  of  the  dead  birds,  cleans- 


436  Avian  Diphtheria  and   Chicken  Pox. 

ing  and  disinfection  of  the  coops  and  runs,  careful  examina- 
tion and  quarantine  of  the  newly  bought  birds,  etc.,  are  identical 
with  those  employed  in  fowl  cholera  (see  p.  95).  As  the 
disease  has  a  latent  development  it  is  proper,  in  a  threatened 
epizootic  to  examine  the  mouths  of  the  healthy  birds  from 
time  to  time,  and  if  the  slightest  changes  in  the  skin  or  mucosa 
are  observed,  the  affected  bird  is  to  be  at  once  isolated  and 
treated. 

Preventive  inoculation.  Manteufel  succeeded  in  immunizing 
chickens  by  injecting  into  the  circulation  or  under  the  skin  a  lymph 
that  had  been  prepared  from  the  scrapings  of  epithelioma  or  mucous 
membranes  mixed  with  saline  solution.  Chickens  treated  in  this  manner 
were  immune  to  subsequent  infection  for  II/2  to  2  years,  even  though 
no  local  signs  of  reaction  followed  injection.  Chickens  that  had  been 
inoculated  with  mixtures  of  virus  and  bile  resisted  subsequent  inocula- 
tions into  the  comb.  Serum  of  highly  immunized  chickens  on  the  other 
hand  possessed  no  preventive  or  curative  value. 

The  earlier  attempts  at  immunization,  directed  as  they  were  ex- 
clusively against  bacillary  infection,  offer  very  little  in  view  of  our 
present  knowledge,  and  can  be  considered  effective  only  against  the 
secondary  infections;  however  brief  mention  of  them  will  be  made  here. 

Loir  &  Ducloux  immunized  healthy  chickens  hy  injecting  subentaneonsly,  first 
1.0  ec.  of  fresh  culture  of  their  diphtheria  bacillus  which  had  been  kept  at  a  tempera- 
ture of  55°C.  for  half  an  hour;  ten  days  later  they  injected  1.0  cc.  of  a  two  months 
old  culture.  One  of  twenty  chickens  so  treated,  and  four  out  of  five  not  treated, 
succumbed  to  a  later  virulent  infection. 

Guerin  found  this  measure  noneffective  in  pigeons,  but  obtained  more  favorable 
results  by  injecting  intraperitoneally  0.5  cc.  of  a  culture  that  had  been  heated  to  55 °C. 
for  an  hour.  He  repeated  this  in  12  days  by  employing  a  culture  that  ha<l  been 
subjected  to  50°C.  only,  for  the  same  length  of  time.  After  an  interval  of  12  to  15 
days  the  pigeons  sustained  a  subcutaneous  injection  of  0.5  cc.  of  virulent  culture  with- 
out any  bad  effects.  The  same  procedure  was  later  successfully  employed  on  young 
chickens.  From  January  1st  to  August  31,  1905,  the  Pasteur  Institute  in  Lille  sent 
out  24,602  vaccine  doses  to  74  parties.  Of  these,  30  parties  whose  observations 
encompassed  10,426  animals,  declared  themselves  as  satisfied  with  the  results,  while 
eight  rendered  an  unfavorable  report  (Eloire). 

The  Behring-Eoux  antitoxic  serum  employed  in  human  therapy  against  diph- 
theria of  children  and  recommended  by  Lang  and  by  Eloire  also  against  bird 
diphtheria  has  been  proved  ineffective  by  Harrison  as  well  as  by  Gratia  &  Lienaux. 

Literature.  Bollinger,  V.  A.,  1873,  LA'III,  39.— Loffler,  Mitt.  d.  G.-A.,  1884,  IT, 
421.— Loir  &  Ducloux,  A.  P.,  1894,  VIII,  599.— Marx  &  Sticker,  D.  m.  W.,  1902,  893; 
1903,  79.— Streit,  Z.  f.  Hyg.,  1904,  XLVT,  407.— Miiller,  Cbl.  f.  Bakt.,  1906,  XLI,  621 
(Lit.).— Burnet,  A.-P.,  1906,  XX,  742  (Lit.).— Bordet,  Ann.  vet.,  1907,  494.— Carn- 
wath,  Arb.  d.  G.-A.,  1907,  XXVII,  388.— Bordet  &  Fallv,  Ann.  vet.,  1907,  494.— 
Hausser,  Cbl.  f.  Bakt.,  1909,  XLVIII,  535  (Lit.).— Schmidt,  Ibid.,  1909,  LII,  200.— 
IThlenhuth  &  Manteufel,  Arb.  d.  G.-A.,  1910,  XXXIII,  288  (Lit.).— Manteufel,  Ibid., 
S.,  305. 

Diphtheritic  inflammation  of  the  eyes  in  ducks.  Kampmann, 
Hirschbruch  &  Lange  in  Poson  observed  on  a  chicken  farm  during  the 
spring  and  fall  of  1902  a  peculiar  disease  in  100  out  of  240  ducks,  of 
which  25  died,  while  15  were  killed  and  60  recovered,  while  other  fowls 
remained  healthy.  The  disease  began  with  severe  itching  in  the  eyes 
followed  in  a  few  days  by  a  conjunctival  inflammation  with  the  produc- 
tion of  a  yellow,  thick  exudate  and  diphtheritic  pseudo-membranes, 
to  which  was  added  an  ulcerative  inflammation  of  the  cornea  and  a 


DiplillK-ri;!  in   Man.  4.')7 

crusty  eczema  of  the  skin  due  to  containiiiatioii  with  the  conjunctival 
secretion.  The  ducks  became  much  emaciated  and  many  died  within 
a  few  weeks,  yet  autopsy  failed  to  reveal  any  marked  changes  in  tiie 
internal  organs.  Racilli  of  the  type  of  ])sendo-(lii)htheria  Ijacilli  W('i-(> 
found  in  the  conjunctival  cxii(hit('.     (CcntralM.  f.  liakl.,  liMJ:},  214.) 

Diphtheria  in  man,  Tiiis  so  justly  feared  disease  of  cliildren, 
produced  hy  the  l)acillus  diphtheriae  hominis  discovered  by  Kle])S  and 
moi'c  carefully  studietl  by  Ijocftler,  and  belonging  to  the  group  of  coryne- 
bacteria,  consists  of  an  acute  diphtheritic  inflammation  of  the  mucous 
membi-ane  of  the  pharynx  and  upper  air  passages,  beginning  usually 
with  fever  and  associated  with  severe  constitutional  symptoms.  The 
Klebs-LoefHer  (lii)hlheria  bacillus  displays  its  })athogenic  action  through 
tlie  medium  of  toxins  which  on  the  one  hand  produce  a  local  inflam- 
matory and  necrotic  process  as  well  as  general  constitutional  symptoms, 
and  is  also  responsible  for  later  nerve  paralysis  which  sometimes  follow 
diphtheria.  Horses  treated  with  the  toxic  filtrates  of  the  cultures  fur- 
nish an  effective  antitoxic  serum. 

The  relationship  between  diphtheria  of  man  and  that  of  animals 
and  particulai-ly  that  of  bii-ds  has  not  been  fully  explained. 

There  remains  no  doubt  wiiatever  that  true  diphtheria  of  man 
and  the  diphtheria  of  animals  are  Iavo  separate  diseases,  occurring  and 
spreading  entirely  independently  of  one  another.  The  bacillus  of 
human  diphtheria,  however,  possesses  a  pathogenic  action  for  animals, 
among  them  for  birds,  and  as  some  species,  such  as  young  guinea 
pigs,  cats  and  dogs,  after  artificial  inoculation,  develop  even  croupous- 
diphtheritic  processes  of  the  mucous  mem])ranes,  it  cannot  be  denied 
that  this  bacillus  under  natural  conditions  may  produce  similar 
disease  in  animals  and  thus  cause  the  latter  to  spread  the  con- 
tagion. This  view  is  supported  1)y  Ferre,  and  by  "Wheeler  and  Brandt, 
who  from  cases  of  avian  diphtheria  and  from  the  mouth  of  diph- 
theritic pharyngeal  disease  of  sick  dogs  respectively,  grew^  cultures  of 
bacilli  whose  pathogenic  action  was  similar  to  that  of  the  Klebs-Loeffler 
bacillus.  Further  support  comes  from  Cobbett,  who  found  a  bacillus 
in  the  nasal  secretion  of  a  horse  suffering  from  laryngitis,  which  cor- 
responded not  only  morphologically,  but  in  its  pathogenic  action  with 
the  bacillus  of  human  diphtheria  and  against  which  the  antitoxic  diph- 
theria serum  proved  effective.  Gallez,  Jr.,  Gratia  &  Lienaux  also 
found  a  bacillus  similar  to  the  Klebs-Loefifler  bacillus  but  less  virulent, 
in  the  contagious  nasal  catarrh  of  birds. 

On  the  other  hand  the  possil)ility  cannot  he  excluded  that  occa- 
sionally the  diphtheria  of  aniinals  mux  produce  diphtheritic  processes 
in  man.  This  may  be  presupposed  particularly  for  those  cases  wheiv 
in  the  products  of  the  di])htheritic  mucous  membrane  inflammation  in 
man  it  is  impossilile  to  (hMuonstrate  the  Klelis-TiOefHer  bacillus,  and 
which  in  all  probability  results  from  some  other  etiological  facto)-. 
Close  relationship  between  avian  diphtheria  and  that  of  man  has 
repeatedly  been  affirmed,  based  on  experiments  or  observations  which 
appeared  to  indicate  the  likelihood  of  transmission  of  the  disease  from 
man  to  birds.  Loir  &  Ducloux  have  succeeded  in  cultivating  the  same 
bacillus  from  the  pseudo-membranes  of  a  child  suffering  from  diphtheria 
which  they  cojisidered  to  be  the  virus  of  avian  diphlheria,  basing  their 
opinion  on  the  results  of  their  experiments.  Finally  it  is  worthy  of 
note  that  the  so  called  pseudo-diphtheria  bacillus  which  several  authors, 
among  them  Roux  &  Yersin,  Frankel,  et  al.,  believe  to  be  an  avirulent 


438  Avian  Diphtheria  and  Chicken  Pox. 

variety  of  the  true  diphtheria  bacillus,  has  repeatedly  been  found  in 
birds  (Gratia  &  Lienaux). 

At  present  the  view  that  the  Klebs-Loeffler  bacillus  may  occa- 
sionally produce  membranous  pharyngeal  inflammation  in  animals 
is  justified ;  such  cases,  however,  are  to  be  differentiated  from  true 
diphtheria  of  man  and  from  the  true  diphtheria  of  animals,  as  cases 
of  pseudo-diphtheria. 

Literature.  Klebs,  Veili.  d.  Kongr.  f.  inn.  Med.,  Wiesbaden,  18S3. — LofSer, 
Mitt.  d.  G.-A.,  1884,  II.— Galli-Valerio,  Cbl.  f.  Bakt.,  1897,  XXII,  500.— Gallez, 
Ann.,  1895,  309.— Gratia  &  Lieneaux,  Ann.,  1898,  401.— Beck,  Hb.  d.  p.  M.,  1903, 
II,  754  (Lit.). 


Group  IV. 

INFECTIOUS  DISEASES  WITH  SPECIAL  INVOLVEMENT 
OF  THE  NERVOUS  SYSTEM. 

1.    Tetanus.    Lockjaw. 

(Tctanos  [French] ;  Sfdrrlrampf  [German];  Tetano  [Italian].) 

Tetanus  is  an  acute  infectious  disease  resulting  from  an  in- 
toxication of  the  nervous  system,  characterized  by  persisting 
spasmodic  contractions  of  the  entire  body  musculature  or  of 
single  groups  of  muscles,  without  impairment  of  consciousness. 
The  disease  is  caused  by  Xicolaier's  bacillus  tetani  and  its 
poisonous  products  of  metabolism. 

-  History.  The  opinions  concerning  the  nature  of  this  disease  were 
until  i[\\\\Q  recently  based  on  purely  theoretical  grounds.  The  associa- 
tion between  muscle  spasm  and  the  increased  irritability  of  the  nervous 
system  was  recognized  during  the  18th  century,  but  the  real  cause 
of  the  nervous  affection  remained  a  mystery.  The  most  generally  prevail- 
ing view  was  that  tetanus,  which  was  so  often  associated  with  injuries, 
arose  reflexly  as  the  result  of  severe  traction  or  contusion  of  perfplieral 
nerves  and  that  the  irritation  thus  originated  was  transmitted  to  the 
spinal  cord  (tetanus  traumaticus),  but  the  efforts  to  produce  the  disease 
experimentall}^  in  this  manner  all  failed  (Arloing  &  Trippier  [1869]). 
Since  in  other  cases  no  preceding  traumatism  could  l)e  demonstrated 
(T.  idiopathicus)  the  cause  was  sought  in  other  circumstances,  par- 
ticularly in  colds  (T.  rheumaticus)  and  even  in  psychic  excitement 
(T.  psychicus),  although  several  authors  (Travers,  Rose,  Spencer  AVells) 
were  already  inclined  to  consider  the  disease  an  intoxication. 

Etiological  research  was  directed  into  a  more  correct  channel  when 
Carle  &  Rattone  (1884)  succeeded  in  producing  the  disease  artificially 
by  inoculating  the  contents  of  an  acne  pustule  of  a  person  who  had 
died  from  tetanus  into  rabbits.  Almost  at  the  same  time  Nicolaier 
(1884)  obtained  positive  results  by  inoculation  of  garden  earth  into 
rabbits,  guinea  pigs,  and  mice,  and  at  the  same  time  recognized  the 
cause  of  the  disease  in  the  form  of  a  spore-bearing  bacillus.  Later 
observations  (Rosenbach,  Baeumer,  Bonome)  have  confirmed  the  in- 
fectious nature  of  the  disease  for  man,  while  Xocard  (1887)  established 
the  identical  origin  of  tetanus  of  horses. 

Kitasato  (1880)  was  the  first  to  grow  the  anaerobic  bacillus  in 
pure  culture;  Brieger  (1887)  demonstrated  the  presence  of  toxic  sub- 

439 


440 


Tetanus. 


stances  in  mixed  cultures,  and  Faber,  (1890)  in  pure  cultures.  Finally 
Behring  &  Kitasato  (1892)  worked  out  an  effective  method  of  immuniza- 
tion against  the  disease,  while  Vaillard  and  Vincent,  Rouget  and  Roux, 
and  Tiberti  and  Tarozzi  furnished  important  contributions  on  the  patho- 
genicity of  the  disease. 

Occurrence.  Tetanus,  a  rare  disease  in  the  more  northern 
countries,  occurs  much  more  frequently  in  tropical  regions  and 
sometimes  attains  an  enzootic  character  among  both  man  and 
beast.  In  the  temperate  zone,  as  in  Europe,  the  disease  is 
considered  as  sporadic  and  here  cases  occur  in  some  regions 
in  rapid  succession  during  the  spring  and  fall.  Considerable 
loss  occurs  usually  in  horses,  sometimes  in  sheep,  while  other 
species  of  animals  as  a  rule  are  much  less  commonly  affected. 
More  recently,  since  greater  attention  has  been  given  to  the 
cleanliness  of  the  wounds,  a  decrease  in  the  number  of  cases 
has  been  observed. 

In  the  Prussian  army  during  the  years  1899  to  1908,  in  an  average 
of  87,000  horses,  42  to  64  (average  of  52)  were  attacked  annually  with 
tetanus,  while  in  the  French  army  during  1899  and  1900,  98  and  94 
eases  respectively,  were  reported. — In  Hungary  the  disease  appears 
to  be  more  common  in  the  southern  regions,  and  in  certain  communities 
it  causes  considerable  losses,  especially  after  castrations. — The  disease 
appears  to  occur  more  frequently  in  the  centers  and  the  outskirts  of 
large  cities,  and  during  certain  years  or  seasons. 

It  is  nuieli  more  common  and  widely  distributed  in  warmer  countries,  and 
occurs  frequently  in  horses,  esjjecially  after  castration,  in  San  Domingo,  in  the 
Antilles,  Algeria  and  Egypt. 

Etiology.  The  hacillus  teiani  Nicolaier,  is  a  straight, 
slender  rod  (Fig.  67)  possessing  feeble  motility,  and  propagates 


Fig.  67.      Bdcillus   tefani  icith 

flac/eJIa.     Two-day  old  agar 

culture. 


Fig.  68.  Bacillus  ietani  with  spores 
in  various  stages  of  develo])ment.  Four- 
day-old  agar  culture.  Carbol-fuchsin 
staining. 


by  fission  and  also  by  spore  formation.  The  spore  is  spherical, 
with  a  diameter  about  twice  as  long  as  the  thickness  of  the 
bacillus,  and  is  situated  at  one  pole  of  the  rod,  thus  giving 


Etioloyy,  Patlioyeiiieity. 


441 


the  spore-boariiii»-  l)acilhis  a  ]Hii-liko  or  dnini-stick-liko  appear- 
ance (Fig.  G8).  In  cnltures  it  may  form  longer  slightly  curved 
threads. 

Staining.  The  tetanus  l);u'illi  stain  readily  and  unifonnly  ^vi1h  the 
usual  a(|Ueous  anilin  dye  stains  as  well  as  by  Gram's  method. 

Cultivation.  The  tetanus  baeilli  are  anaerobic,  but 
develop  also  in  tiie  presence  of  oxygen  Avhen  associated 
with  aerobic  bacteria  Miiich  energetically  consume 
oxygen.  Under  anaerobic  conditions  they  grow  readily, 
especially  ou  media  containing  grape-sugar,  at  body 
temperature,  less  readily  at  room  temperature.  On 
gelatin  and  agar  the  colonies  form  grayish-white  spots 
composed  of  clumps  of  fine  threads,  while  a  white 
streak  develops  at  the  point  of  inoculation,  with  radia- 
tions in  all  directions  (pine  tree  shapes  Fig.  69)  Gela- 
tin is  li(|uefied  slowly,  Iwuillon  is  clouded  uniformly, 
milk  is  not  coagulated ;  on  potatoes  there  is  sometimes 
formed  a  colorless,  transparent  deposit.  Tlie  interior 
of  an  extirpated  eye  is  also  well  adapted  for  its  cultiva- 
tion (Mackie).  Gas  (CH^,  COo)  is  produced  on  sugar- 
containing  media  and  the  cultures  disseminate  a 
peculiar  burnt  odor.  Spore  formation  begins  in  the 
bacilli,  under  favorable  conditions,  after  24  to  30  hours. 

Tenacity.  Since  most  of  them  are  sporebearing,  the  baeilli 
are  almost  as  resistant  as  the  spores.  Direct  sunlight  destroys 
them  in  12  days,  diifuse  light  in  1  to  2  months  (Vaillard  &  Vincent). 
In  decomposing  material  they  remain  alive  for  a  long  time  and 
may-  increase  for  a  time  according  to  experiments  by  Bombicci. 
When  kept  in  a  dark  place  they  are  still  virulent  after  11  years 
(Henrijean),  anil  in  pus  and  animal  tissues  they  retain  their 
vitality  for  months  (Kitt).  Cultures  retain  their  vitality  for  two 
years  (Kitasato).  The  spores  are  killed  by  live  steam  "at  115"C. 
in  o  minutes,  by  STr  carbolic  acid  in  15  minutes,  by  1:1000  corro- 
sive sublimate  and  ^'r  hydrochloric  acid  solution  in  half  an  hour 
(Kitasato),  by  a  V/f  nitrate  of  silver  solution  in  1  minute,  by 
aVf  creolin  solution  in  5  hours  (Tizzoni  &  Cattani).  The  addi- 
tion of  iodine  trichloride  in  the  proportion  of  0. 125-0. 259^  to 
culture  decreases  the  virulence  jiroportionally  to  the  quantity  of 
the  drug  (Behring  6c  Kitasato).  The  digestive  juices  have  a' very  slight  destructive 
action   (Sormani). 

Pathog-enicity.  Fresh  cultures  are  so  slightly  virulent  that 
guinea  pigs  which  are  very  susceptible  to  tetanus  can  stand  a 
subcutaneous  injection  of  0.3  or  0.5  cc.  without  harm,  but 
cultures  ten  days  old  or  older  will  in  very  minute  quantities 
produce  tetanus  in  susceptible  animals.  Filtrates  of  such  cul- 
tures free  from  bacilli  and  spores  act  similarly  and  only  after  a 
certain  period  of  incubation,  showing  that  living  cultures  exert 
their  pathogenic  properties  bv  means  of  toxic  products  (in 
aerobic  mixed  cultures  there  develop  similarly  acting  toxins 
as  in  pure  anaerobic  cultures).  Spores  freed  of  their  toxins  by 
prolonged  washing  or  heating  for  3  hours  at  80°  C.  prove  in- 
effective upon  subcutaneous  injection  even  when  given  in  rela- 
tively large  quantities,  while  these  same  spores  when  injected 
subcutaneously  or  brought  under  the  skin  in  small  paper  sacs 


Fig.  69.     Four' 
day  old  agar  cul- 
ture of  tetanus 
bacilli. 


442  Tetanus. 

will  produce  the  disease  wlien  fine  sand,  coal  dust,  foreign  bac- 
teria (Bac.  prodigiosus),  or  negatively  cliemotactic  fluids  (as  lac- 
tic acid)  are  added. 

In  animals  which  are  infected  subcutaneously  or  intramus- 
cularly tetanus  always  begins  with  local  s^miptoms.  After  such 
an  infection  into  the  thigh  the  muscle  spasm  appears  first  in 
the  posterior  extremity  of  the  same,  then  on  the  opposite  side 
and  later  spreads  to  the  anterior  extremities,  until  it  becomes 
general.  After  intravenous  injection  of  toxins  there  is  general- 
ized tetanus  from  the  beginning,  while  after  intracerebral  inocu- 
lation there  follow  excitement,  intermittent  spasms  and  disturb- 
ances of  motility  (tetanus  cerebralis)  (Roux  &  Borrel) ;  after 
injection  into  the  spinal  cord  severe  attacks  of  pain  occur  with 
subsequent  tetanic  symptoms  (tetanus  dolorosus)  (Meyer  & 
Ransom,  Tiberti). 

The  horse  possesses  the  greatest  susceptiliility  for  the 
virulent  living  cultures  as  well  as  for  the  toxins,  and  is  followed 
by  the  guinea  pig,  goat,  sheep,  mouse,  rabbit;  cattle  are  very 
slightly  susceptible,  dogs  and  cats  still  less  so,  while  chickens 
are  infected  with  difficulty  with  very  large  doses.  Man  is  very 
susceptible  to  both  infection  and  toxins. 

The  toxic  products  of  the  tetanus  bacillus  were  first  studied  by 
Brieger  who  grew  mixed  cultures  on  beef  broth  and  o])tained  four 
substances  (tetanin,  hydrotetanin,  tetanotoxin  and  spasmotoxin)  which 
caused  muscular  spasms  after  sulicutaneous  injection  into  experiment 
animals.  As  these  substances  acted  at  once  and  in  comparatively  large 
doses  they  could  not  be  considered  as  true  toxins.  Later,  after  pure 
cultures  of  tetanus  bacilli  were  grown  Kitasato,  Behring  &  Knorr, 
Tizzoni  &  Cattani,  Roux  &  Vaillard  studied  the  toxic  culture  filtrates 
carefully  without,  thus  far,  succeeding  in  establishing  the  nature  of 
the  toxic  substances.  It  is  probable  that  they  represent  specific  secre- 
tions of  the  bacilli  and  do  not  develop  as  the  result  of  decomposition 
of  albumin-containing  nutritive  media  as  they  are  formed  also  on  albumin- 
free  asparagin  (Buchner).  The  toxin  is  soluble  in  water,  insoluble 
in  alcohol,  chloroform  and  ether;  otherwise  in  certain  characteristics 
it  resembles  very  much  diastases  (is  not  very  stable,  is  precipitated  by 
alcohol,  dializes,  etc.). 

The  tetanus  toxin  is  an  extremely  powerful  poison.  1.0  cc.  of  the 
filtrate  of  a  highly  virulent  culture  kills  a  horse  500  kg.  in  weight; 
0.001  cc.  kills  a  guinea  pig  of  300  gram,  while  other  species  of  animals 
re({uire  proportionally  larger  doses  of  toxin.  If  for  1  gram  body 
weight  of  horse  the  lethal  dose  is  1.  guinea  pigs  require  2,  goats  4, 
mice  13,  rabbits  2,000,  chickens  200,000  doses  per  gram  of  body  weight 
(Knorr). 

The  toxic  value  of  toxins  is  usually  designated  by  the  smallest 
amount  of  virus  necessary  to  kill  an  animal  of  a  certain  weight.  If 
therefore  0.0000001  cc.  toxin  kills  a  15  gram  mouse,  1.0  cc.  Avill  kill 
10  millions  of  mice  of  15  gram  body  weight  each,  equivalent  to  150 
millions  grams  weight  of  mice   (Behring). 

The  action  of  the  toxin  follows  only  upon  subcutaneous,  intra- 
muscular, intraperitoneal,  intravenous  or  intracerebral  injection,  while 
large  doses  of  toxin  when  given  by  mouth  or  intestine  are  entirely 


Patliofjcnioity,  N'alural  IntVctiou.  443 

without,  effect  as  the  toxiu  is  not  absorbed  by  the  mucous  membrane 
(Ransom)  nor  is  it  decomposed  by  bile  and  pancreatic  juice  (Carriere, 
Vincent ) . 

Tlie  powder  obtained  from  filtrates  by  precipitation  with  ammonium 
sulphate  is  also  toxic,  and  is  so  in  correspondingly  smaller  doses  (horses, 
for  instance,  arc  killed  by  0.006  gram). 

Tenacity  of  the  toxin.  The  toxicity  of  the  filtrates  suffers  hardly  any  iinpair- 
niejit  bv  (iilution  with  blood,  blood  serum  or  salt  solutions,  but  is  diminished  upon 
addition  of  mineral  aci.ls  and  alkalis.  The  toxin  is  i)rocipitate<l  by  small  amounts  of 
alcohol,  and  decomposed  by  lar^e  quantities  of  alcohol.  Direct  sunlight  destroys  its 
effect  in  15  to  IS  hours,  a  temperature  of  8(i°C.  in  3  hours,  mineral  aculs  and  alkalis 
in  a  concentration  of  I'/f  in  one  hour  (Kitasato,  Fermi  &:  Pernossi).  Tn  pow<lered 
form  it  is  much  more  resistant;  at  room  temi)erature  in  a  dark  ])lace  it  remains 
effective  for  vears.  while  it  is  grailuallv  attenuated  by  diffused  sunlight;  it  can 
stan.l  constant  heating  to  120°('.  and  even  13.^°C.  for  15  to  20  minutes,  and  is 
destroyed  only  by  15  minutes'  heating  to  159°C.   (Morax  &  Mane). 

Natural  infection.  This  occurs  as  a  rule  through  containi- 
natiou  of  wounds  on  the  skin  and  mucous  membranes  with 
bacilli  and  spores  contained  in  the  contaminating  medium.  The 
most  common  carrier  of  the  contagion  is  earth,  less  frequently 
pus  or  tissue  particles  emanating  from  sick  animals  or  cadavers. 
The  bacilli  and  spores  are  abundantly  distributed  in  the  super- 
ficial humus  layers,  especially  in  such  places  as  contain  much 
manure,  especially  horse  manure ;  they  may  also  be  found  m 
large  numbers  in  the  slime  of  swampy  areas.^  Nicolaier  pro- 
duced the  disease  in  experiment  animals  by  inoculation  ^vith 
garden  earth  and  since  then  tetanus  bacilli  have  been  demon- 
strated in  manv  regions  in  garden  and  farm  earth,  in  street 
dust,  in  manure,  in  various  food  substances,  especially  in  hay. 
The 'experiments  have  also  shown  that  the  bacilli  occur  in  the 
excrements  of  healthv  horses  (Sanchez  &  Veillon,  Nocard),  also 
in  those  of  cattle,^  hogs  and  smaller  experiment  animals 
(Sormani  Strauss,  Molinari),  for  by  the  inoculation  of  such 
material  it  is  frequently  possible  to  produce  the  disease  arti- 
ficially. (Joseph  found  tetanus  bacilli  in  the  intestinal  con- 
tents "of  eight  cattle  examined  for  this  purpose,  and  believes 
that  they  vegetate  constantly  in  older  animals.) 

On  account  of  these  results  which,  by  the  way,  also  furnish  proof  that  the 
tetanus  bacilli  mav  be  present  in  body  cavities  an<l  canals,  with  external  openings, 
without  endangering  the  health  of  the  animal.  Verneuil  believe.l  that  the  contagion 
of  tetanus  developed  originally  in  the  intestinal  tract  of  horses  and  that  tetanus 
in  man  always  occurred  as  the  result  of  coming  in  contact  with  horses  and  with 
straw  or  earth  that  had  been  contaminated  with  their  excrements.  Tt  is  more  likely, 
however  that  the  spores  gain  entrance  into  the  digestive  apparatus  of  horses  through 
dustv  food,  remain  here  a  time  and  pass  on  unchauge.l  into  the  open  (m  feces  of 
man',  as  well  as  in  all  carnivora,  tetanus  spores  are  very  rarely  demonstrated). 

Vvenues  of  infection  are  offered  by  the  various  injuries 
of  the  skin  or  mucous  membranes,  mostly  those,  however,  which 
are  associated  with  destruction  of  tissue  or  accumulation  of 
patholoo-ical  secretions  and  which  readily  come  in  contact  with 
the  earth  on  account  of  their  location,  or  those  in  which  foreign 
bodies   have   penetrated   deeply   into   the   tissues.      Especially 


444  Tetanus. 

dangerous  in  this  res^ard,  are  injuries  from  nails,  nail  punctures 
of  the  hoof  or  foot,  about  the  coronary  band,  and  particularly  in- 
juries about  the  lower  portions  of  extremities ;  fractures  of  bones, 
wounds  of  castration,  and  harness  galls ;  in  horses  tail  docking ; 
furthermore  injuries  of  the  mucosa  of  the  mouth  (through  carious 
or  sharp  teeth)  or  genital  passages  (from  aid  in  difficult  labors), 
in  the  newborn  the  contamination  of  the  navel  wound,  in  foals 
the  operation  of  umbilical  hernia,  injuries  of  the  eyes,  etc.  In 
any  case  the  most  varied  injuries  and  accidents  may  give  rise 
to  the  disease  provided  that  dead  tissue,  extravasated  blood 
or  wound  secretions  facilitate  the  multiplication  of  the  con- 
tagion; aside  from  this  the  penetration  of  the  anaerobic  bacillus 
into  the  deeper  portions  of  the  tissue  or  into  hidden  cavities 
or  pockets  of  wounds  favors  the  development  of  the  disease. 

The  infectious  material  gains  entrance  into  the  wound  with 
earth,  necrotic  tissue  or  wound  secretion  containing  bacilli,  or  the 
infection  is  facilitated  by  wood  shavings,  bone  splinters,  the  har- 
ness of  a  horse  suffering  with  tetanus,  or  by  hair  ropes,  manure 
applied  to  a  wound,  further  by  implements,  surgical  instruments, 
the  hands  of  operators  or  those  assisting  them  in  operations.  In 
this  way,  for  instance,  tetanus  is  conveyed  after  castration 
through  the  medium  of  the  operator's  soiled  hands  or  by  clamps 
which  had  been  used  before,  w^hile  in  other  cases  the  virus 
reaches  the  castration  wound  from  the  horse  lying  down  and 
contaminating  it.  The  cases  which  point  to  the  first  mode  of 
infection  are  those  that  occur  among  animals  which  have  been 
castrated  by  the  same  operator  within  a  short  period  of  time, 
even  though  in  different  places,  when  cases  of  disease  occur 
in  rapid  succession.  Those  pointing  to  the  second  mode  of 
infection  are  the  ones  where  year  in  and  year  out  animals  from 
the  same  farm  become  diseased.  Since  the  antiseptic  treat- 
ment of  wounds,  tetanus  occurs  much  less  frequently  after 
such  operations  which  were  formerly  considered  dangerous 
(castration  with  ligation  of  the  spermatic  cord,  especially  in 
rams  and  calves). 

It  is  therefore  possible  to  designate  the  site  of  infection 
in  most  of  the  cases,  but  there  are  cases  where  even  the  most 
careful  examination  fails  to  reveal  an  injury  of  the  body  surface 
or  of  the  mucous  membranes.  Such  observations,  which  were 
formerly  considered  rheumatic  tetanus,  make  it  probable  that 
the  disease  may  occur  exceptionally  without  any  preceding 
injury.  This  might  be  assumed  in  parturition  tetanus  in  the 
sense  that  the  infectious  virus  is  propagated  in  the  exudate 
w^hich  collects  in  the  womb  and  the  toxins  thus  produced  pass 
from  here  to  the  h^Tlphatic  circulation.  In  this  way  could  those 
cases  be  explained  where  the  occurrence  of  tetanus  may  be 
associated  with  the  retention  and  decomposition  of  the  placenta. 
In  many  cases  of  horse  tetanus  it  is  impossible  to  exclude  the 
possibility  that  the  contagion  multiplies  in  the  follicles  of  the 
tonsils  or  between  the  folds  of  the  intestinal  mucosa  to  such 


X;ilur;il   Iiilcfl  ion,  Susci'j)!  il)ilil  \ .  445 

a  degree  that  colonies  are  loniied  which  ])io(luce  sul'lieii'iit  toxins 
to  cause  intoxication  (Teyssandier  observed  several  cases  of 
tetanus  following  colic).  Infection  occurs  more  readily  by  way 
of  inlhuned  mucous  meml)ranes  (Thnhnann)  and  this  might 
explain  the  occurrence  of  the  disease  in  dogs  after  eating  spoiled 
meat  (Alessandrini).  The  tetanus  bacilli  after  passing  through 
the  intestiiuU  mucosa  nuiy  also  find  a  favorable  medium  for 
development  in  exudates  or  necrotic  areas  of  an  internal  organ, 
for  example  in  abscess  of  the  liver  (Keleti).  Recent  experi- 
ments have  also  shown  that  tetanus  spores  may  probably  pass 
in  liealthy  animals  from  the  intestinal  canal  to  the  hmphatic 
circulation  and  remain  latent  in  the  internal  organs,  until  a 
time  when  circumstances  favoring  their  development  arise. 

Susceptibility.  Among  the  domestic  animals  solipeds  are 
most  connnonly  affected  by  tetanus;  the  disease  occurs  much 
less  frequently  in  cattle,  slieep  and  goats,  wdiile  hogs  and  dogs 
are  only  occasionally  attacked  (in  dogs  the  disease  occurs 
usually  after  extensive  and  contanunated  destruction  of  tissue, 
more  rarely  after  docking  the  tail).  Cows  are  attacked  in  the 
majority  of  instances  after  labor,  only  exceptionally  following 
a  traumatic  gastritis  (Friedrich),  calves  after  castration,  while 
in  sheep  castration,  pox  inoculation,  ear  marking,  etc.,  are  the 
leading  factors  in  the  occurrence  of  infection.  Among  goats 
the  disease  w^as  observed  almost  exclusively  in  rams  which 
were  castrated  at  an  advanced  age. 

■Young  animals  are  more  susceptible  than  older  ones,  and 
the  disease  may  become  enzootic  among  lambs  particularly, 
sometimes  also  among  foals,  as  the  result  of  infection  of  the 
uml)ilicus  (tetanus  neonatorum). 

Pathogenesis.  Healthy  animal  tissue  is  not  a  good  medium 
for  the  propagation  of  the  tetanus  bacteria.  Toxin-free  spores, 
when  not  inoculated  subcutaneously  and  in  excessive  nundiers 
(in  guinea  pigs  2,500  spores  according  to  Vaillard,  Vincent  & 
Ronget),  are  ineffective,  as  they  are  engulfed  by  phagocytes 
and  immobilized.  On  the  other  hand  toxic  spores  produce  the 
disease  even  in  very  small  quantity,  as  the  phagocytes  are  kept 
away  from  them  by  the  negative  chemotaxis  of  the  toxins,  and 
these  germinate  under  the  protection  of  the  toxins  and  enable 
the  bacilli  to  multiply.  In  the  same  manner  spores  are  pro- 
tected by  the  simultaneous  injection  of  negatively  chemotactic 
lactic  acid  or  trimethylamin  (according  to  Hektoen  this  is  not 
the  result  of  chemotactic  but  antiopsonic  actions).  This  explains 
the  effectiveness  of  the  toxin-containing  older  cultures  as  com- 
pared with  the  harmless,  toxin-free,  young  cultures. 

When  the  spores  enter  necrotic  tissue  or  extravasated 
blood  they  multiply  rapidly  and  produce  toxins.  By  injection 
of  spores  into  such  dead  tissues  (badly  contused  muscles,  blood 
extravasations)   the  disease  may  positively  be  produced,  and 


446  Tetanus. 

experience  also  proves  that  tetanus,  under  natural  conditions, 
appears  by  preference  associated  with  such  wounds  as  are  ac- 
companied by  destruction  of  tissues,  hemorrhage  or  accumula- 
tion of  a  purulent  secretion. 

Spores  occurring  free  in  nature  do  not  contain  toxins, 
although  an  infection  occurs  with  spore-containing  earth  in 
healthy  tissue;  this  finds  its  explanation  in  the  fact  that,  to- 
gether with  the  tetanus  spores,  other  bacteria  gain  entrance 
into  the  tissues,  finding  here  a  favorable  medium  for  their  de- 
velopment, and  consequently  causing  disease  of  tissue  which 
then  furnishes  a  suitable  medium  for  the  growth  of  the  tetanus 
organism.  Spore-containing  earth  loses  its  power  of  infection 
when  heated  to  85°  C. ;  such  a  temperature  is  not  sufficient 
to  kill  the  spores,  but  it  does  destroy  other  bacteria  present 
in  the  earth.  Earth  that  has  been  freed  of  its  infective  char- 
acter by  heating  may  again  produce  tetanus  if  simultaneously 
with  its  subcutaneous  injection  there  are  introduced  cultures 
of  bacteria  grown  from  the  earth  before  heating  it.  That  is  why 
tetanus  develops  sometimes  after  comparatively  slight  injuries, 
for  instance  after  the  introduction  of  a  wooden  splinter  or 
following  a  superficial  suppurating  wound  covered  by  a  scab. 

Influences  which  reduce  the  resistance  of  the  tissues  and 
perhaps  paralyze  the  activity  of  phagocytes  favor  infection, 
and  in  this  sense  colds  or  overheating  (hard  work  in  summer 
heat)  may  be  of  importance. 

The  apparently  spontaneous  cases  which  do  not  appear 
immediately  associated  with  any  injuries  are  at  least  partly 
explained  by  the  latency  of  the  tetanus  spores  in  the  animal 
body,  in  that  spores  which  have  penetrated  into  the  body  some 
time  previously  are  kept  alive  enclosed  in  cells,  and  later  germi- 
nate under  the  influence  of  a  favoring  factor  (disease,  colds, 
overheating,  muscular  exertion)  and  cause  a  multiplication  of 
the  bacilli. 

Vaillard  &  Eoiiget  foimd  vial)le  and  virulent  spores  3^2  months  after  injection 
of  spores  into  the  bodies  of  guinea  pigs,  and  Tarozzi  also  demonstrated  that  in 
animals  infected  subcutaneonsly  with  spore-bearing  cultures  of  tetanus  the 
spores  frequently  gain  admission  to  the  blood,  migrating  to  organs  far  removed 
from  the  original  site  of  infection,  where  they  may  remain  latent  for  3^^  months 
or  longer.  When  favorable  conditions  arise,  particularly  necrosis  of  spore- 
containing  tissue,  the  latent  spores  are  revived  to  vegetation  and  may  cause 
tetanus.  Soprana,  Canfora,  also  Eeinhardt  &  Assim  have  arrived  at  similar 
conclusions  in  their  studies  on  the  latency  of  tetanus  spores.  As  the  intesti- 
nal evacuations  of  herbivora  frequently  contain  spores  there  is  always  the 
possibility  that  thej  may  occasionally  gain  entrance  to  organic  tissue,  where  they 
multiply  and  give  impetus  to  the  formation  of  antitoxins.  This  would  explain 
Eoemer  's  findings  in  cattle  over  two  years  of  age  in  which  the  blood  serum 
frequently  showed  antitoxin  in  demonstrable  quantities  (1/2400  to  1/50  units  per  cc). 

The  influence  of  an  increase  of  the  body  temperature  on  the  development  of 
tetanus  was  demonstrated  by  Vincent  who  raised  the  body  temperature  of  guinea 
pigs  in  the  thermostat  or  incubator  to  40.5°C.,  subsequently  injected  spores  that 
had  been  heated  to  SS'C.  and  caused  fatal  tetanus  in  2  to  3  days.  The  bacilli 
were  found  disseminated  through  the  entire  body. 

Germination  and  multiplication  of  bacilli  usually  occur  ex- 
clusively at  the  site  of  infection  and  therefore  bacilli  are  rarely 


Pathogenesis.  447 

foiiiul  ill  the  l»lood  and  iiioro  rciiiole  organs  (spleen,  brain) 
and  then  only  in  minnte  quantities  (Holilbeck,  Dor,  Creite, 
Xieolaier,  Ilneuler,  etc.,  ])robal)ly  tlicy  are  enclosed  in  leueocytes 
and  carried  there).  This  neiialive  findin,^-  harmonizes  with  the 
fact  that  the  bacteria  exert  tlieir  pathoi>enic  function  indirectly, 
through  the  toxic  products  absorl)ed  from  the  lymphatic  circula- 
tion. "On  the  other  hand,  the  fact  that  the  symptoms  of  poison- 
ing, different  from  true  poisons,  such  as  strychnine,  occur  after 
a  comparatively  long  period  of  incubation  (in  guinea  pigs  at 
least  12,  in  mice  6  hours)  points  to  the  fact  that  the  toxin  is 
carried  very  slowly  to  the  central  nervous  system. 

Tetanus  toxin  exerts  a  pathogenic  effect  on  the  motor  nerve 
cells,  primarily  those  of  the  spinal  cord  and  medulla  oblongata, 
giving  rise  to  an  increased  irritability,  indirectly  however  caus- 
ing contractions  of  the  corresponding  muscle  groups.  If  the 
source  of  the  toxins  is  on  the  surface  of  the  body  some  of  them  are 
at  once  bound  by  the  axis  cylinder  (nerve  endings)  and  conducted 
along  the  ner\^s  to  the  central  motor  cells,  whose  irritation  causes 
local  tetanic  muscle  spasms ;  the  other  portion  of  the  toxins 
enters  the  blood,  is  later,  however,  also  bound  by  constantly  in- 
tercepting nerve  fibers  and  conducted  to  the  motor  nerve  cells, 
so  that  muscle  spasms  occur  in  constantly  widening  areas.  If 
on  the  other  hand,  the  toxins  immediately  enter  the  blood,  as 
would  occur  in  intravenous  or  intraperitoneal  injection,  or  after 
an  intestinal  infection  (so  called  T.  splanchnicus),  they  are 
almost  simultaneously  bound  by  all  motor  cells  and  in  such  cases 
the-  muscle  spasms  occur  later,  but  in  almost  all  the  muscles 
simultaneously  (Morax  &  Marie,  Behring).  The  fact  that 
trismus,  in  botli  man  and  horse,  is  one  of  the  first  s^^uptoms 
of  the  clinical  picture  of  tetanus  would  indicate  that  the  tetanus 
toxin  is  more  readily  bound  by  the  trigeminus  neuron  than 
by  the  other  motor  neurons.  The  increased  reflex  irritation  also 
points  to  an  increased  irritation  of  the  sensitive  neurons. 

Bruschettini  was  the  first  to  discover  that  the  tetanus  toxin  was 
conducted  from  the  point  of  infection  to  the  nerve  centers  mainly 
through  the  nerve  channels,  and  his  discovery  was  confirmed  by  Meyer 
&  Ransom,  Stintzing,  v.  Behring,  Tiherti,  etc.  According  to  IMeyer 
&  Ransom  the  toxin  is  taken  up  by  the  nerve  endings  containing  no 
axis  cylinders,  according  to  Pochhammer  hy  the  medullary  sheaths; 
Zupnik,  however,  thinks  that  the  muscles  are  directly  attacked  by  the 
toxin.  In  the  central  nervous  system  the  toxin  combines  eleetively 
mostly  with  the  motor  nerve  cells  of  the  spinal  cord  and  medulla 
oblongata. 

The  slow  progress  of  the  toxin  along  the  nerve  channels  explains 
the  relatively  long  incubation,  as  the  toxin  has  to  he  carried  to  the 
central  nervous  system  along  these  paths;  when  the  toxin  is  brought 
in  direct  contact  with  the  nerve  centers  the  incubation  is  considerably 
shortened. 

The  peculiar  action  of  the  tetanus  toxin  on  the  nervous  system 
is  probably  explained  by   Ehrlich's  side  chain  theory.     According  to 


448  Tetanus. 

this  each  toxin  molecule  is  composed  of  one  non-toxic  (haptophore) 
and  one  toxic  (toxophore)  atom  group.  The  protoplasm  of  the  motor 
nerve  cells  is  composed  of  a  vital  nucleus  and  numerous  side  chains 
(receptors),  of  which  many  possess  a  special  affinity  for  the  haptophore 
atom  groups  of  the  toxin  molecule.  When  such  molecules  of  the  tetanus 
toxin  reach  the  nerve  cells  they  are  anchored  by  the  aid  of  haptophore 
groups  to  the  corresponding  receptors  of  the  cell  protoplasm,  whereupon 
the  toxophore  group  attack  the  vital  nucleus  of  the  cell.  The  opposed 
affinity  between  tetanus  toxin  and  nerve  su])stance  is  demonstrated 
by  the  experimental  observation,  where  it  is  shown  that  a  mixture 
of  toxin  and  brain  substance  is  non-toxic  for  guinea  pigs  (Wassermann 
&  Takaki). 

Ehrlich  also  demonstrated  a  hemolytic  substance  (tetanolysin)  in 
culture  filtrates,  which  was  neutralized  by  antitetanic  serum. 

Recovery  from  one  infection  does  not  immunize  the  animal 
against  a  subsequent  one.  Repeated  occurrence  of  the  disease 
may  result  from  renew^ed  infection,  or  may  follow^  when  tetanus 
spores  w^ere  retained  somewdiere,  as  for  instance  in  a  scar,  in  an 
abscess  or  blood  coagulum  and  germinate  at  a*  considerably 
later  date.  (Repeated  infection  in  horses  was  observed  by 
Johne  after  4,  Hill  after  5,  Hell  after  6,  Mougneau  after  10 
months.) 

Anatomical  changes.  Autopsy  reveals  no  changes  charac- 
teristic of  the  disease.  In  the  central  nervous  system,  especially 
in  the  spinal  cord  and  its  coverings,  hyperemia  is  often  seen 
and  punctate  hemorrhages  are  found  in  the  gray  matter  of 
the  brain,  but  such  findings  are  not  uncommon  in  other  dis- 
eases. This  is  also  true  of  the  microscopic  examination  of 
the  motor  nerve  cells  which  show  slight  degenerative  vacuoles, 
disappearance  of  Nissl's  bodies,  etc.  Marinesco  found  marked 
changes  also  in  the  nerve  fibrils ;  in  many  cases,  liow^ever,  the 
appearance  was  entirely  normal  and  the  positive  findings  may 
be  associated  with  the  infections  accompanying  Avounds.  Small 
hemorrhages  and  serous  infiltration  are  frequently  found  in 
the  peripheral  nerves,  especially  in  those  leading  from  the 
infected  area.  Fatty  degeneration  of  the  heart  muscle  is  an 
almost  constant  occurrence.  The  intramuscular  connective 
tissue  of  the  trunk  and  the  extremities  is  edematously  infiltrated 
and  contains  small  hemorrhages,  with  muscle  bundles  torn  and 
colored  yellow^  or  grayish  due  to  parencli^miatous  or  hyaline 
degeneration.  (Eicliliorn  found  the  muscles  in  a  cow  to  look 
like  fish  meat.) 

In  animals  in  which  rigor  mortis  sets  in  early  the  only 
lesions  are  those  pointing  to  death  by  suffocation  (dark  color 
of  the  poorly  coagulated  blood,  slight  hemorrhages  on  the 
serous  and  mucous  membranes,  hyperemia  and  acute  edema  of 
the  lungs)  and  in  addition  occasional  subsequent  changes 
(pneumonia,  bone  fractures,  signs  of  general  septic  infection). 

The  site  of  infection  should  if  possible  be  disclosed  in  every  case  at  autopsy, 
and  this  requires  at  times  a  very  careful  examination  of  all  the  parts  of  the  body 


Anatomical  Changes,  Symptoms.  ^^t) 

an<l  the  different  organs;  when  oxtonial  in.juiic^s  caiiuot  bo  fouud  great  care  should 
be  exercised  in  the  inspection  of  the  canals  ami  cavities  lined  with  mucous  mem- 
branes, ospecialiy  the  nasal  cavity,  the  pharynx,  the  gums,  and  the  uterus.  In  a 
cas-e  reporte.l  liy  Merkel  the  infection  was  occasioned  by  a  wheat  kernel  that  bad 
entered  the  air  passages,  while  Hengst  traced  the  infection  in  a  cow  back  to  an 
injury  of  the  paunch  by  a  wire. 

The  infectious  nature  of  suspected  material  may  be  ascertained  with  certainty 
by  subcutaneous  or  intramuscular  inoculation  of  pus  or  necrotic  jiieces  of  tissue 
into  guinea  pigs  or  mice.  This  is  not  so  easy  by  microscopic  examination;  however 
the  spore-bearing  tetanus  bacilli  are  found  in  the  inflammatory  products  and  the 
diseased  tissues  associated  with  other  organisms.     (See  Fig.  73  on  page  457.) 

Symptoms.  The  period  of  incubation  after  subcutaneous, 
intraiinisciilar  or  intraperitoneal  injection  of  a  medium-sized 
amount  of  virus  into  smaller  animals  is  about  2  to  5  days  and 
in  laro-er  animals  longer;  its  duration  depends  on  the  strength 
and  quantity  of  the  toxin,  less  so  on  the  susceptibility  of  the 
animal.  Tender  natural  conditions  the  first  symptoms  have 
been  noted  as  early  as  24  hours  after  infection  (mostly  in  very 
young  animals) ;  as  a  rule  the  incubation  lasts  longer,  and  in 
the  majority  of  cases,  especially  in  horses,  it  is  1  to  2  weeks. 

From  Cadiot  "s  compilation  of  3S  horses  suffering  from  tetanus  the  disease 
occurred  at  the  end  of  the  first  day  in  one  case,  on  second  to  fifth  day  in  six  cases, 
fifth  to  tenth  day  in  13  cases,  tenth  to  twentieth  day  in  15  cases,'  twentieth  to 
thirtieth  day  in  three  cases.  According  to  Hoffmann  the  period  of  incubation  in 
parturition  tetanus  in  cows  is  2  to  14  days,  in  rams  and  boars  after  castration 
X  to  14  days,  in  lambs  after  pox  vaccination  13  to  IS  days. — Dieudonne  reports  on 
58  cases  of  tetanus  following  docking  of  the  tail,  where  the  incubation  lasted 
8  to  42  days. — In  a  case  of.  Boeder's  a  calf  was  attacked  by  the  disease  immediately 
after  birth  and  died  on  the  fifth  day,  while  De  Bruin  noted  in  a  colt  that  had  stepped 
on  a  rusty  nail  on  the  day  of  birth  the  first  symptoms  of  tetanus  two  days  after 
the  accident.  Eietsch  performed  artificial  inoculation  and  observed  a  period  of 
incubation  of  15  days  in  mules;  Kitt  observed  it  in  sheep  to  be  6  to  7  days,  and 
in  dogs  2  "lays. 

Excluding  the  rapidly  developing  cases  where  the  disease 
is  completely  developed  within  a  few  hours,  the  beginning 
of  the  disease  causes  no  change  whatever  sometimes  for  1  to 
2  days,  with  the  exception  of  a  disinclination  of  the  animals 
to  move  and  a  sluggish  action  when  they  are  prodded.  The 
legs  bend  less  than  normally  and  the  extremities  are  raised 
stiffly,  while  feeding  is  prolonged,  the  animals  appearing  to 
chew  much  more  carefully  and  apparently  having  some  difficulty 
in  swallowing  food ;  at  this  stage  the  peculiar  projection  of  the 
head  and  the  rigid  station  and  immobility  of  the  ears  may  be 
noted.  These  s>miptoms  indicate  beginning  spasm  of  individual 
muscle  groups,  which,  in  the  majority  of  cases,  appears  first 
in  the  head  or  neck,  less  frequently  in  the  hindquarters  and 
from  here  spreads  forwards  or  backwards.  In  some  cases  the 
spasm  begins  in  the  muscles  nearest  to  the  site  of  infection, 
as  is  the  case  in  artificial  subcutaneous  inoculation.  In  rare 
cases  the  spasm  may  be  confined  to  a  certain  region  of  the  body, 
for  instance  the  hindquarters  (T.  parietalis) ;  usually  it  is  uni- 
versal (T.  universalis),  in  which  case  the  infected  animals  have 
a  characteristic  appearance. 

Vol.  1—29 


450 


Tetanus. 


In  an  advanced  stage  of  the  disease  in  tlie  liorse  the  animal 
will  remain  with  stiffened,  widely  separated  feet,  and  with  head 
and  neck  extended  in  one  position  (Fig.  70).  The  ears  stand 
erect  approaching  one  another;  the  eyes,  whose  pupils  become 
dilated,  are  drawn  deep  into  the  orbits  and  are  immobile  on 
account  of  the  spasm  of  the  eye  muscles,  while  the  anterior 
surface  is  largely  covered  by  the  prolapsed  memln-ane  nictitans 
(particularly  noticeable  when  the  head  is  raised).  The  nasal 
wings  are  drawn  upwards  and  as  a  result  the  nostrils  have 
a  trumpet  like  appearance.  The  mouth  is  held  closed,  with 
the  commissures  usually  dra^Mi  outwards  and  slightly  upwards; 
it  is  difficult  to  overcome  the  spasm  of  the  thick  masseter 
muscles  so  as  to  separate  the  upper  and  lower  incisors  1-2  cm. 
(lockjaw,    trismus).      The    spasm    of   the   constrictors    of   the 


Fig.  70.     Tetanus.     Generalized  muscular  spasms  in  a   liorse. 


pharynx  prevents  swallowing  of  the  saliva  which  runs  from 
the  mouth  in  long  tough  threads. 

As  the  facial  portion  of  the  head  is  raised  by  the  contrac- 
tion of  the  neck  and  upper  throat  muscles,  the  animal  stretches 
the  head  forwards  and  upwards,  while  the  neck  is  extended 
in  a  straight  line  or  is  slightly  curved  upwards,  so  that  its 
upper  margin  forms  a  concave,  its  lower  a  convex  line 
(deer  neck).  The  abdominal  muscles  are  also  contracted  and 
the  abdomen  is  in  consequence  more  or  less  retracted.  The 
tail  is  held  rigidly  and  slightly  raised  or  usually  pulled  a  little 
to  one  side. 

The  spinal  column  usually  forms  a  straight  line  (ortho- 
tonus) ;  exceptionally,  owing  to  unusually  violent  spasms  of  the 
long  back  muscles  there  is  formed  a  concave  arch   (opistho- 


Syiii|ii.mis.  4.;"j-[ 

loiins) ;  or  in  case  of  excess  mnsciilatiin;  on  one  side  a  lateral 
curvature  occurs  (pleurostliotonus). 

The  muscular  spasm  of  the  extremities  results  in  a  straddled, 
sawhuck-like  position,  the  hind  feet  bein<^  but  very  slightly 
arched  at  the  hocks.  Bending-  in  these  or  other  joints  is  im- 
possible or  can  l)e  accomplished  oidy  by  a])i)]ying  considerabh^ 
force;  hence  it  is  also  imi)ossible  to  lift  tlie  feet  from  the  gi-ound, 
and  when  this  is  done  the  disturbance  of  equilibrium  is  apt 
to  cause  falling.  The  patients  avoid  all  i)ossil)]e  movements; 
when  forced  they  manage  to  move  with  gi-eat  difficulty,  lifting 
the  feet  but  slightly  from  the  ground.  Turning  is  especially 
difficult,  as  the  entire  body  acts  like  a  stiff  object;  just  as 
difficult,  and  frequently  impossible,  is  the  motion  of  backing. 

The  nnisculature  is  tense,  almost  board-like  to  palpation; 
some  muscles  project,  appear  of  sharp  contour  and  occasionally 
show  fibrillary  tremors.  In  the  course  of  the  disease  the  spas- 
modic contraction  of  the  nmscles  remains  for  some  time  un- 
changed in  the  same  condition,  for  lionrs  and  even  days;  in 
some  cases  again  certain  variations  occur.  In  such  cases  the 
muscles  are  at  times  less  tense,  movements  easier  and  the 
general  condition  appears  to  be  temporarily  improved;  this 
apparent  improvement  is  soon  followed  by  renewed  severe 
spasmodic  attacks  which  are  easily  originated  by  external  irri- 
tation. 

Reflex  irritability  is  increased  from  the  beginning,  and  the 
effect  of  light,  noise  and  touch  or  movement  increases  tlie  spasm, 
sometimes  to  snch  a  degree  that  the  animals  bend  the  head 
nnusually  far  back  or  even  fall  to  the  ground,  trembling  violently 
while  on  the  ground;  or  sudden  contraction  of  the  dorsal 
muscles  may  cause  fracture  of  one  or  more  vertebrae  (Ziindel). 
Such  paroxysms  are  usually  accompanied  by  profuse  sweat- 
ing, which  is  also  observed  in  other  cases  of  severe  infection 
with  the  disease. 

Consciousness  is  retained  to  the  end;  the  expression  of 
the  eye  indicates  fear,  while  the  facial  expression  appears 
of  a  characteristic  rigidity  on  account  of  the  constant  contrac- 
tion of  the  musculature.  Even  slight  excitement  will  cause  the 
animals  to  shrink  and  to  become  restless. 

The  increased  irritation  of  the  nerves  leading  to  the  genital 
apparatus  causes  a  moderate  but  constant  erection  of  the  penis 
in  males. 

The  spasm  of  all  the  voluntary  muscies  of  the  body  natu- 
rally exerts  a  disturbing  influence  on  the  other  functions  and 
thus  irregularities  in  the  respiratory  and  circulatory  systems 
as  well  as  in  digestion  are  observed.  In  addition  changes  occur 
in  the  internal  organs,  which  markedly  aggravate  the  condition 
of  the  patient  and  incidentally  are  the  direct  cause  of  death. 

Respiration  is  superficiai  and  increased  on  account  of  the 
spasm  of  the  abdominal  and  intercostal  muscles,  so  that  the 
number  of  respirations  may  be  ten  times  that  of  normal.    The 


452 


Tetanus. 


gaseous  exchanges  in  the  lungs  are  not  sufficient  in  spite  of 
the  increased  respiration  and  soon  there  develop  symptoms 
of  impaired  oxidation  of  the  blood,  whenever  the  spasm  is 
continuous,  such  as  cyanosis  of  the  mucous  membranes, 
hyperemia  and  later  acute  edema  of  the  lungs  with  rales  over 
the  trachea  and  thorax.  Breathing  is  frequently  stertorous 
or  groaning  in  nature,  and  sometimes  one  may  observe  on 
inspiration  a  whistling  noise  due  to  the  spasm  of  the  laryngeal 
muscles.  Aspiration  of  mucus  or  saliva  or  forcible  administra- 
tion of  drugs  may  easily  cause  a  pneumonia,  almost  always 
of  gangrenous  character  and  with  lethal  result. 

The  heart  action  does  not  vary  from  the  normal  in  the 
beginning  of  the  disease,  and  in  light  cases  it  may  remain 
unchanged  throughout ;  the  pulse,  however,  is  small,  the  arterial 
walls  tense.  In  severe  cases  the  heart  beat  becomes  very  fre- 
quent and  finally  throbby,  especially  towards  the  fatal  end  of 
the  disease. 

Internal  temperature  is  increased  in  severe  cases  only  and 
then  only  on  the  approach  of  death,  or  when  an  inflanmiation 
of  an  internal  organ  has  become  associated  (pneumonia)  or 
when  general  septic  infection  occurs.  Aside  from  such  cases 
the  temperature  rises  in  uncomplicated  cases  only  one  or  two 
days  or  even  only  a  few  hours  before  death,  increasing  rapidly, 
and  reaching  42-43°  C.  immediately  before  death  (Fig.  71). 


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Fig.  71.     Fever  curve  in  tetanus  with  post-mortem  rise  of  temperature. 

The  increase  of  temperature  continues  after  death,  and  in  two  hours  attains 
45 °C,  The  cause  of  this  increase  in  body  temperature,  first  observed  in  the  human 
cadaver  by  Wunderlich,  is  found  in  the  amount  of  heat  which  is  produced  by  the 
powerful  muscle  contraction  which  increases  after  death  to  some  extent  and  then 
relaxes,  for  similar  post-mortem  signs  have  been  observed  after  poisoning  by  strych- 
nine as  well  as  after  electrical  irritation  of  the  spinal  cord   (Leyden). 


Syiiiptdiiis.  ^53 

Ino^estioii  of  food  is  liindcicd  by  tlio  trisimis,  in  spite  of 
a  i>ood  appetite.  Patients  repeatedly  reach  for  food,  chew 
the  morsels  witli  a  lot  of  noise  and  finally  swallow  them  with 
ditheulty,  or  the  food  remains  in  the  month  and  is  later  expelled 
by  congh.  The  food  ])articles  which  accnmulate  in  the  month 
are  mixed  with  saliva  and  under;L>o  fermentation  or  decomposi- 
tion, decolorizing  the  saliva  and  imparting  to  the  exhaled  air  a 
fetid  odor.  Liqnid  food  is  more  easily  taken,  althongh  sometimes 
even  the  drinking  of  water  becomes  imi)ossible,  in  spite  of  every 
effort,  regnrgitation  being  often  observed.  The  tongne  is  usnally 
coated  with  a  thick,  dirty-grayish  deposit,  the  margins  showing 
the  imprint  of  the  teeth  and  frequently  superficial  injuries. 
Peristalsis  is  suppressed,  defecation  delayed  on  account  of  the 
tension  of  the  abdominal  walls,  and  oidy'a  few  fecal  balls  are 
evacuated  at  a  time. 

Mictiirition  is  also  delayed  and  the  urine  is  more  concen- 
trated, Avith  increased  specific  gravity  as  a  result  of  the  pro- 
longed retention  in  tlie  bladder  as  well  as  reabsorption  of  the 
aqueous  constituents.  In  completely  suppressed  ingestion  of 
food  the  reaction  is  acid  and  the  urine  contains  debris  and 
oxalate  crystals  in  large  amounts  (Friedberger). 

Aeeording  to  Tabusso's  experiments  the  blood  contains  heterolysins,  also 
auto-  iso-  and  heteroag-jrlutinins,  while  the  freezing  point  is  slif,rhtly  diminislied 
fan  averaj^e  of  0.535  against  0.558  for  normal  hors-e  serum),  whereas  in  other 
instances  where  dyspnea  and  asphyxia  are  present  the  molecular  concentration  is 
increas^ed. 

-  In  fatal  cases  the  patients,  which  have  hitherto  ])een 
constantly  standing,  suddenly  break  down,  fall  to  the  ground 
and  die  in  a  few  hours  under  progressive  increase  "of  the 
muscular  contractions.  The  immediate  cause  af  death  is  some- 
times exhaustion,  or  suffocation,  at  times  also  a  hypostatic 
or  traumatic  pneumonia. 

In  localized  tetanus  the  muscle  spasm  is  confined  to  certain 
parts  of  the  body,  and  usnally  to  those  in  which  the  infection 
occurred.  AVhen  the  spasm  affects  the  muscles  of  mastication, 
thfe^  course  of  the  disease  is  usually  unfavorable  on  account 
of  impaired  nutrition;  in  other  cases  the  disease  occasions  as 
a  rule  merely  a  transitory  disturbance  of  function.  When  the 
partial  tetanic  spasm  remains  local  to  the  end,  it  is  usually 
accompanied  by  light  s>Tnptoms  and  the  contraction  of  the 
affected  muscle  groups  does  not  develop  to  as  high  a  degree 
as  in  generalized  tetanus.  In  most  cases  the  localized  tetanus 
is  tlie  incipient  stage  of  general  infection. 

The  clinical  picture  of  the  disease  varies  but  slightly  ac- 
cording to  the  species  of  animals  affected,  and  deviations  in  the 
complications  are  usually  the  only  changes  observed. 

In  cattle  bloating  and  distention  of  the  left  flank  develop 
on  account  of  the  suppression  of  the  movements  of  the  paunch 
and  of  rumination  due  to  spasms  of  the  abdominal  muscles.  The 
patients  show  a  more  pronounced  apathy  or  dullness  and  their 


454 


Tetanus. 


reflex  irritabilitj^  is  less  marked  tlian  in  the  liorse.  D^e^^llann 
and  Shadow  each  observed  a  case  with  marked  npward  curve 
of  the  vertebral  column  (emprosthotonus) ;  Balog  observed 
marked  orthotonus.  In  cows  a  suppurative  inflammation  of 
the  uterus  occurs  frequently,  which  serves  as  the  basic  point 
of  the  disease. 

In  sheep  and  in  goats  opisthotonus  usually  occurs ;  it  is 
pronounced  when  the  animals  are  standing,  but  more  so  after 
they  have  fallen  to  the  ground.  Moderate  bloating  is  also 
noted  frequently. 

The  lockjaw  of  lambs  (tetanus  agnorum)  which  occurs  as 
a  rule  from  a  navel  infection  and  is  not  infrequently  observed 
as  a  stable  enzootic,  begins  with  lassitude  and  sluggish  indis- 
position. Later  movement  becomes  stiff  and  finally  impossible ; 
the  animals  hold  the  head  to  one  side  or  backwards,  curve  the 
back  upwards,  suckle  with  difficulty  or  are  unable  to  do  so,  and 


Fk 


i\t' 


Generalized  muscular  spasms  in  a  do<. 


finally  die  with  symptoms  of  suffocation.  The  disease  is  often 
associated  with  an  acute  intestinal  inflammation  with  profuse 
diarrhea. 

In  hogs,  which  usually  are  affected  with  generalized  tetanus, 
trismus  attains  a  marked  degree  (Jakab  observed  the  disease 
in  this  form  among  16  pigs  of  one  drove)  ;  upward  or  downward 
curvature  of  the  vertebral  column  also  occurs  frequently. 

Tetanus  is  not  common  in  dogs — is  usually  localized  and 
manifests  itself  especially  in  young  dogs  by  transitory  trismus. 
In  severe  cases  one  is  struck  by  the  characteristic  facial  distor- 
tion, the  forehead  being  wrinkled  in  a  sagittal  direction,  by 
the  rigid  erect  position  and  approximation  of  the  ears,  the 
external  strabismus  of  the  eyes  and  the  grinding  of  the  teeth 
as  well  as  the  rigidly  spread  extremities ;  the  vertebral  column 
is  straight  or  curved  downwards  (Fig.  72). 


Course,  Diuguosis.  435 

The  disease  occurs  very  rarely  in  fowls.  Dreymann  observed 
it  in  a  turkey  gobbler  four  days  after  a  doi;-  bite.  The  symptoms 
were  spasm  of  the  entire  musculature,  stiffness  of  the  head 
and  neck,  trismus,  close  approximation  of  the  wings  to  the 
body,  ruffled  feathers  and  cyanosis  of  the  comb  and  wattles. 

Course.  The  most  varied  transitional  stages  may  be  ob- 
served ill  the  course  of  tetanus  in  the  rapidly  progressing  cases 
which  terminate  fatally  in  2  or  3  days  as  well  as  in  those  that 
progress  slowly  and  attain  only  a  limited  degree  of  intensity. 
Death  usually  follows  in  3  to  10  days  after  the  appearance 
of  the  first  symptoms,  very  rarely  earlier  and  even  more  rarely 
later.  The  symptoms  in  the  fatal  cases,  aside  from  slight  re- 
missions, are  progressive  in  intensity  until  death  supervenes. 
There  are  cases  in  which  the  patient's  condition  may  become 
improved  for  a  time  to  such  an  extent  that  recovery  is  hoped 
for;  suddenly  a  remission  occurs,  followed  in  a  few  days  by 
death,  while  no  cause  for  the  change  is  cliscernible.  In  favorable 
cases  the  symptoms,  especially  the  spasmodic  contraction  of 
the  musculature,  abate  towards  the  end  of  the  second  week, 
and  finally  cease  altogether.  Convalescence  will  be  long,  how- 
ever, a  certain  stiffness  of  movement  being  noticeable  in  the 
animals  even  4  to  6  weeks  later,  but  this  also  gradually  dis- 
appears. 

The  course  of  the  disease  is  influenced  by  nutrition  in  that 
those  cases  where  ingestion  of  food  and  water  is  difficult  or 
impossible  on  account  of  the  trismus,  exhaustion  occurs  earlier, 
and  this  is  accelerated  by  the  exertion  occasioned  by  the  con- 
stant muscular  tension.  Further,  the  superficial  respiration 
occasions  danger  of  suffocation,  which  is  enhanced  by  the  easily 
induced  hypostatic  hyperemia  of  the  lungs.  Mild  cases  may 
be  shaped  unfavorably  by  occasional  complications,  and  in  this 
respect  pneumonia  is  especially  dangerous.  It  is  produced  almost 
exclusively  by  aspiration  of  fluid  or  particles  of  food  and  usually 
runs  an  unfavorable  course.  (Schindelka  has  observed  a 
marked  decrease  in  the  tetanic  s^miptoms  after  an  intercurrent 
influenza  in  four  horses.) 

Diagnosis.  A  characteristic  picture  of  the  disease  is  pre- 
sented by  the  continuous  tonic  muscle  spasms  with  retained 
consciousness  and  normal  temperature.  Strychnine  poisoning 
simulates  it  very  closely;  here,  however,  the  spasms  develop 
much  more  rapidly  and  death  results  much  more  c^uickly. 

Tetanus  may  be  mistaken  for  other  diseases  only  in  the 
initial  stages  of  the  disease,  as  long  as  tlie  muscle  contractions 
are  confined  to  one  part  of  the  body  and  while  they  are  not 
very  pronounced.  Cerebrospinal  meningitis  conies  into  con- 
sideration on  account  of  the  rigidity  of  the  neck,  but  here  s\Tnp- 
toms  are  also  present  pointing  to  an  inflammation  of  the  brain 
(dullness,  paralysis  in  the  area  of  certain  cerebral  nerves), 
trismus  is  usually  absent,  reflex  irritability  is  increased,  but 


456  Tetanus. 

external  irritants  do  not  produce  a  rigidity  of  muscles  in  remote 
parts  of  the  body,  while  on  the  other  hand  muscle  paralyses 
occur  in  the  later  course  of  the  disease. 

Clonic  spasms  are  characteristic  of  epilepsy  and  eclampsia. 
In  epilepsy  these  are  separated  by  intervals  of  freedom  from 
spasms.  Tonic  spasms  are  exceptionally  observed  in  ^  single 
muscle  groups  and  then  they  are  only  transitory,  while  the 
patients  also  lose  consciousness  during  the  attacks. — In  rabies 
trismus  is  absent,  the  ears  are  not  stiff  and  here  paralyses 
occur  later. 

Acute  muscular  rheumatism,  when  very  severe,  occasions 
a  similar  spasmodic  condition  at  the  parts  of  the  body  affected 
as  occurs  in  tetanus;  but  here  the  muscles  are  painful  and 
appear  swollen  rather  than  tense,  the  reflex  irritability  is  not 
increased  and  external  irritation  causes  no  extension  of  the 
condition. 

In  articular  inflammations  of  the  extremities  as  well  as 
in  rickets  the  stiff  gait  also  reminds  one  of  tetanus,  but  the 
changes  in  the  shape  of  the  joints  protect  against  error,  while 
the  cause  of  an  apparent  trismus  resulting  from  inflammation 
of  the  maxillary  joint  is  differentiated  by  the  tenderness  of  the 
involved  articulation  and  the  laxity  of  "the  masseters. 

Finally  tetanus  must  be  differentiated  from  tetany  which 
is  produced  by  traction  of  certain  nerves  or  adhesion  to  a 
cicatrix.  As  soon  as  the  nerve  is  freed  these  symptoms  all 
disappear  (Gunning  cured  the  disease  in  one  case  by  freeing 
the  spermatic  cord  stump  which  had  grown  into  the  scrotum). 
Tetanic  symptoms  are  sometimes  observed  in  painful  intestinal 
diseases  (HotTmann  observed  this  repeatedly  during  four  weeks 
in  a  horse  infested  w4th  ascaris).  Recovery  followed  expulsion 
of  the  worms. 

Pus  from  wounds  may  occasionally  reveal  spore-bearing  tetanus  bacilli  on 
microscopic  examination,  which  are  mixed  with  other  bacteria  (f-ee  Pig.  73).  Such 
material  is  also  suitable  for  diagnostic  inoculations  of  mice  and  guinea  pigs. 

Prognosis.  The  course  of  tetanus  is  unfavorable  in  the 
majority  of  cases.  The  mortality  varies  in  horses  between 
55  and  90%,  in  cattle  it  is  a  little  lower,  in  sheep  higher  and  in 
young  animals,  especially  in  lambs,  most  unfavorable  (95  to 
iOO%).  Glinther,  however,  saw  four  out  of  five  colts  8  to  14 
days  old  recover.  The  earlier  the  symptoms  appear  after  in- 
fection, the  more  rapidly  the  muscle  spasm  develops  with  pro 
portionate  intensity,  the  more  unfavorable  is  the  prognosis, 
and  a  marked  locking  of  the  jaw  is  of  bad  significance.  In 
a  longer  incubation  and  more  gradual  development  of  the  dis- 
ease, the  prospects  are  better,  and  should  the  animal  survive 
the  second  week  it  may  most  probably  be  considered  saved  if 
the  respiration  and  nutrition  are  satisfactory  and  no  complica- 
tions set  in. 

From  a  prognostic  point  of  view  the  internal  temperature 


Prouimsis,  Treat iiiciit.  457 

is  also  of  importance,  as  every  increase  in  temperature  during 
the  course  of  the  disease  is  an  unfavorable  sign.  Such  an 
increase  indicates  in  cases  without  complications  that  the  end 
is  near;  in  otlicr  cases  it  is  due  to  some  inlhimmatory  process, 
usually  pneumonia. 

Tlie  cases  of  localized  tetanus  are,  as  already  stated,  al- 
ways more  favorable,  and  the  prognosis  of  tetanus  in  dogs  is 
■usually  ])etter. 

Among  247  horses  with  tetanus  observed  at  the  "Rmlapest  elinic  in  1880-1906, 
202  (lieil,  i.  o.,  Sl.S'/f. — In  tlie  stahlos  of  the  Prussian  army  tetanus  was  diagnoseii 
from  ISSl  to  1008  in  1,1.'?9  horses,  84S,  i.  e.,  lAA'^/f  died,  while  in  the  French  army 
from  1904  to  1905  amoufj  172  eases,  115  or  60.8'/,  died. — Aceordinfj  to  Dieudonne 
the  mortality  from  tetanus  after  docking  of  the  tail   (58  cases)  is  75%. 

Treatment.  The  first  essential  part  in  the  treatment  of 
tetanus  consists  in  a  thorough  disinfection  of  the  seat  of  in- 
fection. If  it  is  possible,  by  removing 
the  pus  and  necrotic  tissue,  as  well  as 
by  a  subsequent  disinfection  of  the 
wound,  to  render  the  tetanus  bacilli 
and  spores  harmless,  the  source  of  the 
poison  is  thereby  eliminated,  and  if 
the  already  absorbed  toxin  has  not  yet 
produced  severe  changes  in  the  ner- 
vous system,  the  recovery  of  the  ani- 
mal may  be  hoped  for,  especially  since 
a  portion  of  the  toxin  is  probably 
eliminated  from  the  body  with  the  se- 
cretions (perspiration,  iirine,  saliva).     F'^'-  ^f-   p^'s  front  a  eviration 

»  T  ■       ,,  •      T       J-  PI        iround  of  alioq  anectedinth  id- 

According  to  these  indications  careful  „„,,,,.  Besides  spore-containing 
search    should    be    made    at    the    sup-       tetanus   bacilli,  streptococci, 

posed   place   of   infection   bv  means     staphylococci,  dipiococcus  lance- 

*  „  ^  .....       -^      .  ,  olatus,  etc.,  are  present. 

01  an  appropriate  incision,  to  de- 
termine whether  it  contains  any  purulent  or  ichorous  secre- 
tion. If  so  it  should  be  washed,  and  if  a  foreign  body  is  present 
it  should  be  removed,  the  suspicious  tissue  should  be  cut  from 
the  walls  of  the  cavity  with  the  aid  of  scissors,  or  curetted  with 
a  spoon,  and  the  cavity  should  be  thoroughly  washed  with  a 
concentrated  disinfectant.  For  this  purpose  a  1%  nitrate  of 
silver,  or  corrosive  sublimate  solution,  S%  chloride  of  zinc 
solution,  or  5%  iodide  of  glycerin  (Van),  are  satisfactory; 
cauterization  may  also  be  applied.  The  disinfection  acts  also 
by  destroying  the  less  resistant  foreign  bacteria,  and  thereby 
rendering  the  conditions  for  the  propagation  of  the  tetanus 
bacilli  unfavorable.  By  the  application  of  a  Bier's  ligature 
the  absorption  of  the  toxins  may  also  be  made  more  difficult. 
If  the  disease  appears  after  docking  the  tail  it  is  advisable  to 
amputate  another  portion,  and  to  apply  tlie  thermocautery  to 
the  surface  of  the  wound. 

Tn  practice  the  lor^al  treatment  of  horses  is  sometimes  very  difficult,  as  the 
patients   i)econie   much   e.xcited,   and    it    is   hardly    possilde   to   lift   the   leg   from   the 


458  Tetani;s. 

ground.     If  however   the  place  of   infection  is  known   with   sufficient  certainty,  it 
appears  justified  to  anesthetize  the  animals  for  the  purpose  of  local  treatment. 

Suitable  quarters  and  proper  food  are  of  great  importance. 
The  patients  sliould  he  put  in  a  quiet  place,  if  possible,  with 
soft  ground,  and  on  account  of  the  increased  reflex  irritability, 
they  should  be  protected  from  loud  noises  and  from  direct 
sunlight  (complete  darkness  is  not  necessary),  and  also  from 
unnecessary  handling  and  examinations.  It  is  only  in  severe 
cases  advisable  to  place  the  horses  in  slings,  usually  when  the 
animals  are  exhausted  to  such  an  extent  that  they  can  stand 
up  only  with  difficulty,  for  once  the  animals  have  fallen  to  the 
ground  the  condition  becomes  very  rapidly  aggravated.  If 
the  animal  is  found  lying  on  the  ground  it  is  advisable  to  allow 
it  to  lie  for  awhile  on  soft  bedding;  then  it  should  be  raised 
carefully,  and  placed  in  slings  if  this  is  possible  without  unduly 
exciting  the  patient. 

As  long  as  the  patients  are  not  unable  to  eat  they  should 
be  given  soft,  easily  digestible  food;  later,  when  mastication 
becomes  difficult  on  account  of  approaching  trismus,  flour  and 
bran  gruels,  to  which  eggs  or  red  wine  have  been  added,  may 
be  given,  while  if  trismus  is  fully  developed  nutritive  enemas 
(milk  and  eggs)  may  be  employed.  At  the  same  time  the  ani- 
mals should  have  fresh  water  within  reach,  so  that  they  may, 
at  their  desire,  rinse  their  mouth  and  quench  their  thirst.  In 
order  to  prevent  the  decomposition  of  the  saliva  and  of  the 
remnants  of  food  it  is  advisable  to  rinse  the  mouth  from  time 
to  time  with  pure  water  or  water  containing  a  little  vinegar. 
The  retained  feces  should  be  removed  by  manual  emptying  of 
the  rectum,  or  by  enemas  of  soap  water;  the  retention  of  urine 
is  relieved  by  pressure  on  the  bladder,  or  if  necessary  by  the 
introduction  of  the  catheter. 

The  internal  treatment  proper  is  of  minor  importance. 
The  administration  of  drugs  per  os  is  dangerous  even  if  trismus 
is  only  slightly  developed,  and  for  this  reason  usually  only 
such  remedies  are  given  as  the  patients  can  take  with  their 
drinking  water  (salines  for  the  prevention  of  constipation). 
In  cases  where  the  infection  appears  to  have  occurred  through 
the  intestines  oil  of  turpentine  (01.  tliereb.,  01.  oliv.  aa  100.0  g. 
per  diem)  is  now  administered  per  os  or  per  rectum,  as  advo- 
cated by  Hartenstein  and  Nocard.  Inhalations  of  chloroform, 
or  chloroform  and  ether  appear  to  act  beneficially,  by  diminish- 
ing the  trismus  somewhat,  so  that  the  animals  can  more  easily 
partake  of  food.  Such  inhalations  should  be  given  immediately 
before  feeding,  but  only  up  to  the  commencement  of  anesthesia. 
Matozzi  recommends  for  reducing  the  trismus  an  ointment  of 
cyanide  of  potassium  (2:8),  Schleg  a  mixture  of  gray  mercury 
ointment  and  camphor  liniment,  to  be  rubbed  into  the  cheeks. 
Chloral  hydrate  or  ether  (3-50  g.  daily  per  rectum),  morphine 
(0.2-0,5  g.  subcutaneously),  cyanogen  (0.3-0.5  g.  subcutaneously 
or  injected  into  the  trachea),  extract  of  belladonna  (2-4  g.  in 


Trcalnii'iil,  Iiniiuin  i/ntimi.  459 

drinking"  water),  salts  of  atropin  (0.02-O.O.S  g.  snbentanoonsly) 
etc.,  may  be  nsod  on  account  of  their  anti-spasmodic  action, 
relatively  small  doses  being  required  for  small  animals.  The 
last  mentioned  remedies  are  preferred  by  some  authors  to 
the  opiates  wliicli  cause  digestive  disturbances  or  symptoms  of 
irritation  (Barrier,  Friedberger,  Pethe)- 

The  value  of  the  subcutaneous  injection  of  carbolic  acid 
as  recently  recommended  by  Maccagni  &  Biancliini,  Croce,  also 
by  8chmid,  Guerrieri,  Cangini  and  others  (20-40  cc.  of  a  2^/o 
solution,  according  to  Croce  10  cc.  of  a  10%  glycerin  solution, 
and  in  addition  carbolized  water  into  the  rectum),  cannot  yet 
be  determined.  Pilocarpin  (0.20-0.50  g.  subcutaneously)  was 
reconnnended  to  promote  the  circulation,  and  to  increase  the 
secretions  through  wliich  it  possibly  would  promote  the  elimina- 
tion of  the  toxins,  but  the  writers,  as  well  as  Friedberger,  failed 
to  obtain  beneficial  results  from  its  application.  Profuse  bleed- 
ing (10  liters  at  one  time  possibly  to  be  repeated  in  one  to  two 
days  and  followed  by  subcutaneous  infusions  of  several  liters 
of  artificial  serum)  as  recommended  by  Crinon  and  also  by 
Dumas,  is  supposed  to  serve  the  same  purpose,  but  its  action 
also  appears  to  be  problematical,  since  together  with  this  the 
administration  of  bromide  of  potassium,  and  antitoxic  serum 
is  recommended,  while  Habicht  advises  also  injections  of  iodipin 
(25-.30  g,  alternating  with  the  bleeding,  and  as  after  treatment). 
Cliigos  and  Diffine  recommend  daily  intravenous  injections  of 
250  cc.  oxygenated  water,  Dabert  peroxide  of  hydrogen  (10  cc. 
daily  subcutaneously,  or  1-2  liters  per  os),  Mayr  the  iodipin 
(100  cc.  subcutaneousl}^),  with  repeated  rectal  infusions  of  a 
3%  septoform  solution.  French  veterinarians  (Chapard, 
Desoubry,  Cagiiy,  Girard  &  Malle)  praise  the  tallianin  (ozonized 
turpentine),  which  is  supposed  to  have  given  good  results  even 
in  severe  cases  (20-.30  cc.  daily  intravenously). 

The  antitoxin  serum  has  given  only  indifferent  results  in 
animals  affected  with  tetanus,  but  may  be  beneficial  if  em- 
ployed at  the  beginning  of  the  afTection,  and  in  relatively  high 
doses  (see  p.  462). 

After  the  disappearance  of  the  muscular  spasms  and  during 
the  long  convalescent  period  care  should  be  taken  that  the  ani- 
mals are  daily  exercised  quite  slowly  for  y\  to  y.>  an  hour,  and 
they  should  be  used  for  work  only  after  several  weeks. 

Immunization  and  Serum  Therapy.  Behring  &  Kitasato 
(1890)  successfully  innnunized  rabbits  by  inoculating  them  first 
with  0..3  cc.  of  filtrate  of  a  virulent  culture,  and  then  repeatedly 
injecting  them  subcutaneously  with  3  cc.  of  a  1%  iodine 
trichloride  solution.  Rabbits  treated  in  such  a  manner  later 
withstood  10  cc.  of  a  culture  of  which  0.5  cc.  killed  other  rabbits. 
They  also  withstood  20  times  the  fatal  dose  of  toxin,  while 
0.2  cc.  of  their  blood  serum  injected  intraperitoneally  into 
rabbits  protected  them  against  a  virulent  infection  given   24 


460  Tetanus. 

hours  later.  If  0.033  cc.  (300  times  the  fatal  dose)  of  a  culture, 
0.0001  cc.  of  which  killed  mice  inside  of  two  days,  is  injected 
into  mice  with  5  times  the  quantity  of  immune  serum  (0.2  cc.) 
the  animals  will  remain  unaffected.  The  blood  serum  of  rabbits 
which  were  not  immunized  had  no  protective  action.  Similar 
results  were  obtained  by  Tizzoni  &  Cattani  in  mice  and  rats 
(1891)  with  blood  of  artificially  immunized  pigeons  and  dogs 
(1-2  drops  of  dog  serum  rendered  ineffective  0.5  cc.  of  toxic 
filtrate  of  cultures). 

These  experiments  formed  the  basis  of  the  serum  immuniza- 
tion and  serum  therapy,  for  which  the  serum  of  horses  is  now 
exclusively  used,  since  Schiitz  found  that  horses  and  sheep 
may  be  also  successfully  immunized  against  tetanus,  and  pro- 
duce a  potent  immune  serum. 

Preparation  of  Immune  Serum,  According  to  Behring's  methorl,  a  virulent 
bouillon  culture  is  obtained,  0.75  cc.  of  which  is  fatal  for  rabbits  in  3  to  4  days, 
and  Oi  this  bouillon  80  cc.  is  mixed  with  0.25%;  60  cc.  with  0.175%;  40  cc.  with 
0.125%  trichloride  of  iodine,  while  20  cc.  is  used  without  any  mixing.  Passing 
from  the  most  attenuated  to  the  least  attenuated  cultures  the  horses  to  be  immunized 
are  treated  once  in  eight  days  with  subcutaneous  injections  of  10-20  cc.  and  finally 
with  the  pure  culture,  0.5  cc.  being  injected  at  first  and  thereafter  each  five  days 
the  dose  being  doubled  for  each  injection. 

According  to  the  procedure  of  Eoux  &  Vaillard  immunization  is  carried  out 
with  filtrates  of  4  to  5  weeks  old  cultures,  of  which  1/400  cc.  kills  a  mouse.  At 
first  a  filtrate  attenuated  with  Lugol'a  solution  is  injected  subcutaneously  in 
increasing  doses  and  later  the  pure  toxin,  first  injected  subcutaneously,  then  intra- 
venously or  intraperitoneally. 

Standardization  of  Immune  Serum.  According  to  Behring's  procedure  the 
potency  of  the  serum  is  determined  in  such  a  manner  that  the  smallest  quantity  of 
serum  is  ascertained  by  inoculations  on  mice,  which  renders  a  certain  quantity  of 
tetanus  toxin  of  a  known  strength,  ineffective  (toxin  and  s'/um  are  mixed  and 
injected  subcutaneously).  As  a  test  toxin  a  dry  tetanus  normal  toxin  (TeTN)  is 
used,  of  which  1  g.  kills  150,000,000  g.  of  mouse  weight,  that  is  10,000,000  mice 
of  15  g.  body  weight  each.  As  normal  serum  (TeAN')  is  designated  that  serum 
of  which  0.1  cc.  renders  ineffective  0.03  g.  of  normal  toxin;  serum,  of  which  0.01 
cc.  exerts  such  an  action,  possesses  10  times  the  strength  (TeAN^")  etc.  One  cc. 
of  normal  serum  contains  one  antitoxin  unit  (A.-E.).  In  Germany  only  a  serum 
can  be  marketed  which  possesses  not  less  than  at  least  ten  times  the  strength 
(TeAN'"),  of  which  1  cc.  contains  at  least  10  A.-E.,  or  0.01  cc.  neutralizes  0.03  g, 
of  normal  toxin. 

Serum  prepared  by  the  Pasteur  Institute  of  Paris  renders  ineffective  1  cc.  of  a 
solution  diluted  in  proportion  of  1:100,000,  which  is  100  times  the  fatal  toxin 
quantity    (=r  0.001  g.  dried  toxin). 

Both  sera  when  dried  in  the  vacuum  are  also  used  in  the  powdered  form, 
10  g.  of  the  German  preparation  containing  100  antitoxin  units,  while  of  the 
Parisian  preparation  1  g.  corresponds  to  10  cc.  of  the  liquid  serum.  There  is  also 
an  antitoxin  prepared  by  Tizzoni  and  Catanni  on  the  market,  which  is  obtained 
from  dog  and  horse  serum. 

The  blood  serum  of  highly  immunized  horses  when  injected 
subcutaneously  in  sufficient  quantities,  protects  animals  against 
the  pathogenic  action  of  a  simultaneous  tetanus  infection  or 
an  infection  occurring  shortly  afterwards.  The  immunity  is 
produced  immediately,  but  lasts  only  a  short  time,  about  3  to 
4  weeks  in  horses,  and  then  diminishes  gradually,  finally  dis- 
appearing entirely.  A  simultaneous  injection  of  immune  serum 
and  toxin  causes  local  tetanic  symptoms,  wdiich  however  last 
only  a  few  days  whereupon  the  animals  recover.    Similar  results 


Iiiiiiiuiiizalioii.  ^(j^ 

are  obtained  wlieii  tlie  .seriini  is  injected  after  tlie  toxin,  hut 
before  the  appearance  of  the  tetanic  muscuhir  spasms,  while 
if  the  injections  of  senini  are  made  still  later  the  fatal  termina- 
tion can  be  averted  only  by  lavf^e  doses  of  serum,  especially 
l)y  its  a(biiiiiisfi-ati()n  into  tlie  blood  circulation,  or  directly  into 
the  brain  (Houx  c^-  Borrel).  After  the  lapse  of  a  certain'  time 
after  toxin  injection  serum  treatment  is  entirely  without  effect. 
The  protective  and  curative  action  of  tetanus  antitoxin 
dei)ends,  according  to  the  ])resent  conception,  upon  the  fact  that 
the  antitoxin  molecules  contained  therein  bind  the  toxin  mole- 
cules circulating  in  the  tissue  fluids  and  render  them  harmless. 
The  repeated  action  of  the  toxin  on  the  nerve  cells  in  the  serum- 
producing  animals  results  in  the  production  of  excessive  num- 
l)ers  of  receptors,  which  are  thrown  off  into  the  circulation, 
and  are  therefore  present  in  the  antitoxin  molecules  (Ehrlich's 
Theory,  see  p.  463).  The  serum  therefore  protects  the  nerve  ele- 
ments from  the  pathogenic  action  of  the  toxin  molecules  which 
have  not  yet  reached  them;  but  it  is  not  capable  of  separating 
toxin  molecules,  which  have  already  become  anchored  to  the 
plasma  of  the  nerve  cells,  and  thereby  restore  the  former  con- 
dition of  the  cells.^  Accordingly  the  serum  affords  protection 
against  infection  immediately  preceding  or  following  its  ad- 
niinistration,  but  if  the  disease  has  already  become  manifest 
it  exerts  a  curative  action  at  best  only  when  the  intoxication  has 
not  greatly  reduced  the  functional  ability  of  the  nerve  cells. 

I.  Immunization  with  Immune  Serum.  Such  an  immuniza- 
tion is  advisable  and  indicated  in  all  of  those  cases  in  which 
tetanus  is  feared  within  a  short  time.  Such  a  possibility  exists 
especially  after  contusions  which  have  become  contaminated 
M-ith  dirt  or  manure,  also  whenever  tetanus  is  frequently  observ- 
ed in  certain  localities  to  follow  upon  certain  injuries'  (castra- 
tion, docking  of  the  tail  operation  for  umbilical  hernia,  skin 
injuries,  etc.,  and  when  during  the  operation  careful  asepsis 
cannot  be  carried  out.  Where  the  necessary  requirements  for 
a  satisfactory  surgical  technique  are  present,  such  prophylactic 
serum  injections  are  of  course  superfluous. 

For  iinmunization  with  Behring's  serum  large  animals  are  injected 
subcutaneously  with  20  A.-V.,  «mall  animals  with  4-5  A.-U.,  while  with 
the  Pasteur  serum  20  or  6-10  ce.  respectively  are  used;  the  inj(>ctions 
may  be  repeated  after  10  to  12  days.  The  "surgical  treatment  of  the 
wound  does  not  become  superfluous  by  the  use  of  this  serum  since  the  in- 
jected serum  does  not  prevent  the  development  of  the  tetanus  bacilli 
(Roux  &  Vaillard).  Besides  the  spores  are  retained  in  the  wounds  for  a 
long  time,  and  if  they  germinate,  after  the  disappearance  of  the  artificial 
passive  immunity,  they  produce  toxins  and  may  cause  disease  in  the 
animal  which  has  again  become  susceptible. 

Iinmunization  is  employed  to  a  great  extent  in  France,  in  accordance  with 
Xocard  's  recommendations.  Tn  the  period  of  1895-97,  2,395  horses,  asses  and  mules, 
44  cattle,  82   sheep   and   lambs,  and   206   hogs  were   immunized.      More   than   2,300 


462  Tetanus. 

of  these  animals  were  immunized  immediately  after  an  operation  and  none  of 
them  became  ill.  Of  about  400  animals  which  were  treated  1  to  5  days  after 
an  accidental  injury  only  one  horse  became  affected  with  tetanus,  and  this  one 
recovered.  The  63  veterinarians  who  carried  out  the  immunization  ebserved  tetanus 
during  this  same  period  in  259  animals  which  had  not  been  given  the  treatment. 
Labat  in  France  (703  cases)  and  Lang  in  New  Caledonia  likewise  obtained  very 
good  results  with  immunization  in  localities  where  the  soil  was  badly  infected. 
Dieudonne  failed  to  observe  a  single  case  of  tetanus  in  colts  which  had  been  treated 
with  serum  after  operations  for  umbilical  hernia,  whereas  33%  of  the  animals 
had  succumbed  previously  under  similar  conditions.  Good  results  are  also  reported 
by  Nandrin  in  tetanus  of  newly  born  foals;  he  found  however  that  5  g.  of  serum 
had  a  toxic  action  and  therefore  considers  3  g.  as  a  suitable  dose. 

According  to  the  recent  experiences  of  Dieudonne  (in  1,009  eases  of  castration 
and  abdominal  operations),  Labat  (in  about  2,000  clinical  operations),  and  Chapellier 
(in  about  ."lOO  castrations),  a  single  serum  injection  suffices  to  accomplish  effective 
results.  (Merillat  observed  the  development  of  fatal  tetanus  in  a  horse  in  spite  of 
the  serum  injection  one  week  after  it  had  been  operated  on  for  a  pail  jiuncture 
of  the  hoof.) 

The  liquid  serum  keeps  at  least  one  year  in  a  dark,  cool  place,  while  dry 
antitoxin  keeps  much  longer.  This  should  be  dissolved  before  using  in  boiled  water. 
According  to  Calmette  dry  antitoxin  exerts  its  protective  or  curative  action  (in 
rabbits)  even  when  it  is  dusted  upon  the  infected  wounds. 

II.  Serum  Therapy.  In  animals  that  are  already  affected 
the  sernm  treatment  has  tlms  far  not  been  snccessfnl.  Animals 
in  which  the  subjective  symptoms  cannot  be  utilized  for  the 
diagnosis  of  the  first  stages  of  the  disease,  come  for  treatment 
as  a  rule  in  an  advanced  stage  of  the  disease,  and  mostly  with 
symptoms  of  general  intoxication.  In  such  cases  the  toxin 
has  already  flooded  the  body,  and  consequently  the  nervous 
system  is  affected  to  such  an  extent  that  even  the  prevention 
of  further  intoxication  is  no  longer  able  to  save  the  animal. 
At  best  the  beneficial  results  can  only  be  expected  from  serum 
treatment  when  it  is  undertaken  on  the  first  day  of  the  disease. 

For  curative  purposes  horses  should  receive  subcutaneous  injections 
as  near  as  possible  to  the  place  of  infection,  with  at  least  100  units  of 
Behring's  serum,  50  cc.  of  Pasteur's  serum  (or  9,000  American  units. 
Trs.).    If  possible  the  injections  should  be  repeated  the  following  day. 

Nocard  could  not  check  the  progress  of  the  disease  in  horses  even 
with  intravenous  injections  of  immune  serum ;  not  even  in  those  cases 
when  the  injection  had  been  undertaken  24  hours  before  the  appearance 
of  the  first  symptoms. 

In  the  period  of  1897-1903  there  were  treated  with  antitoxin  in  the  Prussian 
army  91  horses,  of  which  58  (63.7%),  died,  while  in  the  French  army  the  mortality 
since  the  administration  of  immune  serum  was  reduced  from  72.7%  in  1897,  to 
57.3%  in  1901.  Tn  the  clinic  at  Budapest  of  7  horses  treated  with  serum  4  died. 
A  favorable  result  was  obtained  only  when  the  progress  of  the  disease  was  slow 
and  the  recovery  of  the  animal  was  probable  even  without  such  treatment.  Knorr 
obtained  relatively  good  results  in  some  horses;  however  he  injected  1,000  A.-U., 
repeating  this  dose  after  1  to  3  days   (the  treatment  of  one  animal  cost  $50.00!). 

Later  reports  of  Dieudonne  (31  recoveries  in  79  cases),  Ryder,  Hanunond,  Labat, 
Rickmann  and  others,  speak  more  favorably  of  the  value  of  the  serum  treatment; 
all  however  express  the  necessity  of  vising  large  doses  repeatedly.  Haubold  obtained 
very  favorable  results  in  sheep  which  became  affected  after  shearing,  castration, 
or  docking;  two  doses  of  5  cc.  of  the  Pasteur  serum  were  sufficient  to  produce 
recovery  even  in  severely  affected  animals.  Douville  obtained  recovery  in  four 
dogs  after  the  injection  of  3-5  cc.  of  serum. 

Eoux  &  Borrel  recommend  the  intracerebral  injection  of  immune  serum.  Out 
of  45  guinea  pigs  which  received  four  cc.  of  serum  in  each  hemisphere  after  the 
appearance  of  tetanic  symptoms,  35  recovered  while  of  17  guinea  pigs  which  had 


SiTuiii  Tliciapy.  463 

been  treated  under  similar  oomlitions  siiliciitaiieously  only  two  remained  alive. 
Villar  treated  two  horses  suecessfully  in  tins  manner  (3-8  e<*.  of  serum  were  in.iecte<l 
into  the  liraiu  substance  throii^di  an  openinjj  in  the  frontal  bone).  Sendrail  and 
Cullie  on  the  otlier  liand  saw  the  fata!  teriiiiiiation  in  two  cases  hastened,  while 
with  the  injection  of  serum  into  the  vertebral  canal  they  obtained  a  more  satisfactorj 
result  (-lO  cc.  injected  throujfh  the  lumbo-sacral  articulation  on  two  consecutive  days). 

Kiister  and  Sawanura  claim  a  s]>ecial  action  from  endoneural  serum  injections. 
This  method  is  recommended  as  projdiylactic,  es])eeially  in  those  cases  in  which 
nuiscular  tissue  has  become  injureil,  therajieutically  in  tetanus  ascendens,  while 
not  in  tetanus  descendens;  nevertheless  subcutaneous  and  intravenous  serum  in- 
jections should  also  l)e  used. 

Hartenstein  and  Trelut  obtain  pood  results  from  the  injection  of  l)lood  serum 
from  a  horse  affected  with  tetanus;  the  authors  however  observed  a  ](ronounced 
agjjravation  after  transfusion  of  the  blood  of  an  immunized  horse,  while  I'ilz  found 
the  blood  serum  of  horses  that  had  recovered  from  tetanus  to  be  without  any  effect. 

Treatment  with  Brain  Emulsion.  After  Wasserniann  found  that  a  niixtura 
of  lirain  substame  of  ra])liits  and  toxin  in  certain  proportions  is  not  poisonous, 
and  in  consideration  of  Ehrlich's  theory  that  the  antitoxins  are  nothing  more  than 
receptors  thrown  oft'  from  the  ganglion  colls.  Fiebiger  umlertook  curative  experiments 
at  the  Vienna  clinic,  under  the  direction  of  8chindelka  with  the  injection  of  brain 
substance.  Tn  the  course  of  15  months  20  horses  affected  with  tetanus,  but  excluding 
the  very  severe  cases,  eatdi  received  subcutaneous  injections  of  one  lamb's  brain 
finely  emulsified  in  jihysiological  salt  solution.  Of  these  20  horses  eight  (40%) 
died.  In  most  cases  extensive  and  slowly  healing  abscesses  developed  at  the  point 
of  injection.     Schueniacher  also  reports  favorable  results  from  this  treatment. 

Literature.  Friedberger,  D.  Z.  f.  Tm.,  1«79,  YT.  .S.3  (Lit.)  ;  18S4,  X,  27 
(Lit.).— Carle  &  Eattone,  Giorn.  di  Torino,  1SS4.— Nicolaier,  D.  m.  W.,  1884,  842; 
Y.  A.,  1802,  CXXYITT,  2.— Nocard,  Rec,  1887,  617.— Kitasato,  Z.  f.  Hvg.,  1889, 
YII,  225;  1892,  XT,  256.— v.  Behring,  D.  m.  W.,  190.3,  617.— v.  Behring  &  Kitasato, 
D.  m.  W.,  1890.  1113.— Kitt,  Monh.,  1890,  I,  214  (Review).— Tizzoni  &  (^attani, 
Cbl.  f.  Bakt.,  1891,  IX,  189.— A'aillard  &  Alncent,  A.  P.,  1891,  623.— v.  Behring, 
Das  Tetanusheilserum,  Leipzig,  1892.— Yaillard,  A.  P.,  1892,  224.— Sehiitz,  Z.  f. 
Hvg.,  1892,  XTI,  58.- Roux  &  Yaillard,  A.  P.,  1893,  65.— Drevmann,  Monh.,  1894, 
y;  19.— Dieudonne,  Rec,  1895,  279;  1896,  280;  1909,  433.— Roux  &:  Borrel,  A.  P., 
1898,  225.— Fiebiger,  Z.  f.  Tm.,  1902,  YI,  161.— Lingelsheim,  Hb.  d.  p.  M.,  1903, 
II,  567;  1904,  lY,  983  (Lit.).— Yincent,  A.  P.,  1904,  XYITT,  450;  Bull,  de  I'Acad., 
1907,  LYIII,  233.— Hoffmann,  Z.  f.  Yk.,  1905,  XYTT,  118.— Tiberti,  Cbl.  f.  Bakt., 
1905,  XXXYIII,  307  (Lit.  on  Tetanus  Toxin).— Tarozzi,  ibid.,  1906,  XL,  305. — 
Mavr,  B.  t.  W.,  1907,  931.— Romer,  Z.  f.  Immf.,  1909,  I,  363. 


2.     Rabies.     Lyssa. 

{Canine  madness,  Jti/dropJiohia;  Wufl-raul-heif,  Tollwut,   [Ger- 
uHui];  Bage  [FrencJi];  Rabbia  [Ifaliau].) 

Raines  is  an  acute,  contagious,  and  almost  without  excep- 
tion, fatal  infectious  disease,  the  clinical  picture  of  which  is 
characterized  by  disturbed  consciousness,  increased  nerve  irri- 
tability and  by  sulisequent  s^^nptoms  of  paralysis.  The  disease 
is  usually  transmitted  by  the  bite  of  an  affected  animal  to 
other  animals  as  well  as  man.  The  infectious  \drus  is  a  filterable 
microorganism. 

Historical.  The  disease  and  its  contagious  nature,  as  well  as  the 
danger  connected  with  the  bites  of  mad  dogs,  have  been  well  known 
since  the  time  of  Aristotle,  but  up  to  the  most  recent  times,  there 
has  been  a  certain  belief  in  its  spontaneous  development.  In  fact,  it 
was  supposed  that  hot  feed,  lack  of  drinking  water,  unsatisfied  sexual 
desire,  and  violent  nervous  excitement,  might  cause  the  disease.     By 


464  Rabies. 

means  of  inoculation  experiments  the  infectiousness  of  the  saliva  was 
determined  in  dogs  hy  Zinke  (1804),  Griiner  and  Salm  (1813),  in 
herbivorous  animals  by  Berendt  (1822),  in  human  beings  by  Magendie, 
Avhile  Galtier,  in  1879,  found  the  injection  of  the  virus  into  rabbits 
to  be  a  convenient  and  harmless  method  of  studying  the  disease,  and 
in  1880-81  made  immunity  tests  with  intravenous  injections  of  virulent 
saliva  or  brain  emulsion. 

The  very  extensive  investigations  of  Pasteur  and  his  collaborators, 
Roux,  Chamberland,  and  Thuillier  (1881-1889),  proved  on  the  one 
hand  that  the  purest  and  most  concentrated  virus  is  contained  in  the 
central  nervous  sj^stem;  they  also  established  a  method  for  the  attenua- 
tion of  its  virulence,  and  solved  the  important  question  of  protective 
vaccination  against  the  disease.  Finally,  Remlinger  and  Riff'at-Bey 
(1903)  have  determined  the  tilterability  of  the  virus,  while  Negri  (1903), 
through  the  demonstration  of  specific  cell  inclusions  in  the  nervous 
system  of  the  infected  animals,  has  facilitated  the  postmortem  diagnosis 
considerably. 

Occurrence.  Eabies  occurs  in  all  parts  of  the  world  amoni>' 
dogs,  cats  and  carnivorous  wild  animals  (especially  w^olves  and 
foxes).  Other  animals  and  human  beings  are  seldom  affected, 
and  then  almost  exclnsively  after  having  been  bitten  by  the 
above  named  carnivorous  animals  (about  80%  of  the  observed 
cases  have  been  found  in  dogs).  While  in  earlier  times  the 
disease  appeared  often  epizootically  extending  over  large  areas, 
in  the  course  of  the  last  ten  years  it  has  decreased  or  ceased 
to  appear  in  several  countries  as  a  result  of  the  measures  taken 
against  it. 

In  Germauy,  the  numher  of  oases  of  rabies,  dnring:  the  years  1895  to  1S98,  in- 
creased from  480  to  1,202,  but  in  the  year  1902  they  were  reduced  to  612.  During 
the  years  1903  and  1904  there  was  again  an  increase  to  1,043,  but  since  then  the 
disease  has  been  diminishing.  In  the  year  1908,  683  animals,  of  which  58.5  wer« 
dogs  and  2  cats,  were  found  infected  in  644  communities.  Of  these  cases  87.6% 
were  observed  in  Prussia  where  the  eastern  provinces.  East  Prussia,  Posen,  and 
Silesia  were  principally  infected.  Cases  were  also  found  in  large  numbers  in  Saxony 
and  Bavaria,  while  in  the  remainder  of  the  territory  of  the  kingdom  only  isolated 
cases  were  observed. 

In  France,  the  disease  is  found  all  over  the  country.  Since  1899,  nearly 
2,000  cases  of  rabies  have  been  observed  every  year  (in  the  year  1907,  1,892  cases, 
and  in  1908,  1,482  cases  in  dogs).  In  Paris,  however,  the  number  of  cases  has 
decreased  from  807  in  1900  to  43  in  1907. 

In  Great  Britain,  since  1895  when  there  were  672  cases  in  29  counties,  the 
4k  disease  has  decreased  so  rapidly,  thanks  to  the  energetic  measures  taken  to  eradicate 
it,  that  only  13  cases  in  4  counties  were  observed  in  1902,  and  since  1903  the  whole 
territory  of  the  United  Kingdom  has  been  free  from  the  disease. 

In  Austria,  the  disease  showed  a  steady  increase  during  the  years  1891  to  1899 
(from  815  to  1,551  cases  and  in  1900,  1,187  cases).  It  was  most  common  in  Bohemia 
and  Galicia,  less  prevalent  in  Moravia  and  Lower  Austria.  In  many  instances  the 
infection  was  introduced  into  Galicia  and  Buckovina  from  Eussia  and  Eoumania,  in 
the  border  districts  of  which  countries  an  exceedingly  large  ninidaer  of  dogs  are 
kept  without  supervision,  and  where  rabies  is  not  only  regularly  found  in  dogs, 
but  also  in  wolves.  During  the  10  years  from  1891  to  1900,  4,974  human  beings 
were  bitten  by  mad  dogs,  123  (2.4%)  of  whom  developed  hydrophobia  and  died. 
In  the  year  1908  the  weekly  number  of  cases  at  these  places  amounted  to  from 
14  to  56,  while  the  mountain  and  coast  districts  were  free  from  the  disease. 

In  Hungary,  temporary  improvement  followed  immediately  after  the  veterinary 
law  of  1888  became  effective,  but  since  1893  when  there  were  883  cases  of  disease, 
rabies  has  increased  considerably,  and  in  1908,  2,460  cases  of  rabies,  1,759  being 
in  dogs,  were  observed  in  1,471  communities.  The  majority  of  the  cases  was 
observed  at  the  southern  frontier. 


INSERT  FOLDOUT  HERE 


Oct'unenco.  Klinlo-iv.  4(^5 

Russia  is  lu':i\ily  iiifoctoil  nr^  is  indicatpii  by  tlio  fioqiuMit  iiitroiluotion  of  the 
disease  into  (icimaiiv  ami  Austria  (in  J9()S  tlicre  were  7,2o3  cases  in  4,0G0  coni- 
nuinities). 

Tlie  liisease  is  also  frequently  found  in  Servia,  Bulgaria  and  in  Rouniania 
(273  cases  in  IIHIS ;  in  IDOC,  142  mad  do^s  w(Me  brought  to  the  veterinary  institute 
of  Bucharest),  while  it  is  observed  more  rarely  in  Turkey. 

In  Belfjium  there  were  123  cases  in  1908,  in  Italy  52;1,  in  Switzerland  2.  In 
Holland  41  cases  of  rabies  were  observed  in  1007,  and  in  Sjiain  the  disease  also 
seems  to  appear  frequently,  but  Denmark,  .Sweden  and  JNorway  have  for  years 
been  free  from  tlie  disease. 

In  North  America  rabies  is  very  common  (Frothingliam)  and  has  been  in- 
creasinjif  in  jirevalence  durintj  the  last  ten  years  (Hart).  In  the  United  .States 
230  luMuan  beings  were  the  victims  of  rabies  in  73  cities  from  1890  to  1900,  while 
in  the  District  of  Columbia  91  cases  of  rabies  in  animals  were  reported  from 
1893  to  1900. 

In  Africa,  the  disease  is  also  known,  and  in  Asia  it  appears  very  frequently, 
while  Australia  has  thus  far  been  free  from  it. 

Etiology.  RoiHlini^er  and  Riffat-Bey  protliieod  typical 
rabies  in  6  out  of  19  rabbits  witli  a  filtrate  of  highly  diluted 
vinilout  brain  emulsion  wliioli  passed  throuo'li  a  fairly  porous 
Berkefeld  filter.  Aeeordino-  to  tlie  results  of  these  experiments, 
whieli  woYO  latei'  eonfirmed  by  Di  Yestea,  Sehi'iider,  Bertai'elli 
&:  A'^olpino  and  others,  the  virus  of  rabies  must  belong  to  the 
filterable  microorganisms.  The  attempts  at  cultivation  which 
have  thus  far  been  unsuccessful,  justify  the  supposition  that 
it  multiplies  only  in  the  tissues  and  fluids  of  the  body.  The 
purest  and  most  concentrated  virus  is  secured  in  the  central 
nervous  system  of  the  diseased  animals;  it  is  also  found  in 
the  salivary  glands  and  their  secretions,  and  sometimes  in  other 
glands  of  similar  structure  (lachrymal  glands,  pancreas,  mam- 
mary glands),  while  in  the  aqueous  humor  (Gibier,  Pasteur,  Al- 
banesi,  Courmont  &  Nicolas),  in  the  cerebro-spinal  fluid  (Pas- 
teur), and  in  the  blood  (Marie)  the  virus  is  found  only  in  excep- 
tional cases,  and  in  the  flesh  not  at  all.  (Konradi  found  it  in  the 
blood  of  guinea  pigs,  but  only  in  small  quantities.) 

Negri  Bodies.  Tn  1903  Negri  found  in  dogs  and  rabl)its  inoculated 
with  either  street  or  fixed  virus,  and  also  in  animals  Avhich  had  died 
or  had  been  killed  after  natural  infection  small,  round,  oval  or  three 
cornered  inclusions  in  the  large  ganglion  cells  of  the  hippocampus 
major,  in  the  Purkinje  cells  of  the  cerel)elhnn,  in  the  ganglion  cells 
of  the  cerehral  cortex,  pons,  and  medulla  ohlongata.  and  sometimes 
also  in  the  nerve  cells  of  the  spinal  ganglia  and  spinal  cord.  These 
structures  now  known  as  Negri  bodies,  are  1  to  27  a*  long,  1.5  to  5  m 
broad  and  appear  red  in  color  when  stained  with  methylene  blue- 
eosin  (the  Mann  method  of  staining).  These  cell  inclo.sures  (see  Plate  I) 
contain  in  their  interior  very  small,  strongly  retractile,  and  sharply 
outlined  granules.  Negri  believes  that  these  bodies,  which  have  been 
found  exclusively  in  rabid  animals  and  persons  are  the  parasites 
(protozoa)  of  rabies,  because  among  otlier  reasons  they  appear  in  the 
nerve  cells  only  14  to  23  days  after  aiiiticial  infection,  and  resist  both 
putrefaction  and  the  effect  of  glycerin. 

These  findings  have  later  been  confirmed  by  Volpino,  Beck,  Bosc, 
Eimst,  Bohne,  Lentz,  and  others,  and  the  structure  of  the  bodies  has 
also  been  subjected  to  a  closer  study.  According  to  Yolpino's  investiga- 
tions, the  large  bodies  consist  of  a  hyaline  ground  substance,  in  which 

Vol.  1—30 


466  Rabies. 

sometimes  very  small,  marginal,  and,  at  other  times,  larger,  central 
formations  (small  and  large  inner  formations)  seem  to  be  imbedded, 
which  contain  very  fine  ring,  rod  or  dumb-bell-shaped  inclosures.  The 
rod-shaped  bodies  contain  a  fine  granule  sometimes  at  one  or  both  ends, 
while  the  ring-shaped  bodies  show  one  or  more  similar  chromophile 
granules  around  a  light  central  space. 

This  complicated  structure  at  once  excludes  the  characterization 
of  Negri  bodies  as  products  of  degeneration;  besides,  their  specificity 
is  demonstrated  by  the  fact  that  they  are  only  found  in  rabid  animals. 
There  is,  however,  a  doubt  as  to  their  parasitic  nature  and  their  im- 
portance as  the  exciting  agent  of  rabies.  The  filterability  of  the  virus 
and  the  fact  that  in  the  initial  stage  of  the  disease  and  in  animals 
infected  with  fixed  virus.  Negri  bodies  are  generally  lacking  seem 
to  speak  against  it,  l)ut  still  the  possibility  exists  that  the  true  specific 
virus  consists  in  small  formations,  barely  visible  or  completely  invisible, 
which  develop  only  in  the  nervous  system  of  the  infected  animals, 
and  aided  by  the  cell  reaction,  first  form  small  and  simple  corpuscles 
and  later  large,  complicated  bodies  (Di  Vestea,  Volpino). 

Negri  has  recently  eoiifirined  his  conception  of  the  bodies  named  for  him  as 
true  rabies  parasites  by  microscopic  discoveries  according  to  which  the  formations 
at  a  certain  stage  of  evolution  contain  a  nucleus  in  a  homogeneous  original  substance, 
which  breaks  up  into  very  diminutive  chromatin  granules,  whereupon  the  surround- 
ing plasma  is  divided.  In  this  way  small  corpuscles  are  formed  which  consist  of 
a  chromatin  granule  and  its  capsule,  and  later  grow  up  to  new  independent  bodies. 
Quite  consistent  with  this  conception  are  discoveries  by  Babes,  Koch,  and  Eissling, 
who  in  sections  of  the  cornu  ammonis,  Imt  mainly  in  the  degenerated  ganglion  cells 
stained  according  to  Cajal,  Giemsa  or  Heidenhain,  have  foun<l  cocci-like  formations 
in  large  nundier,  scarcely  1  jx.  in  size,  surrounded  by  a  light  caitsnle.  They  are 
of  the  opinion  that  these  formations  are  the  active  causative  agents  of  rabies, 
while  the  Negri  bodies  which  inclose  them  are  reaction  products  of  the  ganglion 
cells  produced  by  their  irritation. 

Prowazek  considers  the  capsulated  small  formations  as  protozoa  and  designates 
them  as  chlamydozoae,  the  same  as  the  causal  factors  of  vaccinia,  chicken  pest,  etc. 
In  favor  of  their  protozoan  character  and  against  their  bacterial  nature  is  the  fact 
that  rabies  virus  is  injured  by  gall  and  glycoside  (Frantzius,  Kraus,  Eisler,  Lesieur), 
which  substances  are  known  to  be  poisonous  to  protozoa  and  cells,  but  are  not 
poisonous  for  bacteria. 

Finally,  the  specificity  of  the  Negri  body  is  also  shown  by  the  fact  that  its 
abundance  is  in  direct  proportion  to  the  virulence  of  the  same  parts  of  the  nervous 
system.  According  to  Fermi  the  order  of  sequence  is  cornu  ammonis,  cortex  cerebri, 
medulla  oblongata  and  spinalis;  then,  cerebellum,  thalamus  opticus,  and  nucleus 
caudatus. 

Very  small  bodies  from  0.5-2.0  yi.  in  size,  were  also  found  by  Bertarelli, 
Febre  and  Bonnard  in  the  brains  of  dogs  inoculated  with  fixed  virus,  and  by 
Lentz  and  Manqueliau  in  rabbits  treated  in  the  same  way.  Their  absence  or  the 
fact  that  they  could  not  be  found  may  have  some  connection  with  the  knowledge 
that  this  form  of  the  disease  has  such  a  brief  course  that  no  larger  formations 
are  developed.  Schiffmann  found  by  frequent  passages  that  first  the  complex,  aud 
then  the  single,  smaller  bodies  disappear  from  the  cornu  ammonis.  Lentz  describes 
as  ' '  rabies  corpuscles  of  passage ' '  the  Negri-like  formations  which  are  larger  in 
size  and  also  contain  larger,  compact,  inner  corpuscles,  and  besides  are  frequently 
located  extracellularly.  They  come  from  nuclei  or  ganglion  cells  under  simultaneous 
disintegration  of  the  protoplasm. 

Tenacity.  The  medulla  oblongata  of  rabid  animals  retains  its  virulence  for 
months  at  ordinary  room  temperature  when  protected  from  drying  and  putrefaction 
(Pasteur,  Frothiqgham) ;  on  the  other  hand  the  spinal  cord  of  rabbits  becomes 
non-virulent  in  14  or  15  days  when  exposed  in  a  dry,  dust-free  atmosphere  (Pasteur) 
or  in  4  or  5  days  if  spread  in  a  thin  layer  (Galtier).  Fluid  saliva  infects  even 
after  24  hours  (Gibier);  dried  saliva  not  later  than  14  hours  (Celli).  The  virus 
is  destroyed   in    one  half  hour   at   52°-58°    C.    (Hogyes),   and   in  two  minutes   at 


Negri  Bodies,  I'atlinm'iiii'ity.  467 

80°  (Bertarelll).  The  virus  is  soani'ly  infliionued  by  severe  coM  (  —  10° — So'C). 
Putrefaction  destroys  the  virus  only  after  long  exposure;  for  instance  Galtier 
found  that  the  medulla  of  a  dof,'  that  had  been  buried  for  4-1:  days  was  still  virulent, 
Ratz  reported  virulence  iiorsisting  after  exposure  to  putrefaction  for  14  to  "4  days, 
wliile  Klininier  found  the  cord  of  a  rabljit  to  remain  virulent  which  liad  been 
undergoing  jtutrefaction  for  lo  days.  Of  tlie  chendcal  agents,  glycerin  acts  rather 
as  a  preservative,  for  according  to  Kempner  the  medulla  retained  its  virulence  in 
glycerin  for  at  least  S  to  10  days;  according  to  Kodet  &  (lalavieile  for  10  months. 
On  the  other  hand  the  virus  is  destroyed  in  a  few  minutes  when  exposed  to  the 
action  of  each  of  the  following:  Mercuric  chloride  1:1()(K)  (Celli),  diluted  chJorinu 
or  bromine  water  (10-20  drojis  of  the  odicial  chlorine  or  biomine  water  to  Id  cc, 
of  water),  17^;  solution  of  iiotassiiim  permanganate,  and  27  sulphuric  acid 
(Bokay  tS:  Szilagyi),  5%  hydrochloric  acid,  1%  creolin  solution  and  also  to  lemon 
.iuice  (Blasi  &  Traveli).  The  natural  gastric  juice  destroys  the  virus  of  rabies 
in  4|-1.  to  5  hours  (Babes  &  Talasoscu),  and  l)i]e  kills  it  in  several  minutes.  In  a 
vacuum  from  which  the  sunlight  has  been  excluded  the  dried  and  i)nlverized  brain 
substance  wUl  remain  virulent  at  least  9  months   ( Vansteenberghe). 

The  Negri  bodies  are  destroyed  by  weak  alkaline  solutions;  they  aie  however 
very  resistant  to  tlie  action  of  mineral  aci.ls  (Negri)  and  are  only  imperceptibly 
altereil  by  drying,  warmth,  putrefaction,  glycerin  and  water  Miertarelli  &  Daddi). 

Pathogenicity.  By  the  inoculation  of  vinilont  saliva  or 
ol)loni>ata  ciniilsion  the  disease  may  be  transmitted  to  dogs, 
eats,  guinea  pigs,  rabbits,  mice,  rats  and  also  to  other  mammals. 
The  best  results  are  obtained  by  the  injection  of  the  virus  under 
the  dura  mater  of  brain  or  cord,  into  the  l)rain  substance,  into 
the  anterior  chamber  of  the  eye,  or  into  the  muscles.  Ef|ually 
good  results  may  be  obtained  by  injection  into  the  peripheral 
nerves.  Eubbing  the  virus  into  the  scarified  skin  of  dogs  and 
rabbits  is  successful  in  only  50%  of  the  cases.  Subcutaneous 
inoculation  in  dogs  rarely  gives  positive  results.  In  rabbits 
75%  of  subcutaneous  injections  are  successful  only  when  the 
muscles  or  the  nerves  have  been  injured  at  the  same  time. 
Intravenous  injection  sometimes  produces  the  disease  in  dogs 
and  rabbits,  but  not  in  ruminants  or  horses. 

Konradi  has  infected  rabbits  through  the  scarified  skin,  Galtier 
through  the  shaved  skin,  Hogyes,  Galtier,  and  Remlinger  through  the 
uninjured  nasal  mucous  membrane,  and  Galtier  and  Conte  through 
the  conjunctiva,  while  an  infection  of  the  mucous  membrane  of  the 
vagina  only  succeeded  in  exceptional  cases.  Several  experiments  have 
been  conducted  without  results  by  feeding  saliva,  meat,  and  spinal 
cord  of  rabid  animals  to  horses,  dogs  and  sheep  (Delafond,  Renault, 
Hertwig,  Noeard).  Nocard  in  the  course  of  2  months,  had  a  fox  eat 
the  cerebral  and  spinal  tissue  of  6  ra1)id  foxes  and  12  mad  dogs,  the 
unusual  feed  not  having  the  slightest  harmful  effect. 

Birds  may  be  infected  artificially,  but  they  are  not  very  receptive, 
and  the  virulence  of  the  virus  seems  to  decrease  in  their  bodies  (Gibier, 
Lote).  Cold-blooded  animals  are  also  killed  by  the  rabies  virus,  and 
frogs  succumb  with  paralytic  symptoms. 

In  rabbits  which  have  been  infected  successfully,  the  disease  de- 
velops in  its  paralytic  form,  as  a  rule  the  hind  parts  and  exceptionally 
the  front  part  of  the  body  becoming  paralyzed  first.  The  paralysis  soon 
becomes  general,  spasms  in  some  groups  of  muscles  are  observed,  and 
at  last  the  greatly  emaciated  animal  dies  in  the  course  of  2  to  3  days. 
Indications  of  excitement  (unrest,  desire  to  bite)  are  seldom  observed, 
but  these  symptoms  have  been  often  observed  in  guinea  pigs.  In 
dogs  the  usual  symptoms  of  rahies  develop   after  inoculation  and  if 


468  Rabies. 

this  was  intracranial,  the  disease  usually  commences  with  mania  and 
a  desire  to  bite. 

The  virulence  of  street  virus  varies  within  a  rather  wide  range, 
and  this  is  also  indicated  by  the  varying  periods  of  incubation 
after  subdural  inoculation  in  rabbits.  According  to  d'Amato,  the  virus 
from  cats,  foxes  and  wolves  has  a  more  violent  effect  than  that  from 
dogs. 

The  natural  infection  is  brouglit  about  in  tlie  majority  of 
cases  by  man  or  animal  being  bitten  by  a  rabid  animal,  whereby 
the  virulent  saliva  is  inoculated  through  the  wound  into  the 
subcutaneous  tissues,  muscles  or  nerves ;  in  rare  cases  the  con- 
tagion has  been  introduced  by  licking  of  wounds  and  skin  abra- 
sions. The  saliva  is  most  virulent  immediately  after  the  onset 
of  the  disease  and  in  its  further  course  but  it  is  also  infectious 
in  a  lesser  degree  2  to  5  days  before  the  appearance  of  the 
s^Tnptoms  (Eoux  &  Nocard,  Nicholas),  and  in  cases  described 
by  Pampouki  and  Konradi  even  8  days  before  the  appearance 
of  the  first  symptoms.  On  the  other  hand  during  the  long  period 
of  incubation  preceding  these  days,  the  saliva  is  not  infectious 
but  it  may  be  virulent  for  5  days  after  the  animal  has  recovered 
(Remlinger).  Finally,  there  exists  a  possibility  of  transmitting 
the  disease  by  means  of  milk  from  diseased  animals  (Perroncito 
&  Carita,  Nocard). 

The  danger  from  a  bite  depends  on  the  one  hand  on  the 
virulence  of  the  saliva,  on  the  other  hand  upon  the  size,  that 
is  the  depth  of  the  wound,  and  further  on  the  number  of  nerves 
and  lymphatic  vessels  in  the  wounded  part  of  the  body.  Large 
wounds  offer  large  surfaces  for  absorption,  and  from  small  but 
deep  wounds,  the  virus  once  entered,  can  hardly  be  removed, 
while  from  small,  superficial  wounds  it  is  easily  removed  by 
means  of  bleeding.  Therefore,  the  serious  wounds  inflicted  by 
animals  of  prey,  especially  wolves  and  large  rabid  dogs,  and 
the  deep  wounds  inflicted  by  the  sharp,  pointed  teeth  of  cats 
have  an  equally  bad  reputation,  while  the  bites  of  the  herbiv- 
orous animals  are  less  dangerous. 

Rabies  is  particularly  frequent  after  infectious  bites  in  parts 
of  the  body  where  nerves  and  lymph  vessels  are  plentiful  and 
which  are  near  to  the  brain  or  spinal  cord.  Wounds  on  the  lips, 
cheeks,  and  nose  are  considered  as  especially  dangerous,  and  in 
horses  and  cattle  the  infection  comes  mostly  from  these  parts  of 
the  body.  The  density  and  thickness  of  the  layer  of  hair  or  wool 
covering  the  point  bitten  is  important  as  it  might  withhold  the 
saliva.  Similarly  human  beings  are  often  protected  against  in- 
fection on  account  of  the  thickness  and  density  of  their  clothing. 
Thick  wool  especially  renders  such  protection,  and  this  is  in  ac- 
cord with  the  experience,  that  bites  of  rabid  animals  are  much 
more  dangerous  for  clipped  sheep  than  for  those  that  have  a 
dense  covering  of  wool. 

The  contagion,  l)e  it  ever  so  virulent  and  concentrated, 
cannot  penetrate  through  the  uninjured  skin,  while  the  possi- 


Xatui-al  Tn  feel  ion.  459 

hilitj'  ol'  infoptloii  of  the  uninjured  mucous  mcmLranc  cannot 
be  disputed  in  consideration  of  the  recorded  positive  results 
of  ex})eriinents. 

After  the  bite  of  rabid  animals  the  disease  follows  only 
in  a  portion  of  the  cases,  hardly  more  than  half.  As  already 
mentioned  there  is  a  possibility  that  the  contagion  will  not 
reach  the  wound  or  may  be  carried  away  by  bleeding ;  besides,  the 
virus  may  be  removed  or  destroyed  by  means  of  innnediate 
disinfection.  Probably,  in  many  cases,  the  ra])ies  virus  is  de- 
stroyed without  causing  the  disease  after  having  entered  the 
l)ody.  In  favor  of  this  possibility  is  the  experience  that  bites 
from  various  aninuils  are  not  of  equal  danger  in  the  various 
parts  of  the  l)ody,  and  also  that  artificially  infected  susceptible 
animals  do  not  always  contract  the  disease,  while  a  few  cases 
ultimately  recover.  The  animal  organism  is  undoubtedly  capa- 
ble under  certain  circumstances  of  rendering  the  contagion  in- 
effective, when  the  virus  is  present  in  small  amount  or  is  at- 
tenuated, and  this  power  is  decidedly  increased  by  measures 
of  immunization.  Thus  only  can  it  be  explained  why  barely 
.SO-40%  of  dogs  bitten  by  rabid  animals  eventually  develop  the 
disease.  On  the  other  hand  it  is  possible  that  latent  virus 
in  the  brain  and  spinal  cord  is  stimulated  to  rapid  increase 
by  external  influences,  such  as  physical  exertion,  cold,  etc., 
whereupon  the  disease  which  until  this  time  had  been  latent, 
may  develop  within  a  short  time  (Marie,  Remlinger). 

Accor<lin,sir  to  a  compilation  of  Friedberger  &  Frohner,  animals  bitten  by  raliid 
dogs  afterwards  contract  the  disease  as  follows:  According  to  Hertwig,  5%; 
according  to  Haiibner  40%;  according  to  the  calculations  of  the  Lyon  school  20%; 
according  to  those  of  the  Alfort  school  339r,  according  to  E611,  in  Austria,  in  the 
years  1S77-1S87,  40%  of  bitten  horses,  50%;  of  cattle  and  sheep,  36%  of  hogs,  and 
20%  of  goats  contracted  the  disease.  As  a  general  average  30%  may  be  adopted, 
although  for  cattle  and  sheep  50-60%  will  be  reached. 

Regarding  susceptibility  to  rabies  there  exists  no  con- 
siderable difference  among  the  mammals.  While  the  disease 
has  been  observed  very  frequently  in  certain  species  of  animals, 
this  may  be  explained  satisfactorily  by  their  mode  of  living, 
their  manner  of  commingling,  and  by  a  temperament  favorable 
to  mutual  infection.  Therefore,  the  disease  is  observed  most 
frequently  in  vagrant,  vicious  dogs,  then  in  cats  and  wild 
carnivorous  animals,  and  it  is  transferred  to  animals  of  this 
class  by  means  of  bites,  while  herbivorous  animals  infect  each 
other  only  exceptionally. 

The  breed  or  the  sex  of  the  animal  as  well  as  climatic 
factors  are  without  influence  on  the  susceptibility,  and  age  is 
a  factor  insofar  as  in  young  animals  the  outbreak  of  the  disease 
will  follow  after  a  shorter  period  of  incubation.  According 
to  Reinlinger  1  to  2  months  old  puppies  are  very  susceptible 
to  rabies  and  the  virus  in  their  bodies  is  very  virulent  since 
it  produces  t^noical  rabies  by  subdural  and  intraocular  injec- 
tion in  9  to  i.*^  days.     The  more  frequent  appearance  of  the 


470  Rabies. 

disease  during  summer  time  is  sufficiently  explained  by  the 
greater  intercourse  between  the  animals,  and  the  same  fact  ex- 
plains the  frequent  appearance  of  the  disease  in  densely  popu- 
lated districts.  In  various  individuals,  however,  great  differ- 
ences are  noticed,  as  some  animals,  even  dogs,  resist  every  in- 
fection. 

The  relatively  rare  oeciirrenfe  of  rabies  in  Constantinople  was  formerly  ex- 
plained by  the  supposition  that  the  breed  of  dogs  there  had  greater  resistance 
against  the  contagion,  that  the  disease  there  generally  caused  only  paralytic  symp- 
toms, and  that  the  rabies  virus  was  attenuated.  Eemlinger  found  on  the  contrary 
that  the  disease  follows  its  regular  course,  and  that  the  infectious  agent  is  very 
virulent.  According  to  his  opinion,  the  rarity  of  cases  of  rabies  may  be  explained 
by  the  peculiar  way  of  living  and  the  distribution  of  the  street  dogs  there.  They 
are  not  running  about  the  streets,  but  live  in  groups  in  certain  streets  or  parts  of 
streets,  strictly  watching  their  places  of  living,  and  when  a  strange  dog  appears 
it  is  at  once  chased  away.  When  a  dog  develops  rabies,  it  also  remains  in  the 
street  where  it  is  born  and  has  so  far  lived,  while  the  healthy  dogs  by  instinct  avoid 
their  diseased  comrade,  and,  in  case  it  should  try  to  escape,  it  will  be  surrounded, 
barked  at  and  compelled  to  withdraw  to  its  sulking  place.  Only  inexperienced 
young  dogs  come  near  it;  therefore,  in  Constantinople,  only  young  animals  have 
been  found  with  rabies,  and  human  beings  have  been  bitten  by  these  dogs  almost 
exclusively. 

Pathogenesis.  If  the  rabies  virus  becomes  introduced  in 
some  part  of  the  body  through  bites  or  artificial  infection,  it 
penetrates,  as  suggested  alread^^  by  the  theoretical  views  of 
Duboue  in  1879,  as  a  rule  along  the  nerve  tracts  of  the  involved 
part  of  the  body  towards  the  central  nervous  system  usually 
without  entering  the  circulation,  and  from  there  it  is  distrib- 
uted only  gradually.  The  researches  of  Vestea  &  Zagari 
show  that  after  the  inoculation  of  virus  into  a  nerve  of  the 
hip  of  a  rabbit  the  paralysis  will  first  appear  in  the  hind  leg, 
and  from  there  proceed  forwards,  while  after  the  inoculation 
into  a  nerve  of  the  foreleg  or  under  the  meninges,  a  reverse 
process  will  be  observed.  If  the  nerve  connecting  an  extremity 
with  the  spinal  cord  is  severed,  the  subsequent  injection  of 
rabies  virus  into  the  respective  limb  will  not  produce  the  dis- 
ease (Nicolas).  If,  before  the  inoculation  into  a  peripheral 
nerve,  the  spinal  cord  is  cut  through  in  its  entire  breadth,  only 
the  portion  connected  with  the  infected  nerves  up  to  the  place 
of  division  becomes  virulent,  but  not  the  part  on  the  other 
side.  The  results  of  the  inoculation  experiments  have  been  con- 
firmed by  the  histological  researches  of  Schaffer,  who  ahvays 
found  intensive  changes  in  the  portions  of  the  spinal  cord  which 
were  connected  with  the  nerves  coming  from  the  place  of  the  bite. 
If  the  disease  occasionally  develops  after  injection  into  the  blood 
stream  or  into  the  peritoneal  cavity,  the  explanation  is  that  sim- 
ultaneously a  nerve  was  also  injured. 

The  virus  which  has  reached  the  central  nervous  system, 
also  moves  in  centrifugal  direction  along  the  nerve  tracts.  Thus, 
when  the  disease  has  a  rapid  course,  the  virus  will  be  contained 
only  in  the  nerves  connected  wdth  the  place  of  infection  and 
in  the  cerebral  and  spinal  tissue,  but  when  the  course  is  slow, 
the  virus  after  a  certain  time  will  disappear  from  the  nerves 


Patlioj^eiu'sis,   Aiialoiiiical    Cliaii,i,'es.  471 

of  the  infoofod  oxtreinity,  and  reappear  in  the  nerves  of  the 
other  side  of  the  l)ody  (Roiix,  Hogyes)  undoubtedly  after  havine^ 
passed  the  involved  segment  of  the  spinal  cord.  In  the  same 
way,  proceeding  in  centrifugal  direction,  it  reaches  the  acinous 
glands  where  the  conditions  for  propagation  are  favorable; 
thus  the  tissues  of  the  salivary  glands  first  become  virulent, 
and  from  there  the  virus  invades  the  secretion  of  these  glands, 
the  saliva. 

In  the  central  nervous  system,  the  virus  exerts  its  patho- 
g-enic  effect  on  the  walls  of  the  vessels,  causing  small-celled  in- 
flammatory foci  in  the  nerve  tissues,  and  on  the  other  hand  it  at- 
tacks the  nerve  cells.  The  irritation  of  the  nerve  cells  causes  nerv- 
ous excitement,  such  as  disturbances  in  consciousness,  increased 
reflex  irritability,  and,  after  involvement  of  the  medulla  ob- 
longata, high  temperature,  pohniria,  and  diabetes.  After  a  time 
however,  tlie  degeneration  of  the  nerve  cells  leads  to  consecutive 
paralysis  atfecting  finally  the  respiratory  muscles  which  forms 
the  inunediate  cause  of  death.  The  stage  of  irritation  preceding 
the  degeneration  may  be  of  a  very  short  fluration,  and  may  be  so 
little  pronounced,  especially  in  rabbits,  that  the  disease  will  show 
symptoms  of  paralysis  apparently  from  the  start. 

The  virus  of  rabies  probably  exerts  its  pathogenic  action 
through  some  poisonous  chemical  products,  the  character  of 
which  is  yet  unknown. 

Anrep  has  produced  out  of  the  cerebral  substances  of  rabid  animals 
a-  very  poisonous,  alkaloidal  principle,  0.0003-0.0004  g.  of  which,  in- 
jected subcutaneously.  caused  lowering  of  the  temperature,  paralysis 
of  the  extremities,  salivation,  and  death  from  suffocation.  T^dranszlrv^ 
has  obtained  a  solution  from  the  medulla  oblongata,  which,  injected 
under  the  menintrcs  of  rabbits,  killed  the  animals  with  symptoms  of 
street  rabies.  Babes  observed  only  the  development  of  marasmus  after 
injecting  large  quantities  of  brain  emulsion  of  rabid  animals,  which 
had  lost  its  infectiousness  while,  according  to  Galtier,  this  substance 
heated  to  100  to  105°  C.  produced  serious  toxemia  in  sheep,  goats,  and 
dogs  (somnolence,  weakness,  paralysis).  According  to  Aujeszky,  the 
disease  in  rabbits  injected  intracranially  lasts  only  a  few  hours,  while 
in  the  experience  of  Remlinger  rabbits  injected  with  virus-free  brain 
filtrate,  succumb  sometimes  in  a  short  time  with  paralytica!  symptoms. 
(From  such  animals  the  disease  cannot  be  transmitted.) 

Very  rarely  does  the  virus  pass  from  the  female  to  the  offsprin»; 
leaving  a  few  positive  experiments  out  of  consideration  (Kolesnikow, 
Perroncito  &  Caritfi,  Loir,  Dammann  &  Ha.senkanip)  the  medulla 
oblongata  of  the  oflFspriiig  did  not  appear  virulent  (Pasteur,  Celli, 
Zagari,  Galtier,  Ratz;  Konradi  found  it  virulent  but  the  virus  therein 
was  weakened). 

Anatomical  Changes.  The  post  mortem  examination  of  an 
animal  infected  with  rabies  does  not  show  any  characteristic 
changes.  Besides  the  hanging  lower  jaw,  in  carnivorous  animals 
and  especially  in  dogs,  the  stomach  is  contracted  and  empty, 


472  Rabies. 

or  instead  of  normal  food  products,  it  contains  indigestible 
substances  such  as  straw,  liay,  pieces  of  wood  or  bones,  sand, 
stones,  hair,  feathers,  pieces  of  leather,  etc.,  the  mucous  mem- 
brane being  injected  and  swollen,  and  the  summits  of  the 
rugae  studded  with  hemorrhages  ( Jolme)  and  shallow  erosions. 
Foreign  bodies  are  occasionally  found  in  the  esophagus  (Franke) 
or  in  the  intestinal  canal  in  which  case  the  mucous  membrane 
of  the  latter  is  likewise  inflamed.  In  other  species  of  animals, 
the  stomach  is  as  a  rule  empty  or  contains  little  food.  The 
bladder  is  nearly  empty,  the  urine  as  a  rule  containing  sugar, 
and  the  blood  being  varnish-colored  and  fluid. 

Wortley  Axe  found  foreign  bodies  in  90%  of  200  rabid  dogs  on  which  he 
performed  post-mortem  examinations  during  twenty  years,  while  Galtier  in  the 
course  of  thirteen  years  found  foreign  bodies  in  only  657  cases  out  of  1,434  rabid 
animals  autopsied  (1,304  of  which  were  dogs). 

The  post-mortem  examination  may  also  show  an  acute 
catarrh  of  the  mucous  membranes  of  the  respiratory  and  diges- 
tive organs,  hyperemia  of  the  salivary  glands  and  serous  in- 
filtration of  their  connective  tissues,  hyperemia  of  liver,  spleen, 
and  kidneys  and  finally  inflammation  or  edema  of  the  cerebral 
and  spinal  meninges  as  well  of  as  the  gray  matter  of  the  brain. 

The  changes  in  the  central  nervous  system  were  the  subject  of  investigation 
some  time  ago  by  Cantani,  Zagari,  Babes,  Csokor,  Dexler,  and  others,  and  recently 
Schafifer  studied  the  subject  thoroughly  in  connection  with  six  cases  of  hydrophobia 
in  man.  In  the  segment  of  the  spinal  cord  where  the  nerves  coming  from  the 
place  of  infection  enter,  in  the  perivascular  lymph  spaces,  as  well  as  in  the  walls 
of  the  vessels  of  the  gray  matter  of  the  anterior  cornu,  in  the  vicinity  of  the 
central  canal,  and  also  along  the  connective  tissue  trabeculae  of  the  white  substance, 
Sehaffer  found  cell  infiltration,  with  either  capillary  or  larger  hemorrhages.  These 
changes  became  less  and  less  marked  anteriorly  and  posteriorly;  in  the  nerves 
passing  from  the  point  of  infection  toward  the  cord  there  was  also  an  infiltration 
of  small  cells.  In  the  nerve  cells  he  found  filirillation,  hyaline  and  vacuolar  degenera- 
tion, granular  disintegration,  and  pigmentation  atrophy  of  the  cellular  bodies;  the 
white  substance  contained  numerous  amyloid  granules.  In  the  medulla  oblongata, 
innnediately  below  the  floor  of  the  fourth  ventricle,  and  especially  around  the 
origin  of  the  12th,  10th,  and  7th  pairs  of  nerves,  there  were  noted  pronounced 
hj^ieremia,  perivascular  cell  infiltration,  and  small  hemorrhages,  while  the  nerve 
cells  showed  signs  of  degeneration.  In  the  brain  no  changes  of  importance  were 
found,  as  a  rule,  excepting  hyperemia,  slight  cellular  infiltration,  and  rarely  capil- 
lary hemorrhages. 

Csokor  and  Dexler  ascribe  great  diagnostic  importance  to  the  small  scattered 
foci  of  inflammation  in  the  brain,  and  to  the  small  cellular  leucocytic  infiltration 
of  the  perivascular  Ijmiph  sjiaces  as  constant  lesions  of  rallies.  Trolldenier,  how- 
ever, concluded  after  the  examination  of  52  cases,  that  these  lesions  are  absent 
in  the  brain  and  still  more  in  the  medulla  oblongata  (in  the  latter  in  60%  of 
the  cases),  and  that,  on  the  other  hand,  they  may  be  found  in  the  nervous  system 
of  dogs  suffering  from  distemjier  and  cancer. 

Van  Gehuchten  and  Nelis  found  in  the  eerebro-spinal  ganglia  and  those  of 
the  sympathetic  nerve,  but  especially  in  the  plexus  nodosus  vagi  as  well  as  in 
the  upper  cervical  ganglia  of  the  sympathicus,  a  cellular  infiltration  of  the  interstices, 
which  later  causes  the  sensitive  nerve  cells  themselves  to  degenerate  and  atrophy,  aiid 
in  their  ]ilace,  inside  of  the  inspisated  endothelial  capsule,  there  appear  endothelial 
and  small  round  cells  (Fig.  74).  In  many  cases  the  ganglion  consists  exclusively 
of  dense  connective  tissue  infiltrated  with  small  cells,  only  once  in  a  while  atrophied 
nerve  cells  being  observed.  These  changes  are  most  marked  in  the  ganglia  of  rabid 
dogs,  and  less  so  in  those  of  rabbits  and  of  human  beings. 

In  the  salivary  glands  Elsenberg  and  Kossjokow  have  demonstrated  celhdar 
infiltration  of  the  interacinous  connective  tissue,  and  partly  also  of  the  acini,  as 
well  as  granular  fatty  degeneration  of  tlie  glandular  cells. 


Aiuilniiiicnl  ( 'luin^cs,  Syinpldiiis.  ^JQ 

Af^oording  to  Kolesiiikoff  and  Bahes,  tlit'ie  exists  in  flic  ininicliatc  ncit,dil(or- 
hood  of  the  motor  center  of  the  medulla  oblongata  and  the  motor  cells  of  the 
spinal  cord,  an  accumnlation  of  small  ronnd  cells,  whidi  also  invade  the  j.Iasma  of 
Hie  nerve  cells  and  eanse  dej^eneration  and  atrophy.  lialies  considers  these  foci 
as  ciiaracteristic  of  rabies  (rabic  tubercles)  as  tliey  were  i)resent  in  .■!S'.)  cases  of 
rabies  and  absent  in  35  otiier  cases.  Init,  according  to  Bohl,  such  changes  are 
sometimes  also  found  in  cases  of  distemper. 

Symptoms.     The 
l»orio(L    of    iiK'uha- 
tioii  of  rabies  after 
a  natural  infeetioii 
is     ,<;•(' lie  rally 
eral    weeks, 
may     exteiu 
some  montlis. 
duration     is 
flneneed  by  the  vir- 
ulence of  the  virus, 
the  distance  of  the 
place   of   infection 
from    the    central 
nervous   system, 
and  the  age  of  the 
animal.     Generally 
the  lirst  s^^nptoms 
appear  2  to  8  weeks 
after     the     bite; 
sometimes,  how- 
ever, they  occur  as 
early  as  the  end  of 
the  second  Aveek  or 

again  only  after  several  months  and  as  late  as  1  to  2  years. 
In_  dogs  and  swine  the  period  of  incubation  is  generally 
brief  (frequently  only  10  to  15  days)  ;  in  horses  and  cattle  it  is 
longer  (mostly  1  to  3  months).  The  disease  develops  earlier 
in  young  animals  than  in  old  ones. 


.  - '" "  ^*"''=^-^^*^>%X. 


Fig.  74.     Rabies.      Cervical  ganglion  of   a  dog  atl'ected 

with  rabies.     The  nerve  cells  are  jKirtly  atroj)]ii('d.  and  in 

tlieir  place  clumps  of  round  cells  a]j])('ar.     (After  Van 

Gehuchteu  &  Xelis). 


Concerning  tlie  duration  of  tlie  period  of  iiiculiation,  Bouley,  llanbner,  and 
Ziindel  have  gathered  numerous  statistical  data.  According  to  a  compilation  by 
Roll,  the  periods  of  incubation  were  as  follows:  Dogs:  according  to  Bouley  (144 
cases)  in  43%  less  than  30  days,  in  40%  between  30  and  60,  in  14%,  between  "tiO  and 
90  days,  and  in  3%  between  4  and  12  months.  Acconiing  to  Haubner  (out  of  1*00 
dogs)  in  83%  less  than  2  months,  in  16%  9  to  12  weeks,  in  1%-  13  to  16  weeks, 
and  in  only  a  few  7,  S,  and  24  months.  Horses:  According  to  Bouley  (out  of  23 
horses)  in  1  more  than  1  month,  in  11  from  21,4  to  3  months,  in  3  more  than  100 
days;  according  to  Ziindel  (out  of  121  cases)  in  28%  less  than  1,  in  46%  less 
than  2,  in  9%  less  tlian  3  months,  and  in  the  rest  more  than  3  months.  Cattle: 
According  to  Ziindel  (out  of  .179  animals),  in  5%  less  than  15  davs,  in  23%  15 
to  30.  in  39%  30  to  45,  in  13%,  45  to  60  days,  in  17%  3  to  6  months,  and  in 
1  case  each  42  and  95  weeks;  according  to  Hauber  (out  of  234  cases),  in  S2% 
less  than  3  months,  and  in  18%  4  to  9  months.  Sheep  and  Goats:  According 
to  Ziindel  (out  of  188  sheep),  in  6%  less  than  15  davs,  in  41%  15  to  21,  in  10% 
21  to  30,  in  26%  30  to  45,  in  2%  45  to  60  davs,  and  in  7%  still  longer.  Out  of 
20  goats,  in  15%'  less  than  20,  in  60%  20  to  60  days,  and  in  25%  longer. 
Swine:  According  to  Ziindel  (out  of  123  hogs),  in  3%' less  than  8  (?),  in  8% 
8  to  15,  in  51%  15  to  30,  in  27%  30  to  60  days,  and  in  11%,  still  longer.  According 
to    the    observations    of   the   official    Prussian    veterinarian,    the    average    period    of 


474  Rabies. 

incubation  is:  in  horses  46i/l>,  in  cattle  70,  in  dogs  22,  in  swine  26,  in  goats  14, 
and  in  slieep  2(ji^  days.  Finally,  Schiider  found  out  of  395  carefully  observed 
cases  of  rabies  21   (5.3%)   where  the  period  of  incubation  was  3  to  7  months. 

Unusually  long  periods  of  incubation  have  been  observed:  in  horses,  by 
Saikowitsch  17  months,  by  Yirag  18,  Cosswinter  20,  Bahr  21,  Swain  25  months; 
in  cattle,  by  Szabo  323  days  (bite  in  the  snout),  Mieckeley  327  days,  Leipert  19 
months  and  21  days,  and  by  Kalt  23  months.  The  reports  relating  to  periods  of 
more  than  2  years,  however,  must  be  accepted  with  reservation,  as  a  new  infection 
may  have  occurred  in  the  meantime. 

After  artificial  infection,  dogs  develop  the  disease  13  to  19  days  after  sub- 
cutaneous injection,  10  to  15  days  after  sulxlural  injection;  rabbits  show  symptoms 
12  to  21  days  after  subdural  injection,  but  in  exceptional  cases  later,  occasionally 
only  after  43  days.  After  a  series  of  inoculations,  the  period  of  incubation  following 
the  subdural  injection  may  be  shortened  to  5  days   (see  protective  vaccination). 

The  clinical  picture  of  rabies  is  on  tlie  whole  the  same 
in  the  various  species  of  animals,  and  the  only  variations 
observed  are  owing  to  the  fact  that  the  sjmiptoms  are  more 
or  less  subject  to  modifications  in  accordance  with  the  individual 
temperament  and  the  physical  structure  of  the  animal. 

Rabies  in  Dogs.  At  the  initial  stage  of  the  disease  (stadium 
prodromorum  or  melancholicum),  the  animals  show  a  peculiar 
change  in  behavior,  Avhich,  particularly  in  house  dogs  and  with 
the  so-called  "dumb  rabies,"  is  so  inconspicuous  that  it  is 
completely  overlooked,  and  the  owners  associate  with  them  as 
usual  without  suspecting  anything.  Most  dogs  become  capri- 
cious ;  they  are  at  times  irritable  and  gloomy,  and  avoid  all 
noise,  hiding  in  dark  places  under  or  behind  furniture,  in  a 
dark  corner  of  the  room,  or  in  the  stable.  They  obey  the  call 
of  their  master  very  unwillingly,  but  then  jump  about  and  fawn 
on  him  even  more  markedly  than  usual.  In  other  cases  they 
show  a  remarkable  uneasiness,  scratch  with  the  fore  feet,  fre- 
quently change  their  place  of  rest,  walking  uneasily  around  in 
the  yard  or  in  the  room,  suddenly  stopping,  becoming  attentive, 
and  without  any  cause  barking  and  biting  at  the  air  (so  called 
** fly-catching").  If  resting  on  the  ground,  they  frequently 
become  startled  and  attempt  to  catch  imaginary  flies,  growling 
at  the  same  time. 

The  reflex  excitability  is  in  this  stage  already  decidedly 
increased.  This  is  shown  by  the  fact  that  the  animals  when 
approached  in  a  friendly  way,  and  still  more  when  teased, 
become  excited  and  snap  at  the  caressing  hand  and  any  other 
objects  or  their  companions.  This  excitability  is  particularly 
conspicuous  toward  strange  persons  and  dogs,  even  when  they 
are  still  friendly  and  familiar  with  their  habitual  attendants. 
The  reflex  excitability  is  still  more  noticeable  in  that  the  pa- 
tients become  startled  or  jump  up  frightened  even  on  slight 
external  causes,  such  as  a  strong  light,  sudden  noises,  touching 
of  the  body,  etc.  During  such  paroxysms  there  are  also  ob- 
served sudden  but  very  transitory  respiratory  disturbances, 
spasm  of  the  diaphragm  and  dilatation  of  the  pupils.  Many 
dogs  scratch  and  gnaw  or  bite  at  the  place  of  infection  or  the 
cicatrix  formed  there. 


Rabifs  ill    Doirs.  475 

At  tlic  same  tiiiK',  a  ])arti('nlar  cliaii.uv  oi'  appetite  or  taste 
is  observed,  as  the  animals  searceiy  toiicli  their  favorite  food 
or  let  it  drop  a^-aiii  after  liavin.i;-  it  in  the  mouth.  Later  they 
reject  all  food,  altlioni>-h  they  will  chew  all  objects  within  their 
reach,  also  tluMr  own  excrements,  and  swallow  them,  if  possible. 
It  mav  then  be  noticed  that  the  patients  swallow  with  oroater 
difficuitv  stretchino-  the  neck  forward  in  swallowini;:,  allowini,' 
the  food  to  fall  out  of  the  mouth,  and  sliowini;-  a  desire  to  vomit 
or  actuallv  do  vomit.  At  the  same  time,  the  patients  repeatedly 
seek  water,  but  in  spite  of  all  exertions  they  can  swallow  small 
amounts  of  it  only  with  difficulty. 

Sometimes  there  is  also  trouble  with  the  voidin.<>-  of  ex- 
crement and  urine,  the  animals  frequently  attempting  it  but 
with  little  or  no  results.  Besides,  they  continually  lick  their 
own  o-onitals  or  those  of  other  do,i>-s  and  otherwise  show  an 
increased  sexual  desire. 

By  this  time  salivation  exists,  which  symptom  subsequently 
becomes  more  and  more  marked. 

In  the  second  stage  (stadium  excitationis  or  acmes)  which 
develops  in  i/.  to  3  days,  the  described  symptoms  attain  a  higher 
degree  and  the  unrest  and  excitement,  probably  nnder  the  in- 
fluence of  hallucinations,  increase  to  a  violent  rage.  It  is  now 
particularlv  observed  that  the  dogs  frequently  lick  the  earth 
furiously,  chew  any  objects  they  find,  tear  them  to  pieces,  and 
swallow"them  eagerly.  They  want  to  get  away  from  their  usual 
quarters;  if  shut  npin  a  room,  they  show  this  desire  by  stand- 
ing near  and  scratching  at  the  door;  if  tied,  they  try  to  break 
their  chains ;  if  in  a  cage,  they  try  to  bite  the  walls  and  bars. 
Once  escaped,  they  will  run  aimlessly  around,  and  sometimes 
cover  long  distances  without  resting.  They  scarcely  ever  re- 
turn to  their  homes,  but  if  they  do  happen  to  conie  back,  they 
are  usually  exhausted,  covered  with  wounds  of  bites,  and  with 
hair  disheveled.  For  a  while  they  crawl  about  dejectedly  fearing 
punishment  and  fawning  upon  their  master,  or  exhausted  hide 
awa^'  and  rest.  If  the  rabid  animals  on  their  journey  encounter 
other  dogs,  they  will  attack  them  without  cause  or  noise,  and,  if 
possible,  bite  tliem  in  the  head  (healthy  dogs  running  around  in 
strange  places  are  mostly  scared  and  run  away  from  other  dogs). 
If  the  attacked  dog  runs  away  in  fright,  the  diseased  animal  will 
continue  its  journey,  but  if  it  resists,  the  rabid  dog  will  fight  furi- 
ouslv,  and  il:  will  be  observed  that,  while  the  attacked  dog  howls, 
snarls,  and  barks,  the  diseased  animal  Avill  hardly  emit  a  sound. 
The  desire  to  bite  and  the  aggressive  behavior,  are  shown  toward 
other  species,  particularly  small  animals  though  less  conspicu- 
ously, and  in  a  herd  of  sheep  or  swine  a  rabid  dog  mav  in  a  brief 
time  wound  many  animals.  Human  beings  are  less  in  danger, 
as  rabid  dogs  mostly  avoid  them  and  as  a  rule  only  attack  them 
when  irritated  or  excited  by  threats. 

In    dogs    shut   up    in   cages    rabies   generally   appears   in 


476 


Kabiet 


paroxysms.  The  dog,  liis  eyes  bloodshot,  jumps  sidewise 
against  the  bars  and  grabs  them  between  his  teeth  with  such 
violence  that  one  or  more  teeth  are  broken;  or  he  takes  the 
straw  on  the  floor,  the  excrement  or  any  other  object,  and 
shakes  it  furiously  around,  always  without  barking  or  growling. 
If  approached  with  a  stick  or  a  bar  and  teased,  the  dog  will  make 
a  mad  attack,  hold  the  stick  or  bar  between  its  teeth,  and  shake 
it.  The  nature  of  the  object  held  out  is  absolutely  immaterial, 
as  the  dog  will  bite  red  hot  iron  or  burning  coal  without  hesita- 
tion. Some  animals  even  bite  their  own  bodies  and  tear  the  flesh 
to  the  bone. 

Such  attacks  of  rage  are  interrupted  by  shorter  or  longer 
periods  of  depression.  After  an  animal  has  been  wandering 
aimlessly  around  for  a  time  or,  if  shut  up,  has  been  raging, 
it  finally  falls  down  exhausted  and  remains  unconscious  on 
the  floor  breathing  with  difficulty.  Soon  it  will  rise,  remain 
standing  at  one  place  with  staring  eyes,  dilated  pupils,  and 
a  peculiarly  changed  expression  of  the  face  indicating  cunning 
and  fright  (Fig.  75  and  76),  until,  owing  to  some  outside  in- 
fluence, such  as  the  sight  of  other  animals  or  some  object,  but 
sometimes  without  any  visible  cause,  the  attack  breaks  out 
anew. 

In  this  stage,  as  a 
rule,  symptoms  of  par- 
alysis of  some  of  the 
nerves  appear.  Most 
conspicuous  is  the  pe- 
culiar change  in  voice 
owing  to  a  paralysis 
of  the  laryngeal 
nerves  or  muscles, 
which  causes  the  bark 
to  become  hoarse  and 
double  and  accompa- 
nied by  loud,  long 
drawn  howls.  This 
hoarse  barking,  which 
is  so  characteristic 
that  the  trained  ear 
may  suspect  a  case  of 
rabies  from  it  alone, 
is  emitted  frequently 
by  many  dogs,  by  oth- 
ers only  wdien  they 
are  excited.  Swallowing  becomes  very  difficult  owing  to  the 
progressive  inflammation,  and  later  to  the  degeneration  of  the 
lltli  and  12th  pair  of  nerves.  The  regular  food  is  wholly 
rejected,  and  the  animal  is  at-  the  best  al)le  to  swallow  only 
small  amounts  of  Avater  with  difficulty.  These  exertions,  some- 
times even  taking  an  object  in  the  mouth,  may  produce  violent 


Fig.  75.  Rahies.  Characteristic  peculiar  watchful 
and  disturbed  expression  of  the  face,  with  an  out- 
ward position  of  the  eyes ;  at  the  same  time 
paralysis  of  the  masticatory  muscles. 


Rabies  ill  I)n<>s. 


I  i 


altacks  of  suffocation  and  cncii  a  rahics  j)aroxysiu  by  reflex 
action  from  tlie  imieons  inemhrane  of  the  moiitli  and  tliroat. 
Therefore,  animals  tlms  affected  do  not  touch  foo<l  or  water 
at  alL  In  rare  cases,  tlie  mere  offer  of  water  is  sufficient  to 
cause  an  attack  (hence  the  term  liydropliohia),  wliicli  is  only 
the  result  of  the  diflicnlty  in  swallowing,  and,  on  the  whole,  is 
oidy  observed  in  a  portion  of  the  cases. 

At  this  sta.^-e,  salivation  increases,  partly  because  of  the 
more  abundant  secretion  of  saliva,  and  partly  owin,2:  to  the 
existing'  difiicnlties  in  swallowing*-.  Difficulty  in  defecation  and 
urination  is  also  frequently  observed. 


IBb. 


i'i-. 


A'.     The  saiiif  cIol;  as  iii  !•  i^:".  7-'). 


As  an  oxtraoi'dinary  syinptoiu,  Nicolas  ol)scrv('d  spasmodic  move- 
ments at  this  stage  (pushing  forward  and  moving  in  circles)  iu  3  dogs, 
and  also  in  a  goat  that  had  been  infected  intraocularly. 

The  stage  of  irritation  generally  lasts  3  to  4  days  and 
is  then  followed  by  the  paralytic  stage  (stadium  paralyseos  or 
depressionis).  The  attacks  of  rage  become  less  violent  and 
also  less  frequent,  but  in  the  meantime  s>niiptoms  of  insensi- 
bility and  dullness  may  appear.  As  a  result  the  symptoms 
of  an  already  existing  paralysis  become  more  conspicuous,  and 
other  parts  of  the  body  may  also  become  paralyzed. 

As  the  changes  in  the  medulla  and  cranial  nerves  already 


478  Rabies. 

mentioned  also  affect  the  other  nerves,  there  develops  besides 
total  aphony  and  inability  to  swalloAv,  a  partial  and  shortly 
a  total  paralysis  of  the  muscles  of  the  lower  jaw,  tongne,  and 
eyes.  The  mouth  is  kept  open  most,  if  not  all  the  time,  the 
dry  and  livid  tongue  hangs  out  of  the  mouth  paralyzed,  and 
the  saliva  flows  in  long  threads  from  the  lips.  Owing  to  the 
irregular  position  of  the  eyes  the  animals  squint,  the  cornea 
is  dull  and  lusterless  and  the  pupils  are  dilated.  These  symp- 
toms give  the  face  a  peculiar  cunning  and  troubled  expression 
(Fig.  75  and  76). 

Owing  to  the  process  of  degeneration  in  the  spinal  cord, 
paralysis  of  the  muscles  of  the  tail  and  the  extremities  appears. 
The  hind  limbs  are  generally  first  attacked,  which  causes  the 
animal  to  stagger  and  tumble,  at  first  when  running  and  later 
when  walking,  and  to  drag  the  hind  legs  along  the  ground.  The 
paralysis  then  progresses  to  the  tail,  which  hangs  down  between 
the  legs.  The  paralysis  of  the  hind  limbs  finally  reaches  a 
stage  which  makes  it  impossible  for  the  animals  to  move  and 
they  remain  recumbent  on  the  ground ;  if  urged  to .  rise  they 
will  make  only  a  few  fruitless  attempts  with  the  fore  legs. 

Before  the  disease  has  reached  this  stage,  the  animals 
are  already  quite  emaciated;  the  exhaustion  now  increases 
rapidly,  and  the  patients  succumb  within  a  brief  time,  usually 
in  convulsions. 

Omng  to  the  danger  connected  with  intimate  association 
with  the  animals  little  is  known  of  those  symptoms  which  can 
only  be  determined  by  a  close  examination.  As  to  the  tem- 
perature, Hertwig  and  Monin  have  found  that  it  rises  1  to  3 
degrees  during  the  maniacal  stage,  but  that  during  the  paralytic 
stage  it  falls  down  to  several  degrees  below  normal.  The  pulse 
is  rapid  and  tense  from  the  beginning  (Blaine).  In  the  blood 
the  polynuclear  leucocytes  are  multiplied,  and  the  hyperleuco- 
cytosis  increases  toward  the  end  of  the  disease  (Courmont  and 
Lesieur).  The  urine  usually  contains  sugar  (Nocard;  Rabieaux 
&  Nicolas  found  sugar  in  the  urine  in  33  out  of  44  examined 
cases). 

In  artifieially  infected  dogs  the  temperature  is  increased  during  the  initial 
stage  for  V2  to  3  days,  but  afterwards  it  is  low;  in  rabbits  infected  with  street 
rabies  on  the  contrary  the  temperature  commences  to  fall  at  the  onset  of  the  disease 
and  continues  thus  until  the  death  of  the  animal  (Lote).  In  human  beings,  the 
symptoms  of  the  stage  of  irritation  are  accompanied  by  a  moderate  rise  in  tem- 
perature, with  morning  and  evening  remissions,  but  before  death  the  temperature 
becomes  very  high  and  may  continue  to  be  high  for  some  time  after  death 
Moravcsik,  Schaffer). 

The  described  clinical  picture  of  rabies  in  dogs  is  in  some 
cases  subject  to  considerable  modification.  Above  all,  varia- 
tions occur  in  the  duration  of  the  various  stages  and  in  their 
mutual  relations,  the  several  stages  being  briefer  than  here 
stated,  or  longer  at  the  expense  of  the  others.  This  is  especially 
true  of  the  second  stage,  that  of  irritation,  which  is  often  very 


Raljij's  ill    ("nts  ami    in    TTMtx<";.  ^JC) 

short  and  iiulicatod  ])y  fow  coiis))ieii()iis  symptoms  of  excite- 
ment; then  not  infrequently  the  mekincholic  stage  is  followed 
almost  without  interrni)tion  by  the  paralytic  symptoms,  particu- 
larly paralysis  of  the  muscles  of  the  jaw  and  throat,  to  which 
is  then  added  the  paralysis  of  the  hind  parts  of  the  l)ody.  This 
form  of  the  disease,  during-  the  course  of  which  most  patients 
are  weak  from  the  he.ginning-  and  neither  bark  nor  bite,  and 
which  is  o-enorally  fatal  in  3  to  4  days,  is  usually  called  dumb 
rabies  in  contrast  to  the  typical  violent  rabies. 

The  cause  of  the  differences  in  the  course  of  the  disease  is  not 
exactly  known,  but  it  seems  in  some  way  to  be  connected  with  the 
species  and  earlier  life  of  the  animals.  Experience  teaches  that  symp- 
toms of  violent  excitement  are  particularly  observed  in  biting  dogs 
of  a  lively  temperament  living  in  the  open,  while  gentle  house  dogs, 
in  which  aggressiveness  and  the  desire  to  bite  appear  more  rarely  and 
less  conspicuously,  are  attacked  more  frequently  by  duml)  rabies  (accord- 
ing to  Hjortland,  in  Greenland  the  disease  nearly  always  assumes  the 
form  of  duml)  ral)ies). 

Rabies  in  cats  shows  the  same  symptoms  as  in  do.ii-s,  but, 
these  animals  being  of  a  less  confiding  nature,  generally  seek 
dark  corners  in  the  beginning  of  the  disease  and  do  not  leave 
them  any  more  or  they  show  by  continuous  mewing  a  more 
aggressive  behavior  and  a  desire  to  escape.  Then  they  attack 
both  persons  and  animals,  including  dogs,  Avhich  come  in  their 
way,  jumping  at  their  faces  or  biting  their  legs  from  behind, 
inflicting  severe  wounds  with  their  teeth  and  claws.  Ainslie 
observed  in  one  case  that  the  cat  jumped  at  objects  held  before 
it,  did  not  lap  water,  but  was  attacked  with  violent  spasms 
when  sprinkled  with  water.  Later  the  voice  becomes  hoarse 
with  a  peculiar  howling  tone  owing  to  paralysis  of  the  vocal 
cords,  and  2  to  4  days  after  the  appearance  of  the  first  s^inp- 
toms,  paralysis  of  the  hind  parts  appears. 

In  artificially  infected  cats,  Dammann  and  Hasenkamp  first  ob- 
served great  unrest,  fright  and  a  desire  to  take  hold  of  strange  objects; 
later  the  movements  became  staggering,  and  finally  total  paralysis  of 
the  hind  extremities  ai)peared  (but  not  of  the  mas.seter  muscles  or 
the  constrictor  muscles  of  the  anus  or  bladder).  In  the  lieginning  very 
little  water  and  no  food  was  consumed;  the  animals  bit  furiously  at 
a  stick  held  before  them  mewing  and  spitting  at  the  same  time,  and 
when  sprinkler!  Avith  water  they  fell  into  violent  convulsions. 

In  horses,  the  increased  sensitiveness  of  the  scar  formed  at 
the  point  of  infection  (mostly  the  lips,  nostrils  or  front  extrem- 
ities) often  gives  the  first  indication  of  the  beginning  disease. 
The  animals  gnaw  at  the  site  of  the  bite  on  the  body  or  rub  it 
against  objects,  which  behavior  in  otherwise  quiet  horses,  par- 
ticularly if  they  have  been  bitten  several  weeks  previously  by  a 
dog,  arouses  a  reasonable  suspicion  of  an  approaching  attack  of 
rabies.    The  increased  reflex  excitability  is  also  indicated  early 


480  Rabies 

b}^  fright  and  unrest,  wliicli  appear  on  the  slightest  provocation. 
They  change  their  position  every  moment,  i)aw  with  their 
feet,  gnaw  at  the  manger  and  other  objects  near  them,  and 
show  staring,  restless  eyes  with  dilated  pupils;  at  times,  they 
draw  the  lips  convulsively  up  and  backward  so  that  the  teeth 
are  visible,  while  foamy  saliva  runs  from  the  corners  of  the 
mouth. 

With  increasing  restlessness  some  horses  also  show  an  ag- 
gressive behavior  toward  other  horses  or  human  beings,  and 
still  more  toward  dogs,  which  they  attempt  to  bite  and  kick. 
They  will  furiously  attack  a  stick  held  before  them,  and  some- 
times in  biting  the  manger  will  sliow^  strength  enough  to  break 
several  teeth  and  even  the  neck  of  the  inferior  maxillary  bone. 
Many  patients  do  not  spare  their  own  bodies,  but  tear  off  large 
pieces  of  the  skin ;  as  a  rule,  however,  such  rage  is  laof:  observed. 
More  frequently  attacks  of  spasms  lasting  1  to  2  minutes  are 
observed  in  the  masseter  and  respiratory  muscle;!.  Further 
the  appearance  of  increased  sexual  desire  causes  male  animals 
to  have  erections  and  to  eject  semen  involuntarily,  while  mares 
behave  as  when  in  heat;  in  connection  herewith  is  also  observed 
a  frequent  desire  to  urinate.  (Gohre  once  found  a  temperature 
of  39.3°  C.) 

Soon  the  symptoms  of  paralysis  become  marked,  first  in  the 
region  of  the  nerves  originating  from  the  medulla  oblongata.  On 
this  account  swallowing  is  difficult  and  liquids  are  returned  from 
the  mouth  through  the  nostrils.  Owing  to  the  change  of  taste, 
the  animals  eat  nothing  or  at  best  only  indigestible  substances, 
sometimes  even  their  own  excrements.  They  will  smell  of  the 
water  offered  them,  but  will  not  drink  it,  and  with  raised  head 
draw  the  lips  upward  as  if  attempting  to  yawn.  When  neigh- 
ing-, a  hoarseness  of  the  voice  is  observed. 

Later  the  symptoms  of  excitement  liecome  less  frequent  and 
less  severe,  while  indications  of  severe  paralysis  develop,  as  a 
result  of  which  the  patients  fall  to  the  ground  and  finally  suc- 
cumb on  the  3rd  or  4tli  day  of  the  disease,  in  most  cases  with 
violent  convulsions. 

Darmagnac  observed  ascending  paresis  in  one  case  4  months  after 
a  bite  in  one  of  the  hind  legs.  First  there  was  paresis  of  the  same 
extremity,  then  paraparesis  with  hyperesthesia  of  the  hind  quarters, 
and  finally,  paralysis  of  the  muscles  of  deglutition;  the  animal  died 
after  3  days  of  sickness. 

Cattle  also  show  unrest  and  excitement  as  well  as  an  aggres- 
sive tendency,  which  behavior,  so  uncommon  except  in  cattle 
raised  in  the  open,  at  once  attracts  the  attention  of  the  attendant. 
In  such  cases  the  animals  remain  standing  at  one  place,  at  times 
drawing  the  upper  lip  backward,  tearing  up  the  earth  with  feet 
and  horns,  looking-  around  with  the  head  high,  the  eyes  wild  or 
staring,  and  finally  furiously  attacking  the  other  animals  of  the 


Rnl)i.'s  ill    Cattle.  4ftX 

herd  and  vvvn  liiiniaii  Ix'iiig-s,  but  particularly  dogs  which  ha])- 
pen  to  be  near.  Animals  tied  in  the  stable  attempt  to  ^et  loose 
from  tlio  chains,  jump  np  suddenly  from  their  rostinu'  place, 
shake  the  hoa<l,  rise  on  the  hind  legs,  l)ito  at  and  oliml)  into  the 
manger  and  run  the  head  against  the  wall  sometimes  with 
enough  force  to  break  the  horns.  Such  outbreaks  of  rage  are 
interrn])ted  by  nearly  normal  pauses  and  are  then  repeated  at 
first  every  20  to  30  minutes,  but  later  at  increasingly  longer 
intervals. 

The  other  symptoms  are  similar  to  those  in  other  animals: 
the  increased  reflex  excitability,  licking  or  biting  the  place 
of  the  bite  or  its  scar,  hoarseness,  sometimes  rapid  bellowing 
which  the  animals  may  emit  for  hours  without  interruption,  sali- 
vation and  foaming,  gritting  of  the  teeth,  difficulty  in  swallow- 
ing, loss  of  appetite,  bloating  (owing  to  the  paralysis  of  the 
intestinal  mnscles  ?),  cessation  of  rumination,  constipation  with 
following  diarrhea  and  tenesmus,  drying  up  of  the  milk,  convul- 
sions in  some  gronps  of  muscles  (throngh  spasmodic  convulsions 
of  the  muscles  of  the  neck  the  head  is  sometimes  turned  to  one 
side),  increased  sexual  desire,  tenderness  of  the  nrethra  on 
pressure  through  the  rectum  (Bezaguet),  sugar  in  the  urine 
(Xocard,  Nicolas,  and  Eabieaux),  rapid  emaciation,  exhaustion, 
and  extended  paralysis,  until  linally  the  animal  succumbs  on  the 
3rd  to  6tli  day  of  its  illness.  Similar  symptoms  have  also  been 
observed  in  buffaloes  (Esser). 

In  other  cases  the  s^^nptoms  of  irritation  are  only  slightly 
marked  or  entirely  absent,  but  there  appear  instead  early  weak- 
ness of  the  hind  extremities  and  marked  downward  curving  of 
the  spine,  accompanied  by  moderate  bloating,  difficulty  in  swal- 
lowing, and  constipation.  In  walking  or  in  raising  the  head  the 
animals  fall  down  readily,  and  then  kick  with  their  feet,  they 
breathe  laboriously  and  discharge  foamy  saliva  from  the  mouth: 
standing  up  they  emit  a  painful  bellowing,  move  stiffly,  smell  at 
the  hay  and  drinking  water  but  consume  nothing  or  let  the 
water  run  out  again  through  the  mouth  or  the  nose,  while  they 
make  constant  movements  of  mastication.  The  next  day  they 
lie  groaning  on  their  chest  or  with  the  head  resting  on  the 
shoulder,  while  spasmodic  convulsions  appear  in  the  diaphragm 
and  in  other  groups  of  muscles,  and  death  follows  mostly  at  the 
end  of  the  first  week  with  symptoms  of  bulbar  paralysis  and 
rapid  lowering  of  the  temperature. 

Xessl  observed  0  cases  of  rabies  in  cattle  which  were  conspicuous 
by  the  fact  that  the  initial  symptom  was  vomiting  while  the  typical 
paralytic  symptoms  were  absent.  Heks  saw  in  cows  a  tendency  to 
press  against  objects  and  to  inove  around  in  a  circle. 

Intermittent  rabies  was  observed  by  Galtier  in  two  dogs  and  by 
Lignieres  in  one.  Following  the  first  attack  there  was  a  remarkable  im- 
provement, but  after  36,  27  and  28  days  respectively,  a  considerable 
change  for  the  worse  occurred  Avith  fatal  results. 

Vol.  1-31 


482  "        Rabies. 

In  sheep  and  goats  rabies  appears  with  quite  similar  sj^np- 
toms,  except  that  the  stage  of  irritation  is  often  absent  or  of 
very  brief  duration.  If  such  a  stage  develops,  the  unrest  (stamp- 
ing with  one  front  foot,  running  to  and  fro,  climbing  the  wall 
of  the  stable  or  the  fence,  etc.)  and  aggressive  behavior  toward 
their  herd  mates  or  toward  dogs  are  the  more  remarkable  in 
sheep  as  these  animals  otherwise  are  shy  and  easily  scared.  In 
goats  the  symptoms  of  irritation  are  always  more  violent ;  they 
become  very  uneasy  and  pugnacious,  run  against  the  walls,  other 
objects,  animals,  and  persons.  Female  animals  butt  and  bite 
their  own  kids,  while  in  bucks  a  remarkably  increased  sexual 
desire  is  observed.  In  goats  sugar  has  been  found  in  the  urine 
(Porcher). 

The  disease  usually  lasts  from  3  to  5  days  and  ends  with 
symptoms  of  paralysis. 

In  swine  the  affection  begins  nearly  always  with  very  de- 
cided symptoms  of  irritation.  The  animals  run  around  in  all 
directions,  grunt  hoarsely,  root  the  litter  and  the  earth,  gnaw 
and  rub  the  site  of  the  bite,  then  hide  under  litter  and  remain 
quiet  for  a  while  or  continue  to  grunt  while  lying  down.  If  they 
are  aroused  by  a  noise  or  when  touched,  they  jump  up  and  run 
aimlessly  around,  attacking  other  swine,  their  own  young,  other 
animals,  and  even  human  beings.  While  rooting,  they  swallow 
various  substances  and  saliva  runs  in  abundance  from  the 
mouth.  They  seek  water,  but  can  only  drink  with  difficulty. 
Young  pigs  sometimes  fall  down  while  running  around,  kneel 
on  their  front  legs,  lay  the  neck  on  the  ground,  and,  in  this  posi- 
tion, push  their  bodies  in  a  straight  line  25  or  30  feet  forward  or 
move  around  in  circles  in  this  same  position  (Papp). 

The  other  s3aiiptoms  are,  on  the  Avhole,  similar  to  those  in 
dogs.  After  the  appearance  of  paralysis,  the  animal  succumbs 
on  the  2nd  to  4th  day  of  the  disease,  but  sometimes  on  the  first 
day. 

According  to  observations  of  veterinarians  (Ziirn,  Gibier) 
the  disease  begins  in  fowl  also  with  conspicuous  fright  and 
unrest,  when  the  animals  run  around  with  ruffled  feathers, 
frightened  look,  and  hoarse  cries,  and  attack  the  healthy  birds, 
other  animals,  and  also  human  beings  with  their  beaks  and 
claws,  until  they  finally  succumb  after  2  to  3  days  with  symp- 
toms of  paralysis. 

After  intracranial  injection,  Galtier,  Pasteur  and  Lote  observed 
only  dullness  and  paresis  of  the  feet  and  neck,  when  the  animals  would 
awkwardly  pick  up  grains  of  corn  and  with  staggering  gait  would  now 
and  then  tumble  down.  In  the  course  of  the  disease  improvement 
was  often  observed  and  the  infected  birds  not  infrequently  recovered. 

Course  and  Prognosis.  The  disease  generally  has  a  course 
of  4  to  7  days ;  in  some  cases  it  last  only  3  days,  but  in  excep- 
tional cases  may  last  11  to  13  days  (Nicolas). 

The  duration  of  the  various  stages  and  their  mutual  rela- 
tion, leaving  out  of  consideration  the  fact  that  they  cannot  be 


Course   ;iii(l    I'lounosis.  4g3 

(lefiiied  oxaetly,  ai)])C'ar  unlike  in  dilTcriMit  cases.  Increased 
excital)ility  is  also  i)i-esent  in  the  iirst  stage,  and  most  of  the 
symptoms  diTfer  only  in  intensity  from  those  of  the  second 
staii-e.  In  the  latter  stai-e  the  desire  to  bite  and  the  ag-gressive 
condnct,  ^vhen  these  sym])tonis  are  present,  are  the  most  charac- 
teristic. Just  as  indistinct  is  tlie  transition  from  the  second 
to  the  third  stage  since,  on  the  one  hand,  partial  paralysis 
may  be  apparent  in  the  stage  of  irritation  and,  on  the  other 
hand,  sym])tonis  of  irritation,  and  ])articnlarly  cases  of  suffoca- 
tion are  not  unconunonly  ol)serve(l  in  the  stage  of  paralysis.  The 
more  rapid  the  conrse  of  the  disease,  the  more  rapidly  the 
symptoms  change  and  intermingle,  wherefore  it  is  nearly  impos- 
sible to  make  an  exact  distinction  between  the  various  stages  in 
the  conrse  of  the  affection.  In  cases  of  dumb  rabies  striking 
symptoms  of  irritation  are  absent. 

The  disease  is,  with  very  few  exceptions,  fatal.  The  pos- 
sibility of  recovery  has  been  proved  in  cases  where  artificially 
infected  dogs  have  recovered  from  the  typical  disease  (Pasteur, 
Konx,  Hogyes,  Kemlinger,  and  others).  Consequently  we  must 
not  conclude  that  the  bite  is  not  infectious  from  the  fact  that  the 
biting  dog-  has  remained  alive,  but  this  opinion  should  only  be 
reached  if,  during  the  two  weeks  following  the  bite,  no  "sus- 
picious symptoms  are  observed  in  the  animal. 

Pasteur  observed  recovery  from  rabies  iii  dogs;  later  Hogyes 
noticed  that  out  of  159  dogs,  which  had  contracted  ral)ies  in  different 
ways,  13  or  8.1%  recovered.  Of  these  6  Avere  not  treated  at  all,  Avhile 
the  remaining  7  were  given  the  antirabies  vaccination  treatment.  Rera- 
linger  found  the  saliva  of  a  cured  dog  virulent  20  days  after  the 
beginning  of  the  disease  and  5  days  after  recovery. 

Cases  where  dogs  were  still  alive  while  persons  bitten  by  them  had 
already  died  from  rabies,  have  been  reported  by  Talko  and  Johne. 

Diagnosis.  The_  establishment  of  the  diagnosis  is  not  con- 
nected witli  any  particular  difficulties  in  cases  where  the  various 
stages  are  distinctly  separated  and  there  has  been  an  opportun- 
ity to  observe  the  whole  course  of  the  disease  or  at  least  the 
greater  part  of  it.  An  exact  diagnosis  being  extremely  impor- 
tant and  necessary,  particularly  in  cases  where  human  beings  or 
other  animals  have  been  bitten  by  suspected  animals,  it  is  advis- 
able not  to  kill  the  suspected  animals,  but  to  keep  them  under 
strict  observation  and  await  their  natural  death.  The  svinptoms 
of  irritation,  the  aggressive  conduct  and  subsequent  paralysis, 
particularly^  the  appearance  of  bulbar  paralysis  form  a  very 
characteristic  picture  of  the  disease,  and  the  diagnosis  is  made 
easier  by  the  existing  suspicion  of  infection.  Statements  to  the 
effect  that  no  bite  has  been  received  must  be  taken  with  reserva- 
tion, as  light  wounds  are  inflicted  not  infrequently  without  the 
knowledge  of  the  owner.  In  making  the  diagnosis  the  former 
behavior  and  temperament  of  the  animal  must  be  taken  into 
consideration. 


484  Rabies. 

If  no  reliable  liistory  of  the  case  is  available  or  if  it  has  only 
been  possible  to  have  the  animal  under  observation  for  a  short 
time,  the  diagnosis  may  present  considerable  difficulty.  From  a 
practical  point  of  view  every  animal  in  which  a  sudden  change 
of  conduct  is  observed  should  be  considered  as  suspicious  and 
only  declared  unaffected  when  for  3  to  4  days  no  symptoms 
appear  to  confirm  the  suspicion. 

Differential  Diagnosis.  Diseases  more  or  less  similar  to 
rabies  are  observed,  especially  in  dogs,  and  they  may  cause  con- 
fusion, particularly  if  sj^nptoms  of  nervous  excitement  are  pres- 
ent. Thus,  a  violent  irritability,  sometimes  connected  with 
aggressive  conduct  and  a  desire  to  bite,  may  appear  as  a  result 
of  acute  inflammatory  processes  of  the  meninges  and  the  cere- 
bral substance.  Here  belongs  the  acute  cerebral  hyperemia  as 
well  as  acute  meningitis  and  encephalitis  without  regard  to 
whether  these  diseases  occur  from  unknown  causes  or  outside 
influences,  or  are  caused  by  animal  parasites  or  tumors  existing 
in  the  brain.  In  such  instances  the  further  course  of  the  disease 
will  decide,  as  cases  of  paralysis  in  other  diseases  are  not  devel- 
oped in  the  same  sequence  and  uniformity  as  in  rabies.  Eclamp- 
sia and  epilepsy  are  characterized  by  clonic  spasms  all  over  the 
body  while  in  epilepsy  there  is  also  the  clear  conciousness  be- 
tween the  attacks.  Nervous  distemper  is  characterized  by  the 
simultaneous  symptoms  in  the  eyes  and  respiratory  organs,  as 
well  as  by  distemper  exanthema. 

Repeated  or  continuous  pains  in  some  parts  of  the  body 
may  irritate  the  animal  to  a  degree  which  will  cause  attacks  of 
frenzy  or  delirium  that  are  sometimes  confounded  with  rabies. 
To  these  belong  the  acute  inflammation  of  the  intestines  caused 
by  intestinal  worms,  particularly  tenia  echinococcus,  foreign 
bodies,  poisoning,  perforation  of  the  intestines,  as  well  as  many 
cases  of  colic  with  violent  swiptoms  in  horses ;  further,  dog 
diseases  caused  by  pentastomum  tenioides,  eustrongylus  gigas, 
and  spiroptera  sanguinolenta,  and  finally  dermanyssus  mites 
in  the  external  auditory  canal  of  cattle,  scabies  mites  in  the  ears 
of  dogs,  as  well  as  muscular  rheumatism.  In  the  course  of  these 
diseases  no  paralysis  appears,  but  the  clinical  aspects  of  the 
disease  may,  owing  to  the  exhaustion  and  comatose  condition 
on  approaching  death,  be  very  similar  to  rabies  sometimes  to  a 
degree  that  makes  an  autopsy  necessary  to  determine  the  real 
nature  of  the  disease. 

After  lodgement  of  foreign  bodies  in  the  pharynx  or 
between  the  teeth  of  dogs  and  cats,  rabies  may  be  suspected, 
because  the  animals  show  restlessness,  and,  owing  to  difficulty 
in  swallowing  and  to  stomatitis,  saliva  is  abundant  and  the  voice 
is  hoarse  from  the  perilaryngeal  edema.  On  account  of  difficulty 
in  moving  the  lower  jaw  the  mouth  is  kept  continuously  open, 
which  condition  is  very  similar  to  the  paralysis  of  the  masseter 
muscles.     In  such  cases,  as  well  as  in  the  apparent  paralysis 


Differential  Diagnosis.  485 

resulting  from  dislocation  of  the  inferior  maxilla,  the  mouth 
is  continuously  o])en,  wiiilo  in  rabies  the  jaw  moves  slightly  up 
and  down  but  only  in  limited  degree.  Finally  a  trigeminal  or 
facial  paralysis  sometimes  develops  independently  or  in  the 
course  of  distemper;  however,  in  such  cases  the  total  absence 
of  other  symptoms  of  paralysis,  especially  in  the  hind  limbs,  is 
against  rabies. 

In  cats,  dogs,  and  cattle,  perhaps  also  in  other  animals, 
rabies  is  easily  confounded  with  paralysis  bulbaris  infectiosa, 
which  disease  is  to  be  considered  especially  when  the  animals 
rub  and  gnaw  at  the  place  of  the  bite  (see  p.  496). 

Finally,  owing  to  confinement  of  hitherto  free  animals,  to 
the  lack  of  opportunity  for  copulation,  nymphomania  and  saty- 
riasis, removal  of  the  young  from  their  dams,  as  well  as  in 
many  acute  infectious  diseases,  attacks  of  frenzy  may  occur,  but 
they  may  be  readily  distinguished  from  rabies  by  proper  obser- 
vation of  the  accompanying  conditions,  particularly  the  absence 
of  paralytic  symptoms. 

As  to  the  post-mortem  diagnosis,  the  absence  of  normal  food 
and  the  presence  of  foreign  bodies  in  the  stomach  form  the 
only  finding  that  is  in  any  way  characteristic,  but  even 
this  does  not  afford  any  real  proof,  because,  in  exceptional 
cases,  foreign  bodies  are  also  found  in  the  stomachs  of  dogs 
not  suffering  from  rabies,  especially  in  young  dogs  and  in  those 
with  digestive  troubles  (in  the  latter  the  bodies  are  usually 
found  with  normal  food).  On  the  other  hand,  the  presence 
of  food  substances  in  the  stomach  does  not  by  any  means  exclude 
the  possibility  of  rabies.  The  presence  of  sugar  in  the  urine 
strongly  supports  the  diagnosis  of  rabies,  but  even  this  does 
not  constitute  a  full  proof,  because  sugar  is  also  found  in  the 
urine  in  other  diseases.  The  difficulty  of  diagnosis  is  enhanced 
by  the  fact  that  many  rabid  animals  are  killed  before  the  com- 
plete development  of  the  s^anptoms,  so  that  even  partially  char- 
acteristic changes  have  no  time  to  develop. 

The  existence  of  rabies  is  established  definitely  by  animal 
experiments  and  also  by  microscopical  examination  of  the  brain, 
at  least  if  the  results  are  positive. 

Complement  fixation  with  nerve  substance  as  antigen,  has  not  yet  sncceeded  in 
showingf  the  presence  of  the  coniplonient  fixing  am])oceptors  in  the  serum  of  immunized 
or  rabid  animals  (Centanni,  Heller  &  Tomarkin,  Friedberger). 

Microscopical  Diagnosis.  Tn  this  connection  the  detection  of  Negri 
bodies  has  a  very  high  diagnostic  value,  while  the  examination  of  the 
nerve  ganglia  gives  less  certain  results. 

1.  Detection  of  Negri  Bodies.  The  numerous  experiments  follow- 
ing the  discovery  of  these  formations  (see  p.  465)  have  shown  uni- 
formly that  they  are  only  present  in  animals  or  human  beings  suffering 
from  rabies,  and  that,  through  their  detection,  the  diagnosis  of  rabies 
may  be  definitely  estabhshed.  On  the  other  hand,  they  may  not  be 
present  in  the  initial  stage  of  the  disease,  and  rabid  animals  are  often 
killed  shortly  after  the  affection  develops;  therefore  the  negative  result 


486  Rabies. 

of  the  microscopical  examination  does  not  exclude  a  diagnosis  of  rabies. 
In  the  case  of  animals  which  have  died  from  rahies  or  have  been  killed 
at  an  advanced  stage  of  the  disease,  the  microscopical  examination  of 
the  brain  (cornii  ammonis,  medulla  oblongata,  cerebellum)  with  positive 
results  right  after  the  autopsy,  makes  an  exact  diagnosis  possible,  and 
in  such  cases  one  may  also  conclude  from  a  negative  result  that  rabies 
has  not  been  present.  In  the  latter  case,  if  human  beings  have  been 
bitten  by  the  animal,  the  final  diagnosis  should  be  made  subject  to  the 
results  of  inoculations  into  animals. 

Negri  examined  jiiicroscopically  75  brains  of  animals  suspected  of  rabies; 
in  50  cases  the  results  were  positive,  and  the  diagnosis  was  always  confirmed  by 
the  biological  method,  while  in  5  out  of  72  cases  with  negative  results  the 
inoculation  experiments  resulted  positively.  According  to  Luzzani,  up  to  the  year 
lf)05,  457  brains  of  animals  had  been  examined  by  Italian  students  for  Negri 
bodies;  out  of  these  297  were  proved  positive  through  inoculation,  and  in  only  9  of 
this  number  were  there  no  Negri  bodies  found,  while  Krajuschkin  in  4  out  of  34, 
Nicolas  in  7  out  of  61,  Nelis  in  2  out  of  61,  and  Bohne  in  10  out  of  109  cases 
of  established  rabies  did  not  succeed  in  detecting  Negri  bodies  (according  to  Ball, 
the  number  of  such  non-confirmed  findings  amounts  to  about  3.5%).  At  the  Berlin 
institute  for  infectious  diseases,  Lentz  on  applying  the  method  of  Mann  found 
Negri  bodies  370  times  or  in  86.4%,  and,  on  applying  his  own  method,  in  52  out 
of  55  or  in  94.5%.  Eatz,  at  Budapest,  saw  the  histological  findings  confirmed  by 
animal  experiments  in  25S  cases.  Hart,  at  Vienna,  found  both  methods  to  agree 
in  498  cases  while  in  22  cases  the  histological  examination  gave  negative,  the 
inoculation  of  animals  positive  results. 

All  students  agree  that  Negri  bodies  appear  exclusively  in  cases  of  rabies, 
and  in  none  of  the  many  eases  examined  were  Negri  bodies  found  without  the 
inoculation  experiments  confirming  the  presence  of  rabies. 

Technique.  For  the  examination  the  cornu  ammonis  is  most  suitable  and 
secondly  the  cerebellum;  but  in  cats  the  cerebellum  is  more  satisfactorily  examined, 
because,  according  to  Luzzani,  in  the  cornu  ammonis  of  normal  cats  formations 
sometimes  appear  which  in  stained  prejiarations  are  very  like  Negri  bodies  in 
their  initial  stage.  Besides,  Standfuss  calls  attention  to  the  fact  that,  particularly 
with  nervous  distemper  in  dogs,  ganglion  cells  about  to  degenerate  may  contain 
red  colored  granules;  further,  that  the  karyosome,  which  may  be  double  has  a 
similar  structure  and  also  may  be  found  outside  of  the  nucleus.  "Distemper- 
corpuscles"  have  also  been  observed  by  Lentz,  partly  in  the  tissues,  partly  in 
highly  decomposed  ganglion  cells;  according  to  his  opinion,  they  originate  from 
the  conglomeration  of  the  chromatin  substance,  and  are  different  from  Negri 
bodies  in  that  they  contain  no  inner  grantdes. 

[At  the  present  time  the  uiost  suitable  method  of  quickly  demonstrating  Negri 
bodies  is  by  Frothinghani  's  impression  preparations,  stained  according  to  Van 
Gieson.  A  transverse  section  is  cut  from  the  Amnion 's  horn  and  placed  upon  a 
block  of  wood  near  the  edge,  thus  permitting  a  slide  to  be  pressed  evenly  upon  it. 
By  lifting  the  slide  with  a  quick  motion,  an  impression  of  the  cut  surface  of 
the  organ  remains  on  the  glass,  and,  as  the  histological  structure  is  preserved,  an 
excellent  substitute  for  a  microscopic  section  is  obtained.  At  least  four  such 
impressions  should  be  made  on  one  slide,  increasing  the  pressure  for  each  preparation 
until  the  tissue  becomes  quite  flat.  Before  the  preparations  have  dried  in  the 
air;  fix  in  methyl  alcohol  for  one  half  minute,  or  longer;  drain  off  the  alcohol  and 
immediately  cover  the  slide  with  Van  Gieson 's  stain  heating  gently  for  one-half 
to  one  minute ;  then  wash  in  water,  dry  with  filter  paper  and  examine  without  a 
cover  glass.  The  Negri  bodies  stain  a  pinkish  to  purplish  red,  their  inner  structure 
blue.  The  nerve  cells  are  blue  and  the  red  blood  corpuscles  colorless  or  yellowish. 
Van  Gieson 's  stain  consists  of  10  cc.  distilled  water,  two  drops  of  a  saturated 
alcoholic  solution  of  rose  aniline  violet,  and  one  drop  of  saturated  aqueous  solution 
of  methylene  blue;  as  modified  by  Frothinghani:  20  cc.  of  tap  water,  three  drops 
saturated  alcoholic  solution  of  basic  fuchsin,  and  one  drop  saturated  aqueous  solution 
of  methylene  blue.     This  stain  remains  effective  for  about  twenty-four  hours.     Trs.] 

Very  pretty  pictures,  particularly  suitable  for  an  exact  study  of  the  structure, 
are  given  in  cover  glass  preparations  and  in  sections  by  the  staining  methods  of 
Mann,  Bohne,  and  Lentz. 

2.  Detection  of  Changes  in  the  Nerve  Ganglia.  The  changes  in 
the  ganglia  of  the  peripheral  nerves   described  by  van  Gehuchten  & 


^lici-osfdiiical    Diauiidsis.  487 

Xelis.  fspcciiilly  in  (il.  iiodosuin,  in  01.  ccrvicalc  sni)reiHUin,  iind  in 
Gl.  Gasseri  (see  p.  472),  whieh  are  only  eonspit-nons  when  the  animals 
have  died  from  street  rabies,  merely  justify  a  diagnosis  of  suspected  rabies, 
because,  aeeordin*;  to  investigations  by  Bold,  IMcCarthy  &  Ivavcncl' 
Frothingham,  and  others,  they  are  also  present  in  other  int'cetious 
diseases.  Besides,  according  to  Man(|uelian  and  Vallee,  the  ganglia  of 
old  dogs  show  a  similar  microscopic  picture ;  Raymond,  however,  found 
that  both  in  nervous  distemper  and  in  healthy  old  dogs  the  small  cellular 
infiltration  Avas  considerably  less  pronounced,  Avliile  the  nerve  cells 
showed  normal  nucliM  and  no  migratory  round  cells  were  contained  in 
the  perivascular  spaces.  Therefore,  this  method  may  still  render  good 
service,  jiarticulai-ly  in  cases  Avhere  susi)icion  of  rabies  already  exists,' 
and  when  the  detection  of  Negri  bodies  is  not  successful. 

The  examination  always  requires  the  prej)aration  of  regularly  stained  sections,. 
Imt  may  be  finisheil  in   12  to  24  hours  by  means  of  the  aceton-paraflin  inil)e(l<ling 
method. 

Diagnostic  Inoculations.  If  material  from  the  animal  is  successful 
in  jn'oducing  rabies  artificially  in  another  animal,  there  can  be  no 
doul)t  that  the  former  Avas  infected  Avith  rabies.  For  inoculation  pur- 
poses the  medulla  oblongata  of  the  suspected  animal  is  most  suitable, 
from  the  center  of  Avhich  a  small  piece  is  excised  Avith  sterilized  instru- 
ments, carefully  rubbed  into  an  emulsion  Avith  boiled  Avater  and  then 
filtered  through  clean,  fine,  linen  cloth.  For  test  animals  rabl)its  and 
dogs  are  most  suitable,  but  guinea  pigs  (Konradi),  mice  and  rats 
(Fermi)  may  also  be  used. 

The  subdural  injeetion  (Pasteur)  is  performed  in  rabbits  by  trephining  one 
of  the  parietal  bones  of  the  animal  with  a  small  trepan  (diameter  5-6  mm.),  and 
then  1-2  drops  of  the  previously  prepared  emulsion  is  injected  between  the  dura 
and  the  surface  of  the  brain  by  means  of  a  h.A'podermic  needle  which  is  l)ent  in 
a  right  angle.  The  opening  is  then  covered  with  the  skin,  and  the  edges  of  the 
wound  are  united  by  means  of  sutures. 

For  the  intracerebral  injection  (Leclainehe),  a  small  opening  is  maile  in 
the  cranium  by  means  of  a  fine  drill,  and  %-%  cc.  of  the  above  named  emulsion 
is  injected  about   1   cm.   deep   into  the  brain  with  a  straight  needle. 

The  intraocular  injection  (Gilder,  Xocard,  Johne)  recommends  itself  owing 
to  its  simplicity.  The  cornea  which  previously  has  been  anesthetized  by  the 
application  of  cocaine  (10-20  drops  of  a  2-5%  solution),  or  acoin  (0.1%  solution), 
is  perforated  with  the  straight  needle,  and  1-2  drops  of  the  emulsion  is  injected 
into  the  anterior  ocular  chamber. 

In  the  intramuscular  injection  which  also  has  stood  the  test  (Helman, 
Klimmer),  1.0  cc.  of  the  emulsion  is  injected  into  the  muscles  of  the  legs  or 
shoulders  of  a  rabliit  or  guinea  pig.  This  method  is  particularly  to  be  preferred 
in  cases  where  the  1>rain  substance  is  not  fresh,  or  the  purity  of  the  injection  material 
is  questionable  for  some  reason  or  other. 

For  the  same  purpose  Lebell  recommends  the  injection  under  the  meninges 
of  the  spinal  cord;  Oalli-Yalerio  mentions  the  injection  into  the  cranial  cavity 
through  the  foramen  occipitale  magnum,  or  rubbing  the  infected  material  into  the 
mucous  membrane  of  the  nose  by  means  of  a  piece  of  cotton  fastened  to  a  wire 
(according  to  KonrAdi,  the  period  of  incubation  in  this  case  is  sometimes  very  long). 
Dawson  and  Oshida  recommend  an  injection  in  the  cranial  cavity  through  the 
foramen  opticum  (inserted  beside  the  inner  angle  of  the  eye,  along  the  wall  of 
the  ocular  cavity)  ;  finally  Szpilmann  recommends  the  injection  under  the  conjunctiva 
(Hogyes,  however,  found  this  ]iroeeeding  mostly  ineffective).  The  subcutaneous 
and  the  intravenous  injections  are  very  unreliable,  and  therefore  they  are  not  to 
be  recommended.  It  is  also  advisable  to  inject  at  least  2  animals  by  the  altove 
mentioned  methods,  because  sometimes  the  injection  of  the  same  virulent  material 
does  not  affect  every  animal. 

The  methods  just  described  are  easy  to  adopt  in  general  veterinary  practice, 
owing  to  their  simplicity;  if,  however,  the  laboratory  of  an  institution  has  been 
secured  for  this  purpose,  the  test  material  must  be  sent  there  in  a  condition  fit  for 


488  Rabies. 

inoculation.  For  this  purpose,  the  medulla  oblongata,  the  cerebellum,  and  the  cornu 
amnionis,  that  is  the  whole  nucleus  of  the  brain,  or  the  whole  brain,  are  to  be 
preserveil  in  50%  glycerin,  or  the  whole  head  is  separated  from  the  trunk  and 
sent  unopened. 

Injections  with  infections  material  by  the  fonr  first  methods  named 
result,  as  a  rule,  in  producing  rabies  within  2  to  3  M^eeks,  but  some- 
times the  period  of  incubation  is  longer.  Aujesky  observed  a  period 
of  incubation  of  43  days  after  subdural  injection,  Gal  one  of  51  days 
after  intraocular  injection,  and  Klimmer  one  of  235  days  after  intra- 
muscular injection.  This  relatively  long  period  reduces  tlie  practical 
value  of  the  method,  as  it  does  not  permit  the  use  of  protective  vaccina- 
tion on  bitten  human  beings  who  depend  on  the  results  of  the  diagnostic 
inoculation.  Besides  while  the  positive  result  of  the  inoculation  surely 
indicates  the  presence  of  rabies,  a  negative  result  does  not  in  the  same 
way  preclude  its  presence;  in  addition  the  rabbits  may  die  from  septi- 
cemia when  the  technique  or  the  material  has  not  been  quite  clean. 
Unclean  or  putrid  nuilerial,  after  a  previous  dilution  with  physiological 
solution  of  sodium  chloride  (1:250),  may  be  cleansed  by  filtration 
through  a  Berkefeld  filter,  and  with  such  filtrates  a  positive  result  may 
be  obtained  with  tissue  kept  for  63  days  (Mazzei). 

In  rabbits  inoculated  with  positive  results,  the  disease  is,  as  a  rule, 
attended  with  symptoms  of  paralysis  (see  p.  467),  and  in  dogs  it  takes 
the  usual  course.  According  to  Beck,  rabbits  are  also  killed  within 
1  to  2  weeks  by  subdural  injections  of  cerebral  sulistance  of  dogs  which 
have  died  from  nervous  distemper,  in  which  cases,  however,  the  intestines 
and  bladder  are  also  paralyzed,  and  the  disease  cannot  be  transmitted 
further  from  one  ral)bit  to  another.  In  paralysis  bulbaris  infectiosa 
(see  p.  495),  the  inoculated  rabbits  violently  scratch  and  rub  the  place 
of  injection,  and  as  a  rule  l)ecome  sick  after  2  to  4  days,  or  at  the  latest, 
after  8  days. 

Treatment.  Rabies  wiiicli  is  already  developed  cannot  l)e 
arrested  or  changed  in  its  course. 

More  successful  is  the  treatment  of  wounds  from  bites  for 
the  purpose  of  preventing  the  future  development  of  rabies,  by 
destroying  the  infectious  saliva  already  introduced.  One  of 
the  most  effective  methods  consists  in  having  the  ^vound  bleed 
profusely,  because  the  floAving  blood  w^ashes  the  virus  out  of 
the  tissues ;  at  the  same  time  it  is  advisable  to  Avasli  the  wound 
thoroughly  with  a  disinfectant  solution,  such  as  strong  vinegar, 
absolute  alcohol,  permanganate  of  potash  (1%),  carbolic  acid 
(3%),  and  particularly  1%  solution  of  Inchloride  of  mercury. 
In  cases  wdiere  the  Avound  comes  too  late  under  medical  treat- 
ment, the  elimination  of  the  contagion  may  be  attempted  by 
means  of  a  red  hot  iron  or  of  caustics.  The  caustics  mostly  used 
are  muriatic  acid,  sulphuric  acid,  nitric  acid,  iron  chloride, 
lunar  caustic,  ammonia,  etc.,  in  the  most  concentrated  solutions. 
This  treatment  is  possibly  aided  by  subcutaneous  injections 
in  the  region  of  the  bite  of  1 :10,00()  solution  of  bichloride  of 
mercury,  1 :1000  of  silver  nitrate,  1%  solution  of  carbolic  acid, 
1 :1000  of  collargol.  In  addition  the  application  of  a  Bier's  liga- 
ture might  also  prove  helpful  (Fermi  thus  saved  all  test  animals, 
even  when  the  ligature  ^vas  applied  four  hours  after  the  infec- 


Troalincut.    ri-oloclivc   TiKiculatidii.  489 

tion).  Exporioiieo  toachos  that  tliese  proccdiiros,  when  applied 
wit  hill  tiie  Hrst  quarter  of  an  lionr  after  the  l)ite,  will  often  suc- 
ceed in  postponino-  an  attack  of  ral)ies,  while  later  the  result 
l)econies  more  and  more  uncertain,  according  to  the  length  of 
time  passed  after  the  bite. 

A  favorable  result  of  the  treatment,  however,  no  matter 
how  soon  it  has  been  a]iplied,  can  never  be  predicted  with  cer- 
tainty and,  therefore,  the  bitten  animals,  in  spite  of  the  treat- 
ment, must  be  considered  as  suspicious,  they  should  be  placed 
under  cai'eful  observation  and  also  be  subjected  to  a  protective 
vaccination  (see  p.  491).  Dogs  and  cats  should  be  destroyed 
as  soon  as  possible  upon  reasonable  suspicion  of  infection. 

Tlio  troatineiit  with  railiuni  rays  stiidieil  by  Tiz/oTu  &  Boiijriovaimi  seems, 
aeconliii^  to  investigations  by  Calabrese,  Danysz,  and  Ehens,  to  l)e  of  little  value 
from  tests  on  ralibits,  and  it  can  hardly  be  applied  to  domestic  animals. 

Protective  Inoculation.  The  disease  which  develops  in  dogs, 
injected  witli  ral)ies  virus  may  in  rare  cases  come  to  a  stop,  and 
finally  a  complete  cure  may  be  effected.  Such  recovered  cases 
cannot  be  infected  later  with  rabies  even  with  large  doses  of 
virus,  the  disease  having  immunized  the  organism  against  the 
virulent  infection.  This  fact  was  first,  and  almost  at  the  same 
time  ascertained  by  Pasteur  and  Azary,  and,  on  account  of  the 
favorable  results  of  the  experiments,  Pastenr  later  introduced 
an  efficient  method  of  anti-rabies  vaccination. 

First  of  all,  he  ascertained  the  important  fact  (1884)  that 
the  virus,  through  artificial  transmission  from  dog  to  monkey 
and  then  fnrther  to  other  monkeys,  is  gradually  so  attenuated 
that  it  does  not  any  longer  cause  rabies  in  dogs,  but  makes  them 
immune  against  a  later  artificial  infection  with  nnattenuated 
virus.  On  the  other  hand,  the  virulence  may  be  increased  by 
repeated  passage  through  the  bodies  of  rabbits  and  guinea 
pigs.  The  increased  virnlence  manifests  itself  by  the  fact  that 
material  originating  from  later  generations  injected  subdurally 
in  rabbits  will  cause  rabies  after  a  considerably  shorter  period 
of  incubation. 

The  rabies  virus,  in  the  shape  in  which  it  is  obtained  from 
animals  infected  in  a  natural  way  (street  rabies),  is  inconstant 
since  animals  infected  mtli  it  contract  rabies  after  periods 
of  incul)ation  which  vary  in  their  duration.  Transmitted 
through  ])odies  of  rabbits  and  guinea  pigs,  the  effect  on  the  ani- 
mals is  not  only  increased,  but  also  becomes  so  constant  that 
the  spinal  cord  from  the  25th  rabbit  regularly  causes  symptoms 
of  rabies  on  the  8th  day,  that  from  the  r)Oth  on  the  7th,  and  that 
from  the  90tli  on  the  6th  day.  Virus  that  has  been  thus  strength- 
ened also  keeps  this  quality  later  on,  wherefore  Pasteur  desig- 
nates it  as  ''fixed  virus  of  rabies."  (Later,  Hogyes  has  reduced 
the  period  of  incubation  to  5  days  by  using  young  rabbits  for  the 
series,  of  injections.) 


490  Rabies. 

With  the  increase  in  virulence  for  rabbits,  a  similar  increase  does 
not  seem  to  follow  for  other  animals  and  for  human  beings.  Thus 
Helman  injected  1-10  g.  of  fixed  virus  into  34  dogs  and  8  monkeys  4 
days  in  succession  without  rabies  appearing  in  a  single  animal ;  further, 
Nitzsch  inoculated  himself  under  the  skin  with  an  emulsion  from  a 
4-5  mm.  piece  of  rabbit  cord  without  experiencing  any  bad  results  what- 
ever, and  also  found  the  fixed  virus  without  effect  on  dogs  and 
monkeys. 

After  securing  a  rabies  virus  of  known  and  constant  viru- 
lence, Pasteur  set  to  work  to  obtain  its  attenuation.  Having  had 
to  discontinue  the  passage  through  monkeys,  owdng  to  its  high 
cost,  he  chose  tlie  following  procedure : 

The  medulla  and  spinal  cord  of  a  rabbit,  which  has  contracted 
rabies  after  a  subdural  injection  with  fixed  virus,  are  suspended  free 
by  means  of  threads  in  a  bottle  closed  by  a  plug  of  cotton  and  the  bottom 
of  which  is  covered  with  pieces  of  caustic  potash.  At  a  constant  tem- 
perature of  23°  C,  the  spinal  cord  will  dry,  and  also  gradually  lose 
its  virulent  properties,  so  that,  for  instance,  spinal  cord  dried  for  5 
days  will  produce  the  disease  on  the  8th  day,  cord  dried  for  9  days 
on  the  15th  day,  and  the  same  dried  for  14  days  will  be  absolutely  without 
effect.  If  spinal  cord  from  a  rabbit  dead  of  rabies  is  treated  in  this 
manner  daily  for  14  days,  there  will  be,  after  2  weeks,  material  on  hand 
of  14  different  degrees  of  virulence. 

Pasteur  then  immunized  dogs  by  injecting  at  first  tlie  most 
attenuated  virus,  and  then  every  second  hour,  a  virus  grad- 
ually less  attenuated  until  he  readied  spinal  cord  wdiicli  had 
been  dried  only  one  day.  Dogs  which  had  been  subjected  to 
2-3  series  of  such  inoculations  w^ere  later  bitten  by  a  rabid  dog, 
and  ^vere  also  injected  subdurally  Avith  fixed  virus  or  street 
virus,  without  suffering  harm. 

Through  further  experiments,  Pasteur  proved  that  this 
method  of  immunizing  likewise  prevented  the  appearance  of  the 
disease  in  dogs  previously  bitten  by  rabid  animals.  The  im- 
munity obtained  by  protective  vaccination  lasts  aliout  one  year, 
l)ut  is  still  effective  after  t^vo  years  insofar  as  rabies  develops 
after  a  considerably  longer  period  following  inoculation  (Pas- 
teur). In  exceptional  cases  the  immunity  may  be  effective  up 
to  5  years  (Hogyes) ;  it  may  be  further  prolonged  by  vaccina- 
tions repeated  at  intervals. 

Finally,  in  July,  1885,  Pasteur  successfully  applied  the 
method,  which  he  had  proved  to  be  effective  in  dogs,  to  a  boy 
Avho  had  been  bitten.  Since  then,  the  anti-rabies  protective 
vaccination  has  always  been  practiced  on  human  beings  in  Pas- 
teur Institutes  established  for  this  purpose,  either  according  to 
Pasteur's  or  to  a  somewhat  modified  method. 

I.     Protective  Vaccination  with  Dried  Substance  of  Spinal  Cord. 

(Pasteur's  method.)  The  method  which  is  nearly  always  followed  in 
human  beings  consists  in  taking  2  mg.  of  the  dried  substance  of  the 
spinal  cord  of  rabbits  dead  of  rabies  after  inoculation  with  fixed  virus, 


Metlioils  (if  Vnccinaf ion.  491 

triturating  it  with  sterilized  hoiiillou  into  an  (Miiulsioii  and  then  injecting 
it  suhcutaneonsly  in  the  al)cloniinal  region.  The  first  injection  is  made 
with  the  s]nnal  cord  dried  for  14  days,  and  tlien  the  substance  dried 
one  day  less  is  injected  at  first  every  half  a  day,  and  later  every  day, 
until  finally  the  cord  dried  for  only  8  or  even  2  days  is  injected.  The 
inoculation  with  cord  dried  T).  ."5.  and  2  days  is  repeated  once  or  twice, 
especially  in  the  case  of  wounds  from  bites  on  the  head.  (Pfianz  in 
practice  applied  this  method  with  favorable  results  on  a  dog.) 

II.  Protective  Vaccination  with  Attenuated  Virus.  (Method  of 
Hogyes.)  Ilogyes  prepared  from  virulent  spinal  cords  of  rabbits  by 
tritu'ration  with  sterilized  physiological  solution  of  sodium  chloride, 
emulsions  of  different  concentrations  (1/5000,  1/2000,  1/500,  1/200, 
1/100,  1/10)  and  injected  them  snlicutaneously  every  second  hour  from 
the  weakest  to  the  strongest.  Dogs  thus  treated  later  resisted  bites  from 
rabid  animals  as  Avell  as  the  subdural  injection  of  fixed  virus  or  street 
virus,  and  moreover  this  method  is  effective  after  the  appearance  of  the 
disease.  (This  also  proves  that  not  the  strength,  but  the  amount  of  the 
vaccine  is  of  most  importance,  and  that  with  the  Pasteur  protective 
vaccination,  not  an  attenuation,  but  rather  a  reduction  of  the  amount 
of  virus  is  important.)  Since  1895,  this  method  has  been  exclusively 
applied  at  the  Budapest  Pasteur  Institute  and  also  at  other  places  to 
hununi  beings. 

Hogyes  in  this  way  produced  innnunity  in  36  dogs,  and  in  most  eases  ihe 
immunity  was  absolute,  as  it  also  protected  the  animals  against  a  later  subdural 
infection.  He  experimented  further  with  16  other  dogs  which  were  infected  by 
bites  of  rabid  dogs;  8  of  them  were  not  subjected  to  treatment,  while  8  were 
inoculated  according  to  the  above  named  method  with  attenuated  virus.  Of  the 
former  group  5  contracted  rabies,  while  all  the  animals  of  the  latter  group 
remained  alive. 

Kurz  &  Aujeszky  applied  the  method  at  a  stock  farm,  where  immediately 
before  .3  animals  had  died  from  rabies,  by  injecting  4-4  colts,  6  of  which  had 
woumls  of  bites  on  their  bodies.  The  method  was  as  follows:  On  the  first  day 
about  15  cc.  of  the  emulsion  1:2000  were  injected,  and  2  hours  later  a  similar 
amount  of  the  emulsion  1:1000;  on  the  second  day,  about  8-10  ce.  of  the  emulsion 
1:.')00,  and  2  liours  later  a  similar  amount  of  emulsion  1:.300;  on  the  third  day 
8-10  ce.  of  the  emulsion  1:100.  After  an  interval  of  5  days  the  three-days'  cycle 
was  repeated  in  the  same  manner,  and  after  a  further  interval  of  3  days  the  colts 
received  3-5  cc.  according  to  their  body  weight  of  the  emulsion  1:10.  The 
vaccination  had  no  injurious  results  for  the  colts,  and  none  of  them  later  contracted 
rabies.  Aujeszky  further  vaccinated  a  pack  of  hounds  in  the  following  way: 
In  the  forenoon  of  the  first  day  .1  cc.  of  emulsion  1:.5000;  in  the  afternoon,  3  cc. 
of  emulsion  1:3000;  in  the  forenoon  of  the  second  day  4  cc.  of  the  latter  emulsion, 
in  the  afternoon  2.-5  cc.  of  emulsion  1:1000;  on  the  third  day,  in  the  forenoon 
2  cc.  emulsion  1:500,  in  the  afternoon  1  cc.  emulsion  1:200,  The  hounds  suffered 
no  ill  effects  from  the  vaccination. 

III.  Protective  Vaccination  by  Intravenous  Injection  of  Cerebral 
Substance  (Galtier's  Method).  Galtier  immunized  sheep  and  goats  as 
early  as  1885  by  injecting  saliva  or,  in  another  series  of  experiments, 
medulla  oblongata  from  rabid  dogs  into  the  jugular  vein ;  the  animals 
resisted  both  a  subsequent  and  a  previous  virulent  subcutaneous  injec- 
tion, while  the  control  animals  (sheep  and  rabbits)  contracted  rabies 
after  a  similar  infection.  Nocard  &  Roux  later  ascei-tained  that  sheep 
immunized  in  this  way  also  resisted  the  intraocular  infection,  provided 
that  the  protective  vaccination  was  done  within  24  hours  after  the  viru- 
lent infection ;  they  found  further  that  the  immunity  lasted  at  least  9 
months.     The  method,  applied  at  the  latest  8  to  4  days  after  the  bite, 


492  Rabies. 

is  said  to  be  effective  only  in  ruminants,  while  it  has  not  proved  reliable 
in  horses  (Nocard,  Conte)  and  dogs  (Protopopoff,  Helman).  AVysoko- 
witz  has  also  tried  the  method  on  70  human  beings. 

The  inoculation  is  conducted  as  follows:  Pieces  of  spinal  cord  from  dogs 
having  died  of  street  rabies  are  ground  up  with  sterilii^ed  water,  and  5-7  cc.  of 
the  thin  emulsion,  filtered  through  linen  cloth,  are  slowly  injected  twice  in 
succession  into  cattle  and  horses,  and  2-3  cc.  into  sheep  or  goats,  with  an  interval 
of  from  6  hours  to  one  day;  the  emulsion  is  injected  into  the  jugular  vein  or  one 
of  the  ear  veins. 

Eecently  Nicolas  also  found  the  method  efficacious  in  larger  ruminants  but 
without  effect  in  goats,  while  Forgeot  and  Eaynaud  had  unfavorable  results  in 
cattle  (out  of  8  vaccinated  animals  5  died  afterwards  from  rabies).  According 
to  Remlinger  and  Mustapha-Effenrli,  sheep  sometimes  die  after  the  vaccination  from 
rabies  or  an  intoxication,  while  Delannoy  states  that  it  is  only  suitable  for  large 
ruminants. 

Babes  found  that  dogs  might  be  immunized  against  a  subsequent  virulent 
infection  by  subcutaneous  injection  of  cerebral  substance  of  healthy  sheep,  and 
also,  that  an  emulsion  of  virulent  cord  was  made  harmless  by  the  addition  of 
normal  cerebral  substance.  Aujeszky,  Calabrese,  and  others,  however,  did  not 
obtain  any  immunizing  effect  from  the  normal  cerebral  sulistance.  Tn  agreement 
herewith,  Friedberger  &  Eisler  showed  that  an  emulsion  of  fixed  virus  (1:100) 
is  neutralized  by  0.005  cc.  of  serum  from  a  horse  which  had  often  been  treated 
with  such  virus,  while,  on  the  contrary,  normal  cerebral  substance  was  not  capable 
of  alisorbing  the  proved  antirabic  substance  from  the  immune  serum.  Recently, 
Fermi  expressed  the  opinion  that  normal  nerve  substance  possesses  immunizing 
properties,  and  he  succeeded  in  immunizing  rodents  per  o.s;  Kraus  and  Fukuhara, 
however,  could  not  confirm  the  results  of  these  experiments,  as  they  proved  that 
normal  nerve  substances  are  not  able  to  produce  antirabic  substances  in  animals 
treated  with  them. 

Immunizing  experiments  with  liver  tissue  and  Itile  (Marx)  have  not  produced 
good  results,  but  Protopopoff  succeeded  in  immunizing  dogs  both  against  subsequent 
and  previous  infection  by  means  of  subcutaneous  or  intravenous  injection  of  virulent 
cerebral  substance  which  had  been  kept  in  glycerin  for  a  long  time  (30  to  60  days). 

Protopopoff  and  Helmann  immunized  dogs,  sheep  and  goats,  and  Marx  im- 
munized ra1)bits  and  dogs  by  intraperitoneal  injections  of  relatively  large  amounts 
of  virulent  cerebral  tissue.  Marx  believes,  however,  that  only  fixed  virus  immunizes 
in  this  manner.  The  immunity  is  obtained  after  12  to  14  days  and  lasts  from 
6  to  11  months. 

IV.  Serum  Immunizaion.  Babes  &  Lepp  found  that  hlood  serum 
from  dogs  which  had  been  made  immune  against  rabies  by  repeated 
vaccination  wnth  rabies  virus  protects  dogs  against  the  subdural  infec- 
tion, when  subcutaneously  injected  with  doses  of  5-10  cc.  Later,  Tiz- 
zoni  and  Centanni  prepared  an  effective  serum  by  successive  immuniza- 
tion of  sheep,  1.0  cc.  of  which  protects  25  kg.  of  body- weight  of  rabbits 
against  the  effect  of  street  rabies  virus,  and  in  vitro  makes  800-1600  g. 
of  virulent  cerebral  substance  harmless.  According  to  their  opinion, 
the  dried  serum  keeps  unchanged  for  a  long  time,  and  is  effective  both  at 
the  beginning  and  at  a  later  stage  of  incubation,  immediately  before  the 
appearance  of  the  first  symptoms.  Recently,  however,  Kraus  &  Fuku- 
hara found  by  numerous  experiments  that  serum  obtained  from  such 
sheep,  dogs  and  horses  may  destroy  the  rabies  virus  by  direct  contact, 
but  that  neither  a  preventive  nor  a  curative  application  has  any  pro- 
tective action  of  any  kind. 

In  order  to  obtain  an  active  immunity,  Remlinger  repeatedly  in- 
jected sheep  with  a  mixture  of  fixed  virus  and  immune  serum  with  good 
results,  and  Schiirer  succeeded  in  protecting  dogs  against  intramuscular 
and  natural  infection  by  a  single  subcutaneous  injection  of  a  similar 
mixture,  while  Marie  obtained  effective  immunity  against  the  subdural 
infection  of  dogs  by  subcutaneous  injection,  at  first,  of  a  20  cc.  mixture 
of  virus  and  serum,  and,  2  weeks  later,  of  12-20  cc.  of  fixed  virus.    Rem- 


Yeterinary  Police.  493 

linger  also  applied  this  inethod  to  4  horses  suspected  of  int'eetion,  in- 
jecting subcutaneonsly  700  ec.  of  a  mixture  of  serum  and  fixed  virus 
each  in  a  dilution  of  1  :1000.     The  horses  remained  healthy. 

Veterinary  Police.  Accordinn'  to  tlio  votorinary  police  or- 
dinaiieos,  wliieh  ai'c  nearly  everywhere  alike,  all  animals  suf- 
fering- from  rabies  must  be  destroyed,  and  all  those  suspected 
of  liavino-  the  disease  or  of  being:  infected  must  be  placed  under 
veterinary  observation;  dogs  and  cats,  however,  with  the 
exception  of  those  wliicli  have  bitten  human  beings,  are  to  be 
killed  on  the  first  suspicion  of  infection.  The  time  of  observa- 
tion must  be  at  least  3  months,  and  even  then  an  outbreak 
of  the  disease  cannot  with  certainty  be  excluded.  Meat  or  milk 
from  rabid  or  suspicious  animals  must  not  l)e  used  for  con- 
sumption, but  such  products  from  animals  only  suspected  of 
being  infected  may  be  put  on  the  market  without  hesitation  as 
long  as  these  animals  appear  completely  healthy. 

Tlie  most  important  and  effective  prophylactic  measure 
for  eradicating  rabies  in  large  sections  of  country  is  the  gen- 
eral obligatory  dog  tax.  The  latter  has  caused  a  reduction  of 
cases  where  it  has  been  adopted  and  in  some  countries  the  com- 
plete eradication  of  tlie  disease  liy  reducing  the  number  of  dogs, 
particularly  vagrant  and  ownerless  dogs,  and  thereby  reducing 
the  opportunity  for  infection.  On  the  other  hand,  the  obliga- 
tory muzzling  of  dogs  was  found  effective  only  in  connection 
with  the  dog  tax  and  with  other  measures  of  prevention  (killing 
of  bitten  dogs  and  cats  and  tlie  longest  possible  quarantine), 
and  it  can  moreover  only  be  applied  in  larger  towns  and  cities. 
A  reduction  in  the  number  of  cases  of  rabies  can  only  be  accom- 
plished by  carrying  out  the  same  preventive  measures  in  large 
districts. 

Bavaria  offers  an  instructive  illustration  of  the  favorable  results  obtained  in 
the  reduction  of  rabies.  From  1S63  to  1876,  14  to  18  human  beings  were 
victims  of  the  disease  annually,  while  the  number  of  rabid  dogs  amounted  to  about 
500  every  year.  Under  the  influence  of  the  obligatory  dog  tax  introduced  in  1876, 
the  number  of  rabid  dogs  was  reduced  to  61  in  189.3,  and  from  1883  to  1898  no 
human  beings  died  from  rabies.  In  the  years  1898  to  1900  fatal  cases  of  rabies 
and  suspicious  instances  were  again  observed,  but  only  through  being  introduced 
from  outside,  particularly  from  the  East  (Kitt).  Like  favorable  conditions  prevail 
in  Saxony  where  the  number  of  rabid  dogs  was  reduced  to  22  from  1879  to  1893. 
In  the  Grand  Duchy  of  Baden,  the  introduction  of  the  dog  tax  in  connection 
with  obligatory  muzzling,  in  the  year  1875,  resulted  in  a  rapid  decrease  and  finally 
in  the  complete  eradication  of  rabies. 

In  Hungary,  the  favorable  results  of  the  dog  tax  were  apparent  during  the 
first  years  after  the  enactment  of  the  veterinary  law  of  1888,  as  the  number  of 
rabid  dogs  was  reduced  from  1,286  to  609  during  the  years  1890  to  1892;  later, 
however,  the  disease  again  increased  owing  to  the  faulty  enforcement  of  the  tax 
law  and  to  the  fact  that  it  had  not  been  made  obligatory  in  all  communities. 
Szakall  showed  from  statistical  data  that  rabies  was  more  rare  in  communities  with 
a  general  obligatory  dog  tax,  but  appeared  more  frequently  where  exemptions  from 
the  dog  tax  had  been  granted  for  certain  kinds  of  dogs. 

That  muzzling  alone  is  not  sufficient  to  eradicate  the  disease  completely 
is  shown  in  the  City  of  Berlin.  During  the  years  18.'53-1875  obligatory  muzzling 
was  in  force,  but  in  spite  of  it  rabies  sometimes  assiuned  an  enzootic  character 
(1865-1867,  1871-1873).  After  the  promulgation  of  the  Prussian  law  of  1875,  the 
disease  decreased  rapidly,  and  since  1883  only  isolated  cases  of  rabies  have  been 
observecl. 


494  Rabies. 

That  obligatory  muzzling  at  least  when  supported  by  other  strict  measures, 
also  gives  good  results  has  been  shown  by  the  experience  in  London  where  the 
fatal  cases  in  human  beings  immediately  ceased  every  time  after  its  introiluction, 
while  such  fatalities  always  occurred  again  when  obligatory  muzzling  was  abandoned. 
In  the  same  way,  the  cases  of  rabies  of  dogs  in  England  varied  according  to 
the  enforcement  or  the  repeal  of  the  muzzling  ordinance.  (From  1890  to  1893 
obligatory  muzzling  caused  a  reduction  of  cases  of  rabies  from  312  to  129,  79, 
and  38;  from  1893  to  1896  the  absence  of  obligatory  muzzling  increased  the  cases 
of  rabies  to  93,  248,  672;  since  1896  oldigatory  muzzling  again  reduced  the  cases 
of  rabies  from  438,  to  151,  17,  9  [Salmon].) 

The  efiicieuey  of  suitable  measures  against  rabies  has  been  proved  not  only 
in  Denmark,  Sweden,  and  Norway,  but  also  in  Germany,  where  it  has  succeeded 
in  restricting  the  disease  to  such  a  degree  that  it  is  only  observed  to  any  extent 
in  the  eastern  border  provinces  of  Prussia,  while  in  the  interior  of  the  country 
only  very  circumscrilied  foci  exist.  Finally  in  England  the  disease  rapidly  decreased 
and  in  1903  was  completely  eradicated  as  a  result  of  ol)ligatory  nuuzling,  and 
after  the  importation  of  dogs  from  the  continent  (1897)  and  Ireland  (1899)  had 
been  prohi])ited  or  made  dependent  on  a  6  months  quarantine.  Eabies  has  not 
been  observed  in  England  since  its  eradication  in  1903. 

Literature.  Galtier,  C.  E.,  1879;  J.  vet.,  1904,  274  and  330.— Pasteur,  1881, 
XCII,  1259;  1882,  XCVITT,  457;  1885,  CI,  705;  1899,  CVIII,  1228.— Eoux,  A.  P., 
1888,  II,  18;  1889,  III,  69.— Nocard  &  Eoux,  A.  P.,  1888,  II,  341;  1890,  IV,  163.— 
Hogyes,  A.  P.,  1888,  II,  133;  1889,  III,  449.— Schaffer,  A.  P.,  1889,  III,  644.— 
Kitt,  Monh.,  1890,  I,  314  (Eeview).— Johne,  Z.  f.  Tm.,  1S98,  II,  349.— Van  Gehuchten 
&  Nelis,  Ann.  vet.,  1900,  XLIX,  243.— Vallee,  Eev.  vet.,  1900,  763.— Negri,  Z.  f, 
Hvg.,  1903,  XLIII,  507;  1904,  XLIV,  519;  1909,  LXIII,  421.— Eemlinger  & 
Eiffat-Bey,  Soc.  biol.,  1903,  July  II.— Schiider,  Z.  f.  Hyg.,  1903,  XLII,  362;  A.  f. 
Tk.,  1904,  XXX,  610.— Eemlinger,  A.  P.,  1904,  XVIII,  150;  1909,  XXIII,  430.— 
Schniirer,  Z.  f.  Hyg.,  1905,  LI,  46  (Lit.  on  immunity). — Tizzoni  &  Bongiovanni, 
Cbl.  f.  B.,  1905,  XXXIX,  187;  1906,  XL,  745.— Bohne,  Z.  f.  Hvg.,  1906,  LII,  87 
(Lit.).— Nitseh,  Cbl.  f.  Bakt.,  1906,  XLII,  647.— Panisset,  Eev.  gen.,  1906,  VIII, 
113  (New  lit.).— Lentz,  Cbl.  f.  Bakt.,  1907,  XLIV,  374;  1908,  LXII,  63.— Frosch, 
Hb.  d.  p.  M.,  1,  Ergzbd.,  1907,  626.— Nicholas,  J.  vet.,  1908,  198.— Marie,  A.  P., 
1908,  XXII,  271.— Standfuss,  A.  f.  Tk.,  1908,  XXXI V,  109  (Lit.  on  Negri  bodies).— 
Fermi,  Cbl.  f.  Bakt.,  1907-1910,  XLITI-LIIL— Eatz,  Kongr.  Haag,  1909  (Lit.).— 
Koch  &  Eissling,  Z.  f.  Hyg.,  1910,  LXV,  85. 

Rabies  in  Human  Beings.  In  countries  where  rabies  occurs  fre- 
quently among  the  animals,  it  is  also  often  observed  in  human  beings. 
In  about  90%  of  the  cases,  they  are  infected  by  the  bites  of  dogs,  while 
in  the  other  cases  (about  7  to  8%)  cats,  wolves  and  other  animals  trans- 
mit the  infection.  Of  the  persons  bitten  by  rabid  animals,  about  16  to 
20%  die  of  rabies  (according  to  Babes  60  to  90%  die  after  bites  of 
wolves)  mostly  after  bites  in  the  face  or  on  the  hands.  The  period  of 
incubation  is  at  least  13  days,  usually  from  20  to  60  days,  and  only  in 
exceptional  cases  is  it  longer  than  90  days  (after  bites  from  wolves  the 
disease  usually  appears  in  the  third  week). 

The  symptoms  of  rabies  in  human  beings  are  at  first  dejection, 
itching  and  trembling  in  the  bitten  part,  also  fever ;  soon  respiratory 
troubles,  uneasiness,  difficulty  in  sw^allowing,  aversion  to  liquids,  abun- 
dant salivation,  in  general  increased  reflex  excitability,  and  in  conse- 
quence attacks  of  delirium,  appear;  lastly  paralysis  of  the  muscles  of 
the  face,  eyes,  and  tongue,  as  well  as  the  extremities  and  the  trunk  is 
observed.  In  exceptional  cases,  the  disease  develops  from  the  beginning 
in  the  paralytic  form. 

The  results  of  the  anti-rabies  protective  vaccination  are  as  a  rule 
favorable  since,  after  regularly  conducted  vaccination,  less  than  1% 
of  persons  who  Avere  undoubtedly  bitten  by  rabid  animals  die  subse- 
quently of  rabies.  On  the  whole,  results  are  the  more  satisfactory  the 
earlier  after  the  bite  the  vaccination  begins,  and,  everything  else  being 
equal,  they  are  most  favorable  after  bites  on  the  legs  and  body,  somewhat 
less  favorable  following  bites  on  the  hands,  and  the  least  so  after  bites  on 


Kahii's   ill    Hiiiiiiiii    I'ciiiijs.  495 

the  lieail  jiiitl  I'ac-c.  Tlu*  mortality  ligiu'cs  (•oiii])Uti'il  accorcliiig  to  these 
])oints  of  intWiion  on  36.801  vaccinated  persons,  amount  to  0.82,  0.56 
aiul  1.78^(   respectively. 

DiiiiiiiX  tlio  yoais  ISSC  to  1908,  31.759  persons  were  sub.iected  to  protective 
vaei'ination  at  the  Pasteur  Institute  in  Paris,  and  after  the  t-onipieted  treatment 
ll2!t  j.iTsoiis,  or  0.419r,  <lie<l.  Tlio  annual  jterccntaj^e  of  mortality  durinij  the 
above  named  i>eriod  has  been  lowered  from  0.94  to  (1.19%.  In  Jierlin  1,416  Ijitten 
persons  were  subjected  to  protective  vaccination  durinj^  tlie  years  1S9S  to  1902, 
and  of  these  12  or  0.84%  died  afterwards  of  rabies,  wliile  amon<j  non-vaccinated 
persons  the  ]«ercentatre  of  mortality  amounted  to  14.8%  (Doebert).  At  the  Pasteur 
Institute  in  Budapest  4;'),0(57  bitten  persons  were  vaccinated  durinfj  the  years  1890 
to  1909.  Of  these  181  or  0.4%,  died  of  rabies  afterwards  (last  year  only  0.19%>), 
while  durinor  the  years  1890  to  1903,  out  of  1.861  bitten  but  non-vaccinated  persons 
266  or  14.29%  later  contracted  the  disease.  Durincr  the  years  1890  to  1895, 
Pasteur's  method  was  used,  while  subsequently  that  of  Jliiixyes  was  emjiloyed. 

Accordinij  to  a  compilation  by  Bernstein  in  190."),  104,:?.")?  persons  were 
subjected  to  treatment  in  40  Pasteur  Institutes  in  all  parts  of  the  world,  outside 
of  Australia.  Of  those  560  persons  or  0.54%  died  more  than  14  days  after  the 
conclusion  of  the  treatment  while  0.19%.  died  within  14  days,  making'  the  total 
of  deaths  0.73%.  According  to  the  location  of  the  bite,  whether  it  was  infiicte<l 
on  the  head  or  on  the  hands,  the  percentage  of  mortality  was  1.99  and  0.36%? 
respectively. 

Literature.  S.  Hogyes,  Lyssa,  Xothnagel's  Handbuch,  1897,  \,  1,  T. — 
Bernstein,   Vjschr,  f.   ger.   Med.   u.   off.   Saiiitatsw.,   1905,  XXXI,   1. 

Infectious  Bulbar  Paralysis  (Pseudo  Rabies).  After  the  inoeuhi- 
tion  of  rabbits  with  the  medulla  from  a  cow  and  a  dog  which  died  with 
suspicious  symptoms  of  rabies  Aujeszky  observed  a  disease  in  the  experi- 
ment animals  which  resulted  in  their  death  "\nthin  48  to  50  hours.  The 
most  conspicuous  symptom  was  a  very  severe  itching  at  the  point  of 
inoculation. 

According  to  his  and  to  SchmiedhotTer's  investigations  the  disease 
may  be  produced  by  subdural,  intraocular,  intramuscular,  or  subcutan- 
eous inoculations  of  brain  substance  from  animals  dead  of  the  disease, 
or  with  parts  of  the  tissues  from  the  jwint  of  inoculation.  The  disease 
may  also  be  produced  in  guinea  pigs,  rats  and  mice,  very  easily  in  car- 
nivorous animals,  cattle  and  sheep,  while  the  ass  is  less  susceptible  and 
horses  can  be  infected  only  with  difficulty.  Fowls  are  resistant  to  the 
infection.  Artificial  infection  occurs  also  by  the  feeding  of  organs  con- 
taining the  virus  to  cats  and  dogs,  as  well  as  rodents.  The  virus  is 
most  concentrated  in  the  tissue  fluids  at  the  point  of  inoculation,  then  in 
the  blood  and  in  the  central  nervous  system.  It  is  not  present  in  the 
bile,  saliva,  or  urine  f  0.001  cc.  of  blood  is  sufficient  to  produce  an  infec- 
tion). Dense  porcelain  filters  retain  the  virus.  Miiile  the  filtrate  through 
coarser  filters,  which  however  do  not  let  bacteria  pass,  is  infective  in 
large  quantities.     Attempts  at  cultivation  have  so  far  been  fruitless. 

Virulent  brain  substance  remains  infective  for  months  in  50%  glycerin, 
while  by  slow  drying  it  is  rendered  avirulent  in  from  3  to  6  days.  Defibrinated 
blood  kept  in  an  ice  chest,  retains  its  virulence  for  from  1  to  3  weeks.  Heating 
to  55°-60°  C.  destroys  it  in  from  30  to  35  minutes,  80°  in  three  minutes,  and  100° 
immediately.  Of  chemical  agents  io%  hydrochloric  acid  destroys  it  in  3  minutes, 
1%  corrosive  sublimate  immediately,  5%  carbolic  acid  in  2  minutes,  3%  lysol  in 
10  minutes.  2%  formalin  in  20  minutes,  and  absolute  alcohol  in  30  minutes 
(Sehmiedhoffer). 

After  a  subcutaneous  injection  a  local  reddening  develops  at  the 
])oint  of  inoculation.  Avhich  later  results  in  a  neci'osis.  The  animals 
.scratch  and  rub  the  affected  part  severely;  in  the  meantime  they  become 
very  weak,  and  usually  die  within  a  few  hours.     The  experimental  dis- 


496  P.seudo  Rabies. 

ease  appears  similar  to  the  spontaneous  cases  in  animals.  After  the 
infection  per  os  a  marked  inflammatory  swelling  and  sensitiveness  of 
the  lips  and  the  buccal  mucous  niem])rane  were  observed. 

The  disease,  which  up  to  the  present  time  has  been  observed  only  in 
Hungary,  occurs  not  very  infrequently  in  cats  and  dogs,  as  Marek  diag- 
nosed it  in  the  clinic  at  Budapest  from  1902  to  1908  in  118  cats  and  29 
dogs.  Some  of  the  cats  had  previously  been  fed  spoiled  meat ;  in  the 
majority  of  cases,  however,  the  history  relative  to  this  point  was  nega- 
tive. Some  OA^'ners  lost  all  their  cats  from  the  disease,  without  con- 
sideration of  sex  and  age.  Szabo  reports  16  cases  occurring  among  a 
pack  of  hounds.  The  disease  has  been  repeatedly  observed  among  cattle 
and  also  in  rats. 

Symptoms.  After  an  incubation  period  of  20  hours  to  10  days 
(following  artificial  infection),  a  peculiar  change  in  the  behavior  of  the 
animal  is  observed.  Dogs  and  cats  become  apathetic,  change  their  rest- 
ing place  often  and  sit  crouched  up ;  cats  meow  and  yawn,  sometimes 
painfully.  There  is  profuse  salivation ;  inappetence  is  present  from  the 
onset  of  the  disease  with  frequent  vomiting,  and  constant  symptoms  of 
paralysis.  In  about  half  of  the  cases  the  patients  manifest  severe  itching 
on  any  part  of  the  head,  which  they  scratch  with  the  fore  paws,  or  rub 
against  some  object,  sometimes  so  severely  that  inside  of  several  hours 
extensive  abrasions  or  even  deeper  injuries  result.  In  other  cases  this 
symptom  is  absent,  but  the  groaning  or  painful  meowing  indicates  that 
the  animals  are  in  pain.  With  rare  exceptions  the  examination  of  the 
nervous  system  shows  paralysis  of  the  pharynx  and  pruritis,  also  an  un- 
even dilation  of  the  pupils  associated  with  at  first  increased  reflex 
irritability,  later  diminished  pupillary  reflex,  muscular  sensibility,  and 
superficial  and  deep  reflexes.  In  most  cases  periodical  twitching  may 
be  observed  in  the  flexor  muscles  of  the  head  and  neck,  sometimes  also 
the  muscles  of  the  lip.  The  respiration  is  markedly  labored,  the  tem- 
perature is  normal  or  only  slightly  elevated  and  the  patients  succumb 
almost  exclusively  inside  of  24  to  36  hours.  In  cattle  a  persistent  rub- 
bing of  the  muzzle  or  of  other  parts  of  the  face  is  observed,  which 
results  in  more  or  less  extensive  bloody  areas,  denuded  of  hair  and  sur- 
rounded by  edematous  swellings.  At  the  same  time  the  animals  bellow 
loudly,  and  kick  spasmodically  with  their  hind  legs.  In  the  mean- 
while a  pronounced  swelling  and  weakness  of  the  hind  quarters  develop, 
while  the  appetite  is  for  a  time  normal.  Finally  the  disease  terminates 
in  death  after  12  to  36  hours. 

The  autopsy  reveals  inflammatory  lesions  which  occur  at  those  parts 
of  the  bodies  of  the  animals  which  were  painful  during  life :  perhaps 
there  are  also  hyperemia  or  small  hemorrhagic  extravasations  in  the 
cerebral  meninges.  Kecovery  has  so  far  been  observed  only  in  one  cat. 
This  animal,  which  on  the  first  day  had  no  appetite  whatever,  ate  more 
frequently  on  the  following  day,  at  the  same  time  manifesting  spasmodic 
contractions  of  the  muscles.  The  spasms  became  less  frequent,  saliva- 
tion ceased  after  the  fourth  day,  and  on  the  eighth  day  the  cat  had 
recovered. 

The  disease  is  distinguished  from  rabies  on  the  one  hand  by  the 
absence  of  furious  attacks,  aggressive  behavior,  and  of  paralysis  of  the 
jaw;  on  the  other  hand  by  the  fact  that  the  blood  as  well  as  the  brain 
tissue  is  infectious,  while  the  saliva  is  not,  and  finally  that  the  disease 
after  a  period  of  incubation  of  not  more  than  several  days,  runs  a  very 
rapid  course.    Especially  characteristic  of  infectious  bulbar  paralysis  is 


Symptoms.  497 

its  sudden  appearance,  accompanied  hy  the  very  acute  and  usually  fatal 
course,  and  the  severe  itehiutr  of  a  certain  part  of  the  body;  if  this 
latter  syniptoiii  is  absent  the  disease  may  be  readily  mistaken  for  acute 
poisoning  in  dogs  and  cats. 

The  nature  and  mode  of  natural  infection  are  not  yet  sufficiently 
known.  The  observation  that  rats  sometimes  die  in  great  numbers  with 
the  disease  simultaneously  with  numerous  cases  in  dogs,  cats  or  cattle 
(Balas.  Ilutyra),  and  that  the  conspicuous  itching  occurs  mostly  on  a 
portion  of  the  face,  renders  the  supposition  very  probable  that  domestic 
aninuds  are  infected  by  diseased  rats  (possibly  also  mice),  although  the 
possibility  that  the  infection  of  the  various  species  of  animals  may  occur 
simultaneously  through  a  connuon  source  cannot  be  excluded. 

Literature.  Au.ieszky,  Cbl.  f.  Bakt.,  1902,  XXXII,  353.— Marek,  Jahresber. 
d.  Hochs.lmle   Budapest,  1902-03,  1908-09.— Hutyra,  B.  t.  W.,  1910,  149.— Schmied- 

hoflfer.  Koz]..  1010. 

Epizootic  of  Cats  with  Nervous  Manifestations.  :Mori  observed 
an  epizootic  of  cats  in  Siena  which  connnenees  with  sudden  severe 
excitement,  when  the  animal  becomes  frightened,  and  with  widely  opened 
eyes  runs  up  and  down,  turns  in  a  circle,  and  finally  collapses  as  if 
paralyzed,  passing  urine  involuntarily.  On  the  following  days  depres- 
sion and  coma  alternate,  the  attacks  continually  becoming  "more  pro- 
nounced and  of  longer  duration ;  further  there  is  a  conjunctivitis  with 
paleness  of  the  other  mucous  membranes,  yawning,  difficult  respiration, 
accumulation  of  feces  in  the  colon,  and  relaxation  of  the  anus.  The 
autopsy  revealed  in  one  case  a  marked  swelling,  softening  and  hyper- 
emia of  the  spleen,  fatty  degeneration  of  the  liver,  as  well  as  "dark, 
fluid  blood. 

This  disease,  the  symptoms  of  which  decidedly  resemble  those  of 
acute  lead  poisoning  (Chyzer).  is  supposed  to  be  caused  by  a  facultative 
anaerobic.  Gram  negative  bacillus  0.8-2.0  m  long,  having  peritrichally 
arranged  flagellae.  The  bacillus  is  pathogenic  for  guinea  pigs,  rabbits, 
pigeons  and  white  mice.  Feeding  one  cc.  of  the  culture  to  a  cat  re- 
sulted in  an  elevation  of  the  temperature,  followed  later  bv  hypothermia 
and  diarrhea  (Cbl.  f.  Bakt.,  1905,  XXXVIII,  40.) 


Vol.  1— -JS 


Group  V. 
CHRONIC  INFECTIOUS  DISEASES. 

1.    Tuberculosis. 

{Tiiherculose   [German  and  French];    Tuhercolosi  [liaVian].) 

Tuberculosis  is  a  clironic  contagious  infectious  disease  of 
man  and  domestic  animals.  It  is  caused  by  Koch's  Bacillus 
tulierculosis  or  one  of  its  varieties.  Anatomically  it  is  char- 
acterized, in  its  incipient  stage  at  least,  by  small  non-vascular 
nodules  known  as  tubercles  which  have  a  tendency  to  undergo 
cheesy  degeneration. 

(a.)    Tuberculosis  of  Mammals. 

{Pearl  disease,  Grapes;  Perlsuclit,  Shrofulose,  Lunfjenschwind- 

sucht,  StiersucM,  Monatreiterei,  DriisenJcrankheit,  Franz- 

osenkranTxheit  [German];  Cacliexia  houm  tuberculosa, 

PhfJiisis  puhnonuni  [Latui];  Pomyneliere  [FrencJi]; 

Malattia  glandolare  [Italian]). 

History.  Tul)erculosis,  and  particularly  that  form  known  as  pul- 
monary consumption,  has  from  the  remotest  time  been  known  as  the 
most  prevalent  disease  of  man.  A  large  percentage  of  all  deaths  is  due 
to  tuberculosis.  The  study  of  its  nature  had,  therefore,  until  the  be- 
ginning of  the  last  century,  been  confined  almost  exclusively  to  man. 
Until  recently,  however,  the  results  of  these  investigations  amounted  to 
little  more  than  theories  or  hypotheses.  The  peculiar  character  of  the 
tubercle  was  necessarily  recognized  by  pathologists  in  the  early  history 
of  the  study  of  the  disease.  Morton,  as  early  as  1689,  regarded  the  tu- 
bercle as  the  anatomical  foundation  of  pulmonary  consumption.  At  a 
later  date  special  stress  was  laid  upon  the  importance  of  cheesy  degenera- 
tion as  characteristic  of  tuberculous  lesions.  AVhile  Bayle,  in  1819,  re- 
stricted the  definition  of  the  tubercle  to  non-caseating,  gray  and  trans- 
lucent nodules,  he  as  well  as  Baillie  (1794)  and  Laennec  (1819)  con- 
sidered pulmonary  consumption  and  scrofula  as  identical  morbid  pro- 
cesses. Laennec  held  the  view  that  the  tubercle  owed  its  origin  to  a 
specific  tubercle-producing  substance,  soft  and  homogenous  in  con- 
sistency, which  was  secreted  from  the  blood,  and  that  the  inoculation  of 
this  primary  tubercle  substance  could  produce  the  local  development  of 
tuberculous  tissue.  As  he,  however,  like  later  on  Magendie  and  Roki- 
tansky,  attached  undue  importance  to  the  cheesy  character  of  th(?  tu- 
bercle, he  included  many  other  morbid  processes  which  consisted  of 
simple  degenerations. 

498 


History.  499 

Virt'how,  ill  1847,  hud  a  more  restricted  concept  ion  of  the  nature 
of  tuhereulosis.  This  was  based  upon  a  histological  foundation  and 
reeognized  as  tulx'rculous  such  lesions  only  as  presented  small,  well 
marked  non-vaseular  nodules  or  groui)s  of  nodules,  or  cheesy  masses  that 
were  evidently  the  result  of  the  de^^'iieration  of  such  nodules.  Accord- 
ing to  this  view,  however,  he  excluded  several  forms  of  diseases  which 
are  undoubtedly  tuberculous  in  character,  viz.,  tubeivulosis  of  the 
lymphatic  glands  (scrofula),  tuberculous  caseous  pneumonia  and  tu- 
berculosis of  animals. 

Of  the  various  forms  of  tuberculosis  in  animals,  so-called  pearl 
disease  in  cattle  in  particular  long  ago  attracted  general  attention,  and 
the  ri'gulations  concerning  meat  inspection  in  various  countries  con- 
cerned themselves  with  this  question  in  detail.  In  the  beginning  of  the 
eighteenth  century  pearl  disease  was  generally  supposed  to  be  identical 
with  syphilis  of  iiian,  and  supposed  to  be  the  result  of  unnatural  inter- 
course of  svphilitic  persons  with  animals  (Franzosenkrankheit).  As  a 
result  of  this  view  all  cattle  atfected  with  pearl  disease  were  excluded 
from  use  as  food.  At  the  end  of  the  same  century,  however,  this  view 
of  the  nature  of  pearl  disease  was  found  to  be  incorrect.  But  the  appre- 
ciation of  the  true  nature  of  the  disease  was  the  result  of  a  very  gradual 
development  of  our  knowledge.  During  the  first  half  of  the  last  century 
some  authors  (Gurlt,  Hering,  Fuchs)  regarded  pulmonary  tuberculosis 
of  cattle  and  pulmonary  consumption  of  man  as  identical,  and  others 
(Gerlach,  Spinola,  Leysering)  placed  pearl  disease  of  the  peritoneum 
of  cattle  in  the  same  group.  On  the  other  hand,  Virchow  disputed  the 
occurrence  of  tuberculosis  in  animals  altogether.  According  to  his  view 
which  was  subsequently  shared  by  Roll,  the  morbid  growths  of  the  lungs 
and  serous  membranes  were  in  reality  neoplasms,  sarcomata,  which  might 
.be  considered  identical  with  lympho-sarcomata  of  man. 

The  question  assumed  a  new  aspect  when  in  the  year  1865  Yillemin 
proved  by  means  of  experimental  infection  that  tuberculosis  was  trans- 
missible from  man  to  animals,  and  from  animal  to  animal  respectively. 
Morgagni  had  already  200  years  ago  believed  in  the  infectiousness  of 
pulmonary  consumption  and  Klencke  produced  in  1843  tuberculosis  in 
rabbits  by  the  intravenous  injection  of  tuberculous  material.  But  in, 
spite  of  tiiis  the  spontaneous  development  of  the  disease  according  to  the 
humoral  pathological  theory  continued  to  be  asserted.  Yillemin  obtained 
positive  results  in  his  experiments  with  tuberculous  material  from  man 
as  well  as  with  material  from  cattle  atlfected  with  pearl  disease,  and  thus 
furnished  proof  of  the  infectiousness  of  tuberculosis  as  well  as  the 
identity  of  the  disease  in  man  and  in  animals.  In  recent  years  Villemin  's 
experiments  have  been  abundantly  verified  by  numerous  repetitions,  and 
at  the  same  time  the  various  modes  of  infection  have  been  elucidated. 
These  latter  experiments  have  shown  not  only  that  tuberculosis  is  trans- 
missible by  means  of  subcutaneous  or  intraperitoneal  infection  (Klebs, 
Bollinger,"  Kitt),  intraocular  inoculation  (Tohnheim  &  Salomonssen, 
Baumgarten),  as  well  as  through  inhalation  (Tappeiner,  Weichselbaum) 
of  tuberculous  material,  but  furthermore  they  have  shown  that  other 
foreign  substances  could  not  produce  similar  pathological  processes 
(jNIartin.  Ponfick,  Langerhans").  Semmer  observed  that  the  injection 
of  milk  and  blood  from  a  cow  witli  advanced  pulmonary  pleural  tuber- 
culosis into  the  jugular  vein  of  a  pig  produced  a  pronounced  general 
tuberculosis.  Chauveau  (1868)  as  well  as  Oerlach  (1869)  succeeded  in 
producing  the  disease  by  feeding  tuberculous  material  from  cattle. 
Klebs  produced  pearl  disease  of  the  peritoneum  by  means  of  intraperi- 


500  Tubei'culosis. 

toneal  injection  of  tuberculous  sputum.  Bolling-er  obtained  the  same 
result  by  the  injection  of  tuberculous  lung  tissue. 

As  the  result  of  a  statistical  study  of  the  various  feeding  experi- 
ments with  the  transmission  of  tuberculosis,  Cohnheim  declared  in  1879 
that  the  correct  diagnosis  of  tuberculosis  could  no  longer  be  made  from 
a  purely  anatomical  point  of  view  and  that  the  etiological  viewpoint 
alone  was  justifiable.  He  maintained  further  that  the  cellular  structure 
of  the  nodules  was  as  little  characteristic  of  a  purely  tuberculous  pro- 
cess as  the  tendency  to  cheesy  degeneration  wiiich  had  been  emphasized 
by  Laennec.  He  held  that  either  process  could  be  considered  as  tu])er- 
culous  only  when  their  infectious  nature  had  been  demonstrated.  Fur- 
ther, since  other  tubercles  or  cheesy  products  are  not  infectious,  though 
similar  in  their  anatomical  structure,  the  infectiousness  of  the  t)'UG 
tubercle  must  be  due  to  a  specific  virus. 

Nothing  now  was  lacking  in  the  chain  of  evidence  but  the  recogni- 
tion of  this  specific  virus  in  order  that  the  infectious  nature  of  tuber- 
culosis might  be  recognized  as  a  scientifically  demonstrated  fact.  This 
was  accomplished  by  Robert  Koch  in  1882  w^hen  he  proved  by  incon- 
trovertible evidence  that  tuberculosis  in  man  as  well  as  tuberculosis  in 
animals  was  dependent  upon  the  pathogenic  action  of  a  morphologically 
and  culturally  characteristic  bacterium.  The  theory  of  the  infectious- 
ness of  tuberculosis  was  hereby  placed  upon  a  firm  foundation  and  fur- 
ther research  was  thenceforth  directed  to  the  establishment  of  the  vari- 
ous conditions  under  which  infection  took  place  and  the  means  by  which 
the  discovery  of  efficient  methods  of  prevention  was  possible. 

In  recent  years  the  study  of  the  etiology  of  tuberculosis  received 
a  new  stimulus  w^hen  Koch,  in  an  address  before  the  Tuberculosis  Con- 
gress of  London  in  1901,  declared  that  bovine  and  human  tuberculosis 
were  different  diseases,  that  the  human  disease  was  not  transmissible  to 
cattle  and  that  it  was  not  necessary  to  observe  special  precautions  to 
protect  man  against  pearl  disease  or  bovine  tuberculosis.  This  opinion 
was  diametrically  opposed  to  former  views  expressed  by  him  or  held  by 
the  medical  profession  in  general.  The  various  commissions  which 
were  thereupon  appointed  by  the  German  government  as  well  as  the 
English  Royal  Commission  for  the  study  of  this  question  did  not 
express  an  unqualified  endorsement  of  the  views  expressed  by  Koch. 
Nevertheless  they  produced  valuable  information  regarding  the  mor- 
phological, cultural  and  pathogenic  characteristics  of  tubercle  bacilli 
of  different  origin.  Simultaneously  the  question  of  the  exact  mode 
of  infection  was  again  forced  into  the  foreground  of  investigation.  At 
this  time  two  theories,  sharply  opposed  one  to  the  other,  received  general 
recognition,  viz.,  the  view  of  Flligge  who  held  that  infection  occurred 
chiefly  through  inhalation  of  the  virus  into  the  air  passages,  and  that  of 
Calmette  who  held  that  infection  by  way  of  the  alimentary  canal  was  of 
most  frequent  occurrence.  In  recent  years,  however,  the  tendency  is  to 
accept  a  combination  of  these  two  views  on  the  modes  of  infection,  while 
the  importance  of  either  mode  is  recognized. 

These  as  well  as  the  extraordinarily  niunerous  and  painstaking 
investigations  of  other  details  of  the  tuberculosis  question,  the  numerous 
associations,  congresses  and  conferences  which  were  organized  in  rapid 
succession,  and  the  active  social  and  economic  interest  Avhich  developed 
with  reference  to  this  question,  give  cause  to  hope  for  a  gradual  repres- 
sion of  this  devastating  disease.  As  far  as  tuberculosis  of  man  is  con- 
cerned the  various  public  sanatoria  and  dispensaries  have  produced 
happy  results  in  the  way  of  disseminating  popular  knowledge  concern- 
ing the  disease.     The  results  of  a  similar  campaign  for  the  suppression 


History,     OcciinciKe.  .lOl 

of  tlio  tlisoaso  amoiiK  animals,  tliougli  less  lar  reaching  in  their  effects, 
have  also  heen  gratifying. 

The  results  which  were  for  a  time  expected  from  the  curative  value 
of  tuberculin  (Koch,  1890)  were  realized  to  a  slight  extent  only.  On 
the  other  hand  tuberculin  has  proven  itself  a  valuable  diagnostic  agent 
and  has  been  used  with  particular  success  among  domestic  animals.  The 
diagnostic  properties  of  tul)erculin  and  the  recognization  of  the  condi- 
tions which  produce  infection  constitute  the  l)asis  of  Bang's  system  for 
the  extermination  of  tuberculosis.  By  means  of  this  system  the  eradi- 
cation of  the  disease  can  be  accomplished  without  serious  economic  loss 
even  in  badly  infected  herds.  On  the  other  hand,  the  advantages  ex- 
pected from  protective  inoculation  of  cattle  by  means  of  hunum  tul)ercle 
bacilli  (Behring,  1902)  have  by  no  means  been  realized  in  the  same 
degree,  and  the  problem  of  employing  this  agent  in  the  fight  against 
tul)erculosis  remains  for  the  futui'e  to  solve. 

Among  the  more  recent  discoveries  which  deserve  special  mention 
are  Pinpiet's  local  "allergic"  tuberculin  reactions  and  Much's  non-acid- 
fast  form  of  tubercle  bacillus. 

Occurrence.  The  prevalence  of  tuberculosis,  especially 
amon,"-  cattle  and  swine,  stands  in  intimate  relation  to  the  de- 
velopment of  intensive  agriculture.  Among  cattle  its  spread 
is  favored  to  a  great  extent  by  our  modern  soiling  system, 
forced  maturity  of  young  animals  and  increased  traffic  in  live 
stock.  Thus  tuberculosis  is  practically  unknown  on  the  ex- 
tensive prairies  of  North  America,  in  Central  Africa  and  on 
many  islands  (Iceland,  Sicily).  It  is  almost  unknown  among 
the  cattle  of  the  steppes  of  Eastern  Europe,  while  it  is  par- 
ticularlv  prevalent,  in  the  central  and  western  countries  of 
Europe,  especially  in  the  neighborhood  of  large  cities  where 
it  is  increasing  in'prevalence.  Large  dairy  establishments  near 
cities  suffer  comparatively  greater  losses  than  the  smaller  herds 
of  farmers  in  mountainous  regions.  Young  animals  are  less 
frequentlv  affected  than  older  stock.  Among  swine  the  disease 
has  gained  a  foothold  through  the  practice  of  feeding  the  prod- 
ucts of  creameries  and  skimmed  milk  to  young  swine.  Among 
other  domestic  animals,  with  the  exception  of  fowds,  the  disease 
is  nnich  less  prevalent,  although  no  species  is  entirely  free  from 
its  ravages. 

The  importance  of  tuberculosis  to  the  cattle  industry  lies 
in  the  fact  that  the  average  age  of  usefulness  of  the  young 
animals  has  decreased  in  direct  proportion  to  the  increased 
prevalence  of  tubercnlosis,  and  to  the  fact  that  the  losses  from 
the  elimination  of  indifferent  and  poor  milk  producers  is  con- 
tinually increasing.  The  raising  of  young  animals  is  attended 
with  greater  difficulties  and  expense;  the  volume  of  milk  pro- 
duced bv  infected  herds  is  decreased,  and  the  emaciation  of 
affected 'animals  reduces  their  food  value.  Moreover  the  large 
number  of  carcasses  of  diseased  animals  which  are  condemned 
for  food  purposes  causes  annually  a  consideral)le  economic  loss 
to  the  national  wealth. 

Our  knowledge  of  the  prevalence  of  the  disease  has  been 
gained  on  the   one  hand  from   statistics  furnished  by  public 


502 


Tuberculosis. 


abattoirs  and  on  the  other  hand  from  results  furnished  by  the 
tuberculin  test.  The  value  of  slaughter  house  statistics  where 
only  the  more  or  less  conspicuous  lesions  are  noted,  depends  to  a 
great  extent  upon  the  experience  and  care  of  inspectors  in 
charge.  The  tuberculin  test  furnishes  evidence  of  the  existence 
of  the  disease  in  its  most  incipient  stage,  hence  the  percentage 
of  cases  disclosed  by  the  latter  is  much  larger  than  that  in- 
dicated by  the  former. 

In  Germauy  iuvestig^ations  of  the  Imperial  Board  of  Health  for  the  year 
1888-1889  show  that  from  2  to  8%  of  all  cattle  were  tuberculous.  Since  then, 
however,  meat  inspection  statistics  and  the  results  of  extensive  tuberculin  tests 
have  shown  the  disease  to  be  far  more  prevalent.  Thus  according  to  Biedamgrotzky  's 
compilations  in  1,110,2.52  animals  slaughtered  in  the  abattoirs  of  Saxony,  Prussia  and 
Bavaria  in  the  period  from  189.5  to  1897,  1.3.1%  were  found  tuberculous.  During 
the  same  period  the  abattoirs  in  the  Empire  of  Germany  furnished  353,162  tuberculous 
animals.  Of  these  9,705  were  condemned  and  18,322  were  sold  under  declaration. 
The  resulting  annual  loss  is  estimated  at  six  and  one-half  million  marks,  or  a  little 
over  one  and  a  half  million  dollars.  During  the  same  period,  of  1,107,552  slaughtered 
5wine,  1.22%  were  found  tuberculous.  This  resulted  in  the  condemnation  of  the 
carcasses  of  2,600  head  of  swine  while  39,000  head  were  sold  under  declaration. 
The  actual  loss  from  tuberculosis  in  swine  (carcasses)  was  one  and  three-quarter 
million  marks  or  over  four  hundred  thousand  dollars. 

The  following  table  which  is  taken  from  the  official  report  on  sanitary  police 
control  of  abattoirs  of  the  German  Empire  shows  the  percentage  of  animals  con- 
demned on  account  of  tuberculosis: 


Cattle 

Calves 

Swine 

Sheep 

Goats 

Dogs 

Horses 

1904 

17.89% 

0.26% 

2.46% 

0.20%, 

0.69  7o 

0.86% 

0.15% 

1905 

19.16% 

0.30% 

2.87% 

0.22% 

0.76%, 

? 

0.16% 

1906 

20.66%, 

0.35% 

2.81% 

0.17% 

0.72% 

? 

0.17% 

Abattoir  reports  of  the  various  states  of  the  German  Empire  show  that 
tuberculosis  is  on  the  increase  among  cattle  as  well  as  among  other  species  of 
animals.  A  few  localities  only  show  a  decrease  in  the  prevalence  of  tuberculosis 
among  swine  and  calves  (Ostertag).  Thus  the  kingdoms  of  Bavaria,  Prussia  and 
Saxony  furnish  the  following  tables  of  information: 


BAVARIA 

Cattle 

Calves 

Sheep  and  Goats 

Swine 

Horses 

1898 

5.7   % 

0.05% 

0.03% 

0.35% 

1900 

6.0  % 

0.07% 

0.46% 

0.03% 

1902 

6.8   % 

0.12% 

0.66%, 

0.04% 

0.08% 

1904 

9.20% 

0.21% 

0.09% 

0.147o 

0.96% 

0.16% 

1906 

10.31% 

0.28% 

0.12%, 

PRUSSIA 

0.19% 

1.40% 

0.11% 

Cattle 

Calves 

Sheep 

Goats 

Swine 

Horses 

1898 

16.09% 

0.15% 

0.11% 

0.50% 

2.23% 

1900 

15.0   % 

0.16% 

0.09% 

0.38%, 

2.41%, 

0.12% 

1902 

16.4  % 

0.19%o 

0.08% 

0.35% 

2.80% 

0.10% 

1904 

20.33%, 

0.28% 

0.20% 

0.51% 

2.64%, 

0.12% 

1906 

23.40% 

0.33% 

0.17% 

SAXONY 

0.61% 

2.96% 

0.16% 

Cattle 

Calves 

Sheep           Goats 

Swine 

Dogs 

Horses 

1898 

30.46% 

0.24% 

0.09%           0.41% 

3.16% 

0.16% 

1900 

29.47%r 

0.30% 

0.29%           2.57% 

3.65% 

0.26% 

0.19% 

1902 

30.98% 

0.36% 

0.24%           2.97  7o 

4.31% 

0.16% 

0.87% 

1904 

34.49% 

0.46% 

0.14%           1.83% 

5.13% 

0.31% 

1.14% 

1906 

37.76%. 

0.56% 

0.14%           1.99% 

5.43% 

0.25% 

1908 

37.58% 

0.50%f> 

0.09%           1.96% 

5.07% 

0.30% 

The  percentage  of  infection  revealed  by  tuberculin  tests  in  general  has  been 
very  high.  Thus  in  the  kingdom  of  Saxonv  for  the  years  1891  to  1897  it  varied 
between  57  and  84%.  Up  to  the  middle  of  the  year  1904,  68%  of  3,083  cattle 
that  were  tested  reacted.     Thus  the  assumption  of  Klimmer  that  2/3  of  all  cattle 


Occnni'iico.  50o 

har])or  "crnis  of  tubcrc-ulosis  has  a  basis  of  fa.-t.  On  the  other  han.l  Ostertag,  basintr 
his  estimate  iinoii  personal  experieme  in  Northern  Germany  an-l  in  the  region 
surroun.linfj  Stiitt-art,  estimates  that  23%  of  all  cattle  are  alVeote,l  with  tuberculosis. 

In  France  the  disease  is  very  prevalent.  In  several  re<,nons  (Bretafjne,  Nivernais, 
Hautes  Yosf^es,  etc.)  estimates  of  veterinarians  place  the  percentage  of  tuberculous 
cattle  at  30  to  40'};  or  more.  In  some  instances  herds  that  were  apparently  free 
from  disease  showe.l  bv  the  tuberculin  test  that  they  contained  from  50  to  80%  of 
reactors  Over  ten  per  cent  of  all  cattle  in  the  French  Eepnblic  are  claimed  to  be 
tuberculous  (Xocard  &  Leclainche).  In  the  abattoir  La  Vilette  in  Pans  the  per- 
centage of  tuberculous  calves  was  from  1S99  to  1903  reduced  from  0.31  to  0.1o% 
(Cesari).  Autopsies  hehl  on  dogs  in  Alfort  in  1900  to  1904  revealed  4.6%,  3%, 
7  ''%  and  9.17o  respectively,  to  lie  tuberculous   (Petit). 

In  Great  Britain  Wallev  found  as  early  as  1879  tuberculosis  to  be  a  very 
prevalent  disease  among  Aldeiney  and  Shorthorn  cattle.  From  1897  to  1899,  4,10o 
or  -^6  0%  of  15,392  cattle  that  were  tested  with  tuberculin  reacted. 

In  Austria  tuberculosis  occurs  in  all  of  the  Crown  Lands.  Some  abattoir 
reports,  however,  show  very  low  percentages  of  infection.  Thus  in  1900  lower 
Austria  is  credited  with  1.4%,  upper  Austria  with  2.9%  and  the  other  provinces 
with  1%  of  infected  animals.  In  Vienna  1.3  to  1.87c;  in  Moravia,  in  the  years 
1896  and  1897  39.8%,  of  2,314  tested  cattle  gave  positive  reactions  and  4.4% 
doubtful  reactions.  During  the  following  years  tests  that  were  made  in  Salzbiirg 
revealed  from  41  to  44%  of  reactors;  in  Silesia  25  to  40%;  in  lower  Austria  u3.4%>; 
in  Gallicia  among  Polish  cattle  14.2%  ;  among  milk  cows  60.3%  of  reactors 

The  slaughter  house  reports  of  Budapest  in  Hungary,  give  the  following 
exact   statistics: 

Cattle : 

Longhorned  Improved  Calves  Buffalo  Swine              Horses 

Breeds  Breeds 

1809            12.2%o  13.8%  0.006%,  0.07%r                                        

1901            14.1%  13.9%  0.01  %  0.26%                                        

1903            15.0%  16.9%,  0.01  %  0.07%               2.6  7o               

1905            16.6%  21.6%,  0.03  %  0.11%               1.42%               

1907            19.8%  25.2%  0.04  %  0.89%               \A\%               

1909            16.8%,  21.8%c  0.03  %  0.58%               1.53%,               

Tuberculin  tests  comlucted  on  cattle  of  the  colored  breeds  revealed  the  following 
results : 

Xo.  of  Herds   Cattle  under  ly..  years  Cattle  over  2V2  years  ..."^-^fi':?.^ 

Tested         Reacted  Tested       Reacted  fiomJubei- 

culosis 

190'>  34  1723  170=    9.8%  1871  250  =  13.3%  3 

1903  34  1145  166  =  14.4%  2588  323  =  12.6%  7 

1904  56  2847  251=    8.1%  3639  966  =  26.8%  8 

1905  85  3152  2S5  =  9.0%  4404  1033  =  23.4%  22 
iqOfi  93  .3859  296=  7.5%  5999  1345  =  16.5%  12 
1907  88  2.548  256  =  10.0%  4422  760  =  17.1%  20 

\ccordincr  to  investigations  by  Uihelvi  covering  20  estates,  1,517  or  75.36% 
of  ''0'l3  head^'of  cattle  tested,  reacted;  of  1,495  calves  and  yearlings  tested,  o26 
or  35  18%  reacted.  On  the  other  hand  of  117  herds  belonging  to  peasants  ot 
the  county  of  :\Ioson  53  were  found  free  from  tuberculosis.  Among  the  remaining 
herds  of  "this  district,  of  501  cattle  tested  25.7%c  reacted  and  of  177  calves  and 
veariings  that  were  tested  only  one  reacted.  The  infected  herds  of  these  peasants 
"were  all  located  near  the  larger  states  from  which  discarded  cattle  were  occasionally 

^^^^  In  Belgium  in  1906  among  2,905  herds  that  were  investigated  and  of  19,004 
cattle  that  were  tested,  48.8%  reacted.  During  the  year  1900,  10,269  tuberculous 
cattle  were  officially  condemned  and  slaughtered.  In  the  Netherlands  the  large 
abattoirs  revealed  from  2  to  13%  of  all  cattle  as  tuberculous.  In  Switzerland 
statistics  show  that  the  percentage  is  much  lower  although  m  several  cantons  (Bern, 
Geneva  Ziirich,  Winterthur)  the  percentage  in  slaughtere-l  cattle  is  reported  to  be 
as  high   as    19%.      Tuberculin   tests   show   that   from   40   to   50%;    of  all  cattle  are 

tuberculous  fZschokke).  ,      ,      .      .  ^   x,       ini.i  ^      , 

Denmark  was   free   from   tuberculosis   at   the  beginning   of   the    19th   century, 
but  became  infected  by  the  importation  of  Swiss,  Holstein  and  English   ;*;^5^^^1'o;;'J 
cattle       \s   a   result,   the   first  tuberculin   tests   made   m   this   country    (lS93-lSt4) 
showed   that    from    38.5%    to   40%    of   the   cattle  were   tuberculo-JS      The   abattoir 


504  Tuberculosis. 

statistics  of  Copenhagen  for  1895  showed  that  29.7%  of  all  slaughtered  cattle 
and  over  10%  of  all  swine  were  tuberculous.  In  the  period  beginning  April,  1893, 
and  ending  with  the  year  1908,  19,717  herds  were  tested  with  tuberculin.  Of 
these  11,553  were  first  tests.  A  total  of  503,879  cattle  were  tested  of  which  108,378 
or  21.5%  reacted  to  the  tuberculin  test.  During  this  period  the  number  of  reactors 
was  reduced  from  40%  to  8.5  %i.  Of  10,344  herds  tested  for  the  first  time  in  the 
year  1903,  2,664  herds  (consisting  of  33,946  animals)  were  found  free  from  tuber- 
culosis. Most  of  these  herds  contained  less  than  25  animals  each;  153  herds  were 
composed  of  from  26  to  55  animals   (Bang), 

In  Norway,  in  1895  to  1909,  of  25,832  herds  that  were  tested,  4,217  or  16.3% 
were  tuberculous.    Of  219,925  animals  tested  12,823  or  5.5%  were  infected  (Malm). 

In  Sweden,  from  1897  to  1908,  of  12,720  herds  which  were  tested  for  the 
first  time,  5,527  herds  were  free  from  reactors.  Of  306,372  animals  tested  30.7% 
reacted   (Eegner). 

In  Finland,  from  1894  to  1900,  of  75,447  cattle  that  were  tested  13.7% 
reacted  (Hojer). 

Of  the  other  European  countries  tuberculosis  is  very  prevalent  in  Northern 
and  Central  Italy,  in  Spain  and  in  Portugal.  According  to  Nogueira  the  disease 
exists  to  the  extent  of  3.8%  among  bulls  which  are  reared  in  the  open  to  supply 
the  market  for  bull  fights.  The  disease  is  prevalent  to  an  equal  extent  in  Eussia, 
Roumania,  Servia  and  the  Herzegovina.  On  the  other  hand  the  cattle  of  the  steppes 
of  Eussia  are  practically  free  from  the  disease.  Of  30,000  Servian  cattle  killed 
annually  in  Budapest  uj)  to  the  year  1906,  only  .20  to  .23%  were  found  tuberculous. 

Outside  of  Europe  tuberculosis  occurs  wherever  European  breeds  of  cattle  have 
been  imported.  Thus  the  disease  is  very  prevalent  in  North  America  where,  accord- 
ing to  Salmon,  among  suspected  herds  that  were  tested,  25%  were  found  infected, 
while  among  unsuspected  herds  9%  were  found  infected.  Eeports  of  the  Bureau 
of  Animal  Industry  show  that  of  400,008  cattle  tested  9.25%  reacted.  According 
to  Melvin  the  disease  causes  an  annual  loss  of  $23,000,000  in  the  United  States. 
Tuberculosis  is  also  quite  prevalent  in  South  America.  In  Buenos  Ayres  3.7% 
of  all  cattle  and  10.8%  of  all  swine  were  found  tuberculous.  In  the  State  of 
San  Paoblo  20%  of  milk  cows  are  tuberculous.  Finally  the  disease  is  also  prevalent 
in  Africa  (Egypt  and  Southern  Africa)  as  well  as  in  Australia.  In  Japan  where 
tuberculosis  has  always  been  prevalent  among  human  beings,  it  has  been  known 
in  cattle  only  for  the  past  30  years  and  since  then  has  been  gaining  ground  rapidly. 
The  disease  was  introduced  by  the  importation  of  American  cattle   (Kanda). 

Etiology.  The  Bacillus  Tuberculosis  Koeli  is  a  slender, 
slightly  bent  bacterium,  1.5-4.0  ii.  long  and  0.3-0.5  ii.  in 
diameter,  which  seems  to  be  covered  with  a  thin  w^axy  substance. 
It  is  non-motile  and  non-sporulating.  In  tissues  it  occurs  singly ; 
in  morbid  secretions  it  is  frequently  found  in  groups,  in  parallel 
bundles  or  in  pairs  placed  at  an  acute  angle  (see  Fig.  77).  In 
rare  cases  it  is  composed  of  a  chain  of  two  or  three  links.  In 
fresh  cultures  it  grows  in  wavy  lines,  while  older  cultures  pro- 
duce long  threads  which  may  show  a  tendency  to  branch  and 
form  club-shaped  swellings.  Stained  bacilli  from  morbid  secre- 
tions show  colorless  spaces  which  give  them  the  appearance  of 
coccus  chains. 

Besides  the  typical  acid-fast  form  of  the  tubercle  bacillus 
there  has  recently  been  discovered  by  Much  a  non-acid-fast 
granular  form  which  consists  of  small  granules  arranged  in 
straight  rows.  This  probably  represents  a  young  culture  variety 
of  the  species  from  which  the  rod  shaped  acid-fast  bacterium 
develops  (see  Fig.  78  and  Fig.  79).  The  granular  form  which 
is  found  especially  in  pearl  disease  of  cattle  and  in  cold  ab- 
scesses of  man,  is  just  as  virulent  as  the  acid-fast  rod-like 
species. 

By  means  of  special  staining  methods  the  interior  of  the 
tubercle  bacillus  reveals  a  granule  (rarely  two  or  four  granules), 


INSERT  FOLDOUT  HERE 


Eiiuloirv, 


50.") 


Fig.  77.  Bac.  Tiihrrculosis.  arid- 
fast  form.  Bronoliial  secretion 
from  cattle.  Stained  by  Ziclil- 
Xelsseu's  uiethod. 


which  Spoiii^lor  rofovs  to  as  "s])linlors"  and  rc.uavds  as  true 
spores.  Most  investigators,  however,  h)ok  iii)on  these  bodies 
as  chromatin  granules  snch  as  are  found  also  in  other  ])acteria 
whether  they  are  sporulating  or  non-s])orulating  species. 

Staining.  The  typical  tuherelo  ha- 
filhis  is  stained  most  readily  and  eharac- 
teristieally  with  a  warm  carl)ol-t'iK'hsi;i 
sohiliou  or  with  any  aniline  water  gen- 
tian-vioh^t.  After  once  ahsorhinp;  the 
stain  the  latter  becomes  so  well  lixed  that 
it  is  impossible  to  remove  it  with  alcohol 
or  mineral  acid  (5 '/J  sulphuric  acid— 
30%  nitric  acid).  This  characteristic 
(acid-fast  or  alcohol-fast)  which  is  met 
also  in  the  bacillus  of  leprosy  and  in  sev- 
eral saprophytic  bacteria,  is  due  to^  the 
presence  of  fatty  acids  in  the  body  of  the 
l)acillus  (Deycke'i.  No  other  bacteria  ex- 
cept those  mentioned  possess  this  charac- 
teristic. 

]\ruch's  granular  form  of  the  tubercle 
bacillus  may  be  stained  by  Gram's  method 
of  sul)jectinor  it  to  the  action  of  aniline- 
gentian  violet  for  24  to  48  hours  at  body 
temperature.     (See  Diagnosis.) 

Culture.  The  tubercle  bacilli  will 
grow  only  in  the  presence  of  oxygen  and 
"at  a  temperature  varying  from  29  to  42 ' 
C,  its  growth  being  most  prolific  at  blood 
temperature.  The  best  culture  media  are 
those  containing  egg  albumen,  although 
the  bacillus  Avill  grow  also  on  common 
laboratory  media  which  do  not  contain 
this  substance.  The  chemical  reaction  of 
the  medium  must  be  neutral  or  slightly 
acid.  The  presence  of  glycerin,  grape 
sugar  or  phosphoric  acid  favors  its  growth 
Avhich  is  usuallv  very  slow.  Cultures  are 
never  visible  before  the  end  of  a  period 
of  at  least  one  or  two  weeks. 

On  blood  serum  and  on  8  to  5% 
glycerin  agar  the  cultures  appear  as  fol- 
lows: In  the  course  of  two  weeks  after 
inoculation  of  material  small  gray  dry 
lusterless  granules  or  scales  make  their 
appearance.  These  are  gradually  sur- 
rounded by  a  halo  (Fig.  80).  Tu  the 
course  of  time  they  form  an  irregular, 
crumpled,  dry  granular  continuous  mass 
whieh  is  easily  removed  from  the  surface 
of  the  medium.  On  glycerin  bouillon 
after  surface  inoculation  there  is  formed 
a  fine  pellicle  which  ultimately  develops 


Fig.  78.  Bac.  Titherculofti.t,  gran- 
ular form,  Bronchial  secretion 
from  cattle.  Stained  by  iluch's 
n  etliod. 


Fig.  79.  Bae.  Tulierculnfii.'i,  Stain- 
ed l)y  Hermann's  method.  (The 
same  material  as  in  Fig.  77-78  ) . 


506 


Tuberculosis. 


into  a  thick  membrane  covering  the  entire  surface  of  the  fluid.  In  the 
course  of  time  this  membrane  increases  in  thickness  and  becomes 
crumbly.  Very  slight  jarring  of  the  container  will  cause  it  to  break  into 
fragments  causing  portions  to  sink  to  the  bottom  of  the  flask  where  they 
develop  into  globular  mulberry-like  white  colonies.  The  bouillon  re- 
mains clear  throughout  its  mass.  Upon  glycerin-potato  medium,  one  of 
the  most  suitable  for  its  growth,  there  develop  dry  crumbling  masses 
which  unite  to  form  a  rough  irregular  covering.  (See  Plate  II.)  Acid- 
reacting  brain-agar  and  brain-serum  are  also  excellent  media  for  its 
growth. 

Arloing  succeeded  in  producing  so-called  homogeneous 
cultures  by  repeated  shaking,  in  which  the  unusually  long 
l)acilli  are  less  acid  fast  than  usual  and  motile.  The  origi- 
nal potato  cultures  had  a  shiny  fatty  appearance. 

Morphological  and  Cultural  Differences  Observed 
in  Tubercle  Bacilli  of  Different  Origin.  These  were  pointed 
out  by  Theobald  Smith  in  1S!J8.  Later  other  investigators 
(Kossel,  Weber  &  Heuss)  confirmed  the  results  reported  by 
Smith.  According  to  these  investigators  two  types  or 
varieties  of  tubercle  bacilli  are  recognized  (human  type  and 
bovine  type).  These  types,  however,  do  not  include  the 
avian  form  of  tubercle  bacillus  nor  the  varieties  which 
occur  in  cold  blooded  animals.  Intermediate  between  the 
liuman  and  the  bovine  type  are  observed  many  transition 
forms  some  of  which  it  is  impossil)le  to  classify  with  either 
group.  The  cultural  characteristics,  however,  are  clearly 
manifest  only  when  the  various  types  are  grown  on  the 
same  medium  and  under  similar  conditions,  particularly 
upon  beef  broth  of  amphoteric  reaction  with  2%  glycerin. 

The  bacilli  of  the  human  type,  when  found  in  morbid 
secretions  or  tissues  or  in  pure  culture,  are  usually  more 
slender  and  show  the  irregular  staining  to  better  advantage 
than  the  bacilli  of  the  bovine  type.  Further,  on  some  va-. 
rieties  of  potato  the  cultures  of  the  human  type  assume  a 
dark  red  color  in  the  course  of  three  weeks  ( Arpad) .  They 
also  show  more  rapid  growth  in  first  cultures  than  the  bacilli 
of  bovine  tuberculosis.  On  the  other  hand  the  latter  are 
frequently  characterized  by  their  fine  verrucose  surface  on 
potato  culture. 

The  bacilli  of  the  human  type  grow  luxuriantly  on 
glycerin  bouillon,  formnig  a  wrinkled  membrane  of  even 
thickness  which  spreads  over  the  entire  surface  of  the 
liquid,  while  the  bovine  type  forms  a  fine,  delicate  and  fre- 
(|uently  fenestrated  pellicle  upon  which  small  nodular  pro- 
tuberances develop  in  the  course  of  time  (Kossel,  Weber  & 
Ileuss).  Then  again,  the  mulberry  shaped  colonies  which 
develop  after  inoculation  of  small  numbers  of  bacilli  are 
characteristic  of  the  bovine  type. 

On  bile  medium  or  on  potato  impregnated  with  5% 
glycerin  bile,  tul)ercle  liacilli  will  develop  only  if  obtained 
from  the  same  species  which  furnished  the  bile.  Thus  the 
human  type  will  grow  only  on  bile  medium  produced  from  human  liile 
and  the  bovine  type  on  bovine  bile,  the  avian  type  on  bile  obtained  from 
fowls  (Calmette  &  Guerin). 


Fip.  80.  Gly- 
cerin a  ^f  a  r 
cult  lire  of  the 
tubercle  ba- 
cillus, five 
weeks  old. 


Mori>li(>l()-iic'al   and   ("ultiiial    Diflferenecs.  5()7 

Another  difference  observed  between  the  two  types  uiuk-r  discus- 
sion is  that  in  cultures  of  the  Imvine  type  tiie  aeidity'd. 'creases  until  the 
medium  at  times  becomes  alkaline,  while  media  contaiiung  a  growth  of 
the  human  tyj)e,  though  at  lirst  reduced  in  acidity,  becomes  more  and 
luore  aeid  Avith  the  age  of  the  culture  (Smith).  According  to  llothhaar, 
Fibiger  &  Jensen  this  characteristic  is  inconstant. 

These  two  types  of  bacilli,  however,  are  not  confined  strictlv  to 
definite  species  of  animals,  both  types  occurring  in  dilFerent  species. 
However,  in  the  great  majority  of  cases  tulx-rculosis  of  man,  dogs  and 
eats  is  caused  by  the  liuman  type  and  tuberculosis  of  cattle  and  other 
ruminants  and  of  swine  is  caused  almost  exclusively  by  the  bovine  type. 

Tenacity.  The  tuberclo  bacillus  is  extremely  resistant  to  external  inflnenf-es. 
Tins  IS  probably  due  to  the  waxy  capsule  by  which  it  is  protected.  When  exposcl 
to  the  direct  rays  of  the  sun  they  are  destroyed  in  a  few  hours.  In  dilluse  iij^ht 
they  will  retain  their  virulence  from  .3  to  10  days  (Fliifjjre).  In  artificial  lij,dit 
they  are  destroyed  in  48  hours  (Galtier).  Simple  drying,  especially  when  imbedded 
in  iiitroj,'eiious  tissue  or  fatty  nu'dium  has  little  cfliVct  on  their  vitality.  Thus  in 
dry  sputum  ]H-otected  from  light  they  may  remain  virulent  126  days  (Schill  & 
Fischer),  m  ihy  an<l  pulverized  tissue  from  cattle  lung  1()2  davs,  in  large  tissue 
masses  loO  days  (Cadeac  &  IMalet).  Stone  found  that  sputum  was  infectious  after 
three  years.  ])ecomposition  affected  their  vitality  very  little.  Thus  decomposing 
sputum  harbors  virulent  bacilli  for  six  weeks  (Schill  &  Fischer)  and  decomposed 
cattle  lung  167  days  (Cadeac  &  Malet).  In  water,  cultures  remain  virulent  70 
days,  in  tissue  12(»  days. 

The  bacilli  will  remain  virulent  in  raw  milk  for  10  davs  (Gasperini)  at  the 
end  of  which  period  they  probably  succumb  to  the  influence  of  I'actic  acid  (Bollinger). 
On  the  other  hand  they  have  been  known  to  remain  virulent  .S3  days  in  Emmen'taler 
cheese  and  104  days  in  Cheddar  cheese  (Harrison).  In  sweet  cream  butter  they 
remain  virulent  4  weeks.  They  are  destroyed  in  the  course  of  ten  days  in  sour 
cream  butter  containing  4  to  6%  common  salt.  Sometimes  5  davs  suffice  to  destroy 
them  under  these  conditions  (Petterson).  On  the  other  hand  thev  have  been  known 
to  remain  virulent  45  days  in  such  butter  (Schroeder  &  Cotton).  Treatment  with 
H,0,  ("Budderisicrung")  destroys  the  tubercle  bacilli  with  certainty  (Bergman 
&  Hultman).     Kefir  fermentation  does  not  affect  their  virulence. 

The  influence  of  high  temperatures  varies  according  to  the  medium  in  which 
they  are  found.  Simple  boiling  or  contact  with  live  steam  will  destroy  dry  or  moist 
sputum  in  5  or  1.5  minutes,  respectively.  On  the  other  hand  dry  sputum  can  he 
safely  sterilized  by  the  action  of  dry  heat  at  100°  C.  continued  for  one  hour  (Schill 
&  Fischer).  Tn  milk,  bacilli  wdiich  were  originally  present  as  well  as  liacilli  which 
have  been  added  in  cultures,  are  destroyed  in  25  minutes  when  heated  to  65°  C. 
providing  the  milk  was  heated  in  a  closed  vessel  (Forster).  On  the  other  hand' 
heating  the  milk  in  open  vessels,  which  does  not  result  in  an  equal  distribution  of 
temperature  throughout  the  mass,  will  not  destroy  all  tubercle  bacilli  in  the  course 
of  six  minutes,  even  if  the  temperature  reaches'  80°  C.  All  bacilli  found  in  the 
film  which  forms  on  the  surface  of  tlie  milk  are  more  or  less  protected  from  the 
action  of  the  heat  (Galtier,  Snnth,  Bang).  According  to  Rabinowitsch  &  Beck 
cream  can  be  sterilized  by  heating  for  2  minutes  at  85°  C.  (Herr).  According 
to  investigations  of  Barthel  \-  Stenstrom  bacilli  will  withstand  an  exposure  of 
80°  or  85°  C.  when  the  milk  is  coagulated  while  they  are  destroyed  in  non-coagulated 
milk  at  the  same  temperature.  Thus  pasteurizing  at  a  temperature  of  S(i°  continued 
for  one  minute  will  suffice  to  destroy  the  tubercle  bacilli  providing  no  coamdation 
occurs.  Freezing  temperature  of  1°  to  8°  C.  will  not  destroy  the  bacilli^in  I'^O 
days   (Cadeac  &  Malet). 

With  respect  to  chemical  agencies,  bacilli  occurring  in  albuminous  substances 
are   most   effectively   destroyed   by   such   chemicals   as   will   not    coagulate   albumen 

Thus  carbolic  acid  5<^,  acetic  acid  31.8%,  or  corrosive  sublimate  1:1000 500  wili 

not  destroy  them  (Schill  &  Fischer).  Cultures  are  destroyed  in  solutions  of  0  1% 
tuberculin  in  48  hours,  0.2%  methylene  blue,  0.1%  pyoktaunin  in  72  hours  (Jacob 
Bongert  &  Rosenberg);  0.2%  thymol.  4%  boracic  acid  and  4%  creolin  or  Ivsol 
are  also  effective.  Brine  and  smoke  have  only  a  slightly  destructive  action,  virulent 
tubercle  bacilli  having  been  found  in  tuberculous  organs  after  six  weeks  immersion 
in  brine  (Klepzow).  Glycerin  acts  as  a  preservative  of  tuberculous  organs  (Galtier) 
Antiformin  in  solution  of  15%  does  not  affect  tubercle  bacilli  or  other  acid-fast 
bacilli  while  non-acid-fast  bacilli  are  destroyed  by  this  agent.  On  the  other  hand 
20%  solution  of  cholin  will  dissolve  the  tubercle'  bacilli  at  a  temperature  of  37° 
to  56°.     Neurine  is  even  more  effective  (Deycke  &  Much). 


508  Tuberculosis. 

Gastric  juice  at  30°  C.  does  not  affect  the  bacilli  in  3  to  4  hours.  In  the 
course  of  6  or  8  hours,  however,  their  virulence  becomes  reduced  and  in  18  to  24 
hours  they  are  destroyed  (Zagari,  Strauss  &  Wurtz).  Bile  and  pancreatic  juice 
do  not  affect  them   (Gallichi). 

Pathogenicity.  When  susceptible  annuals  are  inoculated 
Bubcutaneously  with  tuberculous  secretions,  tissue  or  virulent 
cultures,  there  develops  at  the  point  of  inoculation  a  tumor 
which  may  break  in  the  course  of  a  few  days,  discharge  a  caseo- 
purulent  mass  and  develop  into  a  sinuous  ulcer.  In  some  cases 
the  ulcer  will  heal  and  the  process  terminate;  in  other  cases 
the  disease  progresses.  After  a  time  the  lymphatic  glands 
which  are  supplied  by  the  lymph  vessels  of  the  affected  region, 
swell  and  become  the  seat  of  the  formation  of  tuberculous  "foci, 
which,  in  the  course  of  time,  undergo  cheesy  degeneration. 
Following  this  the  internal  •  organs  become  affected  almost 
simultaneously,  sometimes  one  after  another  along  the  lymphatic 
circulation  and  at  other  times  apparently  independently  through 
the  medium  of  the  blood.  Cutaneous  inoculations  (rubbing  on 
the  scarified  skin)  usually  produces  only  small  rapidly  healing 
nodules  (Chauveau).  Sometimes,  however,  the  neighboring- 
lymph  glands  become  involved  and  a  general  tuberculosis  may 
follow  (Courmont,  Babes,  Osman  Nouri). 

After  intraperitoneal  inoculation  to  which  animals  in 
general  are  very  susceptible,  the  peritonemn  (especially  the 
mesentery)  the  abdominal  lymph  glands,  the  spleen  and  the 
liver  are  attacked  first.  Adjacent  organs  may  become  involved 
.later.  The  most  effective  method  of  inoculation  consists  in 
the  injection  of  virus  into  the  jugular  vein.  This  is  followed 
by  the  development  of  innumerable  tubercles  in  the  lungs  with 
acute  swelling  of  the  lymphatic  glands  of  the  thoracic  cavity. 
Animals  usually  die  in  the  course  of  a  few  weeks  with  symp- 
toms of  high  fever  and  rapid  emaciation.  Sometimes  other 
organs  are  similarly  affected.  If  inoculation  is  made  in  the 
anterior  chamber  of  the  eye,  typical  tuberculosis  develops  in 
the  iris  in  the  course  of  two  or  three  weeks.  This  local  affec- 
tion is  then  followed  by  a  general  tuberculosis  (Cohnheim, 
Baumbarten). 

The  feeding  or  ingestion  of  pure  cultures  or  of  material 
containing  tubercle  bacilli  (sputum,  milk  tissue)  to  guinea  pigs 
or  calves  is  followed  either  by  tuberculosis  of  the  peripharyn- 
geal, cervical  and  mediastinal  lymph  glands  and  bronchial  tubes, 
or  by  an  infection  of  the  mesenteric  l^anph  glands  and  the  ab- 
dominal organs.  The  pharyngeal  and  intestinal  mucous  mem- 
brane may  remain  practically  healthy  but  on  the  other  hand, 
especially  if  the  infection  was  severe,  the  tonsils  may  ulcerate 
or  the  h^nph  follicles  of  the  intestines  may  undergo  tuberculous 
ulceration.    Old  animals  are  only  rarely  affected  by  these  means. 

Inhalation  of  dry  or  pulverized  tuberculous  tissue  or  secre- 
tions as  well  as  culture  sprays  may  be  followed  by  tuberculosis 
of  the  lungs  and  of  the  bronchial  glands.  The  more  finely  the 
infectious  material  is  pulverized  or  divided  the  greater  are  the 


Pathogen  ieity.  509 

chanoes  of  infoction.  Inhalation  throngh  tlie  mouth  is  more 
elTc'ctivo  than  inhahition  through  tlie  nostrils.  The  inhalation 
of  heavily  infected  air  nsnally  results  in  miliary  tuberculosis 
of  the  hings,  while  slightly  infected  air  may  produce  only 
isolated  tuberculous  foci  which  develop  into  cheesy  pneumonia 
processes  or  cavities  (Cornet  &  ^Mayer). 

Infection  also  follows  the  injection  of  tuberculous  material 
into  the  vagina  or  its  direct  application  to  the  mucous  mem- 
brane (Cornil  &  Dobroklonsky).  Occasionally  the  first  s>anp- 
tom  of  infection  is  a  swelling  of  the  inguinal  glands  without  local 
changes.  Finally  direct  application  of  virulent  cultures  to  the 
teats"  of  the  udder  is  followed  by  a  progressive  infiammation 
of  the  milk  ducts  (Nocard,  Nattan-Larrier). 

Variations  in  the  Pathogenic  Effect  of  Tubercle  Bacilli  of  Dif- 
ferent Origin.  The  results  of  exi)eriiuental  infection  vary  considerably 
accordin;^  to  the  origin  of  the  tubercle  l)acilli  or  of  tiie  material  con- 
taining them,  as  Avell  as  according  to  the  age  and  the  species  of  the 
experimental  animals.  With  rare  exceptions  the  ])aci]li  of  the  bovine 
type  possess  a  higher  degree  of  virulence  for  mammals,  including  the 
ape,  than  the  bacilli  of  the  human  type.  It  seems  immaterial,  also, 
whether  the  particular  type  of  bacillus  in  question  originates  from  one 
species  of  animal  or  from  another.  The  differences  in  the  pathogenic 
action  are  observed  even  in  the  guinea  pig  which  is  unusually  suscep- 
tible. These  animals  succumb  much  more  rapidly  to  infection  with  the 
bovine  tvpe  than  to  infection  with  the  human  type  (Smith,  Gratia). 
The  difference  in  the  results  of  these  tAvo  types  is  much  more  marked, 
.however,  in  rabl)its  and  in  cattle. 

The  difference  between  the  two  types  in  their  effect  on  rabbits  was 
recognized  by  Yillemin  and  later  by  Orth,  Baumgarten,  Vagedes,  Smith, 
Dorset,  Kossel,  Heuss,  Rabinowitsch  and  others.  According  to  Weber 
this  may  be  sunnned  up  as  follows :  The  bacilli  of  the  bovine  type  when 
injected  intravenously  in  0.001  g.  doses  will  kill  rabbits  in  three  weeks, 
while  the  bacilli  of  the  human  type  similarly  administered  produce  at 
first  no  conspicuous  morl)id  syiiiptoms,  but  in  the  course  of  several 
months  symptoms  of  chronic  tulierculosis  develop  which  affects  chiefly 
the  articidations,  the  kidneys,  the  lungs  and  the  testes.  The  bacilli  of 
the  bovine  type  injected  subcutaneously  into  the  abdominal  wall  in 
0.01  g.  doses,  (not  under  the  fascia  into  the  muscles)  produce  a  lung 
tuberculosis  which  terminates  in  death  in  a  short  time.  The  bacilli  of 
the  human  type  will  not  produce  these  results. 

The  effect  of  the  two  types  of  tubercle  bacilli  on  cattle  has,  in 
recent  times,  been  the  object  of  almost  innumerable  experiments.  Tbese 
experiments  as  far  as  they  have  been  limited  to  the  us(^  of  pure  cultures 
have  given  comparatively  uniform  results,  viz.,  that  the  bacilli  of 
the  human  type  possess  either  a  slight,  or  no  pathogenic  action  what- 
ever for  cattle  and  that  the  bovine  type,  on  the  other  hand,  possess  very 
marked  pathogenic  properties  with  regard  to  cattle.  Thus  the  subcutane- 
ous injection  of  bovine  bacilli,  injection  into  the  circulation  or  into  the 
peritoneal  cavity  usually  produces  severe  progressive  tuberculosis.  Young 
animals  occasionally  become  affected  in  the  same  manner  by  the  ingestion 
of  infected  material.  On  the  other  hand  inoculation  of  cultures  of  the 
human  type  produce  a  local  affection  only  or  remain  without  any 
pathogenic  effect.    This  is  particularly  true  if  the  dose  of  pure  culture 


510  Tuberculosis. 

is  not  excessive  (not  more  than  4  eg. ) .    Tlie  ingestion  of  such  material  will 
produce  local  changes  only  iu  the  mesenteric  glands. 

Kossel,  Weber  «&  Heiiss,  who  experimented  with  38  different  strains  of  the 
human  type  and  with  27  strains  of  the  bovine  type,  inchided  in  tlieir  experiments 
a  large  number  of  cattle.  Subcutaneous  inoculation  of  .05  g.  of  culture  produced 
at  first  an  inflammatory  swelling  at  the  point  of  inoculation  which  developed  into 
abscesses  that  broke  and  discharged  their  contents.  Tlils  was  folloAved  liy  enlarge- 
ment of  the  prescapular  glands.  When  the  bacillus  of  the  human  type  was  ui^ed 
this  swelling  attained  the  size  of  a  goose  egg  but  was  considerably  larger  in  cases 
where  the  bacillus  of  the  bovine  type  was  used,  sometimes  as  large  as  a  man's 
head.  When  the  liacillus  of  the  human  type  was  used  the  process  stopped  at  this 
point  and  was  followed  by  retrogressive  changes.  After  seven  months  all  bacilli 
were  destroyed.  On  the  other  hand  the  bacilli  of  the  bovine  type  continued  their 
work  of  destruction  and  produced  a  progressive  tuberculosis  which,  in  30%  of 
all  cases  ended  iu  death  in  the  course  of  8  or  10  weeks.  Feeding  experiments 
demonstrated  that  one  feeding  of  bacilli  of  the  l)ovine  type  sufficed  to  infect  calves. 
Of  eight  animals  some  of  which  were  given  one  treatment,  others  repeated  treat- 
ments, four  died  in  from  79  to  115  days.  Post-mortem  examination  showed  severe 
lesions  in  the  intestines  and  the  regional  mesenteric  glands.  On  the  other  hand 
all  calves  fed  with  glycerin  bouillon  cultures  of  the  human  type  remained  alive. 
The  bacilli  which  had  been  introduced  into  the  intestinal  canal  were  lodged  partly 
in  the  mesenteric  glands  where  they  gave  rise  to  the  formation  of  small  yellow 
calcified  foci  which  hail  not  caused  any  reaction  in  the  otheiwise  normal  tissue. 
In  the  course  of  inlialation  exi>eriments  it  Avas  shown  that  bacilli  of  the  bovine 
type  introduced  in  this  manner  were  exceedingly  virulent.  One  nig.  of  bacilli  was 
sufficient  to  kill  a  calf  four  months  old  within  48  days.  Following  a  period  of 
incul>ation  of  12  to  14  days  the  animals  were  attacked  with  a  high  fever  and 
difficult  respiration.  Four  died  in  the  course  of  26  to  62  days  with  caseous  pneumonia. 
Four  others  were  affected  in  the  course  of  110  to  174  days  with  pulmonary  tuber- 
culosis and  tuberculosis  of  the  adjacent  lymph  glands  and  serous  membranes.  On 
the  other  hand  the  bacilli  of  the  human  type  in  these  experiments  produced  no 
tuberculous  disease. 

The  difference  in  virulence  is  observed  also  where  injections  are  made  into 
the  milk  duets  of  cattle  and  goats.  Thus  tubercle  bacilli  of  human  origin  produced 
only  a  slight  reddening  lasting  a  few  days,  and  attended  with  moderate  sensitiveness 
and  swelling  of  the  affected  quarter.  On  the  other  hand  the  bovine  bacilli  produced 
a  pronounced  tuberculosis  of  the  udder  and  mammary  glands  and,  in  addition, 
probably  as  a  result  of  an  intoxication,  rapid  emaciation  ending  in  death  (Nocard, 
Meyer,  Calmette  &  Guerin,  Zwick). 

The  differences  in  results  referred  to  above  apply  only  to  charac- 
teristic pure  cultures.  Since  both  types  occur  in  man,  inoculation  ex- 
periments with  crude  material,  such  as  sputum,  tuberculous  tissue,  etc., 
give  varying  results.  HoAvever,  these  results  correspond  with  the  fact 
that  the  human  type  is  most  frequently  present  in  man,  while  the  bovine 
type  is  almost  exclusively  present  in  cattle.  (For  further  information 
on  this  subject  refer  to  the  chapter  on  the  Relationship  between  Human 
Tuberculosis  and  Bovine  Tuberculosis.) 

Results  of  experimental  inoculations  of  other  animals  with  morbid 
secretions  or  tissue  show,  in  general,  that  swine  are  readily  infected 
with  either  of  the  two  types  of  bacilli,  that  sheep  and  goats  are  most 
readily  infected  with  material  containing  the  bovine  type  and  that  dogs 
may  be  infected  with  large  doses  of  either  the  human  or  the  bovine 
type  of  bacillus  (Titze  &  Weidanz).  Other  mammals  possess  a  con- 
siderable power  of  resistance  to  infection.  Again,  all  avian  species 
with  the  exception  of  house  birds  (parrots) ,  possess  considerable  resist- 
ing poAver  against  infection  with  the  bacilli  of  the  mammalian  types. 

Infectious  Secretions  and  Products.  In  the  bodies  of  tuber- 
culous animals  the  bacilli  are,  with  the  exception  of  miliary 
tuberculosis,  found  usually  only  in  the  affected  organs,  and  in 


Iiifoftidiis   Spf-refioiis   an<l   Products. 


511 


fnrt  oiilv  111  tlu'  diseased  portions  of  these  organs.  Tliey  are 
Ini-ther  fonnd  in  the  contents  of  body  cavities  and  canals  the 
walls  ot  ■which  contain  tnbercnlous  ulcers  or  which  may  receive 
patholooic  products  from  other  organs  (e.  g.,  hing  secretions  in 
the  int(^stiiial  canal).  In  so  far  as  these  canals  connect  with 
tlie^  outer  air,  the  secretions  and  excreta  discharged  through 
their  openings  may  contain  more  or  less  tubercle  i)acilli  which 
are  thus  disseminated  (open  tu])erculosis,  in  contrast  to  enclosed 
tuberculosis  in  which  the  bacillary  foci  do  not  communicate  with 
the  outer  air). 

Even  in  slightly  advanced  cases  of  tuberculosis  of  the  lungs 
the  bronchial  secretions  as  well  as  the  nasal  secretions  niav  con- 
tain bacilh  in  varying  numbers  either  at  intervals  or  constantly. 
I  he  organisms  may  also  be  present  in  the  saliva  as  a  result  of 
an  admixture  of  bronchial  secretions  with  the  secretions  of 
the  buccal  cavity. 

^  Since  animals  usually  swallow  the  secretions  from  the  lungs 
which  are  cougliod  up  from  time  to  time,  these  become  incor- 
porated with  the  contents  of  the  intestinal  canal  and  are  found 
unclianged  m  the  feces.  In  addition  to  this  source  tubercle 
bacilli  which  are  discharged  from  intestinal  ulcers  mav  be  the 
cause  of  infection  of  the  feces,  consequently  the  excretions  from 
animals  with  advanced  tuberculosis  are  "one  of  the  most  im- 
portant factors  in  the  dissemination  of  the  disease. 

The  fact  that  tubercle  bacilli  may  pass  through  the  intestinal  canal 
mthout  havmg  their  virulence  impaired  in  the  least,  has  been  experi- 
mentally demonstrated  by  Cadeac  &  Boiirnev.  These  investigators 
inoculated  rabbits  with  the  feces  of  a  cow  that  had  been  infected  by 
feeding  tuberculous  organs,  and  in  this  wav  produced  tuberculosis  in 
nearly  every  case.  Even  before  this  Zagari  demonstrated  that  the  feces 
ot  dogs  that  were  fed  with  human  tuberculous  sputum  contained  viru- 
lent baeilh.  The  experiments  by  Ferranini  demonstrating  that  gastric 
juice  containing  2%  of  free  hydrochloric  acid  does  not  reduce  the  viru- 
ience  ot  tubercle  bacilli  in  the  least,  in  the  course  of  1  to  2  hours  are  in 
accordance  with  this  fact. 

Schroeder  &  Cotton  emphasize  the  danger  that  exists  in  the  feces  of 
apparently  perfectly  healthy  cattle  but  which  are  in  fact  tuberculous 
1  hey  lound  that  in  a  number  of  eases  the  feces  of  such  animals  contained 
tubercle  bacilli  constantly  for  periods  of  months  and  vears  The  enor- 
mous nuniber  of  bacteria  present  in  feces  is  indicated  by  the  fact  that 
aoui  g.  ot  such  material  will  produce  a  fatal  tuberculosis  in  guinea  pigs 
the  average  quantity  of  feces  voided  by  a  cow  dailv  being  30  lbs  It 
IS  evident,  of  course,  that  this  infected  mass  of  manure  may  easilv  con- 
taminate the  milk  during  milking. 

^  In  tuberculosis  of  the  kidneys,  especially  of  the  pelvis  and 
m  disease  of  other  portions  of  the  urinarv  ajiparatus,  the  urine 
contains  tubercle  bacilli  (Kallina);  similarly  tuberculosis  of 
the  uterus,  epidid^nuis  or  prostate  gland  may  cause  the  presence 
ot  bacilli  m  the  urine.  In  tuberculosis  of  the  uterus,  the  vaginal 
secretion,  and  in  tuberculosis  of  the  epididjonis  the  spermatic 
tluid  may  contain  tubercle  bacilli. 


512  Tuberculosis. 

In  tuberculosis  of  tlie  udder  the  milk  is  always  infected, 
sometimes  to  such  an  extent  that  0.00001  g.  of  milk  when  in- 
jected intraperitoneally  into  a  giiinea  pig  will  produce  a  fatal 
tuberculosis  (Ostertag).  Further,  the  milk  from  infected  cows 
which  already  show  clinical  symptoms  of  disease,  may  contain 
tubercle  bacilli  even  though  the  udder  is  apparently  perfectly 
healthy;  since  small  tuberculous  foci  in  the  glandular  tissue 
could  not  of  course  be  recognized  by  clinical  examination.  Re- 
cent experiments  have  shown  that  cows  in  apparently  perfect 
health  which  reacted  to  the  tuberculin  test  may  discharge 
tubercle  bacilli  with  the  milk.  In  such  cases,  of  course,  in  the 
face  of  all  negative  clinical  evidence,  the  mammary  tissue  may 
contain  minute  metastatic  tuberculous  foci;  furthermore  the 
possibility  cannot  be  refuted  that  tubercle  bacilli  may  occa- 
sionally gain  entrance  into  the  circulation  from  tuberculous  foci, 
be  carried  into  the  mammary  glands  and  in  this  way  pass  into 
the  milk. 

The  infectiousness  of  milk  from  a  tuberculous  cow  lias  frequently 
been  demonstrated  since  the  time  of  Gerlach  (1869).  Aside  from  the 
product  of  evidently  diseased  udders,  in  which  case  the  milk  almost 
invariably  contained  tubercle  bacilli  in  large  numbers,  Hirschberger 
succeeded  in  producing  tuberculosis  in  guinea  pigs  with  milk  from 
clinically  diseased  cows  with  apparently  healthy  udders,  by  means  of 
intraperitoneal  injection  in  11  cases  out  of  20,  Ernst  in  26.8%  out  of 
33  cases,  Nocard  3  times  in  54  cases. 

As  far  as  the  use  of  milk  is  concerned  coming  from  apparently 
healthy  cows  which  have  reacted  to  the  tuberculin  test,  the  results  of 
experiments  vary. 

Ostertag  was  the  first  to  conrluct  exact  experiments  to  shed  light  upon  this 
subject.  The  milk  from  49  reacting  cows  was  collected  in  separate  containers 
with  observance  of  every  possible  precaution,  and  injected  intraperitoneally  into 
guinea  pigs.  The  results  show  that  not  a  single  sample  of  milk  contained  tubercle 
bacilli.  On  the  other  hand  14  inoculations  of  guinea  pigs  made  from  a  mixture 
of  the  above  49  samples  produced  tuberculous  disease  in  one  guinea  pig.  Feeding 
experiments  with  this  milk  produced  no  positive  infections.  In  a  second  experiment 
the  milk  of  IS  cows  was  used.  In  this  ease  neither  intraperitoneal  injections  into 
guinea  pigs,  nor  the  feeding  of  the  milk  for  several  months  to  guinea  pigs,  swine 
and  calves  produced  tuberculosis.  Similar  results  were  obtained  by  Miiller  and 
Ascher  who  used  the  milk  of  9  and  7  reacting  cows,  respectively,  in  experiments 
with  guinea  pigs.  From  this  Ostertag  concluded  that  milk  from  merely  reacting 
cows  contained  no  tubercle  bacilli. 

Bacteriological  examination  of  milk  of  5  head  by  MacWeeny  and  of  50 
head  of  cattle  by  Stenstrom  some  of  which  were  clinically  diseased,  others  affected 
with  latent  tuberculosis  but  with  healthy  udders  gave  similar  negative  results. 
Hessler  obtained  the  same  results  with  61  merely  reacting  cows.  Schroeder  & 
Cotton  also  are  of  the  opinion  that  tubercle  bacilli  are  excreted  with  the  milk 
only  where  the  udder  itself  is  diseased.  Of  11  cows,  9  of  which  had  generalized 
tuberculosis  and  2  advanced  pulmonary  tuberculosis,  the  milk  proved  virulent  by 
inoculation  in  1.78%  and  by  feeding  in  0.68%  of  cases.  These  results  might  of 
course  have  been  due  to  subsequent  infection  of  the  milk. 

On  the  other  hand  Gehrman  &  Evans  found  the  milk  virulent  in  9  out  of 
41  reacting  cows  in  spite  of  the  fact  that  a  post-mortem  failed  to  reveal  tuberculous 
lesions  either  in  the  udder  or  in  other  internal  organs.  In  2  cows  there  were  only 
slight  lesions  in  a  few  l\Tnph  glands.  Ravenel  demonstrated  the  infectiousness 
of  milk  of  5  reacting  cows  none  of  which  showed  tuberculous  lesions  at  post-mortem 
examination.  Mohler,  of  Washington,  examined  the  milk  of  56  reacting  cows  only 
9  of  which  showed  symptoms  of  tuberculosis  after  months  of  observation,  and  in 
all  case«  the  udder  was  perfectly  normal.     In  8  of  the  cows  the  milk  proved  to  be 


Tnfortious   Soprctidtis  and   Pi-oflurtf?.  f)!  f! 

virulent  in  fcedint^  as  woU  as  in  inoculation  cxperinionts ;  in  'A  cows,  l>y  inoculation 
only;  in  one  cow,  \>y  t'vviWug  only  (fjuinea  pijfs  used  in  this  experiment  receivcil 
80  to  1-0  cc.  of  •wliolV  milk  daily  for  2  to  '.i  months).  Similar  results  were  olttained 
by  Moussu.  The  milk  of  tuberculous  cows  \A'ith  clinically  and  anatomically  healthy 
udders  <;ave  jiositive  results  in  7  out  of  T)?  f,niinea  jiiys  that  were  treated.  Calves 
■u-ere  also  infected  by  feedinjj.  Martel  &  Guerin  examined  20  udders  of  slaughtereil 
animals;  in  all  cases  the  i)arenchyma  as  well  as  the  mammary  glands  were  free 
from  observable  lesions.  The  secretions  of  4  of  these  udders  proved  infectious 
tor  guinea  pi^s.  Finally  De  Jong  found  vindent  tubercle  bacilli  in  the  milk 
of  3  out  of  10  cows  with  slight  closed  tuberculosis. 

One  reason  which  led  Ostertag  to  conclude  that  a  transmission  of  tubercle 
bacilli  into  the  circulation  did  not  take  place  under  normal  conditions  was  that 
the  inoculation  of  a  gvunea  ]iig  with  milk  of  a  cow  which  had  receive<l  a  large  dose 
of  bacillary  nuxterial  into  the  circulation  11  days  jireviously,  ])roduced  negative 
results.  Tlie  experiments  of  Prettner  who  made  repeated  injections  of  pure  cultures 
of  tubercle  bacilli  into  the  circulation  of  2  buffalo  cows,  and  those  of  Coquot  & 
Cesari  who  injected  an  eimdsion  of  bacilli  into  the  mammary  artery  gave  similar 
negative  results.  But  GritUth  demonstrated  the  infectiousness  of  nulk  in  the  course 
of  the  first  week  after  the  subcutaneous  injection  of  bovine  tubercle  bacilli;  Tit^e 
produced  the  same  result  with  human  tidierclc  bacilli.  In  one  case  they  appeared 
24  hours  after  tlie  injection  of  the  culture,  in  another  they  could  be  demonstrate-l 
daily  after  the  third  week  for  144  days  and  in  some  cases  as  late  as  Ki  months 
after  the  injection.  As  a  rule  they  are  excreted  from  one  quarter  of  the  udder 
only,  probably  as  the  result  of  a  focal  infection  without  local  symptoms.  Smith 
found  that  bovine  as  well  as  human  bacilli  in.jecteii  intravenously  into  a  cow, 
appeared  in  the  milk  after  a  few  days.  The  human  bacilli  aiqieared  also  in  the 
feces  and  the  urine.     The  udder  was  not  visibly  aft'ecte<l  in  either  case. 

AVhen  we  take  into  consideration  tliat  even  animals  with 
a  mild  infection  may  at  any  time  suffer  an  attack  of  the  ndder 
throniih  metastasis,  and  that  neither  the  beginninc:  of  tlie  attack, 
nor  the  stage  of  the  disease  can  be  recognized  by  a  clinical 
examination,  the  claim  that  milk  from  merely  reacting  cows 
may  be  dangerous  is  by  no  means  groundless. 

In  milk  of  normal  appearance  tnbercle  bacilli  when  present  are 
evenly  distributed.  If  the  milk  is  coagulated,  watery  or  flaky,  the  bacilli 
are  usually  found  mostly  in  the  solid  parts.  If  milk  is  allowed  to  stand 
the  bacilli  have  a  tendency  to  collect  in  the  cream.  Similarly  the  cream 
of  separator  milk  and  the  walls  of  the  centrifuge  contain  the  bacilli  in 
the  ^I'eatest  numbers. 

The  milk  of  a  single  cow  with  an  infected  udder  may  infect  a  large 
quantity  of  milk  from  healthy  cows  if  added  to  it.  For  this  reason  the 
milk  from  creameries  or  milk  stations  is  so  generally  infected.  Thus 
Petri  in  Berlin  found  14%  of  64  samples  infected ;  Beck  of  the  same  city, 
30%  of  56  samples;  Delepine  &  Niveau,  of  ^Manchester,  11.7' y  of  401 
samples  and  18.5%  of  108  samples;  Preisz,  of  Budapest,  13. 8*"^  of  58 
samples;  Eber,  in  Leipsic,  10.5%  of  21  samples.  Rabinowitsch  found 
that  the  milk  from  creameries  wbich  demanded  the  tuberculin  test  for 
all  dairies  was  free  from  tubercle  bacilli,  while  on  the  other  hand  where 
only  clinically  infected  animals  had  been  removed  the  milk  was  found 
infected. 

Of  course,  milk  from  healthy  animals  may  become  infected  with  bacilli  in 
the  process  of  milking.  There  is  always  abundant  opjjortunity  for  this  in  infected 
stables,  especially  where  the  floors  and  the  bedding  have  been  soiled  with  the 
excretions  and  secretions  of  animals  with  open  tulierculosis.  Where  stables  are  kept 
in  a  generally  unsanitary  condition  and  where  careful  cleansing  of  the  udder  before 
milking  is  disregarded,  where  the  first  few  streams  of  milk  are  not  discarded, 
additional  opportunities  for  infection  are  offered.  Dirty  milk  utensils  and  soiled 
hands  of  the  milkers  naturally  y)lay  an  important  role  in  bringing  about  an  infection 
of  the  milk  of  otherwise  healthy  animals. 
Vol.  1-33 


514  Tuberculosis. 

In  examinations  made  for  the  East  Prussian  Herd  Book  Association  up  to 
July  Ij  1907,  by  Miiller  &  Hassler,  tubercle  bacilli  were  demonstrated  in  156  of 
2,949  milkings  from  herds  consisting  of  30  to  200  animals  each.  The  sources  of 
infection  were  afterwards  found  to  be,  the  udder  in  113  instances,  the  uterus  in  17, 
open  lung  tuberculosis  in  20,  pulmonary  and  intestinal  tuberculosis  in  one  instance. 
In  5  cases  open  tuberculosis  could  not  be  demonstrated. 

Until  very  recently  tlie  general  impression  prevailed  that 
the  bacilli  were  rarely  found  in  the  blood  and  then  only  for 
a  short  time  after  the  discharge  of  a  tuberculous  focus,  thus 
especially  in  the  beginning  of  acute  miliary  tuberculosis.  This 
view  was  based  upon  the  experimental  observations  of  Nocard 
and  MacFadyean  according  to  which  all  comparatively  large 
masses  of  bacilli  injected  intravenously  disappeared  after  a  few 
hours.  In  the  meantime  Neumann  &  Wittgenstein  as  well  as 
Bongert,  showed  that  tubercle  bacilli  injected  into  the  blood 
could  remain  there  for  one  month.  More  recent  investigations 
have  shown  that  in  the  course  of  tuberculosis  and  even  in  the 
very  first  stages  of  the  disease,  tubercle  bacilli  are  by  no  means 
infrequently  present  in  the  blood  and  can  be  demonstrated 
by  the  microscopical  examination  of  small  quantities  of  blood. 
In  such  cases  providing  they  are  not  too  abundant,  an  eruption 
of  miliary  tubercles  does  not  necessarily  follow.  Evidently  the 
animal  organism  has  the  power  to  overcome  an  infection  by  a 
limited  number  of  bacilli.  Miliary  tuberculosis  seems  to  de- 
velop only  after  an  invasion  of  germs  in  large  masses. 

After  Liebermeister  called  attention  to  the  comparatively  frequent  occurrence 
of  tubercle  bacilli  in  the  circulating  blood  of  consumptives,  having  demonstrated 
their  presence  by  guinea  pig  inoculations  in  30%  of  the  second  stage  cases  and 
in  60%  of  the  third  stage  cases  examined.  Forsyth,  Lippmann,  8chnitter  and 
Kosenberger  demonstrated  their  presence  with  the  microscope.  Booth  showed 
microscopically  the  presence  of  tubercle  bacilli  in  the  blood  of  two  apparently 
healthy  cows  suffering  with  pulmonary  tuberculosis.  On  the  other  hand  Hchroeder 
ic  Cotton  in  an  examination  of  42  cattle  could  not  demonstrate  bacilli  in  the  blooti 
either  with  a  microscope  or  by  means  of  guinea  pig  inoculations.  Eavenel  and 
McFarland  arrived  at  similar  negative  results  in  the  examination  of  blood  of  tuber- 
culous human  beings  and  expressed  the  belief  that  Eosenberger  found  acid-fast  para 
tubercle  bacilli  which  are  frequently  present  in  distilled  water.  This  question  which 
is  of  clinical  importance  is  therefore,  as  yet,  unsettled. 

The  muscles  or  flesh  of  tuberculous  animals  also  contain 
bacilli  only  in  rare  cases.  When  tuberculous  masses  (l3niiph 
glands)  are  found  between  the  muscles  or  when  a  general  tuber- 
culosis is  present  following  an  artificial  intravenous  injection, 
the  bacilli  which  are  found  in  the  muscles  after  a  few  days  are 
as  a  rule  no  longer  virulent.  The  expressed  juice  from  muscle, 
even  of  badly  infected  cattle,  is  infectious  only  in  exceptional 
cases.  Further,  the  demonstration  of  tubercle  bacilli  in  such 
cases  has  been  possible  only  by  intraperitoneal  or  subcutaneous 
infection,  while  attempts  to  produce  infection  through  feeding 
experiments  have  all  produced  negative  results. 

Perroncito  injected  muscle  juice  obtained  from  tuberculous  animals  into  the 
peritoneal  cavity  of  several  hundred  guinea  pigs  and  rabbits  with  not  a  single 
positive  result.  Nocard  demonstrated  in  this  manner  that  the  expressed  muscle 
juice  of  only  one  cow  out  of  21  with  general  tuberculosis  was  infectious.     Galtier 


Xntmal   Infection.  f)!.") 

found  the  exprosM'd  iiiumIc  juice  of  two  out  of  15  tubore-ulous  cows  iutVitious. 
Kastuers  arrived  at  negative  results  in  all  cases  as  long  as  he  confined  his  experi- 
ments to  the  muscle  juice  ol>tained  from  tuberculous  cows  at  the  al)attoir  of  Munich 
that  were  itasse<l  for  beef.  However,  when  he  turned  his  attention  to  7  cows,  6 
of  which  had  been  condemned  on  account  of  advanced  generalized  tuberculosis,  he 
produced  '>  positive  results.  According  to  this  view,  meat  may  contain  bacilli  when 
the  internal  organs  are  affected  with  cheesy,  purulent  foci,  while  dry  or  calcified 
lesions  do  not  jjroiluce  infection.  8wierstra  found  bacilli  in  the  muscle  juice  of 
7  out  of  is  coww  ami  of  L'  out  of  S  swine  affected  with  advanced  tuberculosis. 
Bongert  found  the  muscle  juice  virulent  in  5  out  of  b!  cattle  affected  with  softened 
tuberculous  foci.  Iloefnagel  arrived  at  negative  results  in  cases  of  a<lvanced  chronic 
tuberculosis  and  Westenhofer  obtained  only  one  positive  result  of  acute  miliary 
tul  erculosis. 

It  seems  that  the  feeding  of  meat  from  tuberculous  animals  ]>roduced  positive 
results  almost  exclusively  at  the  time  of  the  discovery  of  the  tubercle  bacillus  (Gerlach, 
Oiinther,  Harms).  More  recently  only  the  reports  of  Forster  «&  Brown  give  positive 
results,  while  those  of  Galtier,  Xocard,  MacFadyean  &  Leclainche  give  results 
similar  to  the  earlier  ones  of  Perroncito  which  had  been  negative  without  exception. 
Vander  Sluys  also  was  unable  to  infect  pigs  by  means  of  feeding  large  quantities 
of  muscle  from  animals  affected  with  ailvanced  tuberculosis,  having  i)roduced  only 
one  positive  result  and  in  that  case  only  by  adding  tuberculous  organs  and  bones 
to  the  muscles. 

Natural  Infection.  Observations  in  regard  to  the  occur- 
rence and  dissemination  of  tuberculosis  point  to  the  fact  that 
nnder  normal  conditions  tuberculosis  is  transmitted  only  after 
prolonged  exposure  to  the  contagion,  or  after  repeated  infection 
with  tlie  virus.  It  seems  that  a  single  light  infection  usually 
produces  only  a  local  tuberculous  lesion  which  terminates  in 
recovery  and  in  addition  increases  the  resisting  power  of  the 
individual  to  the  disease.  In  other  words,  it  produces  a  certain 
temporary  immunity.  (For  further  information  see  chapter  on 
Pathogenesis.) 

•     In  the  vast  majority  of  cases  infection  occurs  through  the 
medium  of  ingested  food  or  of  inhaled  air. 

In  alimentary  infection  the  milk  of  diseased  animals  fed 
in  bulk  or  suckled  by  the  young  is  of  the  greatest  importance. 
In  addition  to  this  the  skim  milk  obtained  from  skimming  sta- 
tions also  plays  an  important  role  in  the  dissemination  of  the 
disease.  Skim  milk  is  particularly  infectious  when  the  slimy 
residue  which  collects  in  the  separator  bowl  is  added  to  it,  as 
this  slime  contains  large  masses  of  tubercle  bacilli  when  infected 
milk  is  centrifuged  (Kjerrulf). 

The  infectiousness  of  milk  containing  tubercle  bacilli  liears  an  in- 
timate relation  to  the  occurrence  of  tuberculosis  in  swine  which  are  fed 
with  skim  milk  furnished  by  skimming  stations. 

For  example,  in  North  America  where  swine  were  at  one  time  fed  almost 
exclusively  with  grain,  statistics  for  1894-1895  show  that  of  13,616,539  swine 
slaughtered  in  the  larger  abattoirs  only  579  head  were  tuberculous,  that  is  0.00047c. 
On  the  other  hand  in  1008  when  skim  milk  from  skimming  stations  came  into 
general  use  for  the  feeding  of  swine,  the  percentage  increased  to  2.05%,  Of 
35,113,077  swine  that  were  slaughtered  719,309  were  tuberculous.  Thus  the  per- 
centage of  tuberculous  swine  has  increased  five  thousand  fold  (Salmon).  The 
annual  loss  caused  by  tuberculosis  in  swine  in  the  United  States  exceeds  $3,000,000. 
In  some  abattoirs  of  Holland  (Amsterdam,  Rotterdam)  the  disease  is  observed 
in  10  to  15%  of  all  slaughtered  swine;  in  Denmark  the  disease  was  formerly  present 
in  15  to  18%  of  all  swine;  in  Copenhagen  20%  of  all  swine  were  infected 
(Pederson) ;    in   Germany  some  shipments   averaged   50   to   60%,   and  in   Hamburg 


516  Tuberculosis, 

in  one  instauce  90%  of  all  slaughtered  swine  were  found  tuberculous.  In  Hungary 
the  disease  is  becoming  alarmingly  prevalent  with  the  increasing  practice  of  feeding 
skim  milk. 

In  an  experiment  conducted  by  the  Bureau  of  Animal  Industry  at  Washington, 
87%  of  a  number  of  swine  that  were  fed  for  3  days  with  tuberculous  milk  became 
tuberculous  within  3  to  4  months.  "When  tuberculous  milk  was  fed  for  30  days 
all  animals  in  the  experiment  became  infected  with  general  tuberculosis  within 
50  days  thereafter. 

The  danger  in  feeding  milk  containing  bacilli  to  calves  is  shown 
by  the  common  experience  that  tuberculosis  occurs  much  less  frequently 
in  calves  that  are  fed  with  sterilized  milk  than  in  calves  that  are  per- 
mitted to  suckle  their  infected  dams. 

Finally  tuberculosis  occurs  more  frequently  also  in  horses  in  those 
countries  where  milk  is  used  in  the  treatment  of  sick  horses  (IMacFad- 
yean  in  England),  or  for  food  (Bang  in  Denmark). 

Other  food  stuffs  also  and  drinking  water  may  act  as  the 
carriers  of  the  contagion  when  they  are  infected  with  the  secre- 
tions and  excretions  of  tuberculous  animals.  Abundant  oppor- 
tunity for  such  infection  is  offered  in  all  infected  herds. 

The  feeding  of  tuberculous  organs  from  slaughtered  ani- 
mals and  the  sputum  of  tuberculous  persons  are  effective  means 
of  transmitting  the  disease  to  carnivora  and  omnivora. 

Infection  by  means  of  inhalation  occurs  most  frequently 
in  stables  occupied  by  animals  affected  with  pulmonary  tuber- 
culosis. Slowly  expired  air  from  infected  animals  probably 
contains  no  infection  (Cadeac  &  Malet,  Cornet).  However,  when 
such  air  is  expelled  by  coughing  the  minute  particles  of  water 
which  are  expelled  with  it  may  contain  tubercle  bacilli  and, 
similarly,  particles  of  sputum  that  are  thus  forcibly  expelled 
will  soil  and  infect  the  surroundings  of  diseased  animals  ( Johne, 
Bang,  Frankel,  Fliigge).  Thus  healthy  animals  standing  in 
stalls  adjacent  to  those  infected  with  pulmonary  tuberculosis 
are  continually  breathing  infected  air  while  the  danger  to  other 
animals  in  the  same  stables  but  farther  removed  from  the  in- 
fected ones,  is  much  less.  As  a  matter  of  fact  it  is  frequently 
observed  that,  following  the  introduction  of  a  diseased  animal 
into  a  healthy  herd,  the  animals  in  the  immediately  adjacent 
stalls  are  always  the  first  to  become  infected. 

Johne  was  the  first  to  call  attention  to  the  importance  of  the  small 
solid  or  liquid  particles  which  are  expelled  in  the  act  of  coughing.  More 
recently  Fliigge  and  his  pupils  have  shown  that  tubercle  bacilli  which 
are  expelled  in  the  act  of  coughing,  sneezing  or  even  in  the  act  of  loud 
conversation,  will  infect  guinea  pigs  -when  properly  exposed  (spray 
infection).  The  same  results  were  obtained  by  Ravenel  by  exposing 
guinea  pigs  to  consumptive  cattle  in  the  act  of  coughing.  The  results  of 
numerous  experiments  made  with  sprays  of  pure  cultures  to  produce 
infection  by  inhalation  conform  with  the  former  in  demonstrating  the 
danger  of  the  moist  air  of  expiration.  (See  Pathogenesis.)  On  the  other 
hand  the  danger  of  dust  infection  (Cornet)  or  of  air  containing  merely 
dry  particles  of  secretions  is  considerably  less.  Experiments  with  such 
material  gave  negative  results.     Thus  Cadeac  obtained  only  5  positive 


Natural   Tu  feet  ion.  517 

iv.sults  in  ."{T  guinea  pigs  that  wero  made  to  inliale  dust  ])rodueed  froui 
sputum  whieli  luid  dried  in  the  dark.  A  similar  experiment  with  11 
rahbits  gave  negative  results,  while  36  guinea  pigs  and  8  rabbits  which 
were  forced  to  inhale  moist  material  in  the  form  of  a  fine  spray,  all 
ae(|uired  tuberculosis.  Analogous  experiments  by  Pelei-son  gave  similar 
results,  while  investigations  by  Koehliseh  showed  that  in  inhalation  of 
a  dry  spray  (dust)  at  least  50,000  bacilli  must  be  inhaled  in  order  to 
produce  tuberculosis. 

The  floor,  food  stiifTs  and  air  aro  liable  to  be  infected  witk 
bacilli  ]iarticularly  in  dark,  poorly  kept  and  crowded  stables 
when  the  air  is  saturated  with  moisture  wliieli  retards  tlie 
precipitation  of  the  droplets  expelled  by  coiighinp^.  (Osterta^- 
found  that  the  air  of  a  cattle  stable  contained  a  relative  humidity 
of  80  to  95%.)  Tlie  dano-er  of  infection  in  snch  cases  is  in 
direct  j^roportion  to  the  nnmljer  of  animals  tliat  are  honsed 
tog-ether,  because  the  larger  the  herd  the  greater  the  probability 
that  diseased  animals  are  in  it.  The  generally  observed  fact 
that  large  herds  of  cattle  are  rarely  free  from  tubercnlosis 
is  in  accordance  with  this  statement  as  is  also  the  fact  that  a 
much  larger  percentage  of  small  herds  is  found  free  from 
tuberculosis.  And  this  is  true  in  the  face  of  the  further  fact 
that  the  sanitary  arrangements,  care,  etc.,  of  large  stables  is 
usually  much  better  than  that  of  smaller  stables  (see  p.  503). 

In  tlie  open  air  the  danger  of  infection  is  in  general  very 
slight.  The  bacilli  which  are  expelled  with  the  expired  air 
of  diseased  animals  are  rapidly  disseminated  and  are  destroyed 
in  a  short  time  after  reaching  the  ground  by  the  action  of 
sunlight.  Accordingly  tuberculosis  is  almost  unknown  among 
animals  that  are  continually  on  pasture.  The  disease  spreads 
much  more  slowly  in  stabled  animals  if  they  are  pastured  a 
greater  portion  of  the  time. 

Infection  through  the  act  of  copulation  may  occur  when 
the  generative  organs  of  either  the  male  or  the  female  are 
diseased,  in  males  especially  the  epididymis  causing  infection 
of  the  seminal  fluid,  in  females  a  tuberculous  uterus  causing 
infection  of  the  vaginal  secretion. 

Tuberculosis  of  the  uterus  may  be  produced  in  guinea  pigs 
by  injection  of  cultures  into  the  intact  vagina.  Observations, 
though  rare,  confirm  the  possilnlity  of  this  mode  of  infection 
in  domestic  animals.  Thus  Franck  observed  tuberculosis  of 
the  vagina  in  several  cows  that  had  been  served  by  a  bull  with 
a  tuberculous  penis.  Similar  observations  are  recorded  by 
Zippelius,  Haarstick,  Eber.  Goerig  and  Schmidt  record  the 
development  of  a  primary  tuberculosis  of  the  epididymis  follow- 
ing copulation  with  infected  cows. 

The  primary  infection  of  the  udder  tlirough  the  milk  ducts 
can  occur  by  the  virus  which  is  present  on  soiled  litter  gaining 
entrance  into  the  milk  cisterns  through  the  milk  ducts  where 
it  will  propagate  and  disseminate  (Bang,  Modius,  Sehmidt- 
Miihlheim,  Conte,  Alessandro). 


518  Tuberculosis. 

Infection  from  cutaneons  lesions  is  exceedingly  rare  and 
in  such  cases  the  disease  usually  remains  localized  or  spreads 
at  most  to  the  adjacent  lymph  glands  (Lydtin,  Johne).  Much 
greater  danger  as  far  as  the  source  of  infection  is  concerned 
is  presented  by  castration  wounds,  which  are  rather  rare  in 
cattle  (Bongert)  but  more  frequent  in  swine  as  a  result  of  the 
application  of  milk  or  the  infection  of  the  litter  with  excre- 
tions. Sometimes  infection  may  follow  the  application  of 
sputum  to  the  wound  by  a  consumptive  operator  (Tempel,  Jahn, 
Michael). 

The  mode  of  infection  varies  to  a  certain  extent  according 
to  the  species  of  animal.  Cattle,  it  seems,  are  always  infected 
by  the  products  of  diseased  animals  of  the  same  species.  Thus 
calves  are  usually  infected  by  means  of  infected  milk  while 
older  animals  are  infected  by  the  ingestion  of  solid  food  or 
of  contaminated  drinking  water  or  by  the  inhalation  of  infected 
air.  In  horses  tuberculosis  usually  begins  in  the  alimentary 
canal ;  occasionally  this  is  produced  by  infected  material  derived 
from  tuberculous  fowls  (Nocard),  but  in  most  cases  by  infec- 
tious material  of  human  origin  (Robert,  Roder). — In  pigs  tuber- 
culosis occurs  in  a  vast  majority  of  cases  as  a  result  of  feeding 
cows'  milk  or  w^liey.  Feces  of  diseased  cattle  are  next  in  im- 
portance as  a  source  of  tuberculosis  in  swine,  infection  with 
this  material  usuallj^  occurring  by  way  of  the  pharynx  or  the 
intestinal  tract ;  a  pig  with  diseased  teats  may  infect  its  young 
while  suckling;  and  finally  the  inhalation  of  tubercle  bacilli  is 
probably  also  an  occasional  cause. — Sheep  and  goats  are  prob- 
ably always  infected  by  diseased  cattle. — The  infection  of  dogs 
and  cats  usually  stands  in  causal  relation  with  tuberculosis  in 
man.  As  a  rule  pet  dogs  become  infected  by  licking  the  sputum 
of  their  consumptive  owners  or  by  inhaling  infected  air,  while 
cats  have  become  infected  by  the  ingestion  of  infected  milk. 
(The  tuberculous  dogs  examined  by  Petit  came,  for  the  greater 
part,  from  poorly  kept  saloons  and  coffee  houses  which  were 
much  frequented  by  laborers.) 

Susceptibility  to  tuberculosis  varies  according  to  the  species 
of  animal.  Among  domestic  animals  cattle  and  swine  are  most 
susceptible  to  artificial  infection  while  other  animals  possess 
much  more  resistance.  The  natural  resistance  of  any  species  of 
animal  may  be  overcome  by  intensive  and  repeated  infection. 
In  reality,  however,  buffalo,  horses,  sheep,  goats,  dogs  and  cats 
acquire  tuberculosis  only  rarely  in  spite  of  their  frequent  ex- 
posure to  diseased  cattle  or  human  beings. 

The  frequeney  of  tiibercnlosis  among  the  diflfereiit  species  of  rloniestic  animals 
is  shown  in  statistical  tables  furnished  by  slaughter  house  reports  (see  page  502). 
- — Among  buffalo  the  disease  appears  to  be  less  common  in  Russia  than  it  is  in  Hungary, 
where,  at  the  abattoir  of  Budapest,  it  is  sometimes  found  in  0.9%  of  all  slaughtered 
animals.  Kanzelmacher  found  only  5  head  infected  among  2,715  buffalo  slaughtered 
at  Tiflis,  i.  e.,  0.02%. — Among  asses  Blanc,  Pleindoux  and  Nocard  each  observed 
one  case  of  tuberculosis.  The  fact  that  this  disease  seems  to  be  so  rare  in  this 
species   may  be   due   to  the   small   number   of  observations,   at   least.      Stockmann, 


Susceptibility  to  Tuborculdsis.  519 

L'hauvoau   and   Ailoiiijf   luivo   ilomonstrateil    that   asses   may   be   readily   infected   by 
intravenous  iujeetion   of  tubercle  l)acilli. 

Among  ilogs  and  cats  tuliercuiosis  is  ])articuiarl3'  frequent  in  large  cities. 
Thus  Frohner  found  27  tuberculous  dogs  among  (32,5(K)  patients  ol)served  in  the 
ambulatory  clinics  in  Berlin,  that  is,  0.09%.  Johne  and  Eber  in  Dresden  found 
11  out  of  40U  dogs  tuberculous  and  liut  one  among  100  cats.  Jensen  in  Copenhagen 
found  in  the  course  of  2  years  5.7%  of  tulierculous  animals  among  138  dogs  and 
-.1  cats;  I'etit  &  Basset  in  Alfort  found,  among  2,717  dogs  examined,  152  infected 
\.ith  tuberculosis. 

The  breed  of  an  animal  may  influence  its  susceptibility 
to  tuberculosis.  The  fact  that  tuberculosis  occurs  more  fre- 
quently in  some  breeds  tlian  in  others  is  due  in  a  ft'reat  measure 
to  the  dilferent  conditions  under  wliicli  tliey  may  be  kept  or 
the  uses  to  whicli  they  may  be  put.  Cattle  from  the  Russian 
steppes,  for  example,  become  infected  just  as  readily  as  the 
more  domesticated  breeds  when  tliey  are  removed  from  pasture 
and  fed  in  stables  (working  oxen!).  On  the  other  hand  the 
young-  animals  of  the  latter  breeds  on  mountain  pastures  are 
much  less  frequently  affected  with  tuberculosis  than  animals 
raised  in  barns.  However  that  may  be,  a  greater  resistance 
to  artificial  infection  can  be  demonstrated  to  exist  in  the  cattle 
of  the  steppes  and,  according  to  Kitasato,  in  the  Japanese 
breeds  of  cattle.  The  observation  that  the  breeds  of  the  low- 
lands are  more  generally  affected  than  the  breeds  of  moun- 
tainous regions  is  explained  by  the  fact  that  the  former,  on 
account  of  their  greater  milk  producing  capacity,  constitute  the 
large  dairy  herds  and  are  kept  in  stables  of  large  estates  and 
of  dairies  where  they  are  milked  as  much  as  possible  (Roeckl, 
Boiigert). 

In  the  municipal  aliattoir  of  Budapest,  in  the- years  1899-1902  the  percentage 
of  tuberculous  cattle  among  the  gray  breeds  of  the"  plains  did  not  exceed  0.23% 
and  among  the  cows  of  the  Hungarian  breeds,  which  are  also  kept  out  of  doors 
the  morbidity  was  4.0  to  6.1%.  The  Hungarian  working  oxen,  on  the  other  hand, 
that  had  been  kept  in  stables  for  several  years  and  at  work  were  tuberculous  to 
the  extent  of  13.6-18%-,  while  of  the  cows  "of  the  colored  breeds  14.8-17.2%  were 
tuberculous.  According  to  Kitasato  the  native  Japanese  cattle,  under  normal  con- 
ditions, are  free  from  tuliercuiosis  while  imported  breeds  and  cross  breeds  frequently 
acquire  the  disease.  The  injection  of  highly  virulent  tuberculous  material  into 
52  native  calves  and  19  calves  from  these  cross  breeds  showed  that  the  native 
cattle  withstood  the  subcutaneous  injections  without  harm  and  that  they  could 
be  made  seriously  ill  only  by  means  of  intravenous  or  intraperitoneal  injections. 
Similarly,  Hutyra  found  that  calves  of  the  Hungarian  long  horned  breeds  were 
difficult  to  infect  by  the  inhalation  of  bovine  tuliercle  bacilli  in  contrast  to  the 
easy  infection  of  the  calves  of  the  ordinary  colored  breeds. 

Individual  susceptibility  is  not  the  same  in  all  animals  of 
the  same  susceptible  breed.  In  large  herds  where  the  disease 
has  been  thoroughly  established,  certain  animals  are  alwavs 
found  that  may  be  perfectly  healthy  and  live  to  a  considerable 
age,  although  they  are  constantly  exposed  to  the  same  danger 
of  infection  as  their  mates.  Iii  experiments  of  artificial  in- 
fection also  it  is  noted  that  among  animals  of  the  same  breed 
and  age  some  resist  infection  with  large  masses  of  virulent 
bacilli.  This  individual  immunity  may  be  congenital,  or  it  may 
be  acquired  in  the  sense  that  the  animals  in  question  may  have 


520  Tubeirulosis. 

suffered  a  slight  or  passing  attack  of  the  disease  and  thus 
acquired  a  certain  immunity  which  was  later  perhaps  intensified 
by  repeated  infections  at  longer  or  shorter  intervals  of  time. 

The  dissemination  of  tuberculosis  was  formerly  explained 
by  assuming  special  individual  and  a  family  predisposition. 
In  human  beings  this  was  supposed  to  find  expression  in  a 
lymphatic  constitution ;  and  in  an  improper  development  of  the 
thorax  (flat  and  norrow  chest,  habitus  phthisicus).  As  far  as 
our  domestic  animals  are  concerned  there  is  no  foundation  upon 
which  to  base  such  a  supposition  and  the  great  regularity  with 
which  we  find  the  disease  in  all  large  herds  points  against  the 
correctness  of  this  view.  It  is  true  that  the  disease  is  especially 
prevalent  in  certain  families  or  strains  but  this  may  readily  be 
explained  by  the  uniformly  favorable  conditions  for  infection. 

Formerly  individual  predisposition  was  supposed  to  be  due  to  a 
slight  power  of  resistance  on  the  part  of  the  hody  to  the  tuberculous  virus 
as  well  as  to  an  unfavora])le  constitution  and  to  hypoplasia  of  the  blood 
vessels.  According  to  Baumgarten  tuberculosis  of  human  beings  is 
usually  congenital  in  the  sense  that  the  offspring  is  born  with  tubercle 
bacilli  in  its  system,  where  they  remain  latent  until  they  develop  and 
produce  active  disease  perhaps  only  after  years  under  the  deleterious 
influence  of  various  agencies.  Tuberculosis  of  the  lymphatic  glands  and 
of  the  bones  especially  was  supposed  to  originate  in  this  manner. 

The  existence  of  such  long-continued  latency  is  contradicted  by  the 
common  observation  that  tlie  human  body  is,  especiahy  in  its  earliest 
infancy,  highly  susceptible  to  tuberculosis  and  that  the  disease  then  as 
a  rule  runs  a  rapid  and  fatal  course.  According  to  Behring  the  pre- 
disposition to  tuberculosis  is  attributed  to  an  infection  in  early  youth, 
resulting  in  disease  of  the.  lymph  glands  (scrophulosis)  which,  by  the 
destruction  of  certain  lymphatics  and  their  glands  and  the  production 
of  changes  in  the  walls  of  blood  vessels,  produces  a  hypersensitiveness  to 
tuberculin,  and  that  involvement  of  the  thoracic  lymph  glands  gives 
rise  to  an  abnormal  development  of  the  thorax  by  affecting  the  sternal 
articulations.  According  to  this  view  an  individual  predisposition  would 
not  be  congenital  but  rather  acquired  and  could  be  guarded  against  by 
the  preventing  of  extra-uterine  infection  in  early  life.  But  this  view 
must  be  objected  to  on  the  same  grounds  as  the  former.  As  a  matter  of 
fact,  we  can  not  as  yet  offer  a  satisfactory  explanation  for  individual 
predisposition,  the  existence  of  which  cannot  be  denied. 

After  careful  study  of  the  henl  registers  of  the  estate  WeiiUitz,  covering:  a 
period  of  59  years,  Hermann  concluded  that  in  all  cases  of  tuberculosis  in  this 
herd  one  of  the  following  predisposing  causes  could  be  established ;  late  born 
calves  in  large  families,  lack  of  fresh  air  and  of  proper  e.xereise,  inbreeding, 
tuberculous  parents. 

Heredity  plays  no  very  important  role  in  predisposition 
nor  in  the  dissemination  of  tuberculosis  in  general.  Although 
tuberculosis  may  be  directly  transmitted  from  the  mother  to 
the  unborn  calf,  as  has  been  demonstrated  by  the  actual  ob- 
servation of  well  developed  disease  in  the  newborn  animal,  such 
cases  are  very  rare  and  occur  only  when  the  uterus  itself  or 
the  cotyledons  are  diseased.     Aside  from  this,  animals  born 


TTi'i<'(lif y   nnd   Piodispositinn.  5OI 

tuberculous  dt)  not  livo  and  nro  Trequeutly  l)oni  ])rL'niaturi'ly. 
Calves  several  weeks  of  a,i;e  are  rarely  *fouii<l  affceted  with 
tnbei-enlosis  and  aiuoni>-  slaughtered  calves  the  i)ereenta,i'('  of 
diseased  animals  usually  does  not  reach  i/o^c,  while  tuberculin 
tests^even  in  badly  infected  herds  rarely  reveal  more  than  10 
or  15%  of  infected  animals  under  ()  months,  in  s|)ite  of  the 
fact  that  these  animals  have  had  al)nndant  opportunity  to  be- 
come infected.  The  most  convincing  ))i-oof  against  the  effects 
of  heredity  in  the  transmission  of  tuberculosis  is  furnished  by 
the  fact  that  the  offspring  of  tuberculous  cows  remain  healthy 
and  free  from  tuberculosis  if  properly  guarded  against  infection 
after  birth. 

Tlie  first  ca^o  of  lioitvlitary  tuboreiilosis  was  oRtal)lislio<l  by  JohiiP  when  he 
demonstrated  tubercle  bacilli  and  tubercles  in  the  lungs  ami  liver  of  a  fetus  eight 
months  of  age.  Since  then  similar  cases  were  reported  by  others  (Csokor,  Noeard, 
MacFadyoaii,  etc.).  Up  to  the  year  li»(i9  Albein  had  compiled  reports  of  107  similar 
cases,  f»l  of  which  were  unquestionable.  At  a  later  date  Hoyberg  reported  6  cases 
of  congenital  tuberculosis  among  .^00  calves  examined  immediately  after  birth  and 
Bergman  reported  108  jtersonally  observed  cases,  among  them  4 'fetal;  the  others 
in  calves  not  exceeiling  three  davs  of  age.  These  were  observed  during  the  vears 
1904-8  in  the  abattoir  of  Malmoe   (0.42%   of  all  slaughtered  calves). 

Among  slaughtered  calves  up  to  five  months  of  age,  Klepp  of  Kiel  found 
0.64-1.18%  tuberculous.  In  a  badly  infected  region  of  Jiitlan.l,  in  Aarhus,  Knudsen 
reported  0..3%  to  be  tuberculous.  Stroh 's  estimates  for  1001  and  1002  gives  for 
Bavaria  the  following  figures:  For  every  100  tuberculous  slaughtered  cows.  6-7 
tuberculous  calves;  for  every  100  cows  'with  advanced  tuberculosis,  twentv-five 
tuberculous  calves,  but  some  of  these  were  evidently  cases  of  extra-uterine  infection 
(see  statistics  on  page  502). 

In  the  course  of  his  tuberculin  test  work  in  Denmark,  Bang  found  among  24,267 
calves  under  six  months,  10.0%  tuberculous.  The  author's  own  observations  on  .544 
calves  under  six  months  showed  50  tuberculous,  that  is,  10.8%.  In  one  badly  infected 
herd  15  out  of  48  calves  or  .31.2%  reacted.  In  calves  of  this  age,  however,  the 
results  of  extra-uterine  infection  are  already  evideiit.  because  according  to  Xocard 
and  Bang  the  percentage  of  reactions  does  not  exceed  5%  during  the  first  few 
weeks  of  life,  the  authors  themselves  have  observed  that  in  one  herd  where  44.8% 
of  all  cows  were  infected  onlv  one  out  of  64  sucking  calves  gave  a  ])Ositive  tuberculin 
reaction  (1.6%). 

In  congenital  tuberculosis  of  calves  the  periportal  lymph  glands  are 
always  involved.  Next  in  frequency  are  the  liver,  the  mediastinal  and 
the  peribronchial  glands,  then  the  lungs  and,  in  exceptional  cases  only, 
other  organs  (Klepp,  Rievel).  This  localization  points  to  the  fact  that 
infection  takes  place  in  a  late  stage  of  embryonic  existence,  through  the 
placental  circulation  from  the  dam.  (Bang  is  of  the  opinion  that 
isolated  tul)erculosis  of  the  posterior  mediastinal  glands  has  the  same 
origin.)  In  regard  to  the  rare  occurrence  of  congenital  tuberculosis 
compared  with  the  compai-ative  frequency  of  tuberculosis  of  the  uterus 
of  cattle,  it  is  probable  that  infection  of  the  foetus  occurs  onlv  in  far 
advanced  tuberculosis  of  the  uterus  or  if  the  cotyledons  and  chorion  villi 
are  affected  (Kockel  and  Lungwitz  have  demonstrated  tubercle  bacilli 
m  the  villi  of  the  chorion  and  Burgmann,  demonstrated  them  in  three 
instances  in  the  placenta). 

Without  disease  of  the  placenta  or  tlie  fetal  envelopes  it  would 
hardly  be  possible  for  the  bacilli  to  pass  from  the  mother  to  the  fetus. 
Altliough  Ravenel  and  Bucher  each  reported  a  case  of  congenital  tu- 
berculosis in  the  calf  where  the  uterus  of  the  dam  was  healthy,  very 
slight  tuberculous  changes  could  certainly  have  escaped  macroscopic 
observation. 


522  Tuberculosis. 

The  possibility  of  a  conceptional  or  germinative  transmission  of  tuberculosis 
has  never  been  demonstrated  and  is,  in  addition,  highly  improbable.  Tubercle 
bacilli  have  never  been  found  in  a  germinal  vesicle  or  in  the  egg.  Besides,  infection 
of  the  egg  would  result  in  its  destruction  before  it  could  mature.  It  is  true  that 
Maffucci,  and  later  Baumgarten,  found  that  in  hens'  eggs,  that  were  infected 
artificially  into  the  white  with  avian  tubercle  bacilli,  normal  cell  division  toot 
place  and  occasionally  the  embryo  developed  completely.  However,  what  has  been 
found  to  be  true  for  the  meroblastic  chick  egg  does  not  necessarily  apply  to  the 
egg  of  the  mammal  because  infection  did  not  take  place  directly  in  the  egg  cell 
but  in  the  surrounding  albumen  and  consequently  the  tubercle  bacilli  would  still 
have  to  pass  through  the  area  vasculosa,  the  analogue  of  the  placenta,  before  they 
could  reach  the  embryo  (Wassermayer,  Bongert).  However,  the  chicks  hatched 
from  eggs  thus  artificially  infected  always  died  of  tuberculosis  after  a  short  time. 

While  in  tuberculosis  of  the  urino-genital  tract,  and  especially  in  tuberculosis 
of  the  epididymis  tubercle  bacilli  are  frequently  present  in  the  spermatic  fluid, 
infection  of  the  ovum  could  occur  only  by  the  simultaneous  introduction  of  a 
bacillus  with  the  spermatozoon  into  the  ovum  (bacilli  have  never  been  demonstrated 
in  spermatazoa).  These  theoretical  conclusions  are  in  harmony  with  the  results 
obtained  from  actual  experiments.  Gaertner,  Cornet  and  Hansen  never  succeeded 
in  their  attempts  to  infect  the  offspring  of  rabbits  or  guinea  pigs  by  the  previously 
infected  male. 

The  frequency  of  the  disease  bears  a  close  relation  to  the 
age  of  the  animal.  Young  animals  are  in  general  more  sus- 
ceptible than  older  ones,  yet  the  disease  is  more  frequently  met 
with  in  the  latter  for  the  reason  that  they  have  been  exposed 
to  infection  for  a  longer  time.  As  a  matter  of  fact  the  per- 
centage of  morbidity  increases  gradually  from  the  suckling 
period,  year  after  year,  and  in  cattle  more  than  50%  of  all 
cases,  as  revealed  by  the  tuberculin  test  or  in  the  abattoir,  are 
found  in  animals  over  six  years  of  age. 

In  the  abattoir  of  Budapest  in  the  year  1899,  9,046  tuberculous  cattle  were 
classified  as  follows:  3  at  3  to  4  weeks,  1  at  5  months,  4  at  7  to  9  months,  12  at 
one  year,  39  at  2  years,  81  at  3  years,  118  at  4  years,  326  at  5  years,  1,223  at 
6  years,  and  7,239  over  6  years  (among  the  latter  .5,173  Hungarian  draft  oxen). 
In  Denmark,  according  to  Bang,  40,624  cattle  (1898-1904)  gave  the  following  results 
after  first  tuberculin  tests:  of  5,559  calves  under  six  months,  12.1%  reacted;  of  7,744 
cattle  from  6  to  18  months,  27.5%;  of  5,047  head  from  18  to  30  months,  38.6%; 
of  10,  350  head  from  2%  to  5  years,  44.9%.,  and  of  11,924  cattle  over  five  years,  48% 
reacted.  Of  the  latter  79%  were  already  infected  at  the  age  of  two  years.  In 
Norway,  according  to  Malm  the  tuberculin  reaction  in  calves  under  6  months  reached 
1  to  2%;  at  6  to  12  months,  1.5  to  3.4%;  in  1  to  5  year  old  cattle  4.3  to  7.9%, 
and  in  still  older  animals  5.6  to  10.4%  reacted.  Naegeli  reports  similar  conditions 
among  human  beings;  1  to  5  years  gave  17%  of  reactions;  5  to  14  years,  33%; 
14  to  18  years,  50%;   18  to  30' years,  96%  of  reactions. 

The  sex  influences  the  prevalence  of  tuberculosis  only  in 
as  far  as  it  affects  the  conditions  under  which  the  animals  may 
have  been  kept.  The  disease  is  most  prevalent  in  dairies  com- 
posed of  cows  of  the  more  domesticated  breeds.  Among  these  we 
frequently  find  from  70  to  80%  and  more,  of  reactors.  Steers  and 
bulls  of  these  same  breeds,  which  are  rarely  allowed  to  reach  the 
same  ages,  give  a  much  lower  percentage.  Compared  with 
these  figures  the  percentage  a.mong  the  gray  cows  and  bulls 
of  the  steppes  which  are  kept  mostly  in  the  open  air  are  much 
lower  than  in  stable-fed  oxen  of  the  same  breed  that  are  worked 
for  years  (see  p.  519). 

In  the  German  Empire  the  frequency  of  tuberculosis  was  found  in  the  abattoirs 
as  follows:  Oxen  20.04%,  bulls  15.82%,  cows  27.13%,  yearlings  and  young  cattle 
6.2%,  calves  0.30%.     In  the  abattoir  at  Budapest  in  1903*  the  following  results  were 


Predisposing  Iiiflm-iices.  523 

obtained  of  the  steppe-breeds:  Bulls  4.40%  tuberculous,  oxen  16.84%,  cows  5.39%; 
while  the  colored  breeds  gave  the  following  results:  Bulls  3.92%,  oxen  G.98%  and 
cows  22.61%,. 

External  influences  which  reduce  the  vitality  of  the  animals 
and  the  resisting  powers  of  the  tissues  in  general  favor  the 
development  of  tuhereulosis.  This  applies  particularly  to  damp 
and  poorly  ventilated  dirty  stables  and  to  lack  of  exercise  in 
the  open  air.  These  two  factors  alone  tend  to  produce  super- 
ficial breathing  and  catarrhal  conditions  of  the  respiratory  tract 
and  thus  they  ])roduce  a  local  predisposition,  wliich  is  increased 
by  the  collection  of  secretions  in  the  bronchial  tubes.  In  addi- 
tion to  this  close  stabling  affords  more  abundant  opportunity 
for  infection  from  diseased  animals,  especially  when  frequent 
purchases  are  made  from  suspicious  sources. 

The  predisposing  influence  of  catarrhal  conditions  of  the  air  pas- 
sages is  particularly  striking  in  cattle  that  are  kept  in  the  vicinity  of 
sulphur  and  arsenic  mines  and  smelters.  In  these  animals  the  inhalation 
of  the  smoke  from  the  works,  which  contains  arsenious  acid,  causes  a 
catarrli  of  the  air  passages  and  then  pulmonary  tuberculosis  (which  used 
to  be  known  as  smelter  smoke  pneumonia)  usually  spreads  very  rapidly 
(Siedamgrotzky,  Johne,  Pfeifer),  In  this  connection  the  experiments  of 
Cadeac  &  Malet  deserve  mention.  They  succeeded  in  producing  pul- 
monary tuberculosis  in  rabbits  by  the  inhalation  of  dust  contaminated 
with  tubercle  bacilli  only  in  such  cases  where  the  respiratory  tract  was 
previously  irritated  with  fumes  of  bromine ;  also  the  experiments  of 
Plate  according  to  which  irritation  of  the  intestinal  mucous  membrane 
of  guinea  pigs  with  croton  oil  favored  infection  of  the  intestines  with 
tubercle  bacilli  in  SO^c  of  the  animals. 

Insufficient  and  improper  feeding  with  food  deficient  in 
nutrients  (distillery  slops  and  factory  refuse)  and  over-exer- 
tion or  excessive  milk  production  are  also  predisposing  factors 
by  weakening  the  organism. 

Tuberculosis  frequently  develops  after  acute  inflammation 
of  the  lungs.  The  diseased  lung  tissue  and  the  incompletely 
absorbed  exudate  constitute  a  favorable  medium  for  the  develop- 
ment of  tubercle  bacilli.  In  other  cases  an  attack  of  acute 
disease  weakens  the  body  and  prepares  the  soil  for  a  renewed 
and  successful  attack  of  an  existing,  but  dormant,  tuberculous 
process.  Finally  the  shedding  of  the  milk  teeth  probably  favors 
in  young  animals,  especially  in  pigs,  infection  through  the 
buccal  cavity  and  the  development  of  tuberculosis  of  the  cervical 
hmiph  glands. 

Pathogenesis.  Tlie  principal  ports  of  entrance  for  the  tubercle 
bacilli  are  doubtless  the  respiratory  and  digestive  tracts.  It  is  an  open 
question,  however,  as  to  which  channel  is  of  greater  importance  in  nat- 
ural  infection. 

The  fact  that  in  man  as  M-ell  as  in  animals  the  lungs  and  the  ad- 
jacent lymph  glands  are,  in  the  vast  majority  of  eases,  affected  either 
alone  or  in  conjunction  with  other  organs  or  parts  of  the  body  had 


524  Tuberculosis. 

always  pointed  to  the  apparently  well  founded  conclusion  that  the  lungs 
constituted  the  principal  primary  seat  of  infection.  Infection  was  sup- 
posed to  be  brought  about  by  the  inhalation  of  air  contaminated  with 
the  virus.  It  was  assumed  that  the  bacilli  entered  the  finest  ramifications 
of  the  bronchioles  and  alveoli,  producing  a  broncho-pneumonia,  or  that 
they  were  taken  up  by  the  leucocytes  from  the  mucous  membranes  of 
the  larger  bronchioles  and  transported  to  the  bronchial  glands  through 
the  lymph  vessels  where  they  gave  rise  to  the  development  of  tubercles. 
From  these  glands  they  were  supposed  to  pass  into  the  lungs  by  way 
of  the  blood  stream  and  produce  interstitial  tubercles. 

This  view  of  the  possibility  of  an  ^'inlialation  tuberculosis" 
was  based  upon  positive  experimental  evidence  which,  in  fact 
w^as  obtained  by  making  small  animals  inhale  sprays  of  tuber- 
culous material  (Cornet,  Fluegge,  Petterson,  Baumgarten, 
Ribbert,  Cadeac  and  Malet,  and  others).  Similar  results  were 
obtained  in  cattle  (Ravenel,  Kesselmann,  Nocard  &  Rosignol, 
Kossel,  Weber  &  Heuss,  and  others) ;  also  in  goats  (Reichen- 
bach)  and  dogs  (Tappeiner).  In  all  these  experiments  tuber- 
culosis of  the  tlioracic  organs  and  especially  of  the  lungs  was 
produced.  (See  also  page  508).  During  the  past  few  years  the 
value  of  these  experiments  has,  however,  been  questioned. 

In  the  first  place  it  was  pointed  out  tliat  tubercle  l)aci]li 
thus  inhaled  were  precipitated  on  the  mucous  meml^rane  directly 
posterior  to  the  nasal  openings  or  in  the  diverticula  of  the 
anterior  portion  of  the  respiratory  tract,  thus  never  gaining 
entrance  to  the  deeper-lying  portions  of  the  respiratory  tract 
and  that  the  lungs,  in  these  cases,  had  to  become  infected  by 
absorption  of  the  bacilli  into  the  lymphatic  and  blood  vessels 
which  transported  them  to  these  organs.  (See  p.  526).  This 
objection  was  met,  partially  at  least,  by  Fluegge  &  Heymann, 
more  recently  also  by  Bartel  &  Neumann,  as  well  as  by  Kuss 
who  experimented  with  guinea  pigs,  and  Weber  &  Titze  who 
used  calves  in  their  experiments.  They  showed  that  imme- 
diately after  the  inhalation  of  infected  sprays  even  the  most 
peripheral  portions  of  the  lungs  contained  tubercle  bacilli  (al- 
though only  few).  In  calves  they  were  demonstrated  on  one 
occasion  each,  in  the  middle  and  posterior  lobes  of  the  right 
lung.  Similar  results  were  obtained  with  bacillus  prodigiosus 
by  Hartmann  &  Hartl  and  with  mold  fungi  by  Hildebrand  and 
Ballin.  Kuss  showed  that  soot  and  fine  particles  of  pigments 
(India  ink)  also  reached  the  finest  bronchioles  by  means  of  the 
inhaled  air.  Anthracosis  is  undoubtedly  caused  by  direct  in- 
halation, although  this  statement  is  opposed  to  the  view  of 
Vanstenberhe  &  Grysez. 

The  important  role  played  by  inhalation  is  emphasized  by 
the  fact  that  minimum  quantities  of  virus  (50  bacilli  in  guinea 
pigs)  are  sufficient  to  infect  experiment  animals  while  for  in- 
fection through  the  alimentary  canal,  masses  a  hundred  thou- 
sand times  as  great  are  necessary  (Findel).  Recently  Weber 
&  Titze  showed  the  same  to  be  true  with  calves,  viz.,  that  in-. 


Infection   by   Inlialatinn.  525 

feetion  with  luberculo.sis  resulled  after  iulialatioii  uf  U.Ul  iiii;-. 
while  infection  through  the  alimentary  tract  required  10  nig. 
of  tubercle  bacilli  culture. 

In  view  of  these  results  we  can  no  longer  doubt  the  possi- 
bility of  inhalation  tuberculosis.  As  to  the  practical  importance 
of  this  mode  of  infection,  we  must  remember  that  comparatively 
few  bacilli  reach  the  terminal  ramifications  of  the  l)ronchial 
tul)es  through  the  nu^dium  of  ordinary  infected  air  and  also 
that  the  body  is  provided  with  natui'al  means  to  protect  itself 
against  even  considerable  quantities  of  virus.  Another  fact 
that  should  receive  due  consideration  in  this  connection  is  that 
it  is  only  with  difficulty  that  calves  are  infected  by  means  of 
intratracheal  injections,  even  of  large  masses  (10  cc.  bacillus 
emulsion)  of  virus. 

The  (|ut'sti()u  as  to  whothor  an  infections  inhalation  produces  pul- 
monary tuberculosis  primarily  hy  aerogenous  infection,  or  secondarily 
by  lympho-hematogenous  infection  is  yet  an  open  one.  While  some 
authors  believe  that  the  inhaled  bacilli  give  rise  to  the  development  of 
the  first  tubercles  in  the  nucons  membrane  and  its  lymph  follicles  (Zieg- 
ler,  Ponfik,  Schmorl,  etc.),  others  (e.  g.,  Orth,  Ribhert  and  Baumgarten) 
lielieve  that  the  bacilli  are  immediately  absorbed  by  the  mucous  mem- 
branes and  deposited  in  the  bronchial  glands  from  where  they  reach 
the  lung  tissue  and  the  walls  of  the  hronchial  tubes  through  the  lymph 
and  blood  circulation.  The  tubercles  and  cheesy  foci  which  here  de- 
velop are  then  supposed  to  give  rise  to  a  tuberculous  bronchitis  and 
lironcho-pneumonia. 

This  view  is  especially  applicable  to  pulmonary  tuberculosis  of 
domestic  animals.  According  to  Bongert  the  first  tuberculous  changes 
in  the  lungs  of  cattle  are  observed  in  the  posterior  lobes  to  which  places 
tubercle  bacilli  would  be  most  apt  to  be  carried  first.  This  is  due  to  the 
fact  that  the  pulmonary  artery  passes  in  a  straight  direction  from  its 
point  of  entrance  toward  the  base  of  the  lung,  while  the  artery  for  the 
anterior  lobe  branches  off  at  an  angle  in  a  more  or  less  opposite  direction. 
In  a  direct  infection  from  the  inhaled  air  tlie  anterior  lob(^s  would  natur- 
ally become  infected  first  because  the  origin  of  the  bronchial  branch 
supplying  this  lobe  as  well  as  that  of  the  first  branch  of  the  main  bron- 
chus, according  to  Baerner,  is  situated  at  the  lowest  point  of  the  main 
bronchus.  Consequently  material  inhaled  with  the  air,  especially  fluids, 
is  drawn  principally  into  the  anterior  lobes  of  the  lungs.  Pigs  often 
aspirate  food  particles  into  the  lungs,  and  hence  the  fact  that  the  most 
pronounced  lesions  of  tuberculosis  are  usually  met  with  in  the  anterior 
lobes  accords  Avith  the  above  explanation.  (Tn  human  beings,  for  reasons 
as  yet  not  satisfactorily  explained,  the  superior  apical  lobes  are  affected 
most  frequently.) 

The  great  frequency  of  pulmonary  affection  does  not  in 
itself,  liowever,  prove  that  the  infection  takes  place  "s\^th  the 
same  frequency  by  way  of  the  respiratory  passages.  Eecent 
experiments  have  shown  beyond  question  that  the  lungs  as 
well  as  the  thoracic  hniiph  glands  may  be  infected  from  the 
digestive  tract.  Chanveau  was  the  first  to  call  attention  to  this 
possibility  (1868-1872).    The  latter  fed  tuberculous  material  to 


526  Tuberculosis. 

young  cattle  and  i^roduced  exclusive  infection  of  the  broncho- 
mediastinal lymph  glands.  Klebs,  in  1884,  supported  this  view 
when  he  referred  to  the  meat  and  milk  of  tuberculous  cattle 
as  the  commonest  source  of  infection  for  human  beings.  Orth 
(1887)  emphasized  the  importance  of  intestinal  infection  as  a 
source  of  pulmonary  tuberculosis.  This  question  came  into 
particular  prominence  through  Koch's  well  known  address  at 
the  London  Tuberculosis  Congress  (1901)  and  more  so  through 
the  position  assumed  by  v.  Behring  (1903),  according  to  which 
the  principal  cause  of  tuberculosis  was  intestinal  infection  of 
nurslings,  while  inhalation  tuberculosis  was  of  wholly  secondary 
importance,  and  which  asserted  that  when  this  form  appeared 
to  exist  the  infection  usually  resulted  through  the  hanpliatic 
vessels  of  the  naso-pharyngeal  or  intestinal  mucous  membranes, 
thus  being  after  all  an  intestinal  infection.  Following  this  a 
great  number  of  experiments  were  conducted  by  Weleminsky, 
Ravenel,  Kovacs,  Calmette  &  Guerin,  Vallee,  Weichselbaum  and 
others  which  threw  more  light  upon  this  mode  of  infection  and 
led  many  to  regard  it  as  the  most  frequent. 

Formerly  a  primary  intestinal  infection  was  not  admitted 
unless  the  peripharyngeal  lymph  glands  or  the  intestine  and 
the  mesenteric  glands  were  the  exclusive  or  at  least  the  principal 
seat  of  disease.  In  direct  contrast  to  this  view  experimental 
feeding  of  tuberculous  material  showed  that  tubercle  bacilli, 
especially  when  introduced  in  small  quantities  per  os,  would 
pass  through  the  intact  mucous  membrane  of  the  intestine  and, 
without  necessarily  lodging  in  the  lymph  glands  along  their 
path,  would  pass,  in  part  at  least,  to  the  glands  in  distant  regions 
of  the  body  or  even  directly  into  the  blood  vessels  and  be 
finally  carried  to  the  lungs  where  they  produced  a  primary 
pulmonary  infection  with  all  the  appearances  of  an  inhalation 
tuberculosis.  The  usual  course  taken  by  the  bacilli  is  then, 
on  the  one  hand,  from  the  pharyngeal  region  through  the  cervical 
lymph  vessels  to  the  broncho-mediastinal  lymph  glands  and  on 
the  other  hand  from  the  small  intestine,  especially  the  posterior 
portion  of  the  ileum  by  way  of  the  hniiphatics  to  the  mesenteric 
glands,  through  the  latter  to  the  thoracic  glands  or,  through  the 
thoracic  duct  directly  into  the  pulmonary  circulation. 

Behring  produced  characteristic  inhalation  tuberculosis  in  guinea 
pigs  by  injecting  cultures  into  the  tissue  of  the  tongue.  The  submental 
glands  became  affected  first,  following  these,  the  cervical  and  then  the 
mediastinal  glands.  Later,  the  virus  reached  the  bronchial  glands 
through  the  blood  vessels.  The  subpleural  ramifications  of  the  pul- 
monary artery  then  carried  the  virus  to  the  lung  tissue  where  miliary 
tubercles  developed. 

Weleminsky  and  Kovacs  fed  young  guinea  pigs  repeatedly  with  0.1 
mg.  of  culture  per  100  g.  body  weight  and  after  a  few  days  found  the 
bacilli  on  the  one  hand  in  the  submental,  submaxillary  and  cervical 
glands  and,  on  the  other  hand,  in  the  ileo-eaecal,  mesenteric  and  portal 
glands.  These  results  agree  with  those  obtained  by  Behring.  Calmette 
&  Guerin  introduced  tubercle  bacilli  (0.1-1.0  g.)  partly  through  a  tube, 


Til  feet  ion    hy  Tnlialation.  527 

partly  with  the  food,  into  the  digi'stive  tract  of  guinea  pigs,  goats  and 
cattle.  In  the  older  animals,  whose  lymph  glands,  on  account  of  their 
less  dense  structure  allow  an  easier  passage  of  the  bacilli  the  thoracic 
organs  were  freciuently  found  atFected  exclusively.  Occasionally  the 
bronchial  glands  also  were  involved.  The  younger  animals  showed  af- 
fection of  the  mesenteric  glands.  In  old  animals  bacilli  could  ])e  found 
in  the  lungs  twenty-four  hours  after  alimentary  infection  had  been, 
produced,  while  in  young  animals  tiiey  could  not  be  demonstrated  until 
after  the  fifth  day.  Vallee  obtained  similar  results  by  feeding  infected 
milk  and  by  direct  injection  of  the  bacilli  into  the  mesenteric  glands. 
Orth  &  Rabinowitsch  got  the  same  results  from  endorectal  infection. 
Dellaan  injected  tubercle  bacilli  into  the  stomach  of  a  heifer  and  three 
months  later  demonstrated  a  pronounced  tuberculosis  of  the  lungs  and 
pleura,  but  found  the  intestinal  mucous  membrane  and  its  lymph  fol- 
licles intact. 

The  experiments  of  Ravenel  as  well  as  those  of  Nicolas  &  Desco 
demonstrated  the  rapid  transmission  of  tuliercle  bacilli  from  the  intes- 
tine to  the  thoracic  organs.  They  fed  cultures  in  butter,  warm  water, 
pastry  and  in  soups.  Three  or  four  hours  later  bacilli  Avere  present  in 
the  thoracic  duct.  Bisanti  &  Panisset  demonstrated  the  presence  of 
tul)ercle  bacilli  in  the  blood  five  hours  after  they  had  been  ingested. 
Orth  &  Rabinowitsch  injected  an  emulsion  of  bacilli  into  the  rectum, 
Oberwarth  &  Rabinowitsch  injected  the  bacilli  into  the  stomach  of  a 
pig  and  in  both  instances  the  germs  were  afterwards  found  in  the  cir- 
culating ])lood. 

That  tubercle  bacilli  may  and  do  pass  through  healthy  mucous 
membranes  has  been  amply  demonstrated  on  healthy  animals  by  num- 
berless feeding  and  inhalation  experiments  with  material  which  was 
mechanically  and  chemically  innocuous.  The  experiments  of  Dobrok- 
lonsky  among  others  showed  that  the  mucous  membranes  might  remain 
perfectly  unharmed  during  this  process  (although  Baumgarten,  on  the 
other  hand,  holds  that  the  nnicous  membrane  always  suffers  by  the  en- 
trance of  bacilli  into  its  lymph  follicles,  especially  in  the  intestinal 
mucous  membrane). 

Although  there  is  no  doubt  that  an  infection  of  the  respira- 
tory organs  may  follow  an  intestinal  infection,  or  result  from 
one,  the  fact  that  the  former  are  by  far  the  most  frequent 
seat  of  primary  disease  must  be  explained  by  their  greater 
susceptibility.  This  is  especially  true  of  the  lungs,  thus  ex- 
plaining the  fact  that  these  organs,  no  matter  what  the  mode 
of  infection,  are  usually  more  intensely  involved  than  any 
other  part  of  the  body.  Occasionally  we  find  the  development 
of  an  isolated  tuberculosis  of  the  lungs  following  the  injection 
of  virus  into  the  subcutis  or  into  otlier  remote  organs.  Thus 
we  may  justly  consider  the  lungs  as  far  as  infection  with  tuber- 
culosis is  concerned,  as  a  locus  minoris  resistentiae  (Cohnheim, 
Orth,  Baumgarten,  Bartel).  In  regard  to  tlie  frequent  affection 
of  the  lymphatic  glands  it  is  significant  that  these  constitute 
a  close  filter  for  corpuscular  elements,  especially  in  yotmg 
animals,  and  that  they  arrest  a  considerable  portion  of  tubercle 
bacilli  which  are  in  the  hanph  stream,  and  which  then  in  spite 
of  the  bactericidal  action  of  the  honph  elements   (Manfredi, 


528  Tuberculusis. 

Bartel,  Fontes  and  others),  can  more  easily  give  rise  to  the 
pathological  process,  on  account  of  their  great  numbers,  than 
is  possible  in  other  organs. 

The  great  predisposition  of  the  lungs  for  tuberculosis  is  further 
emphasized  by  the  fact  that  aerogenic  infection  results  exclusively  in 
pulmonary  affection.  According  to  Neumann  &  AVittgenstein  this  pre- 
disposition is  explained  by  the  al)sence  of  certain  ferments  which  have 
the  power  of  splitting  or  reducing  fat  molecules.  Baumgarten  observed 
the  development  of  pulmonary  tuberculosis  after  the  introduction  of 
small  quantities  of  bacilli  into  the  bladder  of  rabbits.  Bartel  saw  pul- 
monary tuberculosis  develop  after  intraperitoneal  infection.  Schroeder 
&  Cotton  produced  pulmonary  tuberculosis  in  cattle  and  swine  by  sub- 
cutaneous infection  at  the  tip  of  the  tail.  Vallee  got  the  same  result 
after  injection  of  a  culture  into  the  milk  cistern  of  a  cow's  teat.  In 
the  latter  case  not  only  the  lungs  but  also  the  supramammary,  the 
ahdominal  and  the  In'oncho-mediastinal  glands  became  involved.  It  is 
important  to  note  that  intravenous  or  peritoneal  infection  of  goats  and 
rabbits  causes  the  development  of  isolated  pulmonary  tuberculosis  with 
the  formation  of  cavities,  especially  when  the  susceptibility  of  these 
animals  was  previously  reduced. 

Welemiiisky  attempts  to  explain  the  frequent  primary  affection  of  tlic  hronchial 
lymph  glands  by  the  intimate  relationship  existing  between  these  glands  and  the 
entire  lymphatic  system.  These  glands  constitute  a  sort  of  ' '  heart ' '  into  which 
lymph  vessels  from  all  directions  }iour  theii-  contents  which  are  then  carried  through 
the  broncho-mediastinal  trunk  into  the  subclavian  vein.  The  correctness  of  this 
view  has  never  been  demonstrated  as  far  as  guinea  jiigs  are  concerned  and,  as 
to  other  animals,  it  is  at  best  questionable.  However,  these  glands  are  also  readily 
infected  following  intravenous  or  intraarterial  injections  of  virus  (Baumgarten). 
It  has  been  observed  that  in  calves  infection  by  these  methods  usually  results  in 
the  development  of  pronounced  lesions  of  these  glands  as  well  as  of  the  lungs 
proper. 

In  regard  to  the  transportation  of  tubercle  bacilli  from  AValdeyer's 
ring  Behring  is  of  the  opinion  that  they  give  rise  to  the  first  lesions 
in  the  superior  cervical  glands  and  then  travel  through  the  lymph  ves- 
sels to  the  bronchial  glands  and  the  lungs.  In  opposition  to  this  view, 
Bongert,  Beitzke  and  Devrient  point  out  that  the  lymphatic  system  of 
the  head  and  neck  is  entirely  separate  from  that  of  the  lungs  and  its 
glands  and  that  the  bacilli  from  the  diseased  subparotideal  and  sub- 
maxillary lymph  glands  pass  from  the  great  lympathic  trunk  into  the 
vena  cava,  thence,  with  the  blood,  to  the  lungs  and  the  bronchial  glands 
(especially  common  in  swine).  The  tonsils  play  no  important  role  in 
this  process,  especially  not  in  cattle.  "With  their  abundant  supply  of 
lymphoid  cells  they  would  rather  act  as  a  protection.  However,  should 
the  bacilli  successfully  pass  through  them  they  would  cause  changes  in 
the  retropharyngeal  glajids  (Devrient). 

Isolated  tuberculosis  of  the  lungs  and  of  the  broncho-mediastinal  glands  in 
cattle  is  frequently  observed  in  abattoirs.  Thus,  in  the  abattoir  of  Budapest  in 
the  years  1898-1901,  of  46,092  cases  of  tuberculosis  in  cattle,  40,.306  showed  affection 
of  the  lungs  only,  including  the  peribronchial  and  mediastinal  glands.  In  about 
one-third  of  the  cases  the  lymph  glands  only  were  affected ;  tonsils  and  retro- 
jiharyngeal  lymphatic  glands  in  only  102  cases.  Bongert  found  the  latter  glands 
affected  in  3  out  of  1,200  cases,  Devrient  in  2  out  of  1,400  cases.  Easmussen  found 
the  tonsils  affected  in  52  out  of  4,708  cases  (1.1%)  and  the  retropharyngeal 
glands  in  228  cases  (4.8%). 


M.idcs  of  Til  feet  i..n.  509 

Of  course  any  organ  oi"  the  hody  uiay  oceasioually  be  found  to  lie 
l)artieularly  preilisposed  to  infection  and  it  seems  that  priiiiai-y  atfcc- 
lion  of  the  boiu's  and  articuhitions  is  thus  explained  (traumatic  influ- 
ences 1.  The  species  of  animal  is  also  of  importance.  Thus  subcutane- 
ous infection  of  guinea  pigs  usually  produces  disease  of  the  lungs, 
almost  never  of  the  sj)leen,  while  in  rabbits,  next  to  the  lungs,  the 
kidneys  are  particularly  prone  to  disease,  and  in  chickens  the  lungs  are 
practically  immune  to  infection  with  avian  tuberculosis  (Weber).  Simi- 
lar ditfei-ences  ai"e  observed  among  the  domcsticaled  animals,  e.  g..  in  the 
l)ig  the  spleen  is  particularly  susceptible  in  contrast  to  other  animals, 
in  cattle  the  sei-ous  membranes,  and  in  dogs  tlie  pericardium.  Finally, 
the  variety  of  tubercle  bacilli  is  to  be  considered.  Thus,  in  man,  the 
bovine  type  usually  causes  disease  only  in  the  digestive  tract  and  in  its 
lymphatic  glands. 

From  what  has  been  stated  it  is  evident  that  in  tuberculosis 
the  infection  of  any  internal  orj^an  whatever  may  result  tlironii'li 
the  respiratory  a])])aratns  (aero^'enic  infection)  or  thron,ii"h  the 
digestive  apparatus  (alimentary  infection).  As  to  wliicli  of 
tliese  modes  of  infection  is  the  more  common,  views  dilTer  at 
the  present  time.  It  is  not  probable  either  that  the  solution 
to  tlie  problem  will  be  an  easy  one.  Bacilli  carried  with  the 
inlialed  air  to  the  naso-pliarynx  may  readily  be  absorbed  throui2:li 
the  alimentary  mucous  membrane.  But,  wdiichever  view  may 
be  the  correct  one,  there  can  be  no  doubt  as  to  the  danger  of 
inhaling  air  laden  with  bacilli.  The  manner  of  infection  de- 
pends no  doubt,  at  least,  in  a  great  measure,  upon  the  conditions 
already  discussed.  Patients  with  open  pulmonary  tuberculosis, 
by  virtue  of  the  exhaled  infected  droplets  constitute  a  source 
of  either  mode  of  infection ;  an  open  tuberculosis  of  other  organs 
of  the  body  constitutes  a  danger  for  alimentary,  infection  almost 
exclusively. 

The  localization  and  character  of  the  tuberculous  lesion 
is  determined  to  some  extent  also  by  the  intensity  of  the  in- 
fection. After  infection  with  a  large  mass  of  virulent  bacilli 
the  morbid  process  usually,  especially  in  older  animals,  begins 
its  development  at  the  point  where  the  largest  number  of  bacilli 
became  lodged  on  the  mucous  membrane.  At  these  points 
tubercles  and  ulcers  are  formed,  such  as  are  observed  in  the 
tonsils  (especially  in  swine)  and  in  the  ileum.  In  the  latter 
they  usually  begin  in  the  hnnph  follicles  of  the  mucous  mem- 
brane. If  the  infection  happens  to  be  slight  the  mucous  mem- 
brane remains  intact  and  the  hnnpli  glands  only  are  affected. 
This  is  because  most  of  the  bacilli  remain  lodged  in  these  glands 
and  the  few  that  happen  to  pass  through  are  either  destroyed 
(phagocytosis)  or,  on  account  of  their  small  numbers,  produce 
lesions  that  are  not  observed  until  a  later  time.  Thus  it  may 
occasionally  be  observed  in  cattle  that  the  retrophar^^^geal 
glands  contain  large  tuberculous  foci,  the  upper,  middle  and 
lower  cervicals  and  finally  the  mediastinal  glands  successively 
smaller  and  more  recent  foci  (Breuer).  By  this  means  we  may 
often  be  enabled,  in  the  beginning  of  the  disease,  at  least,  to 

Vol.  1—34 


530  Tuberculosis. 

recognize  the  mode  of  infection  by  tlie  seat  of  the  oldest  lesion. 
In  by  no  means  rare  instances  the  first  lesions  develop  in 
regions  or  organs  remotely  situated  from  the  point  of  infec- 
tion, apparently  with  preference  after  an  infection  that  is  not 
intensive.  In  these  cases  the  infection  was  transported  by  the 
blood  or  lymph  circulation  without  producing  changes  along 
their  path.  This  path  cannot  often  be  determined  with  any 
degree  of  exactness  and  consequently  it  is  only  in  rare  instances 
that  an  autopsy  reveals  evidence  UDon  Avhich  reliable  conclusions 
could  be  based. 

The  milder  the  infection  and  the  greater  the  resistance 
offered  by  the  body  the  slower  will  be  the  development  of  the 
ensuing  disease.  Thus  it  is  possible  to  produce  artificially  a 
pulmonary  phthisis  characterized  by  excessive  tissue  destruc- 
tion and  the  formation  of  cavities  l)y  the  introduction  of  com- 
paratively small  quantities  of  bacilli  of  slight  virulence 
(Baumgarten)  or  by  inoculating  animals  which  had  been  pre- 
viously partially  immunized.  Under  these  conditions  it  may 
require  months  for  the  disease  to  develop  in  guinea  pigs  and 
two  or  three  years  in  goats  (Behring  &  Roemer,  Nocard,  De 
Jong).  According  to  Calmette  and  Guerin  a  single  intestinal 
infection  of  calves  is  said  to  produce  a  tuberculous  process 
which  usually  heals  in  the  course  of  three  or  four  months  and 
results  in  a  certain  degree  of  immunity.  On  the  other  hand 
a  number  of  successive  infections  repeated  at  short  intervals 
may  result  in  a  progressive  tuberculous  process. 

According  to  Behring  the  mother's  milk  constitutes  the  principal 
source  of  puhnonarv  tuberculosis  in  man.  According  to  this  author 
infection  takes  place  from  the  gastro-intestinal  tract,  conditions  for 
infection  being  particularly  favorable  at  this  period  of  life  since,  accord- 
ing to  Disses,  the  epithelial  layer  of  the  intestinal  mucous  membrane  is 
not  covered  with  a  continuous  layer  of  mucus  during  the  first  days  of 
the  infant's  life.  As  a  result,  as  shown  by  Roemer 's  findings,  large 
undigested  proteid  molecules  and  also  bacteria  can  pass  unchanged 
through  the  intestinal  mucous  membrane  of  new  born  colts,  calves  and 
the  small  lal)oratory  animals,  while  infection  in  adult  animals  is  much 
more  difficult  and  only  possible  either  after  repeated  ingestion  of  virus 
or  after  a  single  ingestion  of  exceptionally  virulent  material  in  large 
amount.  The  bacilli  thus  taken  up  produce  a  scrofulous  diathesis  which 
constitutes  a  groundwork  for  the  infantile  infection  to  develop  into  mani- 
fest disease  in  the  course  of  years  or  decades.  This  result  is  favored  by 
additional  infections  which  take  place  in  later  life,  as  well  as  by  the 
exhausting  effects  of  deficient  nutrition,  catching  cold,  overexertion, 
long  continued  confinement  in  poorly  ventilated  houses,  etc.  This  theory 
has  also  been  applied  to  animals.  However,  just  as  its  correctness  in 
regard  to  man  is  generally  questioned,  its  applicability  to  cattle  is  doubt- 
ful, the  more  so  as  tuberculin  reactions  in  calves  are  seldom  positive 
and  as  the  percentage  of  reactions  increases  only  later,  but  then  steadily. 

The  development  of  the  tubercle.  At  the  point  of  their 
lodgment  and  propagation  the  tubercle  bacilli  give  rise  to  an 
inflammatory  process   resulting  in  tubercle  formation.     This 


Develojiineiit  of  the  Tuliorcle.  5,'^"! 

is  caused  by  a  specific  toxin  produced  by  the  Inicilli  and  results 
in  the  characteristic  product  of  tlie  disease,  the  tubercle.  Sur- 
roundiui^  the  bacilli  are  |2:rouped  round  cells  (according  to 
Bauni^arten  these  are  derived  from  connective  tissue  cells  and 
epithelial  cells,  according  to  Borrel  they  are  large  mononuclear 
leucocytes).  These  round  cells  become  transformed  into 
epithelioid  cells,  with  vesicular  nuclei,  which  enclose  several 
tubercle  bacilli.  As  a  result  of  repeated  karyokinesis  which 
process  the  diseased  protoplasm  can  no  longer  follow  (Baum- 
garten,  AVeigert)  or  as  a  result  of  the  confluence  of  several 
epithelioid  cells  (Metchnikoff )  there  develop  in  the  center  of 
the  cell  mass  polynuclear  epithelioid  cells  as  well  as  true  giant 
cells.  These  also  frequently  contain  tubercle  bacilli.  Later, 
as  a  result  of  reaction  of  the  surrounding  tissue,  mononuclear 
lymphocytes  and  polynuclear  leucocytes  migrate  from  the  ad- 
jacent blood  vessels,  form  a  dense  zone  around  this  cell  group 
and  lodge  themselves  between  the  epithelioid  cells  while  a 
fibrinous  network  of  coagulated  exudate  is  deposited  between 
the  cells  of  this  group.  As  a  result  of  the  toxic  action  of  the 
chemical  products  of  the  bacilli,  perhaps  also  on  account  of 
the  nonvascular  condition  of  the  nodules  and  therefore  of  in- 
sufficient nutrition  (Virchow),  the  completed  tubercle  suffers 
regressive  metamorphoses.  The  central  cells  die  ofT,  break 
down,  and  together  with  the  scanty  connective  tissue  and  the 
intermingled  exudate  are  converted  into  a  granular,  cheesy 
mass  in  which  lime  salts  are  eventually  deposited. 

In  cattle  and  swine  calcified  and  caseated  tubercles  may  contain 
virulent  bacilli,  so  that  this  metamorphosis  does  not  indicate  complete 
recovery.  The  virulence  of  these  bacilli  is,  however,  as  a  rule,  reduced 
(Lubarsch,  Schmitz). 

The  structure  of  the  tubercle  in  different  species  of  animals 
exhibits  variations  of  minor  importance,  which  nevertheless 
are  responsible  for  the  often  characteristic  microscopical  ap- 
pearance of  the  lesions  in  different  species  of  animals.  The 
tubercle  of  cattle  is  characterized  by  an  abundant  groundwork 
of  connective  tissue  frequently  containing  giant  cells  but  con- 
taining comparatively  few  small  round  cells.  These  tubercles 
have  a  great  tendency  to  become  calcified.  As  a  result  of  this 
dense  connective  tissue  groundwork  numerous  adjacent  tuber- 
cles frequently  become  confluent  and  form  tumors  resembling 
fibrosarcomata  in  appearance.  The  tubercles  of  sheep  and 
goats  have  a  similar  structure.  The  tubercle  of  the  horse  is 
Avell  supplied  with  cell  substance  and  consequently  readily 
undergoes  softening.  This  softening  process  may,  however, 
not  set  in  until  at  a  late  stage  of  its  development.  Calcification 
is  only  rarely  observed.  The  tubercle  in  swine  is  well  supplied 
with  small  round  cells  with  little  connective  tissue  ground  sub- 
stance. They  readily  become  caseated  and  not  infrequently 
calcarious.  The  tubercle  of  the  dog  often  undergoes  mucoid 
degeneration,  or  softening,  in  its  later  stages. 


532  Tuberculosis. 

The  term  tubeieulum  was  formerly  applied  to  every  possible  aud  conceivable 
form  of  nodule  or  tumor.  In  1794  Baillie  and  in  1810  Bayle  applied  this  term 
exclusively  to  the  small  gray  nodule  which  occurs  in  tuberculosis.  Later  on  Lai.mnec 
regarded  the  cheesy  substance  as  characteristic  of  tuberculosis  and  finally  Yirchow 
laid  particular  stress  upon  the  fact  that  the  tubercle  was  composed  of  small  cells 
resembling  lymph  cells  and  that  the  structure  was  devvoid  of  a  vascular  supply. 
He  regarded  the  tubercle  as  characteristic  of  tuberculosis.  Langhals  called  attention 
to  the  frequent  occurrence  of  giant  cells  in  the  tubercle.  Schueppel  laid  especial 
stress  on  the  importance  of  the  frequently  observed  epithelioid  cells.  According 
to  the  latter  a  true  tubercle  consisted  of  one  or  several  giant  cells  surrounded  by 
one  or  more  rows  of  large  epithelioid  cells  which  latter  were  again  bound  by  a 
5one  of  small  round  cells.  As  a  matter  of  fact,  however,  giant  and  epithelioid 
cells  may  be  absent  from  true  tubercles,  and  giant  cells  occur  also  in  other  patho- 
logical formations.  Ziegler  showed  that  the  tubercle  was  the  result  of  an  inflam- 
matory process,  originating  like  ordinary  inflammatory  granulation  tissue,  that  is, 
principally  from  migrated  white  blood  corpuscles  and  that  other  tissue  elements  such 
as  the  endothelial  cells  of  the  lymph  vessels  played  only  a  subordinate  role  in  the 
construction  of  the  tubercle.  According  to  him  the  true  tubercle  was  characterized 
by  its  non-vaseularity  and  by  its  tendency  to  undergo  cheesy  degeneration.  Baum- 
garten  maintains  that  the  tubercle  liacillus  gives  rise  to  a  proliferation  of  the  fixed 
connective  tissue  cells  exclusively  (epithelial  as  well  as  connective  tissue  proper) 
which  produce  the  so  called  epithelioid  and  giant  cells  and  that  the  peripheral  zone 
of  round  cells  consists  of  white  blood  corpuscles  whicji  emigrated  subsequently. 
Finally,  according  to  Metschnikoff,  the  epithelioid  and  giant  cells  are  phagocytes 
of  mesodermal  origin  which  are  attracted  by  the  positive  chemotactic  action  of 
the  tubercle  bacilli  which  they  take  up  into  their  sulistance. 

Nodules  resembling  tubercles  will  also  develop  around  dead  bacteria  and 
around  inorganic  foreign  bodies.  These  nodules  however  do  not  undergo  cheesy 
degeneration,  have  no  progressive  tendencies  and  cannot  be  transmitted  by  inocu- 
lation ! 

In  recent  times  it  has  l)(>en  pointed  ont  l\v  varions  investigators, 
especially  Weichsellianni  and  his  pnpils,  that  tnhercle  bacilli  may  exist 
for  a  long  time  in  a  dormant  state  in  the  lymph  glands  without  causing 
the  development  even  of  microscopical  tubercles.  Before  the  discovery 
of  the  tubercle  bacillus  Orth  demonstrated  by  inoculation  experiments 
that  lymph  glands  of  normal  appearance  may  contain  microscopic  tu- 
bercles (1876)  !  The  effects  of  the  tubercle  bacilli  can  manifest  them- 
selves onl.v  in  lymphoid  hyperplastic  processes  ("lymphoid  stage  of 
tuberculosis" — Bartel  &  Spieler).  This  stage  may  have  a  variable  dura- 
tion, may  even  retrogress  and  possibly  exert  an  immunizing  effect.  The 
process  may,  however,  with  or  without  subsequent  infection  lead  to  the 
development  of  specific  tuberculous  changes  at  that  point  or  in  remote 
parts  of  the  body.  Microscopically,  glands  in  the  lymphoid  stage  of  in- 
fection appear  either  entirely  normal  or  show  only  a  homogeneous 
swelling.  Tubercle  bacilli  can  be  demonstrated  by  inoculation  only. 
Joest  doubts  the  occurrence  of  such  a  lymphoid  stage  at  least  in  animals 
M'ith  generalized  tuberculosis,  especially  in  cattle  and  swine.  lie  exam- 
ined 27  such  glands  in  cattle  and  4  in  pigs  and  found  specific  histolog- 
ical tuberculous  changes  in  all  of  them  (epithelioid  tubercles  with  giant 
cells).  Jonske  found  the  same  condition  in  five  glands  that  produced 
inoculation  tuberculosis.  Smit  failed  to  find  histological  tuberculous 
changes  in  seven  swollen  and  hyperemic  glands,  and  Rievel  and  Linnen- 
brink  could  not  discover  microscopical  tuberculous  lesions  in  three  out 
of  twelve  such  glands  that  had  a  normal  appearance. 

That  lymph  glands  may  be  virulent  without  exhibiting  microscopic 
tubercles  has  been  proven  by  investigations  of  Frothingham,  Calmette, 
Guerin  &  Delearde.  These  experiments  were  made  in  calves,  but  the 
inoculations  with  human  tubercle  bacilli  proved  that  they  may  remain 
latent  in  the  bodv  for  months  and,  according  to  Lignieres,  even  for  a 
year.    Virulent  bacilli  may  be  found  in  partially  calcified  lesions  (Raum- 


Distiihntinii    of  Bacilli.  533 

garten,  Liibarseli),  and  according  to  Rabiuowitsch  and  Schniitz  they 
are  also  met  with  in  completely  calcilied  lymph  glands,  althonirh  in  these 
latter  they  have  become  more  or  less  attenuated. 

"When  inhaled  into  tho  liiicst  raiidlications  of  the  broncliial 
tnbos  and  the  alveoli  of  tiie  lun.n's,  the  bacilli  prodnce  a  catarrhal 
inllanunation  resnlting-  in  a  lilling  np  of  the  alveoli  with  librin, 
lencocytes  and  large  epithelioid  cells.  This  cellular  exudate 
soon  undergoes  cheesy  degeneration,  the  intraalveolar  septa 
l)reak  down  and  thus  larger  cheesy  foci  are  formed,  which  are 
at  first  surrounded  by  inflamed  catarrhal  alveolar  tissue  and 
later  on  by  connective  tissue  walls.  Fresh  tubercles  are  usually 
developed  in  tiie  immediate  neighborhood  as  a  result  of  the 
migraiion  of  bacilli  through  the  lymjiliatic  spaces.  Bacilli 
carried  to  the  lungs  wdth  the  blood  produce  typical  tubercles 
in  the  interalveolar  connective  tissue  or  in  the  bronchial  walls 
where  they  produce  fibrinous  proliferation. 

After  the  death  of  the  tnl)ercle  bacilli  the  tuberculous 
process  may  come  to  a  standstill  in  any  stage  of  its  develop- 
ment. Following-  this  phenomenon  a  reactive  inflammation  re- 
sults in  the  production  of  a  fibrinous  envelope  around  the  entire 
focus  (fibrous  tubercle).  In  slightly  advanced  local  affection 
this  process  may  terminate  in  complete  recovery  from  the 
disease. 

Distribution  of  tubercle  bacilli  in  the  body.  According  to 
the  foregoing  explanations  in  regard  to  the  modes  of  infection 
.the  bacilli  pass  along  the  lymph  channels  to  the  regional  glands, 
then,  to  a  certain  extent  at  least,  to  remoter  glands  and  finally 
into  the  blood  stream.  If  they  are  not  destroyed  by  the  lymph 
elements,  or  otherwise,  they  produce  specific  tubercles  at  points 
where  they  happen  to  lodge.  From  the  tubercle  thus  formed 
t]i«?y  pass  through  the  hmph  spaces  ("the  histological  higlnvays 
of  the  body"  Cohnheim),  into  the  neighboring  intact  tissue 
where  they  cause  the  development  of  new  tubercles.  Every 
new  tubercle  then  becomes  the  source  of  other  tubercles.  As 
these  undergo  cheesy  degeneration  the  infected  focus  becomes 
larger  and  larger,  cavities  are  formed  in  the  lungs  and  ulcers 
on  the  mucous  membranes.  In  the  periphery  of  these  new 
tubercles  make  their  appearance. 

In  their  further  course  the  bacilli  follow  the  lymph  spaces 
into  the  regional  ]ymi)h  glands  and  neighboring  organs  where 
they  produce  similar  changes.  From  the  affected  organs  they 
pass  over  to  their  serous  membranes,  become  disseminated 
through  the  lymph  plexuses,  thus  not  infrequently  giving  rise 
to  a  diffuse  tuberculosis  of  these  membi'anes.  The  bacilli  may 
also  penetrate  the  lymph  spaces  of  the  diaphragm  and  the 
morbid  process  spread  from  the  peritoneum  to  the  pleura  and 
pericardium.  The  development  of  tubercles  on  the  serous  mem- 
branes is  ]iot  infrequently  attended  with  a  sero-fibrinous  in- 
flannnation. 


534  Tuberculosis. 

From  the  tuberculous  foci  in  the  lungs  the  virus  passes 
from  the  bronchioles  to  the  larger  bronchial  tubes  and  the 
neighboring  healthy  alveoli.  Thus  the  diseased  area  becomes 
larger  and  larger.  Secretions  containing  bacilli  are  coughed 
up  and  lodge  on  the  mucous  membrane  of  the  trachea  and 
larynx,  especially  on  the  ventral  surface  immediately  posterior 
to  the  attachment  of  the  vocal  chords.  Thus  the  tuberculous 
process  gains  a  foothold  here.  These  secretions  may  also  reach 
the  mouth  whence  they  reach  the  small  intestine  with  the  food, 
causing  the  development  of  tuberculosis  of  the  mucous  mem- 
brane, especially  of  the  ileum.  Tubercles  and  ulcers  that  are 
occasionally  found  here  are  usually  produced  in  this  manner. 
In  a  similar  manner  a  metastatic  process  in  the  renal  paren- 
chyma may  spread  to  the  pelvis  of  the  kidney  and  follow  the 
course  of  the  ureters  downward.  On  the  other  hand  primary 
infection  of  the  uterus,  the  vagina,  the  epidid^miis  and  the 
bladder  may  spread  into  the  pelvis  of  the  kidney  and  from 
there  attack  the  parenchyma. 

If  the  bacilli  enter  the  vessels  they  are  transported  by 
the  blood  stream  and,  if  not  destroyed,  produce  embolisms  in 
various  organs  from  which  tubercles  are  developed.  This  is 
comparatively  frequent  in  the  kidney  and  spleen.  If  the  number 
of  bacilli  entering  the  blood  stream  is  excessive,  numerous 
tubercles  may  develop  in  several  organs  and  give  rise  to  an 
acute  miliary  tuberculosis  (tuberculosis  miliaris  acuta).  This 
happens  most  frequently  when  tu])ercles  which  develop  in  the 
walls  of  arteries  or  veins  of  an  infected  organ,  degenerate  or 
develop  into  ulcers  from  which  the  bacilli  pass  into  the  blood 
stream.  This  danger  is  particularly  great  if  the  vessel  com- 
municates by  a  direct  opening  with  a  nearby  or  adjacent  cheesy 
focus.  Exposed  tubercles  in  the  walls  of  tlie  tlioracic  duct  may 
also  be  the  cause  of  infection  of  the  blood  stream.  (Joest  re- 
ported two  cases  of  open  tuberculosis  of  the  thoracic  duct  in 
cows.) 

If  bacilli  are  discharged  into  the  lumen  of  a  peripheral 
vein  or  into  a  branch  of  the  pulmonary  artery  most  of  the 
bacilli  wall  lodge  in  the  lungs  and  produce  tui3ercles  almost 
exclusively  in  these  organs.  On  the  other  hand  if  tuberculous 
ulcers  exist  in  one  of  the  pulmonary  veins  the  bacilli  which  tliey 
discharge  may  enter  any  organ  of  the  body  that  are  reached 
by  blood  from  the  left  ventricle  and  there  produce  a  miliary 
tuberculosis,  most  commonly  in  the  spleen,  liver  and  kidneys. 

According  to  Eoemers'  experiments,  which  were  confirmed  by  Hamburger, 
Courmont  &  Lesieur  and  by  Leber,  tlie  body  of  a  tuberculous  animal  offers  more 
or  less  resistance  to  subsequent  external  infections.  8uch  additional  external 
infections  are  either  successfully  resisted  or  they  have  only  a  local  effect;  they  may 
even  have  a  curative  effect,  as  had  already  been  shown  by  Koch.  On  the  other 
hand,  after  infection  with  large  masse?,  of  virulent  bacilli  luiig  cavities  may  develop 
instead  of  miliary  tuberculosis.  Calmette  &  Guerin  demonstrated  such  an  "increased 
resistance  in  tuberculous  cattle.  In  these  animals  the  injection  of  highly  virulent 
bovine  bacilli  produced  chronic  processes  only.  This  increased  power  of  resistance 
is  said   to  manifest  itself  also  toward   bacilli  from   the  body  of  the   animal   itself 


Toxins.     ]Mi.\i'(l   Tnfoctioii.  535 

and  not  alono  toward  bacilli  of  a  new  strain,  henco  in  metastatic  autoinfection. 
The  fact  that  metastatic  tuberculous  infection  occasionally  occurs  in  human  bein^js 
and  animals  witii  chronic  tuberculosis  (Joest)  does  not  necessarily  contradict  this 
statement.  Eepeated  or  massive  liematofjenic  infection  from  chronic  foci  may 
establish  a  new  locus  of  infection  even  in  relatively  immune  tissues. 

Toxins.  Tnl)(*rele  l)a('illi  owo  tlieir  activity  to  oii(lo,2:enic 
toxins  as  well  as  to  toxie  ])ro(liiets  of  inetal)olisin.  Xecrol)iosis 
and  caseation  in  tlie  tubercle  is  the  result  of  the  endogenic 
toxins.  Snl)cntaneons  injection  of  dead  bacilli  results  in  a 
local  sterile  abscess,  necrosis,  caseation  and  cachexia.  Alkaline, 
ether-  and  l)enzine-extracts  of  the  bacilli  will  produce  a  similar 
result  (Koch,  Weyl,  Auclair  &  Barbier,  Siegenbeck  van 
Heukelom).  On  the  other  hand  the  fever  which  occurs  in  the 
course  of  the  disease  is  caused  by  the  products  of  melabolism 
which  later  also  are  to  be  found  in  the  filtrates  of  cultures 
which,  in  a  concentrated  form,  are  known  as  tuberculin  (Koch, 
Behriug). 

Accordincf  to  ]\Iarmorek  the  toxin  that  circulates  in  the  Idood  of  an  infected 
animal  and  with  which  the  bacilli  themselves  are  also  impregnated  is  not  the  same 
as  that  in  tuberculin.  This  toxin  is  formed  outside  of  the  animal  body  in  fresh 
cultures  growing  in  leucotoxic  serum,  e.  g.,  liver  bouillon.  When  subcutaneously 
injected  into  horses  it  proiluces  inflammatory  eilema.  Doses  of  5.0  cc.  will  kill 
guinea  pigs.  According  to  Calmette  &  Bretton  boiled  cultures  act  similarly  to 
tuberculin.  According  to  Vallee,  Martin  &  Vaudremer  bacilli  which  have  had  their 
fat  contents  removed  act  similarly  to  hyperactive  tuberculin.  Cantacuzino  observed 
that  the  intravenous  injection  of  large  doses  into  guinea  pigs  rapidly  pro<luced 
death  following  h.vjjothermia,  degeneration  of  the  kidneys  and  the  heart  and  increase 
of  eosinophiles  in  the  blood.  Small  doses  produce  chronic  disease.  Maragliano 
recognizes  two  toxins  of  the  tubercle  bacillus,  an  exogenous  thermolabile  toxalbumin 
(destroyed  by  boiling),  producing  diaphoresis  and  hypertrophy  and  an  endogenous 
.thermostable'  toxoproteid  (heat  resisting)  said  to  have  a  hyperthermic  action. 
Koeppen  on  the  other  hand  could  not  discover  any  difference  between  these  two 
groups.  De  Waele  inserted  collodion  capsules  filled  with  cultures  of  tubercle  bacilli 
under  the  skin  of  experiment  animals.  A  few  weeks  later  they  reacted  to  tuberculin. 
Moussu  inserted  clay  tulies  filled  with  cultures  of  bacilli  under  the  skin  of  cattle 
anil  produced  the  same  result. 

Mixed  Infection.  Tuberculous  organs  constitute  a  favor- 
able soil  for  the  growth  of  saproph^^tes  as  well  as  for  other 
pathogenic  bacteria.  These  are  carried  to  open  lesions  by  the 
air  or  the  blood  stream  transports  them  to  closed  cheesy  foci. 
They  may  multiply  in  these  places  and  are  then  liable  to  modify 
the  anatomical  character  of  the  lesions  as  well  as  the  clinical 
course  of  the  disease.  It  is  also  possible  that  pathogenic 
organisms  produce  certain  primary  lesions  and  thus  prepare 
the  soil  for  an  easier  infection  by  the  tubercle  bacilli.  The 
pyogenic  bacteria  are  particularly  important  in  this  respect, 
a  purulent  and  soft  character  of  tuberculous  foci  being  fre- 
quently, though  not  always,  an  indication  of  such  a  mixed 
infection.  Such  a  metamorphosis  of  a  dry  cheesy  focus  into 
a  soft  purulent  mass  favors  the  dissemination  of  the  tubercle 
bacilli  in  the  organism,  if  only  because  they  are  usually  present 
in  them  in  large  numbers  (Bongert)  and  furthermore  the  fre- 
quent development  of  tuberculosis  following  catarrhal  affections 
and  acute  pneumonia  points  to  the  favorable  influence  of  other 


536  Tuberculosis. 

pathogenic  organism  in  prej^ariug  a  soil  for  the  tubercle  bacillus. 
The  pronounced  intermittent  fever  observed  in  advanced  cases 
of  tuberculosis  is  usually  an  indication  of  an  infection  with 
pyogenic  bacteria  causing  suppuration  in  tuberculous  organs. 

According  to  Oestern  the  liacterial  ilora  in  soft  tuberculous  foci  is  a  very 
limited  one.  Besides  tubercle  bacilli  there  are  chiefly  staphylococci,  especially 
staphylococcus  albus;  sarcina  and  bacteria  resembling  colon  bacilli  are  rarely  found; 
streptococci  are  absent.  If  oidy  tubercle  bacilli  are  present  the  mass  is  yellow 
and  of  a  slimy  watery  consistency.  Otherwise  these  soft  foci  are  caseo-purulent  or 
muco-caseous.  Bongert  has  shown  however  that  in  cattle  the  purulent  softening 
of  the  tuberculous  tissue  is  caused  almost  exclusively  by  tubercle  bacilli,  especially 
when  these  bacilli  are  destroyed  in  considerable  numbers. 

Anatomical  Changes.  The  tubercle  which  is  the  charac- 
teristic product  of  tuberculosis,  is  at  first  a  gray  and  transparent 
nodule,  just  visible  to  the  unaided  eye,  but  soon  becomes  yel- 
lowish as  a  result  of  cheesy  degeneration  which  commences 
in  the  center.  Nodules  of  the  size  of  millet  seeds  or  larger 
are  the  result  of  fusion  of  a  number  of  primary  nodules.  The 
continuation  of  this  process  of  fusion  or  conglomeration  leads 
to  the  formation  of  still  larger,  dry,  yellow  cheesy  masses  or 
foci.  The  tuberculous  nature  of  these  is  indicated  by  the  pres- 
ence of  characteristic  tu])ercles  in  the  tissue  immediately  sur- 
rounding them.  Tubercle  formation  and  caseation  are,  in 
general,  the  characteristic  pathologic-anatomical  changes  in 
tuberculosis  (but  considerable  variations  may  l)e  present  in 
different  species  as  well  as  in  different  organs). 

In  cattle  the  thoracic  organs,  especially  the  lungs  and  the 
broncho-media stinal  lymph  glands  are  the  chief  seat  of  disease. 
In  the  tissue  of  the  lungs  there  are  foci  of  all  sizes,  which  may 
be  firm  and  sharply  circumscribed;  the  surface  on  section  ap- 
pears reddish-gray  or  yellow,  their  substance  consists  of  a  dry, 
crumbling,  cheesy  or  mortar-like  mass  surrounded  by  tough 
connective  tissue;  on  the  other  hand  they  may  consist  of  soft 
yellowish-white  masses  of  pus  surrounded  by  a  thin  connective 
tissue  capsule.  The  presence  of  such  foci  is  iramediatelj'' 
recognized  by  the  nodular  appearance  of  the  surface  of  the 
lung  or  by  palpation  of  the  deeper  seated  nodules.  Their  size 
varies  considerably.  In  advanced  cases  there  are  all  transition 
stages  from  the  small  gray  nodules  just  visible  to  the  unaided 
eye  up  to  tumors  larger  than  a  man's  fist.  In  the  tissue  sur- 
rounding the  large  tumors  there  are  almost  always  new-formed 
tubercles  resulting  from  the  migration  of  bacilli  through  the 
lymph  spaces.  Foci  of  embolic  origin  are  usually  found  in  the 
interstitial  tissue  of  an  otherwise  healthy  portion  of  the  lung. 
The  pulmonary  tissue  between  the  various  tuberculous  tumors 
may  be  apparently  normal,  through  the  filling  up  of  the  alveoli 
with  exudate  they  have  a  homogeneous  reddish-gray  or  yel- 
lowish appearance.  As  a  result  of  proliferation  of  the  inter- 
stitial connective  tissue  certain  areas  become  thickened  and 
tough  and  partly  or  wholly  devoid  of  air.  According  to  the 
severity  of  the  disease  only  a  portion  of  the  organ  may  be 
affected  (in  cattle  usually  the  posterior  lolies  in  swine  the  an- 


Aiiatoiiiicnl    Cliaiijies,  537 

terior  lobes)  or  tubercles  of  all  sizes  may  be  scattered  through 
the  entire  substance  of  the  lung-. 

The  confiuence  of  cheesy  or  caseo-purulent  foci  of  all  sizes 
leads  to  the  formation  of  cavities  which  are  surrounded  l)y 
dense  connective  tissue  lined  on  the  inside  with  sup})urating 
granulation  tissue  which  was  formerly  called  the  pyogenic 
membrane.  The  interior  of  these  cavities  contains  strands 
of  connective  tissue  which  are  ol)literated  blood  vessels.  Some 
of  these  cavities  connnunicate  with  bronchial  tubes  through 
which  they  discharge  their  contents  to  the  outer  Avorld.  As 
a  result  of  exposure  to  the  air  the  muco-caseous  material  which 
is  retained  in  these  open  cavities  decoinposes  into  discolored 
ill-smelling  masses  (phthisis  tuberculosa). 

In  young  animals  pulmonary  tuberculosis  frequently  occurs 
exclusively  in  the  form  of  catarrhal  pneumonia.  The  diseased 
parts  of  the  organ  appear  unifonnly  firm,  solid  and  devoid  of 
air.  The  cut  surface  is  reddish-gray,  grayish-white  or  yellowish- 
gray  and  presents  to  view  a  slight  quantity  of  cheesy  matter 
that  can  be  scraped  off  with  a  knife.  Here  too  the  cheesy 
degeneration  of  the  exudate  and  the  breaking  down  of  the  lung- 
tissue  results  in  the  formation  of  dry  or  soft  cheesy  foci  of 
various  sizes.  Tuberculosis  of  the  superficial  layers  of  the 
pulmonary  tissue  is  frequently  attended  with  a  productive  in- 
flammation of  the  pleura.  This  may  lead  to  pleural  adhesions 
or  to  the  development  of  excresences  which  will  be  described 
below.    In  rare  cases  a  sero-fibrinous  pleuritis  develops. 

Besides  the  affection  of  the  lung  tissue  proper  there  is 
a  catarrhal  condition  in  the  bronchial  tubes  of  the  diseased 
areas.  In  severe  cases  all  of  the  bronchial  tubes  may  be  filled 
with  muco-purulent  secretions.  The  mucous  membranes  are 
swollen  and  injected  and  frequently  contain  tubercles  and 
ulcers;  they  may  become  detached  from  the  bronchial  walls  and 
obliterate  the  lumen  or  cause  bronchiectases.  T'lceration  of 
the  bronchial  mucous  membrane  is  not  infrequent.  Tlie  tuber- 
culous nature  of  the  ulcers  is  indicated  by  their  irregular  form, 
raised  borders  and  yellowish-red  base,  and  by  the  fact  that 
on  and  around  the  ulcers  there  are  small  tubercles  to  be  seen. 
Sometimes  dense  masses  of  tuberculous  growths  are  found  in 
the  larynx,  especially  in  the  ventral  angle  of  the  glottis.  They 
may  completely  cover  the  vocal  chords  or  be  fused  into  one 
large  tumor.  In  exceptional  cases  the  nasal  mucous  membrane 
may  be  covered  with  yellowish-red  granulations  containing 
numerous  caseous  foci  (Joest). 

Tuberculosis  of  the  serous  membranes  is  characterized  in 
the  beginning  by  grayish-red,  succulent,  soft,  yet  tough  ex- 
cresences in  some  of  which  yellowish  nodules  may  be  found. 
In  the  later  stages  there  are  firm  dense  globular  formations 
(pearl  nodes)  with  cheesy  or  mortar-like  foci  in  their  interior. 
The  smaller  excresences  may  be  attached  by  means  of  a  broad 
base,  or  may  be  pedunculated.     They  frequently  become  ad- 


538 


Tubereulosi.'^ 


herent,  producing  grape  or  cauliflower-like  masses  (Fig.  81). 
These  growths  may  be  present  in  enormous  numbers  on  the 
serous  membranes,  and  the  membrane  itself  maj^  be  thickened 
to  the  extent  of  several  centimeters.  This  is  especially  common 
in  the  folds  of  the  pericardium  which  are  frequently  found  in 
a  state  of  adhesion,  surrounding  the  heart  in  the  form  of  a 
dense   fibrous   capsule    several   centimeters    in   thickness    and 


Fig.  81.     Tuherculosis.    Pearl  Disease  of  the  Pleura. 

riddled  with  cheesy  or  mortar-like  foci  (so  called  armoured 
heart — Panzerherz).  This  capsule  is  either  sharply  separated 
from  the  heart,  or  white  connective  tissue  septa  may  pass  from 
it  into  the  substance  of  its  muscular  structure.  The  heart  sub- 
stance itself  may  contain  cheesy  foci  which  may  also  be  present 
where  the  epicardium  is  intact  (embolism).  Tuberculosis  of 
the  endocardium  or  the  valves  is  very  rare  (Bergeon  found 
miliarv  tubercles  on  the  valves  and  on  the  intima  of  the  aorta). 


Anatomical  Clianges. 


539 


It  is  usually  possible  to  (loiiioiistiati'  tuboiclcs  with  giant  cells  in  fresh 
villosities.  Souio  "of  thoM-,  howover,  do  not  show  a  tuberculous  structure  nor  does 
their  inoculation  into  ^niinea  j^iys  pro.luce  tuberculosis.  {ileyuians  fouml  tubercle 
bacilli,  virulent  upon   inoculation,  in  only  58  out  of  70  excrcsences  examined.) 

The  Ivmpliatic  glands  in  the  region  of  tlie  diseased  organs 
are  always  involved.  On  the  other  hand  they  are  not  infre- 
quently, especially  in  young  animals,  the  sole  seat  of  the  disease. 
At  lirst'thev  are  only  homogeneonsly  swollen  and  enlarged  and 


Fig.  82,  Tuhrrculofti.t  of  Thonicic  Organs  of  Cattle,  a  and  b  enlar<j;ed  tuberculous 
bronchial  and  mediastinal  glands;  c  and  d  pearly  tumors  on  the  i)ericardiuni  and 
pleura;  e  trachea;  f  esophagus.     Cheesy  nodules  in  the  lung  substance. 

more  or  less  hemorrhagic ;  later  on  a  section  will  show  spotted 
turbidities  in  a  grayish-red  background.  The  turbidities  con- 
lain  tubercles  or  diffuse  caseous  masses.  At  a  later  stage  the 
glands  develop  into  large  firm  tumors  consisting  of  grayish- 
white  fibrous  tissue  in  wliich  are  imbedded  large  foci  of  a  dry 


540  Tuberculosis. 

cheesy  or  mortar-like  consistency.  By  confluence  with  other 
similar  tumors  they  may  become  metamorphosed  into  fibrous 
sacks  filled  with  a  caseous,  caseo-purulent  or  mortar-like  mass. 

Another  picture  of  tuberculosis  of  the  glands  is  presented 
by  radiating  caseation.  Here  a  section  of  the  hard  dense  gland 
has  the  appearance  of  a  section  of  a  radish,  with  strands  radiat- 
ing in  all  directions  from  the  center.  Cheesy  sections  alternate 
with  viscid  tissue  strands  (Bongert).  In  pulmonary  tuber- 
culosis the  mediastinal  and  the  peribronchial  glands  in  partic- 
ular may  attain  to  enormous  size  (Fig.  82).  In  alimentary  in- 
fection the  retropharyngeal,  the  mesenteric  and  the  portal 
glands  become  similarly  enlarged. 

Stroh  found  the  small  lymph  glands  of  the  muscles  affected  in  1.4%  of  eases 
in  oxen,  3%  in  bulls,  and  22.9%  in  calves.  In  cattle  the  popliteal  glands  were  most 
frequently  affected  (27.1%).  The  prescapular  glands  were  affected  in  26.7%  of 
cases,  the  precrural  glands  and  the  ischial  glands  in  17.2%  and  the  axillary  glands  in 
only  5.5%  of  all  cases.  In  calves  the  percentages  were  as  follows:  Prescapular 
glands  40.8%,  popliteal  glands  23.8%,,  precrural  glands  22.3%,  axillary  glands 
6.9%,  ischial  glands  Q.1%.  The  mammary  glands  were  affected  in  1.7%  of  all 
tuberculous  cows. 

In  the  course  of  the  digestive  tract  cheesy  nodules  and 
ulcers  may  occur  in  the  parenchyma  of  the  affected  tongue, 
sometimes  just  anterior  to  the  eminence  of  the  dorsum  (in  the 
tonsils  of  calves)  and  in  exceptional  cases  in  the  oesophagus 
(May,  Nicolas).  On  the  mucous  membrane  of  the  small  intes- 
tine, especially  the  ileum,  and  in  the  cecum  isolated  tubercles 
as  well  as  ulcers  of  variable  size  may  be  found.  For  them, 
also,  the  infiltrated  prominent  borders  of  the  ulcers  surrounded 
with  tuberculous  nodules  and  the  firm  base  covered  with  dry, 
cheesy  material,  are  characteristic.  They  may  extend  to  the 
submucosa  or  to  the  muscularis;  are  often  elongated  in 
form  and  lie  at  right  angles  to  the  long  axis  of  the  intestine 
(belted  ulcers).  In  rare  cases  similar  ulcers  are  observed 
in  the  mucous  membrane  of  the  fourth  stomach  (Walley,  Kitt, 
F.  Arloing,  Zietschmann.  Plate  observed  one  case  of  fatal 
hemorrhage  from  such  an  ulcer).  Johne  observed  ulceration 
of  the  mucous  membrane  of  the  abomasum.  In  exceptional  cases 
the  tuberculous  process  assumes  the  form  of  polJTOi^s 
growths  on  mucous  membranes  (Johne),  or  of  a  swelling  with 
ulcerating  surface  (such  was  found  in  the  abomasum  by  Joest). 

Chaussee  describes  three  forms  of  intestinal  tuberculosis.  (1)  Ulcerating 
tuberculosis  of  the  mucosa  and  submucosa,  causing  necrosis  and  sloughing.  (2) 
Hypertrophic  tuberculosis  in  which  tubercles  appear  exclusively  in  the  submucosa, 
the  mucosa  itself  becoming  hypertrophied,  projecting  in  the  form  of  a  shallow 
plateau  above  tlie  surrounding  healthy  mucosa.  (3)  The  herpetic  form  of  tuber- 
culosis which  occurs  exclusively  in  the  mucosa  on  the  suiface  of  which  small  shallow 
erosions  are  found. 

In  1905,  0.45%  of  all  cattle  slaughtered  in  the  German  Empire  were  affected 
with  intestinal  tuberculosis. 

The  substance  of  the  liver  may  be  dotted  with  small  tuber- 
cles and  cheesy  foci  or  it  may  contain  abscesses  as  large  as 


Anatomical   Changes.  54.1 

a  man's  fist  with  contents  of  a  niortar-like  consistency  or  a  soft 
muco-caseons  mass.  Tliese  abscesses  are  surronnded  by  dense 
connective  tissue  capsules  and  frequently  give  rise  to  enormous 
enlariiement  of  the  organ.  In  a  case  reported  by  Streitbcrg 
the  liver  weighed  6-i  pounds. 

The  spleen,  especially  of  young  animals,  frequently  con- 
tains numerous  small  tubercles.  Sometimes  only  a  few  large 
cheesy  foci  are  present. 

The  kidneys,  on  the  other  hand,  are  more  frequently  af- 
fected in  ohler  animals.  The  small  firm  tubercles  may  be  dis- 
tinctly seen  in  the  brownish-red  renal  tissue.  The  large  cheesy 
foci  are  usually  embedded  in  tough  connective  tissue  forming 
projections  on  the  surface.  By  becoming  confluent  such  foci 
may  involve  an  entire  lobule  and  upon  rupturing  discharge 
their  cheesy  contents  into  the  pelvis  of  the  kidney  (nephro- 
phthisis). The  niucous  membrane  surrounding  the  point  of  rup- 
ture may  contain  small  tubercles  or  it  may  have  been  converted 
into  a  loosely  adhering  cheesy  mass.  Tuberculous  foci  of  the 
kidneys  may  now  and  then  have  the  appearance  of  hmipho- 
sarcomata.  As  a  rule  the  ureters  are  indurated  and  their 
mucous  membranes  converted  into  a  cheesy  mass  similar  to 
the  condition  found  when  the  process  spread's  upward  from  the 
neck  of  the  liladder.  Tuberculous  processes  in  the  mucous  mem- 
brane of  the  urethra  and  likewise  in  the  vagina  are  rare. 

Of  the  male  sexual  organs  the  epididymis  and  secondarily 
the  testicles  which  then  consist  of  tumors'  with  cheesv  interior 
are  most  frequently  affected;  in  females  the  uterus  and  the 
Fallopmn  tubes  with  or  without  involvement  of  the  peritoneum. 
In  slightly  advanced  cases  small  nodular  indurations  mav  be 
recognized  by  palpating  the  horns  of  the  uterus.  In  advanced 
cases  these  changes  become  more  prononnced,  and  firm  solid 
masses  enclosing  large  quantities  of  yellowish  creamy  or  smearv 
and  sometimes  ichorous  fluid  are  imbedded  in  the  uterine  walls. 
The  mucous  membrane  contains  at  first  small  firm  gravish- 
white  nodules  which  develop  into  tumor-like  structures.  Some- 
times the  mucosa  becomes  extensively  ulcerated.  These  lesions 
may  perforate  the  serous  coat  of  the  uterus  and  their  ragged 
edges  project  into  the  peritoneal  cavity.  As  a  rule  the  Fallopian 
tubes,  especially  the  abdominal  third  (Fischer),  are  involved 
and  appear  as  thick  solid  strands.  The  ovaries  are  usuallv 
affected  only  in  generalized  tuberculosis  of  the  genital  organs ; 
in  nearly  all  of  these  cases  both  ovaries  suffer,  the  morbid 
changes  being  limited  to  hyperplasia  and  the  formation  of 
villosities  on  the  surface  (^Mayfarth),  or  to  the  formation  of 
large  tumors  covered  with  villosities  and  enclosing  cheesy  foci. 
(Gergely  observed  one  case  of  extensive  tuberculosis  confined 
to  the  testicles  following  an  injury  which  resulted  in  retraction 
of  these  organs  into  the  pelvic  cavity.) 

Abattoir  statistics  of  the  German  Empire  show  that  0.47%  of  all  slaughtered 
cows  were  affecte<l   with  tuberculosis  of  the  uterus.     According  to  Ostertag   65% 


542 


Tuberculosis. 


of  all  eases  of  generalized  tuberculosis  involve  the  uterus,  while  Lungwitz  found 
this  organ  involved  in  152  out  of  264  eases  of  pearl  disease  of  the  peritoneum. 
In  far  advanced  cases  the  affected  uterus  may  weigh  40  kilograms  (Moeliius). 
According  to  Fischer's  investigations  the  majority  of  eases  spread  from  the  Fallopian 
tubes  to  the  uterus.  This  seems  to  be  true  even  when  the  lesions  of  the  uterus  appear 
more  advanced. 

Tuberculosis  of  the  udder  is  usually  characterized  by  the 
presence  of  large  firm  tumors  with  cheesy  contents  and  numer- 
ous small  tubercles  scattered  through  the  intervening  tough 
connective  tissue  (Fig.  83).  As  a  rule  either  one  or  both  pos- 
terior quarters  and  the  adjacent  regions  of  the  anterior  quarters 
are  affected.  The  diseased  part  which  is  usually  enlarged,  but 
sometimes  atrophied,  is  separated  from  the  normal  portion  by 
a  well  marked  sinuous  line  of  deniarkation.     The  walls  of  the 


W'/r- 


'II: 


Fig.  83.     Tuberculosis  of  the  Udder.     Tubercular  foci  in  the  glandular  tissue  of 
the  hind  quarter.     Superniamniary  gland  much  enlarged  with  cheesy  foci.     Mossu. 

milk  ducts  may  contain  tubercles  or  they  may  be  enormously 
distended  and  enclose  masses  of  cheesy  detritus  and  flaky  or 
curdled  milk.  Some  of  the  veins  of  the  udder  may  be  found 
obliterated  with  blood  clots  in  which  colonies  of  tubercle  bacilli 
may  here  and  there  be  demonstrated  (Bang).  In  recent  embolic 
infection  the  lobules  of  the  affected  quarters  are  swollen  and 
their  gray  substance  sprinkled  with  yellow  points  or  streaks 
while  the  intervening  connective  tissue  is  riddled  with  minute 
tubercles  and  cheesy  foci  ranging  in  size  from  that  of  a  lentil 
to  a  pea  (Bang,  Moser).  In  advanced  cases  the  affected  quarter 
may  have  been  transformed  into  a  firm  tumor  containing  cheesy 
masses  enclosed  by  tough  fibrous  connective  tissue.  The  super- 
mammary  glands  are  always  involved  when  the  udder  is  af- 


Anatomical   Changes.  54t3 

fected,  l)iit  they  may  also  be  diseased  \vli('ii  tubercles  cannot  l)e 
denioiistralcMl  in  tin'  tissue  of  tlic  uddci',  at  least  with  the  naked 
eye. 

Of  the  central  lu-rvous  system  the  brain  is  most  frequently 
affected.  There  may  be  several  large  tumors  (tyroma,  tuber- 
culum  solitarium)  or  a  number  of  snuiller  cheesy  foci.  These 
always  involve  the  menini^es  and  produce  a  tuberculous  inHam- 
mation.  In  such  cases  recent  tubercles  can  be  found  at  the 
base  of  the  brain,  in  particular  in  the  region  of  the  Sylvian 
fissure  (meningitis  l)asilaris  tuberculosa).  As  a  rule  this  is 
accompanied  by  acute  internal  liydroce])hahis  (very  coimnon  in 
calves  after  protective  inoculation — Ilutyra,  Weber,  Titze  and 
others).  Similar  aifection  of  the  spinal  cord  and  its  envelopes 
is  far  more  rarely  met  with,  and  when  present  it  is  usually 
observed  near  tuberculous  vertel)rae. 

Tuberculous  lesions  are  observed  also  as  follows :  In  the 
spongy  substance  of  flat  bones  especially  the  ri])s  and  vertebrae 
but  in  exceptional  cases  also  in  the  bones  of  the  cranium  and 
of  the  pelvis ;  in  long  bones  the  marrow  may  be  affected ;  in 
articular  cartilages  of  the  long  bones;  in  the  joints  (exudative 
inflammation  with  induration  of  the  capsular  ligaments  result- 
ing in  villous  proliferation  and  destruction  of  the  cartilages, 
according  to  Hamoir  most  common  in  the  knee) ;  on  the  nasal 
mucous  membrane  with  occasional  involvement  of  tlie  cartilages, 
muscles  and  septum;  in  the  muscles  of  the  body  (usually  cheesy 
foci  originating  in  the  intermuscular  lymph  glands  and  occa- 
sionally foci  approaching  the  size  of  a  bean  scattered  between 
the  bundles  of  muscle  fibres) ;  in  the  subcutaneous  connective 
tissue  (firm  tumors  arranged  in  rosary-like  order  and  cheesy 
abscesses) ;  very  rarely  in  the  skin,  tendon  sheaths  of  the  ex- 
tremities, penis,  prostate  gland  and  in  the  eye  (tubercles  in 
the  iris  followed  by  caseous  panophthalmia,  or  fibrinous  iritis 
without  tubercles   [Manleitner] ). 

On  post-mortem  examination,  especially  in  meat  inspection,  we  dis- 
tinguish between  primary  and  secondary  tuberculosis  of  the  various 
organs.  The  term  primary  is  applied  to  lesions  resulting  from  direct 
infection  from  outside  and  spreading  into  the  surrounding  tissue  from 
the  point  of  infection,  either  by  direct  growth  or  through  the  lymph 
spaces  and  lymph  vessels,  ])ut  not  by  means  of  the  l)lood  stream.  Second- 
ary lesions  are  those  resulting  ha?matogenically  from  infected  embolisms 
of  the  blood  vessels,  and  are  consequently  found  in  the  interstitial  con- 
nective tissue.  They  do  not  communicate  with  the  outer  world  and 
therefore  rarely  suppurate  (Ostertag).  According  to  the  discussion  on 
page  530  the  possibility  of  the  occurrence  of  primary  lesions  of  lympho- 
genic or  even  ha^matogenic  oriprin  in  internal  organs  is  not  excluded. 

The  term  local  tuberculosis  is  applied  to  lesions  that  have  spread 
or  have  become  disseminated  by  direct  growth  only  or  thron^h  the  lym- 
phatics or  one  of  tlie  lesser  circulations  (pulmonary  or  portal).  If  the 
greater  circulation  Avas  the  means  of  disseminating  the  virus  the  result- 
ing atfection  is  referred  to  as  generalized  tuberculosis  (Weigert,  Oster- 
tag).    In  the  latter  instance,  if  the  infection  was  slight  the  resulting 


544  Tuberculosis. 

disease  assumes  a  chronic  character,  while  if  the  infection  was  extensive, 
acute  miliary  tuberculosis  develops.  Generalized  tuberculosis  is  atyp- 
ical when  the  organs  usually  attacked  escape  an  infection  from  the 
blood  stream  and  localization  of  the  morbid  process  occurs  in  remote 
organs  (Poppe). 

Breuer  's  statistics  on  the  localization  of  tuberculous  processes  for  1900-02 
(Budapest)  give  the  following  information:  Of  28,968  cases  of  tuberculosis  98.6% 
were  local,  1.4%  generalized.  In  91%  of  local  affections  the  lesions  occurred  in 
one  thoracic  organ  only,  in  0.8%  in  one  abdominal  organ,  in  0.2%  in  the  tonsils 
and  the  retropharyngeal  glands,  while  in  seven  instances  several  organs  were 
affected.  Of  100  eases  of  generalized  tuberculosis  the  lungs  were  affected  in  92,  the 
liver  in  76,  the  intestines  and  mesenteric  glands  in  59,  the  kidneys  in  57,  the  serous 
membranes  in  70,  the  spleen  in  40,  the  udder  in  22  and  the  uterus  in  8  instances. 
(Ostertag  observed  tuberculo^^is  of  the  uterus  in  65%  of  all  cases  of  generalized 
tuberculosis.  Henschel  found  uterus  affection  in  6.4%  of  all  cases  of  hfematogenic 
origin.) — In  young  cattle  under  four  years  with  generalized  tuberculosis  the  spleen 
is  nearly  always  affected  while  the  kidneys  are  free  from  lesions.  In  older  cattle 
the  kidneys  are  attacked  as  frequently  as  the  spleen  (Ostertag).  Meat  inspection 
statistics  of  the  German  Empire  for  1905  show  that  0.6%  of  all  tuberculous  cows 
have  tuberculosis  of  the  udder,  according  to  Bang,  2%;  Ostertag,  0.5  to  1.0%; 
MacFadyean,  1  to  2%;  Williams,  3%;  Yallee  and  Villejeau,  5.3  to  6.5%;  Stroh, 
1.7%;  and  according  to  Henschel,  2.6%. 

Acute  tuberculosis  (tuberculosis  niiliaris  acuta)  is  confined 
either  to  single  organs,  particularly  the  lungs,  or  the  entire 
body  may  be  affected.  This  depends  upon  whether  the  virus 
was  distriliuted  through  a  vessel  supplying  a  limited  area  only 
as  would  be  the  case  with  a  peripheral  artery  or  with  the  pul- 
monary artery,  or  whether  it  had  gained  access  to  the  greater 
circulation  or  the  pulmonary  veins.  This  form  of  the  disease 
is  characterized  by  the  presence  of  enormous  numbers  of  recent 
tubercles  of  approximately  the  same  age.  They  are  usually 
distributed  evenly  through  the  tissues.  The  surrounding  areas, 
contrary  to  what  is  observed  in  chronic  tuberculosis,  are  usually 
normal  in  appearance.  There  may  however  be  general  hyper- 
emia or  indications  of  beginning  inflammation.  There  is  always 
acute  swelling  of  the  lymph  glands  and  reddening  of  the  cortical 
substance. 

In  buffaloes  the  tuberculous  foci  (mostly  in  the  thoracic 
organs)  are  grayish-white,  yellowish  or  entirely  white  and  con- 
tain remarkably  juicy  cheesy  masses.  Softening  is  rare  and 
calcification  is  an  exceptional  occurrence;  pearl  disease  of  the 
serous  membranes  is  equally  rare  (Breuer). 

In  sheep  and  goats  the  tuberculous  changes  are  in  general 
the  same  as  in  cattle.  The  serous  membranes  may  contain 
pearly  tumors  and  the  uterus  may  be  the  seat  of  disease  just 
as  in  cows.  Koch  and  Probst  have  observed  the  formation 
of  large  cavities  in  the  lungs  of  these  animals.  Contrary  to 
the  usual  observations  in  other  animals  sheep  do  not  exhibit 
the  progressive  changes  of  necrotization,  caseation  and  calci- 
fication. The  lesions  are  usually  calcified  and  surrounded  with 
thick  fibrous  walls.  Delmer  ascertained  the  presence  of  gener- 
alized tuberculosis  in  a  goat  six  months  of  age  and  IMicucci 
observed  primary  intestinal  tuberculosis  in  the  sheep. 


Anatoiiiicnl   Cliansres. 


545 


111  horses,  especially  in  young  animals,  the  mesenteric  and 
retropharyngeal  lymph  glands  are  most  frequently  affected 
(phthisis  mesaraica).  The  affected  glands  may  be 'white  and 
moist  on  section  and  resemble  lymphosarcomata  or  their  in- 
terior may  consist  of  a  soft  nmco-caseous  mass.  In  exceptional 
cases  there  is  calcification.  They  may  represent  masses  of 
tumors  firmly  enclosing  large  vessels  (e.  g.  the  posterior  vena 
cava  and  portal  vein);  they  may  involve  the  vessel  walls  or 
have  grown  into  their  lumen  producing  thrombi  (Lustig),  or 
leading  to  generalized  tuberculosis.  Cheesy  lymph  glands  may 
communicate  with  the  interior  of  the  large  intestine  (Lothesj. 
In  some  cases  the  intestinal  mucous  membrane  contains  numer- 
ous nodules  of  the  size  of  a  hazelnut,  some  of  them  ulcerated 
on  the  crest,  also  irregular  ulcers  with  smooth  or  ragged 
borders,  ranging  in  size  up  to  that  of  the  palm  of  a  hand;  itlieir 
base  may  extend  to  the  submucosa  and  contain  small  tubercles. 
The  large  intestines  and  the  rectum  alone  may  be  thus  affected 
(Ratz;  Darmagnac  observed  a  case  of  perforation  of  a  rectal 
ulcer  producing  acute  peritonitis).  The  liver  mav  contain 
smiilar  lesions  but  they  are  rare  in  the  spleen.  The  former 
may  reach  three  times  its  normal  size  and  the  latter  has  been 
observed  to  weigh  13  kg.  (Schulz)  or,  according  to  A.  Marcus, 
dimensions  of  74  by  SSi/o  cm.  (According  to  MacFadvean, 
Johne  and  Kitt  tumors  of  this  sort  formerly  descril)ed  as 
hinphadenomata,  which  occasionally  are  almost  tendinous  in 
consistency  are  usually  tuberculous  in  nature.) 

-  The  disease  of  the  lungs  is  usually  miliarv  in  nature.  Less 
frequent  are  tumors  as  large  as  a  nut  or  larger,  which  section 
appear  homogeneous,  like  a  turnip,  or  with  soft  centers  con- 
taining a  dirty  gray  or  yellow  purulent  or  caseo-purulent  mass ; 
m  some  cases  they  are  enclosed  in  a  connective  tissue  capsule. 
The  intervening  connective  tissue  is  either  normal  or  exces- 
sively proliferated.  Changes  indicating  acute  inflammation,  as 
are_  observed  in  glanders,  do  not  occur  in  tuberculosis.  The 
peribronchial  hinph  glands  are  usually  considerablv  enlarged 
and  contain  yellowish  tubercles.  The  mucous  membranes  of 
the  respiratory  tract  may  also  show  ulcers. 

Tuberculosis  of  the  serous  membranes  (peritoneum,  pleura 
and  pericardium)  usually  occurs  in  the  form  of  tvpical  pearl 
disease  (Bang,  Xocard,  Felisch,  Foelger,  Ratz).  Occasionallv 
there  is  an  accumulation  of  much  sero-fibrinous  exudate  in  the 
pleural  cavity  and  the  pericardium  (Aubry).  Tuberculous 
lesions  may  occur  also;  in  the  phar^mgeal  and  cervical  glands 
(Froehner),  hi  the  vertebrae  and  ribs  (Wolff,  Haendel,"  Town 
&  Hobday),  in  the  heart -muscle  (Foelger),  in  the  subcutaneous 
connective  tissue  and  in  the  muscles  (Cadiot,  Fallv).  Enders 
described  the  rare  occurrence  of  complete  calcification  of  the 
thoracic  aorta  where  it  lies  adjacent  to  the  dorsal  vertebrae. 
Hansenkamp  describes  tuberculous  lesions  in  the  marrow  of 
the  lumbar  vertebrae  and  in  the  adjacent  membranes.     Behr 

Vol.  1-36 


546  Tuberculosis. 

describes  calcified  concave  scaly  lesions  in  the  endocardium  as 
large  as  a  silver  dollar,  also  lesions  as  large  as  a  lentil  on  the 
nasal  mucons  membrane. 

The  tuberculous  lesions  usually  contain  tubercle  bacilli  in 
large  numbers. 

In  pigs  tuberculous  lesions  are  most  common  in  the  diges- 
tive organs  and  their  lymph  glands.  In  some  of  the  cases  we 
find,  in  addition  to  tubercles  in  the  mucous  membrane  of  the 
pharynx  and  in  the  tonsils,  enlargement  of  the  retropharyngeal, 
cervical  and  mediastinal  lymph  glands  (scrophulosis).  These 
glands  contain  a  thickish  cheesy  purulent  mass.  Tuberculous 
processes  in  some  of  the  superficial  glands  may  even  perforate 
the  skin.  In  other  cases  the  mesenteric  glands  may  be  similarly 
affected.  The  lumbar  glands  may  constitute  an  irregular,  con- 
voluted tumor  mass  under  the  spinal  column.  In  these  cases 
tuberculous  nodules  and  ulcers  occur  also  in  the  intestines, 
especially  in  the  ileum  and  cecum.  The  liver  and  spleen  may 
contain  cheesy  foci  ranging  in  size  up  to  that  of  a  nut.  In 
exceptional  cases  wedgelike  or  irregular  firm  foci  extend  from 
the  surface  of  the  liver  or  spleen  toward  the  interior  of  the 
affected  organ.  On  section  these  areas  show  a  homogeneous 
structure,  are  grayish-white  or  yellowish-white  in  color  and 
present  no  evidence  of  caseation  or  calcification  (Junack, 
Sommer).  In  rare  cases  the  peritoneum  is  covered  with  numer- 
ous small  nodules.  (The  so  called  cheesy  enteritis  of  pigs 
[page  133]  may  perhaps,  in  exceptional  cases  also  develop  upon 
a  tuberculous  basis.) 

In  the  lungs  the  disease  may  manifest  itself  by  the  presence 
of  a  few  or  of  exceedingly  numerous  small  dry  cheesy  foci, 
or  a  correspondingly  smaller  number  of  larger  centers.  Or 
there  may  be  a  caseous  or  cheesy  pneumonia  with  large  areas 
of  the  lung  devoid  of  air,  firm  and  inelastic,  the  sections  ap- 
pearing grayish-red  or  grayish-yellow.  The  adjacent  portions 
of  the  pleura  are  indurated,  and  sometimes  covered  with  a  layer 
of  red  fibro-granular  connective  tissue  i/4  mm.  thick  and  result- 
ing in  extensive  adhesions  (Schlegel).  The  same  changes  may 
occur  in  the  pericardium.  Small  tubercles  and  small  ulcers 
are  occasionally  found  in  the  tracheal  mucous  membrane  (Graf) ; 
in  such  cases  the  peribronchial,  substernal  and  subspinal  lymph 
glands  are  usually  enlarged  and  caseated. 

Tuberculosis  of  the  central  nervous  system  results  from 
the  spread  of  a  tuberculous  process  of  the  inner  or  middle 
ear  or  of  the  petrous  bone  (Schuetz) ;  it  may  also  be  produced 
metastatically  in  tuberculous  disease  of  remote  organs  (Azary). 
Tuberculosis  of  the  spinal  meninges  is  very  rare.  It  manifests 
itself  in  the  appearance  of  numerous  yellowish  miliary  nodules 
on  the  peripheral  surface.  Occasionally  they  form  large  con- 
glomerate tumors  which  produce  compression  atrophy  of  the 
spinal  cord  (Vogt). 

Tuberculosis    of    the    bones    is    comparatively    common, 


Aiiatoiiiicnl    ("liaiiyos.  547 

especially  of  the  vertebrae,  the  ril)s  and  long  bones.  Less  fre- 
(luent  is  tuberculosis  of  tlie  iiiaimiiary  i;laii(ls  (Xocard).  When 
pi-esent  it  is  usually  in  coujuuctiou  with  disease  of  the  joints 
or  of  the  muscles  (Moule,  IStroese,  AVinter,  llasenkamp).  In 
rare  cases  there  is  affection  of  the  nasal  mucous  membrane 
which  manifests  itself  in  diffuse  induration  and  the  presence 
of  tu1)ercles  and  ulcers  (Zschokke,  Balas).  Tubercuh)sis  of  the 
eye  (Manleitner,  Keil)  and  tuberculosis  of  the  ovaries  (llasen- 
kamp) is  also  rare. 

Of  4,4()S  easos  of  tuberculosis  in  swine  observed  in  1002  in  tlie  abattoir  at 
Budapest  97..")7„  liad  local,  2.5%  generalized  tuberculosis.  In  87%  the  local  tuber- 
culosis was  confined  to  one  organ;  in  74%  the  tonsils  and  retropharyngeal  lymph 
glands  only  wore  a  dec  ted ;  in  13%  several  organs  wore  afl'ected  in  the  same  animal. 
The  lungs  were  involved  in  100%  of  all  cases  of  generalized  tul)erculosis,  the  spleen 
in  97%.  the  liver  in  01%,  the  bones  in  43%,,  the  joints  in  15%,  the  muscles  in  3% 
(Breuer). — According  to  Stroh  the  lymph  glands  of  the  muscles  were  affected  in 
14.4%  of  all  cases,  the  i)rescapular  glands  ludng  involved  in  52.()5%;  of  these,  the 
preerural  in  34.1%.  and  the  popliteal  glands  in  13.3%.  Tn  6,107  cases  of  generalized 
tuberculosis  studied  by  Tlonsehel  the  prescapular  glands  were  affected  in  35.8%,, 
the  preerural  in  3%,,  the  popliteal  glands  in  4.3%,,  the  ischial  glands  in  1.1%, 
the  pubic  glands  in  2.8%,,  and  the  udder  in  0.3%,. 

American  reports  i)oint  to  the  extreme  frequency  of  affection  of  the  submaxillary 
glands  which  are  involved  in  93%  of  all  cases  of  tuberculosis  of  swine. 

In  dogs  primary  tuberculosis  may  occur  in  the  lungs  or 
in  the  digestive  tract.  Particular  attention  has  been  given  to 
this  form  of  tuberculosis  in  the  publications  of  Jensen,  Cadiot, 
Froehnei%  Eatz,  Petit  and  Basset.  In  the  lungs  we  find  sharply 
circumscribed  tumors  of  variable  size,  which  may  consist  of 
sarcoma-like  tissue  of  an  even  white  texture  on  section,  or 
their  interior  may  be  a  viscous  mass  of  pus.  They  may  also 
consist  of  dry,  cheesy  or  chalk-like  masses.  Some  of"  these 
tumors  may  have  developed  into  cavities,  perforated  a  bronchial 
tube  or  communicate  with  the  abdominal  cavity  through  the 
visceral  portion  of  the  diaphragm  (Fiebiger).  In  other  cases 
there  may  be  broncho-pneumonic  areas  with  small  soft  foci 
in  their  grayish-red  substance.  The  mucous  membranes  of  the 
bronchial  tubes  and  the  trachea  may  occasionally  contain  tuber- 
cles or  villous  proliferations.  The  peribronchial  and  mediastinal 
lymph  glands  are  as  a  rule  consideraldy  enlarged,  resemble 
sarcomata  on  section,  are  grayish-white  in  color  or  their  sub- 
stance is  dotted  w^itli  cheesy  foci  or  masses  of  viscous  pus.  If 
the  bronchial  glands  are  much  enlarged  they  may  result  in 
an  upward  and  backward  displacement  of  the  heart.  In  excep- 
tional cases  the  tuberculous  process  is  limited  exclusively  to 
the  latter  glands  or  to  these  and  the  cervical  glands  while  the 
lung  tissue  remains  normal  in  appearance  or  reveals  only  recent 
changes.  The  pleura  may  contain  tuberculous  nodules  or  in- 
durated areas,  sometimes  also  papilloma-like  proliferations  or 
tumors  resembling  pearly  nodules  (AYenzel,  Joest).  Some- 
times there  is  an  accumulation  of  reddish  purulent  exudate  in 
one  or  both  pleural  sacs,  or  there  may  be  more  or  less  extensive 
adhesions.    Affection  of  the  pericardium  usuallv  results  in  ad- 


548  Tuberculosis. 

liesion  of  the  i3ericardial  folds,  but  there  may  be  an  extensive 
accumulation  of  sero-fibrinous  or  hemorrhagic  exudate.  Clieesy 
nodules  are  occasionally  found  in  the  muscle  of  the  heart. 
In  exceptional  cases  the  aorta,  surrounded  by  tuberculous  h^npll 
glands,  becomes  indurated.  Portions  of  its  walls  may  become 
necrotic  (Eber)  or  a  tuberculous  nodule  may  perforate  the  latter 
and  project  into  the  lumen  of  the  vessel  (Ratz). 

The  mesenteric  glands  are  frequently  considerably  en- 
larged and  present  the  same  characteristics  as  the  affected 
thoracic  glands.  Frequently  the  peritoneum  is  also  involved, 
especially  its  visceral  layer.  A  limited  area  may  be  covered 
with  a  few  large  nodules  or  numerous  small  tubercles  may  ex- 
tend over  great  expanses  of  this  membrane,  while  the  omentum 
is  transformed  into  a  thick  irregular  cord.  On  the  mucous  mem- 
brane of  the  intestine,  especially  the  duodenum  and  ileum,  only 
few  cheesy  nodules  or  ulcers  are  occasionally  found.  The  liver 
is  frequently  the  seat  of  cheesy  foci,  some  of  them  as  large 
as  an  apple,  the  larger  ones  causing  depressions  on  the  surface 
of  the  organ.  Their  marrow-like  sulistance  contains  grayish- 
white,  Avhite,  soft,  purulent  or  crumbling  foci.  In  rarer  in- 
stances small  or  large  tuberculous  foci  are  found  in  spleen  or 
kidneys;  these  occasionally  perforate  into  the  pelvis  of  the 
latter  organ  and  set  up  ulcerating  processes  (Jensen).  Ball 
observed  isolated  tuberculosis  of  the  mucous  membrane  of  the 
pharynx  in  the  form  of  a  granular  pharyngitis. 

Finally  tuberculous  changes  occur  in  rare  instances  in  the 
sexual  organs,  pancreas,  bones,  certain  joints  (Cadiot),  sub- 
cutaneous connective  tissue  (Ratz  observed  two  cases  of  tuber- 
culosis of  the  thoracic  lymph  glands  that  extended  to  and  in- 
volved the  overlying  skin).  Tul)erculosis  may  also  occur  in 
the  cerebral  meninges  as  a  tubercular  meningitis  (Nocard, 
Cadiot,  Ratz,  Petit),  etc. 

Acute  miliary  tuberculosis  has  also  been  observed  in  dogs 
and  Cadiot  describes  a  case  where  small  tubercles  in  the  swollen 
parenchymatous  organs  were  A^sible  with  the  unaided  eye  while 
the  tissues  contained  numerous  tubercle  bacilli  (tuberculous 
septicemia). 

In  32  cases  described  by  Petit  and  Basset  the  pleura  was  affected  in  19 
instances,  the  pericardium  in  15,  tlie  peritoneum  in  10,  the  myocardium  in  1,  the 
endocardium  in  2,  the  intestine  in  3,  the  mesenteric  glands  in  5,  the  liver  in  15, 
the  spleen  in  1,  the  kidneys  iu  9,  the  lunos  and  bronchial  lymphatic  glands  in 
17,  the  bronchial  Ij'niphatic  glands  alone  in  1,  the  lungs  alone  in  2,  and  the  mesenteric 
glands  were  affected  in  one  case  where  the  large  and  small  intestines  were  intact. 

In  cats  tuberculous  changes  are  similar  to  those  observed 
in  dogs.  The  abdominal  organs  and  especially  the  mesenteric 
lymph  glands  are  affected  most  frequently.  The  disease  may 
have  its  seat  in  these  organs  exclusively  or  the  respiratory 
organs  may  also  be  involved.  Jensen  observed  one  case  of 
tuberculosis  of  the  uterus,  one  of  the  testicles,  one  of  the  joints 
and  two  of  the  subcutaneous  connective  tissue;  Hobday,  one 
case  of  generalized  tuberculosis. 


Syiii[>t()iiis.  549 

Symptoms.  In  keeping-  with  tlie  extraordinary  variability 
of  the  i)atliolot;i('-anatoniieal  elianges  that  occur  in  tuljcrcuhjsis, 
the  symptoms  ot"  tiie  disease  vary  not  oidy  in  dilTerent  species 
of  animals  but  to  an  almost  equal  extent  in  individuals  of  the 
same  species.  The  insidious  and  long  drawn  out  course  of  the 
disease  gives  rise  to  additional  variations. 

In  advanced  stages  of  the  disease  the  body  temperature  is 
at  limes  temporarily  elevated.  The  course  of  the  fever  is  in- 
termittent or  remittent,  with  evening  exacerbations  and  morn- 
ing remissions;  sometimes  the  typus  inversus  is  oljserved.  In 
the  ciironie  course  of  the  disease  febrile  attacks  lasting  several 
weeks  alternate  with  free  intervals  of  the  same  duration.  Near 
the  termination  of  the  disease  the  fever  is  usually  liigli  and 
continuous.  The  same  is  observed  when  an  acute  miliary  tuber- 
culosis develops  from  a  chronic  affection. 

Tuberculosis  of  Cattle.  The  period  of  incubation,  after 
severe  artilicial  infection,  is  rarely  longer  than  two  weeks.  In 
natural  infection  it  is  much  longer;  sometimes  months  and 
even  years  may  elapse  before  the  appearance  of  the  slightest 
indications  of  disease  become  manifest  to  ordinary  observation. 

Ac-poiding  to  Xoeard  and  Rossionol  artificial  infection  by  inhalation  requires 
10  to  32  days  and  alimentary  infection  32  to  48  days  before  the  animal  will  react 
to  tuberculin.  In  experiments  conductdl  with  calves  by  the  authors  symptoms  of 
fever  appeared  eight  days  after  the  intravenous  injection  of  0.02  gm.  of  cultures 
of  tubercle  bacilli. 

Pulmonary  tuberculosis,  the  most  frequent  form  of  the  dis- 
ease, manifests  itself  by  a  short,  dry,  vigorous  cougli.  At  first 
this  occurs  only  when  cold  or  dusty  air  is  inhaled  or  when  the 
circulation  is  accelerated  by  the  sudden  rising  of  the  animal 
or  by  drinking  cold  water.  In  this  stage  the  appetite  is  usually 
good  but  symptoms  of  exhaustion  may  be  observed  after  pro- 
longed exercise. 

Gradually,  usually  after  the  lapse  of  months,  s^^nptoms 
pointing  to  pulmonary  affection  become  more  pronounced.  The 
cough  becomes  more  frequent  and  painful,  may  be  dry  and  coarse 
or  feeble  and  almost  soundless.  From  time  to  time  the  animals 
discharge  a  ropy,  muco-purulent,  yellowish-gray  secretion  from 
the  open  mouth;  as  a  rule  however  this  secretion  is  swallowed 
as  may  be  demonstrated  by  observing  the  left  esophageal  grove 
immediately  after  an  act  of  coughing.  It  may  also  be  retained 
in  the  space  anterior  to  the  soft  palate  lietween  the  tongue  and 
last  molar  teeth  where  it  may  be  reached  by  the  hand  (Ostertag). 
Sometimes  the  bronchial  secretion  is  discharged  through  the 
nose;  in  this  ease  the  presence  of  pus  corpuscles,  alveolar 
epithelium  that  has  undergone  fatty  degeneration,  fat  crystals, 
elastic  fibres  and  tubercle  bacilli  may  be  demonstrated. 

As  the  cough  increases  in  frequency  the  type  of  respiration 
begins  to  change;  it  becomes  more  frequent  and  laborious,  in- 
spiration assumes  more  of  n  costal  type  and  expiration,  which 


550  Tuberculosis. 

may  be  attended  by  groans,  becomes  abdominal.    These  sj^np- 
toms  are  most  pronomiced  after  exercise  or  during  work. 

A  physical  examination  of  the  thorax  rarely  reveals  char- 
acteristic changes.  A'esicular  respiration  may  be  increased, 
diminished  or  imperceptible.  In  slight  affections  there  may  be 
dry  rales,  observal)le  locally  or  over  the  entire  extent  of  the 
thorax,  caused  .by  the  presence  of  more  or  less  viscous  or  fluid 
secretions  or  by  accumulations  of  mucus  in  the  In-onchial  tubes. 
The  percussion  sound  may  be  normal  or  changed  only  slightly. 
If  lesions  are  of  considerable  size  and  located  near  the  surface 
the  sound  becomes  dull  in  circumscribed  areas,  and  in  such 
cases  bronchial  sounds  may  be  recognized,  while  large  cpn- 
tig-uous  areas  of  dullness  hardly  occur.  Cases  where  tAinpanitic 
resonance  points  to  the  presence  of  large  cavities  are  rare, 
but  an  odor  of  decomposed  bronchial  secretion  and  necrotic  lung 
tissue,  perceived  in  the  expired  air,  points  to  this  condition. 

W'heie  aiiscultatiou  gives  unsatisfactory  or  negative  results  it  is  advisable  to 
exercise  tlie  animals  by  running  them  around  for  a  time,  a  procedure  which  usually 
produces  more  or  less  distinct  rales  in  animals  whose  lungs  are  affected.  In  similar 
cases  Eoebert  and  Ellinger  recommend  closing  the  nasal  openings  with  the  hands 
while  auscultating.  Nocard  suggests  the  injection  of  0.2  to  0.3  gm.  of  pilocarpine. 
Krautstrunk  suggests  arecolin,  0.08  gm.  Ostertag,  however,  observed  that  the 
injection  of  0.05  gm.  of  arecolin  in  a  strong  heifer,  produced  staggering,  falling 
and  great  dyspnoea.  It  should  be  noted  here  that  the  injection  of  the  above  sub- 
stances may  now  and  then  produce  rales  in  perfectly  healthy  animals. 

Affections  of  the  trachea  and  larynx  usually  produce 
catarrhal  symptoms  only.  However,  where  there  is  suspicion 
of  tuberculosis  it  is  safe  to  make  a  probable  diagnosis  of 
laryngeal  tuberculosis  when  we  find  the  region  of  the  larynx 
sensitive,  the  cough  very  painful  and  spasmodic  and  degluti- 
tion difficult.  "When  tuberculous  tumors  exist  in  the  larynx  the 
latter  may  be  enlarged  and  distinct  vibration  may  be  felt  at 
each  inspiration.  At  the  same  time  the  respiration  becomes 
stertorous,  the  animals  holding  their  heads  stretched  forward 
and  avoiding  lateral  movements,  and  sometimes  attacks  _  of 
suffocation  are  observed.  On  account  of  the  incomplete  closing 
of  the  glottis,  particles  of  food  may  enter  the  trachea  during 
the  act  of  deglutition  resulting  in  attacks  of  coughing  and  if 
only  for  this  reason,  the  affected  animals  usually  eat  sparingly. 
Hoiterbach  noted  aphonia  in  a  case  of  isolated  tuberculosis 
of  the  larynx  in  a  cow  with  good  nutrition.  When  attempting 
to  low,  the  cow  would  only  emit  a  faint  blowing  sound.  Accord- 
ing to  Friedberger  tuberculosis  of  the  respiratory  organs  in- 
volves the  larynx  in  only  0.13%  of  cases. 

In  rare  cases  the  nasal  mucous  membrane  is  affected.  Near 
the  nostrils  the  mucous  membrane  contains  firm  nodules  up 
to  the  size  of  a  pea  which  are  usually  yellowish  in  the  center. 
Ulcers  may  also  be  visible,  or  they  may  be  situated  higher  up 
and  detected  by  palpation  only.  Tliis  condition  is  always  at- 
tended with  a  muco-purulent  nasal  discharge.  The  pharyngeal 
glands  are  enlarged  and  contain  cheesy  foci  (Jensen,  Gutbrod). 


Tuberculosis  of  Cattle. 


551 


The  alac  of  tlio  nostrils  may  be  indurated  and  the  lower  jaw 
enlarged  (Lirnanx), 

Tnlierenlons  intlammation  of  the  pleura  is  not  frequent  but 
usually  occurs  simultaneously  with  the  affection  of  the  lun^. 
It  may  be  the  cause  of  soreness  of  the  thoracic  walls  whicli 
causes  the  animals  to  flinch  or  cough  when  pressure  is  applied 
to  the  })art.  Pleuritic  friction  sounds  may  indicate  roughness 
of  the  ])leura  or  the  presence  of  pearly  tumors,  and  large  nnisses 
of  the  latter  may  produce  a  dull  sound  upon  percussion,  while 
in  fully  developed  cases  the  friction  of  the  rough  pleural  sur- 
faces may  be  felt  with  the  hand.  As  a  rule,  however,  especially 
when  the  lung  is  extensively  affected,  it  is  impossible  to  diag- 
nose pleuritic  involvement. 


Fig.  84.     Cow  witli  Advanced  ruliiiouaiy  Tulu'iculosis. 

The  general  nutrition  of  the  animal  suffers  in  direct  pro- 
portion as  the  disease  of  the  respiratory  organs  advances. 
Symptoms  of  oligemia  are  indicated  by  paleness  of  the  mucous 
membranes  and  increasing  emaciation.  The  skin  loses  its 
elasticity  and  adheres  more  firmly  to  the  underhdng  structures, 
the  animals  become  ''hidebound,"  the  tuberosities  and  angles 
of  the  bones  of  the  pelvis  become  prominent.  The  skin,  when 
raised  into  a  fold  returns  reluctantly  to  its  ftormal  position 
and  the  haircoat  becomes  staring  and  loses  its  luster  (Fig.  8-4). 
The  facial  expression  indicates  exhaustion  and  sickness,  while 
the  eyes  lose  their  natural  luster  and  are  withdrawn  into  their 
sockets.  The  appetite  is  at  first  variable  but  finally  becomes 
poor;  while  in  addition  attacks  of  diarrhea  persisting  for  days 


552  Tubei'culusis.    ' 

weaken  the  patients.  The  digestion  is  usually  more  or  less 
disturbed  and  the  condition  is  aggravated  by  periodical  attacks 
of  bloating,  caused  by  compression  of  the  esophagus  by  the 
enlarged  peribronchial  and  mediastinal  lymph  glands  which 
interrupt  or  prevent  eructations  of  gas  and  interfere  with 
rumination.  In  case  of  suspected  animals  this  latter  condition 
always  indicates  the  probable  presence  of  tuberculosis  !  (Johne), 
it  is  however,  usually  not  observed  until  symptoms  of  pulmonary 
affection  have  manifested  themselves.  Distention  of  the  jugular 
vein,  Avliich  is  occasionally  observed,  may  he  due  to  the  same 
cause. 

Cardiac  symptoms  are  usually  observed  only  wlien  the 
pericardium  is  involved.  There  may  be  pericardial  friction 
sounds  and  more  or  less  pronounced  disturbance  of  the  heart 
action.  But  since  the  pericardial  sac  rarely  contains  any  con- 
siderable amount  of  fluid  these  sounds  are  usually  absent.  The 
heart  sounds  are  clearly  audible  and  in  rare  cases  only  may 
cardiac  dullness  be  noted.  Swelling  of  the  skin  in  the  anterior 
thoracic  region  is  rare  as  is  also  a  jugular  pulse  (contrast 
Avith  traumatic  pericarditis).  In  advanced  stages  of  the  disease 
the  pulse  is  subject  to  considerable  variation  in  character  as 
well  as  in  rate.  In  advanced  cases  it  is  much  accelerated  and 
empty. 

In  one  case  observed  by  Lienaux  there  was  displacement  of  the 
heart  toward  the  right  side,  and  great  distention  of  the  jugular  vein 
as  a  result  of  compression  by  the  anterior  lobe  of  the  left  lung  which 
was  indurated  and  contained  numerous  cheesy  and  calcified  foci.  Tn 
another  ease  he  succeeded  in  demonstrating  the  presence  of  tubercle 
bacilli  in  the  pericardial  fluid  which  was  obtained  by  aspirating  the 
pericardial  sac. 

Toward  the  termination  of  the  disease  the  respiratory  diffi- 
culties become  increasingly  great.  The  affected  animals  stand 
wuthout  moving  from  the  spot,  with  elbows  projecting  outward, 
the  neck  held  low  and  the  head  stretched  for\vard,  groaning 
and  gasping  for  breath  while  their  forced  respiratory  move- 
ments cause  the  whole  l)ody  to  tremble.  The  cough  is  Aveak, 
painful  and  frequent  and  is  easily  provoked  by  slight  pressure 
exerted  upon  the  back.  Purulent  or  ichorous  secretion  which 
is  discharged  from  the  nostrils  is  no  longer  '^ licked  away"  l)y 
the  animal.  As  the  animals  become  Aveaker  and  more  and 
more  emaciated  they  lie  dowai  continuously,  l^eing  no  longer 
able  to  stand.  In  the  meantime  the  abdominal  organs  may  have 
become  involved;  there  is  a  continuous  diarrhea,  and  finally, 
after  long  suffering  the  end  approaches  without  spasms. 

Tuberculosis  of  the  abdominal  organs  which  in  regard  to 
frequency  of  occurrence  is  second  to  pulmonary  tuberculosis 
develops  in  an  equally  insidious  manner.  Tuberculosis  of  the 
peritoneum  may  reach  an  advanced  stage  of  development  before 
it  manifests  its  presence  by  any  outward  indications.     In  cows. 


Symjitoiiis    ill    ("attli", 


OOo 


however,  wlicji  llie  i)i-oces.s  spreads  to  the  serous  eoats  uT  the 
sexual  organs  there  is  unusual  excitement  during  the  jjeriod 
of  oestrum.  If  served  bj'  a  male  they  either  do  not  eonoeive  or 
they  are  apt  to  abort  at  about  the  middle  of  gestation.  In 
later  stages  of  tlie  disease  this  exeitement  becomes  continuous 
(n^-mphonumia)  and  may  then  also  exert  an  nnfavorable  in- 
fluence upon  the  nutrition  of  llie  animal.  Otherwise  this  form 
of  tuberculosis  does  not  necessai-ily  interfere  sei-iously  witli 
nutrition  and  aninuils  may  grow  fat  even  with  advanced  and 
extensive  disease.  The  presence  of  the  latter  is  often  unsus- 
pected until  on  post-mortem  examination  after  the  animals  are 
slanghtered.  Still,  in  the  advanced  stage  of  the  disease  the 
affection  of  other  oi'gans,  esjx'cially  the  liver  and  the  spleeji 
and  also  the  mesenteric  lymph  glands  will  exert  a  disturbing 
influence  on  the  organs  of  digestion  and  gradually  anemia  and 
emaciation  l)ecome  more  and  more  evident. 

Large  tumors  on  the  pe)-itoneum  may  now  and  tlien  be 
accurately  located.  The  presence  of  large*^  pearl  nodes  on  the 
left  side  of  the  paunch  or  on  the  opposing  peritoneal  mem- 
brane may  be  palpated  by  applying  the  hand  to  the  left  flank. 
Tumors  in  the  pelvic  cavity,  especially  when  located  near  the 
internal  sexual  organs  may  occasionally  be  palpated  through 
the  rectum.  Any  large  tumors  with  irregular  surface,  or  masses 
of  smaller  structures  of  hard  consistency,  when  present  in  the 
pelvic  cavity,  may  be  looked  upon  as  tuberculous  excrescences. 
These  structures  do  not  take  finger  impressions  and  the  small 
ones  if  loosely  imbedded  in  connective  tissue  or  if  they  are 
pedunculated  usually  slip  from  the  grasp  (Storch).  Enlarged 
sacral,  lumbar,  medial  iliac  and  mesenteric  glands  mav  also 
be  palpated. 

In  the  course  of  the  digestive  tract  tuberculous  changes 
may,  m  rare  cases,  be  met  with  in  the  mouth,  viz.,  the  nuicous 
membranes  of  the  pharjmx,  the  hard  palate  and  the  fauces. 
Here  there  are  irregular  ulcers  with  firmlv  adhering  grayish- 
yellow,  cheesy  deposits,  sometimes  knobbv  l)orders.  The"  sur- 
face of  the  tongue,  especially  at  the  point  just  anterior  to  the 
eminence  of  the  dorsum  of  the  tongue  mav  have  similar 
ulcers.  Its  substance  may  contain  firm  no(bilos  "or  be  uniforndy 
indurated  which  condition  interferes  more  or  less  Mith  the 
niovements  of  this  organ  also  mastication  and  deglutition 
(Moussu). 

The  symptoms  of  intestinal  tuberculosis  are  very  indefinite 
Digestive  disorders  which  are  liardiv  ever  absent  i"n  advanced' 
tul)erculosis  ai-e  not  infrequently  caused  bv  an  involvement  of 
the  intestines  but,  on  the  other  hand,  digestive  disorders  mav 
be  entirely  absent  even  in  advanced  disease  of  these  organs 
The  most  significant  s:^iuptoms  are  colickv  pains  and  cons'tipa- 
tion  alternating  with  diarrhea.  The  intestinal  evacuations  mav 
be  quite  fluid  and  not  infrequently  mixed  ^yith  mucus  and  pus 
J^ometimes  there  are  streaks   or  even   clots   of  blood      Occa- 


554 


Tuberculosis. 


sionally  microscopic  examination  will  reveal  tlie  presence  of 
pus  corpuscles  and  red  blood  cells  when  its  general  appearance 
would  not  cause  us  to  suspect  them. 

Tuberculosis  of  the  liver  and  spleen  can  be  recognized  as 
such  only  in  cases  where  considerable  enlargement  of  the  organs 
has  taken  place.  There  may  be  dullness  upon  percussion  in 
the  overlying  region  or  their  posterior  irregular  nodular  bor- 
ders may  Ije  palpated  behind  the  costal  arch. 

Among  the  sexual  organs  tuberculosis  of  the  testicle  may 
be  recognized  by  the  presence  at  its  superior  and  posterior 
border,  corresponding  to  the  position  of  the  epididymis,  of 
a  firm  painless  swelling.  The  testicle  itself  does  not  become 
enlarged  until  at  a  considerably  later  date  and  then,  becoming 


WW^ 


(^ 


''  p-  ■■■  .\\a. 


Fig.  85.  Superficial  lymph  glands  of  the  ox.  Kp.  Submaxillary  gland  ;  O  parotid 
gland;  o// superior,  wff  middle,  ?//:?  inferior  Cervical  glands ;  Zi  Prcscapular  gland  ; 
Kf  Preerural  glands;     W  Inguinal  glands. 


confluent  Avith  the  ei^ididymis,  the  two  organs  constitute  one 
tumor.  Usually  there  is  simultaneous  h^^drocele.  In  a  few 
cases  fistulae  perforate  the  skin  above  the  epididymis  and  dis- 
charge yellowish  pus.  In  tuberculosis  of  the  penis,  which  is 
very  rare,  we  find  firm  nodules  at  the  end  of  the  organ  and 
occasionally  induration  of  the  edges  of  the  prepuce  (Eber, 
Trotter).  In  tuberculosis  of  the  uterus  a  turbid,  mucous  or 
muco-purulent,  yellowish,  or  rather  ichorous  and  ill  smelling 
vaginal  discharge  is  a  constant  symptom.  Occasionally  this 
discharge  contains  cheesy  fragments  and,  in  exceptional  cases 
streaks  of  blood.  Rectal  examination  may,  in  some  cases  reveal 
the  presence   of  enlarged  sacral  hTiipli  glands   or  the   horns 


Symptoms   in    Tattle, 


555 


of  the  uterus  wliicli  have  become  transformed  into  knotty  struc- 
tures the  size  of  a  man's  arm.  The  Fallopian  tubes  may  present 
twisted  strands  as  thick  as  a  linger  and  occasionally  the  uterus 
is  transformed  into  a  lari'-e  iirm  ball  (liess).  Cows  thus  allVcted 
do  not  conceive  but  are  frequently  in  heat,  although  sexual  desire 
vanishes  as  the  disease  advances.  Tuberculosis  of  the  vagina 
and  of  the  vulva,  which  is  very  raiv,  manifests  itself  in  the 
appearance  of  small  yellowish  nodules  and  erosions  (Fisclier) 
or  tumors  as  large  as  peas  and  ulcers  with  raised  borders. 
There  may  also  be  ol>served  a  purulent  discharge,  hypersensi- 
tiveness  and  swelling  of  the  lips  of  the  vulva  and  enlargement 
of  the  perineal  lymph  glands.  JTess  observed  a  case  of  tuber- 
culosis with  thickening  of  the   labia  of  the  vulva  resembling 


Fig.  86.     Tul)oroiilosis  of  the  submaxillaiy  parotid  and  ])r('.riiral  lymph  ghinds. 

elephantiasis.     Fischer  referred  to  this  form  as  lupus  hyper- 
trophicans  of  cattle. 

Since  the  superticial  lymphatic  glands  (Fig.  85)  in  the 
pharyngeal  and  cervical  regions  become  primarily  infected  and 
the  remaining  glands  become  involved  in  most  cases  as  a  resm: 
of  tuberculosis  of  neighboring  organs  the  determination  of  in- 
fection of  the  former  glands  is  of  special  importance  in  the 
diagnosis  of  this  disease.  Large  tumors,  attaining  to  or  ex- 
ceeding the  size  of  a  man's  fist  are  now  and  then  found  in  one 
or  several  of  the  following  locations,  viz.,  intermaxillary  space, 
l)ehind  the  ascending  portion  of  the  inferior  maxilla  in  the  sub- 
parotid  region,  on  the  side  of  the  neck  above  the  jugular  furrow, 
anterior  to  the  scapula,  at  the  inside  of  the  elbow,  in  the  pre- 
crural  and  inguinal  regions,  in  the  flank,  at  the  superior  border 


556 


Tuberculosis. 


of  the  mammary  gland.  These  tumors  are  usually  only  slightly 
movable,  round  or  oval  in  form,  the  very  large  ones  usually 
nodulated,  firm,  painless  and  not  adherent  to  the  overlying  skin 
(Fig.  86  and  87).  In  calves  they  may  be  elastic  and  fluctuating, 
if  incised  they  evacuate  a  white  creamy  pus.  In  rare  cases  in- 
flammatory processes  develop  in  and  around  these  tumors  caus- 
ing them  to  adhere  to  the  overlying  skin,  rupture  and  discharge 
their  contents  outwards.  There  then  remains  a  fistula  with 
pale  red  granulating  borders.  Very  greatly  enlarged  Ijmiph 
glands  may  interrupt  the  functions  of  neighboring  organs ;  thus 
enlargement  of  the  glands  of  the  throat  may  interfere  with 
deglutition  or  respiration  while  that  of  the  glands  of  the  axillary 
region  and  the  groin  occasionally  produces  lameness. 


Fig.  87.     Tuberculosis  of  the  sulmiaxillary,  preseapular  and  inguinal  lymph  glands. 

Tuberculosis  of  the  udder  begins  with  a  rather  diffuse  pain- 
less induration  of  one  or  both  posterior  quarters  without  local 
hyperthermia.  The  process  occasionally  spreads  to  the  adja- 
cent quarters  and  gradually  develops  into  an  exceedingly  hard 
and  nodular  tumor  which  may  approach  the  size  of  a  child's 
head  and  cause  atrophy  of  the  remaining  parts  of  the  gland 
(Bang,  Fig.  88).  In  other  instances  we  may  observe,  esi3ecia]ly 
after  the  udder  has  been  milked  dry,  several  nodules,  or  larger 
nodes  in  the  otherwise  uniformly  elastic  glandular  tissue  of 
one  or  more  quarters  of  this  organ.  These  tumors  are  firm, 
painless,  do  not  show  an  increased  temperature  and  may  exist 
singly  or  as  a  conglomerate  mass  with  nodular  surface,  affect- 
ing a  part  of  or  an  entire  quarter.  This  may  cause  the  teats 
on  one  side  of  the  udder  to  assume  an  irregular  direction  and 


Syiii])t()ms  ill    C'altli'. 


557 


"become  parallel  or  conve],i^e  instead  of  diveri^iiii;'  (Osterta^, 
Fig-.  90).  At  the  upper  border  of  tlie  udder  either  on  the 
affected  side  or  on  both  sides  the  enlarged  lymphatic  glands 
may  be  located  by  ])alpation  (Fig.  89).  In  exceptional  cases 
the  snpermammary  lymph  glands  may  l)e  enlarged  and  the  ndder 
itself  present  a  normal  appearance.  In  these  cases,  however, 
it  may  be  assumed  that  in  all  probability  the  udder  itself  is 
also  infected.  In  very  rare  cases  the  affection  begins  with 
increased  local  temperature  and  moderately  painful  swelling 
of  one  quarter  but  in  the  course  of  a  short  time  the  above  de- 


Fig.  88.    Tuberculosis  of  tlie  right  hind  quar-        Fig.   89.    Tuberculosis  of  the  loft 

ter  of  tlie  luldor  with  pronounced  atrophy  of  the  hind  (luartor  of  the  udder  with  exten- 

glandular  tissue.     Fnlargeinent  of  the  precrural  sivo   enlargement   of  the  left  super- 

lynij)h  gland.  "  mammary  gland  ^rt^.     (Ostertag.) 


scribed  characteristics  appear.  In  other  rare  cases  chronic  con- 
ditions will  become  acute,  the  diseased  quarter  becomes  more 
tumefied  and  painful,  there  is  increased  temperature  and  the 
neighboring  lymph  glands  show  acute  enlargement  (Lucet). 

In  regard  to  milk  production,  contrary  to  what  occurs  in 
other  inflammatory  processes  of  this  organ,  no  interruption 
occurs  for  some  time  in  the  course  of  tuberculous  disease.  As 
the  morbid  processes  advance,  however,  the  secretion  gradually 
diminishes  until  it  ceases  entirely  in  the  affected  quarters.  In 
the  meantime  the  milk,  which  is  at  first  normal  in  appearance, 
becomes  thin  and  greenish-yellow  in  color  (Fig.  92).     Later, 


558 


Tuberculosis. 


wliite  flakes  and  curdled  masses  appear  and  finallj^  the  secretion 
assumes  a  watery  appearance. 

According  to  Stroh  the  milk  obtained  from  the  tubercnlons  quarters  is  fre- 
quently alkaline  in  reaction,  contains  an  increased  amonut  of  salts  of  sodium, 
chlorine,  lime  and  phosphorus,  the  fat  is  diminished  and  the  milk  sugar  present  in 
only  small  quantities  or  absent  altogether.  The  nitrogenous  contents  consist  of 
paraglobulin  and  albumin  instead  of  casein  and  albumin  as  in  normal  milk. 
Monvoisin  also  found  the  acidity  considerably  reduced  (from  1.4  to  2.0  g.  of  lactic 
acid— normal  contents  per  liter — to  0.80,  0.24  and  even  0.12  g.)  which  is  in  contrast 
to  ordinary  inflammations  of  the  udder  where  the  acid  content  is  usually  increased 
on  account  of  decomposition  of  lactose.  The  percentage  of  fat  may  be  reduced 
from  the  normal  (being  instead  of  3..5-4.5%  only  1.5%).  Milk  sugar  may  be 
almost  entirely  absent.     The  freezing  temperature  remains  about  the  same. 

According  to  Ostertag  the  examina- 
tion of  the  mammary  lymph  glands  is  best 
accomplished  by  grasping  with  the  index, 
middle  and  ring  fingers  the  skin  of  tliat 
portion  of  the  lateral  faces  of  the  udder 
which  lie  opposite  the  inner  sides  of  the 
thighs,  beginning  at  about  the  middle 
of  the  udder  and  pushing  upward,  when 


Fig.  90.  Tuberculosis  of  the  greatly  en- 
larged left  hind  quarter  of  the  udder. 
(Ostertag) . 


I'ig.  91.    Palpation  of  the  manunary 
lymph  glands. 


the  lymph  glands  may  be  palpated  from  without  and  from  below  (Fig.  91).  These 
glands  lie  in  the  angle  which  is  formed  by  the  upper  and  posterior  border  of  the 
udder.  As  a  rule  the  posterior  border  of  these  glands  does  not  project  beyond 
the  posterior  border  of  the  udder. 

To  confirm  the  diagnosis  it  is  advisable  to  cleanse  and  disinfect  the  udder 
with  soap  and  water,  rinse  with  alcohol  and,  with  the  aid  of  a  harpoon,  remove 
a  portion  of  tissue  from  the  affected  region  for  bacteriological  examinations  (see 
pp.  571  and  574). 

Tuberculosis  of  tlie  kidneys  or  more  properly  speaking, 
tuberculosis  of  the  pelvis  of  the  kidneys,  is  indicated  by  the 


Symptoms  in   Cattle. 


559 


^ 


prononnced  ammoniacal  odor  of  the  urine  and  the  presence 
of  aUniiinn  in  the  turbid  urine.  Microscopically,  pus  cells, 
variously  formed  epitlielial  colls,  irregular  detritus,  connective 
tissue  libers  and  tubercle  bacilli  (Iro)  may  be  demonstrated. 

Tuberculosis  of  the  central  nervous  system  manifests  itself 
in  two  forms.  Solitary  tuberculous  foci,  according  to  their 
location  and  size,  either  in  the  brain  or  in  its  nerve  trunks, 
produce  disturbance  of  function.  The  clinical  picture  is  the 
same  or  similar  to  that  produced  by  other  tumors  and  for  that 
reason  a  specific  diagnosis  can  be 
made  only  by  the  determination 
of  tuberculous  disease  in  other 
organs. 

The  s\^nptoms  of  cerebral  af- 
fection on  the  other  hand  are: 
fearfulness,  unsteady  swaying 
gait,  constrained  or  forced  move- 
ments, occasional  clonic  spasms 
Avhicli  may  involve  the  whole  body 
in  the  form  of  epileptiform  at- 
tacks, partial  or  complete  par- 
alysis of  regions  supplied  by  cer- 
tain cranial  nerves  (incoordina- 
tion of  the  extrinsic  muscles  of  the 
eyes  [eyes  awry]  and  impaired  or 
total  loss  of  vision,  comparatively 
frequent) ;  slow  and  frequently  in- 
terrupted mastication,  holding  the 
head  to  one  side,  desire  to  push 
forward  or  upward,  hemiplegia, 
arythmic  and  slow  pulse;  if  the 
spinal  cord  is  involved,  stiffness 
of  the  hind  quarters  and  tail, 
paraparesis  or  paraplegia.  These 
symptoms  not  infrequently  appear 
suddenly  in  animals  that  were  ap- 
parently healthy,  rapidly  become 
more  aggravated  and  pronounced 
and  terminate  in  death  after  one 
or  two  days.  (In  regard  to  locali- 
zation of  foci,  see  Vol.  II.) 

The  symptoms  of  acute  inflam- 
mation of  the  cerebral  meninges 
may   follow   the   sjTuptoms   of   a 

local  affection  or  they  may  make  their  appearance  without  pre- 
vious warning  The  principal  symptoms  are:  increased  reflex 
excitability  and  fearfulness,  great  restlessness,  delirium  or  rav- 
ing madness ;  unsteady  gait,  muscular  tremors,  nystagmus,  jerk- 
ing of  certain  muscles,  opisthotonus  or  spasms  of  the  entire 
body;  symptoms  of  paralysis  in  the  region  of  certain  cranial 


Fig.  92.  Milk  from  a  tulx^rculous 
quarter  of  the  udder.  Turbid,  greeu- 
isli  yellow  fluid  with  flaky  cheesy 
sediment. 


560  Tuberculosis. 

nerves,  especially  incoordination  of  the  extrinsic  muscles  of  the 
eyes  and  unequal  size  of  the  pupils.  Later  there  may  be  ex- 
treme stupor  and  finally  complete  unconsciousness ;  the  animal 
gets  down,  is  completely  helpless  and  occasionally  makes  forced 
involuntary  movements  with  the  extremities.  In  the  meantime 
respiration  and  heart  activity  are  subject  to  great  variation, 
not  infrequently^  the  Cheyne-Stokes  type  being  observed. 

In  tuberculosis  of  the  eye,  which  is  very  rare,  we  may  ob- 
serve tubercles  up  to  the  size  of  a  hemp-seed  in  the  bulbar 
conjunctiva  (Priewe),  in  the  substance  of  the  iris  (Winter), 
or  on  the  posterior  surface  of  the  cornea  (Schmidt).  The  de- 
velopment of  the  affection  is  attended,  either  from  the  beginning 
or  not  until  a  later  stage,  with  turbidity  of  the  cornea  and 
symptoms  of  an  acute  iritis.  The  process  usualh'  terminates  in 
panophthalmitis  and  atrophy  of  the  bulbus. 

In  localization  of  the  tuberculous  process  in  the  posterior  portions 
of  the  ocular  globe,  e.  g.,  the  posterior  face  of  the  lens,  a  diffuse  iritis 
and  turbidity  of  the  lens  may  be  observed  (Spoerer).  Winter  observed 
nodules  in  the  sclerotic  in  the  external  canthus  of  the  eye  in  one  case 
and  Lottermoser  observed  a  tumor-like  swelling,  as  large  as  a  hazelnut, 
in  the  lower  nasal  quadrant  of  the  bulbus.  The  granular  structure  of 
this  growth  could  be  observed  through  the  overlying  yellowish  cornea 
and  sclerotic.  There  w^ere  observed,  also,  minute  yellowish  nodules  in 
the  iris  which  latter  was  adhered  to  the  turbid  cornea. 

Maiileitner  found  the  eye  affected  in  five  per  cent  of  all  cases  of  generalized 
tuberculosis.  The  choroid  is  most  frequently  affected  (70%)  although  clinical 
symptoms  are  usually  absent  while  tuberculosis  of  the  iris  begins  with  symptoms 
of  iritis  and  leads  to  the  formation  of  visible  nodules. 

Of  the  bones  we  most  frequently  find  a  few  ribs  involved 
which  become  thickened  in  circumscribed  areas,  cold  abscesses 
and  fistulae  developing  in  the  surrounding  parts.  In  disease 
of  the  vertebrae  sjanptoms  pointing  to  compression  of  the 
spinal  cord  is  observed  and  usually  sensitiveness  to  pressure 
of  the  affected  region  of  the  spinal  column. 

Haug  observed  stiffness  of  the  hind  quarters  and  tail  and  contraction 
of  the  muscles  of  the  loins  and  croup  in  tuberculosis  of  the  first  two 
lumbar  vertebrae.  Hamoir  and  Stenstroem  observed  inability  to  stand 
and  occasionally  loss  of  sensation  in  circumscribed  areas  of  the  spinal 
column,  also  lameness  and  genu-flexion.  The  general  condition  of  the 
animal  often  remained  good.  Wyssmann  observed  mydriasis  in  one  case 
of  tuberculosis  of  the  occipital  condyles,  also  opisthotonus,  heavy  gait 
and  subsequently  dullness.  In  a  case  observed  by  Gueldra  an  animal 
with  disease  of  the  last  two  cervical  vertebrae  could  not  move  its  head 
laterally  and  in  another  case  tuberculosis  of  the  twelfth  dorsal  vertebra 
interfered  with  mastication  and  locomotion. 

Tuberculosis  of  the  joints,  most  frequent  of  the  knee,  less 
common  of  the  carpal  or  tarsal  articulations  (Guillebeau)  mani- 
fests itself  in  subacute  inflammation,  moderate  swelling  and  dis- 
turbance of  function  of  the  affected  joint.     Upon  puncture  a 


Symptoms  in  Goats  and  Sheep.  561 

ropy,  caseo-purulent  exudate  is  usually  (lischarj>e(l.  The  ten- 
dons in  the  affected  region  are  usually  irreirularly  ciilariicd  and 
very  sensitive.  Accordine:  to  Hess  the  tendons  of  the  ]\[.ext. 
carpi  radialis  and  of  the  M.ext.digit.pedis  longus  are  most  fre- 
quently involved. 

In  the  skin  and  in  the  subcutaneous  connective  tissue  there 
occur,  in  rare  instances,  tirm  tumors  the  size  of  a  hazelnut  con- 
taining cheesy  or  mortar-like  nuisses  in  one  or  more  locations. 
Lazace  observed  a  case  in  Avhich  .*)0  such  nodules  occurred  in 
the  slioulder  and  arm  while  the  remaining  oi-gans  of  the  body 
were  healthy.  These  nodules  nuiy  break  spontaneously,  leaving 
tistulae  which  heal  only  with  the  aid  of  surgical  treatment  and 
then  leave  shiny  radiating  scars  (according  to  Vigadi  this 
affection  resend)les  tuberculosis  cutis  colliquativa  hom.  in  ap- 
pearance). In  exceptional  cases  a  considerable  nodular  enlarge- 
ment of  the  tail  results  from  tubercular  infection  (Moule  & 
Nocard). 

Acute  miliary  tuberculosis  runs  its  course  attended  with 
severe  febrile  and  general  symptoms,  the  true  cause  of  which 
can  not  usually  be  recognized  except  in  animals  already  known 
or  suspected  to  be  tuberculous.  The  symptoms  consist  of  ex- 
treme dullness,  rapid  emaciation,  continuous  or  remittent  but 
invariably  high  fever,  increased  heart  activity  and  weak  but 
rapid  pulse  also  respiratory  difficulty  without  recognizable  per- 
cussion dullness  in  the  lungs.  Animals  thus  affected  usually 
die  in  the  course  of  a  week.  In  a  few  cases  s^inptoms  of  acute 
meningitis  are  observed  (incoordination  of  the  extrinsic  muscles 
of  the  eyes,  nystagmus,  unequal  pupils,  opisthotonus). 

Tuberculosis  of  goats  and  sheep.  Thus  far  only  few  clinical 
cases  have  been  observed.  Mathis  and  Leblanc  observed,  in 
a  goat  four  years  of  age,  emaciation,  coarse  cough,  accelerated 
and  labored  breathing,  bloody  mucous  discharge  from  the  nose, 
bronchial  breathing  and  rales  upon  auscultation  of  the  lungs, 
and  pericardial  friction  sounds.  Edgar  described  a  similar 
case.  In  a  goat  that  became  sick  one  month  after  parturition, 
Hess  observed  loss  of  appetite,  frequent,  moist,  short  and  pain- 
ful cough,  abdominal  respiration,  rapid  decrease  in  flow  of  milk 
but  normal  temperature  throughout.  In  a  goat  with  well  de- 
veloped pulmonary  tuberculosis  Schroeder  observed  that  the 
udder  was  also  affected  and  transformed  into  a  nodulated  pain- 
less tumor  as  large  as  a  man's  li-ead  and  as  hard  as  a  stone. 
Xocard  saw  a  similar  case. 

Tuberculosis  in  sheep  always  runs  a  chronic  course  and 
usually  manifests  itself  in  the  form  of  a  gradually  progressing 
puhuonary  affection.  As  a  result  of  enlargement  of  the  thoracic 
l}7nph  glands  bloating  is  common.  Other  superficial  lymph 
glands  also  become  occasionally  involved  (Mayer). 

Tuberculosis  of  Horses.  The  first  symptom  of  pulmonary 
tuberculosis  in  horses  is  an  occasional  dry,  or  slightly  moist, 

Vol.  1—36 


562  Tuberculosis. 

short,  weak  congli.  Later  on  the  animal  is  easily  exliansted 
after  work,  and  symptoms  of  ''heaves"  make  their  appearance. 
In  some  cases  there  is  slight  mncons  or  mnco-pnrnlent  nasal 
discharge  which  may  also  be  intermittent.  The  discharge  may 
be  streaked  with  blood  or  there  may  be  epistaxis.  Sometimes 
it  may  be  very  profnse  and  consist  of  almost  pnre  pns.  In 
the  act  of  conghing  similar  secretions  and  occasionally  necrotic 
particles  of  lung  tissue  are  discharged  from  the  mouth.  Per- 
cussion of  the  thorax  usually  reveals  nothing  abnormal  and 
auscultation  usually  reveals  nothing  except  rough  vesicular 
breathing  or,  in  addition,  toward  the  end  of  expiration,  fine 
rales.  Occasionally  areas  of  dullness  or  an  extensive  but  sub- 
dued tympanitic  percussion  sound  without  respiratory  bruits 
or  with  bronchial  bruits  may  be  recognized  in  the  posterior 
borders  of  the  lungs  (Goedecke,  Zuern).  In  rare  cases  symp- 
toms may  be  observed  that  point  to  breaking  down  of  lung 
tissue  and  cavity  formation.  Sometimes  a  pleuritis  with  a 
tendency  to  latent  development  accompanies  the  affection  of 
the  lung  proper.  There  are  friction  sounds  and  filirinous  exu- 
date which  later  becomes  serous.  At  a  later  stage  there  is  loss 
of  appetite  and  coincident  with  this  a  gradual  or  rapid  develop- 
ment of  extreme  anemia  and  emaciation. 

In  tuberculosis  of  the  pharyngeal  lymph  glands  Stiennon 
observed  dysphagia,  moist  cough,  muco-purulent  nasal  dis- 
charge, sensitiveness  of  the  pharyngeal  region  and  rattling  ex- 
piration. 

Tuberculosis  of  the  intestines  and  mesenteric  glands  is 
more  frequent,  especially  in  colts,  but  presents  no  characteristic 
swiptoms.  The  affected  animals  are  in  a  bad  state  of  nutrition, 
develop  poorly,  the  flanks  are  drawn  in,  the  abdomen  is  pen- 
dulous or,  on  the  contrary,  ''tucked  up."  There  may  be  oc- 
casional slight  symptoms  of  colic;  defecation  is  irregular,  con- 
stipation alternating  with  diarrhea,  the  latter  finally  becoming 
chronic  and  leading  to  exhaustion  of  the  patient.  The  feces, 
especially  when  large  intestinal  ulcers  are  present,  are  thin  in 
consistency,  yellowish  and  ill  smelling.  Eectal  examination  may 
enable  us  to  demonstrate  the  greatly  enlarged  h^nph  glands 
which  appear  as  tumors  the  size  of  a  man's  fist,  firm,  nodular 
and  movable.  Similar  structures  may  be  felt  below  the  spinal 
column  near  the  kidneys  as  well  as  in  the  liver  and  the  spleen 
(Zuern),  a  form  of  so  called' tabes  mesaraica. 

According  to  Nocard  and  Goedecke  a  comparatively  com- 
mon symptom,  especially  of  tuberculosis  of  the  abdominal 
organs,  is  that  of  polydypsia  and  polyuria.  The  quantity  of 
urine  may,  for  weeks  at  a  time  be  increased  four-fold  and  then 
resemble  that  of  the  carnivora  in  having  an  acid  reaction.  Uric 
acid  is  present  in  large  quantity  while  hippurie  acid  is  dimin- 
ished or  disappears  entirely.  During  febrile  attacks  the  urine 
contains  also  albumen. 


Syiiiptoiiis  in   Horses.  563 

In  a  ease  of  tulioroulosis  of  tlic  aluioiiiiiial  or^rans  Portet  foiiii<l  the  urine 
to  contain  4.")9f  of  urea  and  9.2%  of  uric  acid.  Althou<rii  the  urine  contained  no 
albumen  its  sediment  was  rich  in  homogeneous,  light-refracting,  casts  and  some 
epithelial  casts.  Schindelka  also  observed  jiolyuria  in  one  case  of  tuberculosis  of 
the  lung,  while   Kiiijischeer  demonstrated  albuminuria  in  a  similar  ease. 

Tli(>  lyiii])li  ulaiids  near  tlic  siirfacc  of  llic  l)0(ly  arc  oc- 
casioiially  also  oiilar,ii(Ml.  Tims  in  a  oase  (leseri))ed  by  ]?al)e 
tlio  siil)i)ai'oti(l('al  lyinpli  inlands  foniiod  a  mass  3  to  5  ki;'.  in 
weii>-lit,  but  hardly  underwent  any  eliani>"es  in  the  course  of  a 
year.  In  a  case  o1)sorvod  l)y  Jolino  t^-  Siedam,£>Totzky  and  in 
one  1)y  Roebert  the  prescapuUir  i>lands  were  greatly  onlar^'ed, 
in  the  hist  case  forming'  a  tumor  woiiiiiino-  25  k,"*.  In  a  case 
described  by  Davis  tlie  trachea,  esopliagus,  blood  vessels  and 
nerves  were  involved  but  the  lun,os  were  free  from  tuberculosis ! 
Eberhardt  observed  foci  of  thick  pus  in  the  enlar<>'ed  sub- 
maxillary lymph  inlands  three  years  before  the  death  of  the 
animal. 

In  very  exceptional  cases  tuberculosis  of  the  nasal  mucous 
membrane  may  be  met  with,  which  manifests  itself  exclusively 
in  the  ap]iearauce  of  firm  liray  nodules  with  reddened  borders 
(Behr)  and  in  size  a]^proachin<i-  that  of  a  lentil.  Or  there  may 
be  defects  in  the  mucous  membrane  surrounded  with  raised 
Iwrders  while  nodules  as  lar^e  as  small  peas  are  seen  in  the 
surroundino-  area.  Eventually  the  commencement  of  the  morbid 
process  is  announced  by  intermittent  epistaxis  and  enlari>-ement 
of  the  intermaxillary  glands  into  painless  and  not  sharph"  de- 
fined tumors  as  large  as  a  hulled  walnut.  The  overlying  skin 
is  not  adherent  (Gerspacli).  Again,  the  nasal  mucous  mem- 
brane may  contain  only  a  scar  while  the  firm  intermaxillary 
glands  are  studded  with  miliary,  or  transparently  fibrous,  or 
partly  calcareous  nodules  (Joly).  The  latter  glands  may  also 
consist  of  a  mass  of  nodules  with  cheesy  or  partly  calcareous 
interior  (Xocard). 

Tuberculosis  of  the  udder  is  very  rare.  Parascandolo  & 
Meis  observed  a  case  in  the  "dry"  udder  of  a  mare.  The  lesion 
consisted  of  a  large  tumor  containing  a  thick  cheesy  purulent 
substance. 

Tuberculosis  of  the  skin  and  subcutis  is  equally  rare 
(Schindler,  Goedecke).  Firm,  painful  tumors  approaching  the 
size  of  an  apple  appear  in  numerous  regions  of  the  body,  the 
surrounding  areas  are  edematous  but  the  h^nph  vessels  do  not 
become  prominent.  Some  of  these  tumors  may  break  open  ancl 
the  lesions  are  then  covered  with  dark  brown  scabs. 

The  temperature  is  from  time  to  time  elevated  from  2° 
to  3°  F.  Near  the  termination  of  the  disease  it  ranges  between 
103°  and  105°  F.  (Siedamgrotzky).  Schindelka  and  also  Batt 
observed  morning  exacerbations  and  evening  remissions  with 
comparatively  slow  pulse.  Tabusso  ol)served  diills  and  profuse 
sweating  during  the  exacerbations. 

Coincident  with  tuberculosis  of  the  abdominal  organs  the 
development  of  miliary  tuberculosis  of  the  lungs  is  frequently 


564  Tuberculosis. 

observed.  This  is  characterized  by  high  fever,  excessive 
dyspnea  and  by  a  rapidly  fatal  course.  The  lungs  give  a 
tympanitic  percussion  sound  and  vesicular  Ijruits  upon  auscul- 
tation (Goedecke). 

Tuberculosis  of  Swine.  During  life  the  disease  can  be 
definitely  recognized  only  when  the  lymph  glands  are  involved 
(scroj^hulosis).  In  pronounced  cases  the  submaxillary,  pharyn- 
geal and  cervical  glands  are  excessively  enlarged  and,  through 
confluence,  constitute  firm  nodular  tumors  as  large  as  a  fist. 
They  are  very  sensitive  to  pressure  and  more  or  less  adherent 
to  the  surrounding  tissues.  This  process  is  attended  with  the 
development  of  a  diffuse  swelling  in  the  parotid  region  which 
interferes  with  the  free  movement  of  the  head  and  lower  jaw. 
These  tumors  may  extend  along  either  side  of  the  neck  in  rosary 
fashion  and  additional  tumors  may  be  present  in  the  prepectoral 
region.  Swelling  of  the  lymph  glands  of  other  regions  of  the 
body,  especially  those  of  the  flexor  surfaces  of  the  extremities 
may  also  be  present.  Some  of  these  tumors  may  become  fluc- 
tuating, break  open  and  discharge  a  thick  purulent  or  cheesy 
mass.  This  results  in  the  production  of  a  fistula  which  dis- 
charges cheesy-purulent  secretions  for  a  long  time.  Spon- 
taneous healing  does  not  take  i3lace. 

Tuberculosis  of  the  abdominal  organs,  especially  as  a  pri- 
mary affection  in  young  pigs  manifests  itself  in  slowly  develop- 
ing but  steadily  increasing  impairment  of  digestion.  The  af- 
fected animals  gradually  lose  their  nonnal  vigor  and  liveliness, 
their  tails  lose  the  curl,  the  back  is  humped,  they  stand  around 
listlessly  or  bury  themselves  under  the  bedding  for  hours  at 
a  time.  The  appetite  is  at  first  impaired,  the  animals  selecting 
only  choice  morsels  and  later  refusing  all  food.  Constipation 
and  diarrhea  alternate  and  during  the  latter  ill  smelling  semi- 
fluid feces  mixed  with  cruml)ly  material  are  discharged.  Now 
and  then  there  is  bloating  caused  by  the  accumulation  of  gases  in 
the  intestines.  Later  on  the  flanks  become  hollow,  the  abdomen 
becomes  pendulous  and  the  lower  portion  increased  in  its  trans- 
verse diameter.  If  the  animals  are  handled  they  evince  signs 
of  pain,  the  enlarged  scrophulous  lymph  glands,  and  the  loops 
of  intestines  which  have  become  adherent  by  inflammatory 
process  may  occasionally  be  felt  as  firm  irregular  swellings.  The 
animals  become  more  and  more  emaciated,  the  mucous  mem- 
branes become  pale  and  the  eyes  are  drawn  into  their  sockets. 
Here  and  there  the  skin  is  covered  with  brown  crusts.  The 
weakness  constantly  increases  until  exhaustion  leads  to  death 
after  several  months  of  illness. 

In  tuberculosis  of  the  lungs  there  is  at  first  a  dry,  short, 
suppressed  cough  as  well  as  moderately  accelerated  and  difficult 
breathing.  In  the  course  of  time  the  cough  becomes  more  fre- 
quent and  distressing  and  is  sometimes  attended  with  vomiting. 
In  the  further  course  of  the  disease  the  respiratory  difficulties 
become  excessive,  the  animals  sit  on  their  haunches  and,  with 


Syiiiploiiis   ill    Swine.  565 

their  forele*gs  spread  out  and  extended  breathe  spasinodically 
with  the  aid  of  the  aecessory  nnfseles  of  respiration.  The  nutri- 
tion suffers  from  the  ])ei>innin,i''  except  in  a  few  cases  where 
tlie  disease  takes  a  clironic  course.  'I'lic  aniinals  enunciate 
rapidly,  the  mucous  membranes  become  i)alt',  and  death  results 
from  exhaustion  after  a  few  months  or  sometimes  in  lliree  or 
four  weeks. 

Solitary  tubercles  in  the  brain  ))r()(luce,  at  lirst,  clonic 
spasms  and  forced  involuntary  movements  that  may  be  limited 
to  certain  ,<>rou])s  of  muscles  or  affect  the  whole  body,  l^ater 
there  may  be  i)aralysis  of  certain  cranial  nerves,  or  hemiplegia. 
These  sym])toms  are  ])ai'licularly  fretiuent  in  youni;'  ])i,i;s.  \'<),s;t 
observcil  ])ai'a))le.iiia  and  pr()la))sus  of  the  rectum  in  tuhercidosis 
of  the  fourth  lumbar  vertebra  as  a  result  of  pi-essure  on  the 
spinal  cord. 

Tuberculosis  of  the  eye  nuinifests  itself  in  turbidity  of  the 
cornea  and  accumulation  of  a  ]dastic  exudate  in  the  anterior 
chamber  with  simultaneous  affection  of  the  posterior  re^L^ions 
of  the  ocular  globe.  Keil  saw  l)oth  eyes  of  a  pig  thus  affected. 
Tubercles  in  the  background  of  the  eye  may  also  be  recognized 
with  the  oplitlialm()scoi)e  (Azary). 

The  bones  an<l  joints  are  particularly  liable  to  become 
affected  in  general  tuberculosis.  In  addition  to  individual  ribs 
and  vertebrae  the  articular  surfaces  of  the  bones  of  the  ex- 
tremities may  become  involved.  The  corres])onding  joints  swell 
excessively  and  impede  locomotion.  Now  and  tlien  the  process 
extends  to  the  skin  from  which  point  the  accumulated  cheesy- 
purulent  masses  are  discharged.  Tuberculosis  of  the  petrous 
]iortion  of  the  temporal  bone  causes  vertigo  and  disturbance 
of  bodily  equilibrium.  Occasionally  granulating  growths  are 
observed  in  the  external  auditory  canal  when  the  latter  affection 
exists. 

Acute  miliary  tuberculosis  is,  as  in  other  species,  charac- 
terized l)y  high  fever,  dyspnea,  diarrhea,  rapid  enmciation  an<l 
death  after  a  short  time. 

Tuberculosis  of  Dogs.  The  clinical  picture  of  this  disease 
in  dogs  lias  been  descrihed  most  minutely  l)y  Cadiot  and  by 
Froehner.  The  lirst  symptoms,  though  usually  not  very  con- 
spicuous, are  as  follows:  Capricious  appetite,  slight  emacia- 
tion, exhaustion  on  running,  difficult  breathing,  general  weak- 
ness, etc.  In  some  cases  the  clinical  evidence  of  the  disease 
is  for  a  long  time  limited  to  the  aforementioned  symptoms 
which  are  little  characteristic.  In  the  majority  of  cases,  how- 
ever, symptoms  of  tuherculosis  of  the  lungs  and  abdominal 
organs  make  their  appearance. 

Pulmonary  tuberculosis  begins  with  a  short  dry  cough 
which  may,  in  some  animals  lead  to  vomiting.  Later  on  the 
cough  becomes  more  frequent,  the  patients  discharge  muco- 
purulent secretions,  there  may  be  an  occasional  bloody  dis- 
charge from  the  nose  and  respiration  becomes  more  and  more 


566  Tuberculosis 

labored  (25  to  40  respirations  per  minute).  Dry  or  moist  rales 
may  be  heard  on  auscultation,  and  percussion  gives  in  spots 
a  dull  or  empty  sound.  In  these  areas  the  respiratory  sounds 
are  either  absent  or  they  are  bronchial  in  character.  In  rare 
cases  there  may  be  indications  of  cavities  (tympanitic  or 
amphoric  sounds,  succussion  and  amphoric  respiration).  Sen- 
sitiveness of  the  thoracic  wall,  or  continuous  areas  of  dullness 
which  may  extend  over  the  entire  held  of  percussion,  together 
with  the  absence  of  respiratory  sounds  may,  in  frequent  in- 
stances point  to  the  existence  of  a  pleuritis.  If  this  occurs  on 
the  left  side,  the  beats  of  the  heart,  which  organ  has  been 
displaced  to  the  right,  may  be  felt  on  the  right  side.  In  rare 
cases  there  may  be  symptoms  of  pneumothorax  but  these  are 
always  attended  with  accumulation  of  large  quantities  of  serous 
exudate  (dullness  and  muffled  heart  sounds).  In  the  advanced 
stage  the  greatly  exhausted  and  emaciated  animals  are  tortured 
l)y  a  frequent  spasmodic  cough.  The  secretions  discharged  on 
coughing  are  purulent,  gray  or  greenish  in  color  and,  if  cavities 
are  present,  have  a  bad  odor.  Not  infrequently  there  is  a 
nasal  discharge  which  has  similar  characteristics.  The  exhaled 
air,  also,  has  a  disagreeable  odor. 

Tul)erculosis  of  the  pericardium  occurs  in  the  course  of 
the  disease  in  the  lungs  or  the  pleurae  or  independently  of  the 
involvement  of  any  other  organ.  In  either  case  it  may  lead 
to  the  accumulation  of  large  quantities  of  serous  exudate  and 
manifest  itself  by  the  usual  symptoms  of  an  exudative  peri- 
carditis. The  nature  of  the  aifection  may  therefore  be  recog- 
nized or  suspected  only  b}"  the  insidiousness  of  its  course  or 
by  microscopical  examination  of  aspirated  pericardial  fluid.  If 
the  thoracic  glands  are  much  enlarged  the  lieart  sounds  may 
in  exceptional  cases  become  less  distinct,  the  heart  may  be 
dislocated  upward  and  backward,  and  there  may  be  s^^nptoms 
of  compression  of  the  esophagus   (Marek), 

Tuberculosis  of  the  abdominal  organs  is  indicated  in  a 
general  way  by  impaired  nutrition  as  a  result  of  which  the 
affected  animals  become  emaciated  and  anemic.  If  the  Ivmph 
glands  are  much  enlarged  they  may  be  felt  through  the  ab- 
dominal walls.  The  enlarged  liver  may  be  recognized  in  the 
same  manner,  also  by  the  increased  percussion  dullness  or  by 
the  nodular  border  which  may  be  felt  behind  the  costal  arch 
and  the  xyphoid  appendage. 

In  the  course  of  the  disease  the  temperature  is  periodically 
elevated  (1°  to  2°  F.  or  more).  Toward  its  termination  the 
pulse  becomes  soft  and  rapid,  the  heart  beats  throbbing. 
Hydrothorax  and  ascites  are  comparatively  frequent.  The 
appetite  is  diminished,  thirst  increased  and  the  mucous  mem- 
brane of  the  mouth  is  drv.  Constipation  alternates  with  per- 
sistent diarrhea  during  which  the  intestinal  evacuations  contain 
much  mucus  and  occasionally  also  blood.  Finally,  after  be- 
coming extremely  emaciated  the  animals  die,  the  temperature 
finally  falling  very  low. 


Syniptonis  in    Cats,     Course.  oH" 

111  one  case  Mucllor  oliPcrvod,  on  the  side  of  tlie  nock,  a  tleep  iilcer  with  a 
simious  border  and  torpid  granulating  base.  The  neighboring  lymph  glands  were 
enlarged.  Cadiot  observed  a  fistula  of  the  witlicrs  and  clnoiiic  arthritis  of  tuberculous 
origin. 

Acute  miliary  tiiitcrciiiosis  nuis  a  rapid  course  atleiKK'd 
witli  syin})toins  of  an  acute  infectious  disease  (Petit).  Accord- 
ini;-  to  Cadiot  tuberculosis  in  do^s  may  also  assume  a  ;-iepticemic 
character. 

Tuberculosis  of  Cats.  The  clinical  api)eai'aiice  of  this  dis- 
ease is  as  yet  not  \\i*ll  known.  Since  the  })atliolo,i>'ico-anatomical 
ciian,i>es  are  very  much  alike,  tiie  clinical  synii)toms  are  probably 
similar  also. 

Tims,  J.ellnuinn  observed  the  foHowini;'  iu  two  an.i'ora  cats: 
Excessive  emaciation  and  anemia,  anemic  heart  bruits,  labored 
breathing  and  accelerated,  weak  pulse ;  in  one  case  the  abdominal 
cavity  contained  a  milky  fluid  with  tubercle  bacilli,  there  was 
also  pronounced  leucocytosis;  in  the  other  case  there  was  dull- 
ness u])on  ])ercussion  on  both  sides  of  the  chest  and  bronchial 
breatliini>-;  a  tumor  was  present  in  the  abdominal  cavity,  under 
the  spinal  column.  Hobday  &  Belcher,  in  a  ease  of  general 
tuberculosis,  found  the  sul^parotideal,  the  sulnnaxillary  and  the 
prescapular  lymph  glands  enlarged  and  purulent.  Finally, 
Petit  &  Co()Uot  described  a  case  of  tuberculosis  of  the  skin 
on  the  face  in  which  the  bridge  of  the  nose,  one  cheek  and  the 
corresponding  lower  eyelid  were  transformed  into  one  ulcerat- 
ing surface. 

Course.  Tuberculosis  aiw^ays  has  an  insidious  beginning, 
develops  in  a  chronic  manner  and  usually  preserves  its  chronic 
character  until  its  fatal  terminatioii.  The  development  of  the 
disease  is  usually  so  slow  that  years  may  elapse  before  morbid 
symptoms  point  to  its  presence  and  when  observed  iu  mature 
animals  it  is  usually  found  to  have  had  its  beginning  iu  early 
youth.  The  tuberculous  process,  in  its  slow  and  chronic  course, 
usually  does  not  exert  a  harmful  influence  on  the  general  con- 
dition of  the  animal  until  after  th(^  lapse  of  consideral)le  time, 
which  explains  that  animals  in  well  nourished,  or  prime  condi- 
tion and  in  apparently  perfect  health  may  frequently  exhibit 
extensive  tuberculous  changes  when  slaughtered.  This  is  par- 
ticularly true,  iu  a  general  way,  with  regard  to  tuberculosis 
of  cattle  and  especially  in  cases  of  pearl  disease  of  the  serous 
membranes.  In  many  cases  this  form  of  tuberculosis,  even  when 
far  advanced,  does  not  iu  the  least  affect  the  general  condition 
of  the  animals.  In  other  animals,  especially  iu  young  animals, 
the  disease  usually  runs  a  less  insidious  course.  Tu  young  pigs 
that  are  infected  by  milk  from  tuberculous  cows  the  course 
of  the  disease  luay  be  so  rapid  that  the  progressive  changes 
may  be  noted  from  week  to  week. 

In  the  course  of  this  uaturallv  chronic  affection,  especially 
in  its  later  stages,  acute  exacerbations  occur  from  time  to  time. 


568  Tuberculosis. 

during  wliicli  previously  liealthy  areas  become  involved  by  the 
process.  Bacillary  emboli  give  rise  to  the  development  of 
new  tuberculous  foci  in  remote  organs  or  an  infection  with 
pyogenic  organisms  complicates  the  morbid  process.  The 
chronic  course  of  the  disease  may  be  accelerated  by  influences 
that  exert  a  weakening  action  on  the  body  like  catching  cold, 
railroad  transportation,  overwork,  etc.  Intercurrent  acute 
disease  and  parturition  may  have  the  same  effect  (Froehner 
observed  a  chronic  case  of  tuberculosis  of  the  horse  become 
acute  after  an  attack  of  pleuro-pneumonia  and  Guenther  the 
same  in  a  cow  after  abortion).  Exacerliations  of  this  sort  are 
announced  by  elevation  of  temperature,  symptoms  of  general 
indisposition  and  occasionally  more  frequent  coughing.  After 
a  few  weeks  former  conditions  again  prevail.  In  the  advanced 
stage  of  the  disease  these  temporary  improvements  become 
less  and  less  frequent.  Again,  in  other  cases,  especially  in 
young  animals  and  after  an  intensive  injection  of  virus,*^  the 
disease  may  become  steadily  progressive  and  lead  to  complete 
exhaustion. 

Following  the  entrance  of  numerous  bacilli  into  the  blood 
streani  the  simultaneous  development  of  numerous  tubercles 
or  rapid  increase  of  virus  in  the  blood  may  lead  to  a  fatal  ter- 
mination within  a  few  weeks.  Symptoms  of  acute  miliary  tuber- 
culosis, which  is  an  acute  febrile  disease,  attend  this  condition. 

Tuberculosis  of  tlie  cerebral  meninges  also  runs  an  acute 
course,  while  solitary  tubercles  developing  in  the  substance  of 
the  brain  may  remain  unobserved  for  a  long  time  or  only  cause 
functional  disturbances  of  the  nerves,  especially  spasms  and 
paralysis,  until  they  finally  reach  the  meninges  "and  there  set 
up  acute  inflammation. 

In  large  herds  the  disease  usually  spreads  very  gradually. 
Since  the  development  of  the  disease  in  a  single  animal  may 
extend  over  a  course  of  years,  large  herds  may,  in  spite  of 
infection,  be  kept  up  for  years  or  even  decades.  The  prompt 
removal  of  affected  animals  which  show  physical  indications  of 
the  disease  and  their  replacement  by  younger  stock  may  retard 
a  rapid  deterioration  of  the  apparently  fair  general  condition 
of  the  herd.  However,  in  herds  of  this  sort,  especially  if  they 
are  dairy  herds,  the  disease  will  continue  to  spread  irresistiblv. 
In  the  course  of  time  the  age  limit  at  which  the  first  clinical 
symptoms  of  disease  make  their  appearance  is  gradually  re- 
duced and  accordingly  more  and  younger  animals  must  be 
ranged  out  every  year.  Finally  the  malady  will  make  its  ap- 
pearance as  a  clinically  observable  disease  in  quite  young  ani- 
mals, viz.,  in  the  form  of  tuberculosis  of  the  l>anph' glands,  of 
the  lungs  and  of  the  bones. 

piagnosis.  Even  if  we  exclude  the  early  stages  of  tuber- 
culosis in  which  no  clinical  symptoms  whatever  are  observable 
it  is  only  rarely  possible  even  in  advanced  stages  of  the  disease 


Uiapiosis.  HGO 

to  rccog'iiize  it  witli  absolute  ])Ositiveness.  Tlio  syiii])toiiis 
simply  point,  in  a  general  way,  to  arCeetion  of  certain  origans, 
hut  hardly  enable  us  to  form  an  oi)inion  as  to  the  nature  of 
the  disturbance.  Although  the  diagnosis  is  often  suggested  by 
a  sus])ieion  of  an  infection,  this  of  itself  is  not  sufficient  to  justify 
the  positive  diagnosis  of  tubei'culosis.  Synii)toins  ])ointing  to 
the  existence  of  tuberculosis  are  as  follows:  Insidious  develop- 
ment of  the  disease,  gradual  running  down  in  condition,  stunted 
growth  in  young  animals,  periodical  or  occasional  attacks  of 
fever  without  a])i)arent  cause  and  a  gradually  ])rogressive  af- 
fection of  the  lungs.  Great  importance  should  be  attributed 
to  enlargement  of  the  hnnphatic  glands.  AVhile  the  latter  may 
occur  as  an  independent  affection  it  is  usually  an  indication 
of  tuberculosis  of  the  corresponding  organs.  On  the  other 
hand  enlarged  hnnpli  glands  may,  by  exerting  pressure  on 
neighboring  organs,  produce  disturbances  of  function  (bloating, 
venous  pulse,  lameness)  that  would  justify  the  conclusion  that 
deeper  lying  organs  are  affected. 

In  the  great  majority  of  cases,  however,  an  exact  diagnosis 
is  possible  only  by  the  aid  of  special  diagnostic  methods,  among 
which  microscopical  examination  of  morbid  tissues  and  secre- 
tions, inoculation  of  experimental  animals  and  the  tuberculin 
test  are  of  practical  importances 

Post-mortem  examination  of  slaughtered  animals,  or  of 
animals  that  died  from  the  effects  of  the  disease  is  usually 
the  easiest  method  of  determining  the  tuberculous  nature  of 
existing  lesions,  but  even  in  such  cases  a  microscopical  examina- 
tion is  almost  indispensable  to  enable  us  to  differentiate  with 
certainty  between  tuberculosis  and  other  morbid  conditions 
which  occasionally  show  a  remarkable  similarity  (actinomycosis, 
pseudo-tuberculosis). 

Microscopic  Determination  of  Tubercle  Bacilli.  Tlie  determination 
of  true  tubercle  liaeilli  in  a  tissue  or  secretion  al)solutely  clinches  the 
diagnosis  of  tuberculosis.  Negative  results  of  an  examination  for 
tubercle  bacilli  do  not,  on  the  other  hand,  justify  the  exclusion  of  the 
disease  because  tuberculous  lesions,  especially  cheesy  foci,  may  contain 
very  few  tubercle  bacilli.  If  tul)erele  liacilli  are  present  in  large 
numhers,  however,  they  are  comparatively  easy  to  demonstrate.  But 
in  making  a  diagnosis  it  should  always  be  kept  in  mind  that  there  are 
other  bacteria  with  morphological  and  staining  characteristics  (acid-fast 
liacteria)  that  give  them  a  remarkable  similarity  to  tubercle  bacilli  (see 
p.  571).  However,  these  acid- fast  bacteria,  except  in  paratuberculous 
chronic  enteritis  of  cattle,  are  not  known  to  be  pathogenic.  They  occur 
merely  as  harmless  sapro])hytes  which  have  been  carried  from  the 
outside  into  exposed  cavities  and  canals  and  their  secretions.  It  is 
only  exceptionally  that  they  are  found  in  pathological  tissues  and  thus 
it  is  comparatively  safe  to  regard  all  acid-fast  bacilli  that  are  found 
in  tissues  and  secretions  not  communicating  M'ith  the  outer  world 
(unopened  lymph  glands,  deep  cheesy  foci,  tissue  of  the  udder)  as 
tnherele   bacilli    while   similar   findings   undei-   opposite   conditions   can 


570  Tuberculosis. 

not  be  looked  upon  as  conclusive  evidence.  Strictly  speaking,  this  is 
also  true  in  the  examination  of  milk  because  paratubercle  bacilli  may 
gain  entrance  into  the  lactiferous  ducts  through  the  excretory  canals 
(De  Jong).  Nevertheless  this  is  only  of  rare  occurrence.  (Ostertag, 
in  his  extensive  investigations  along  these  lines  never  found  acid-fast 
bacilli  in  freshly  drawn  milk,  while  Bang  failed  only  26  times  in  2,174 
cases  in  which  tuberculosis  was  diagnosed  on  the  basis  of  an  examination 
of  the  milk.)  Accordingly,  the  demonstration  of  acid-fast  bacilli  in 
milk  drawn  after  the  first  few  streams  from  the  udder  have  been  dis- 
carded may,  though  not  with  absolute  certainty,  be  looked  upon  as 
in  all  probability  indicating  the  presence  of  tuberculosis.  In  regard 
to  other  secretions,  especially  those  of  the  bronchial  tubes,  the  possi- 
bilities of  contamination  are  much  greater  and  conse(|uently  greater 
caution  must  be  exercised  in  making  a  diagnosis  on  the  strength  of  a 
bacteriological  examination.  But  even  in  these  cases  the  demonstration 
of  acid-fast  bacilli,  slender  in  form  and  irregularly  stained,  point  with 
great  probability  to  the  presence  of  tuberculosis  while,  on  the  other 
hand,  the  occurrence  of  these  forms  in  the  vaginal  secretions  is  of  less 
definite  value  and  their  occurrence  in  the  feces  has  slight  significance 
only. 

In  the  living  animal  a  resected  subcutaneous  lymph  gland  or  other  nodule, 
the  purposely  removed  contents  of  an  abscess,  aspirate<l  exudate  from  the  thoracic 
cavity  or  from  the  joints,  suspected  tissue  from  the. udder  removed  with  a  harpoon 
or  milk  drawn  under  aseptic  precautions  are  materials  liest  suited  for  examination. 
Ejecta  from  the  lungs,  nasal  discharge,  pus  from  an  already  open  abscess 
or  joint,  secretions  from  ulcers,  urine,  spermatic  fluid  and  vaginal  secretions  may 
also  be  examined.  Since  animals  seldom  discharge  bronchial  secretions  directly  into 
the  outer  world  (although  expelled  particles  are  now  and  then  to  be  found  adhering 
to  the  wall  immediately  in  front  of  the  animal's  head,  in  the  stall)  these  must 
be  obtained  by  specially  devised  artificial  methods.  Holding  a  cloth  over  the 
mouth  and  nose  and  then  forcing  a  cough  impulse  by  compression  of  the  nostrils 
will  enable  one  to  obtain  particles  of  mucus  which  lodge  on  the  cloth  (Leeuwen). 
The  same  results  may  be  obtained  by  forcing  the  animal  to  cough  against  a  board 
wall  or  a  linen  cloth  held  immediately  in  front  of  it.  After  the  animal  is  through 
coughing,  masses  of  mucus  are  usually  lodged  between  the  tongue  and  molar  teeth 
where  they  can  be  removed  by  hand.  The  mucus  which  remains  lodged  on  the 
pharyngeal  membrane  may  be  removed  by  means  of  a  small  wad  of  cotton  or 
a  sponge  attached  to  the  end  of  a  flexible  rod  (Xocard,  Greffier,  MacFadyean). 
According  to  Ostertag  the  use  of  a  small  spoon  with  handle  about  4-5  cm.  long  is 
more  practical.  Previous  injections  of  pilocarpine  have  no  value,  because  they 
simply  increase  the  quantity  of  secretions,  the  purulent  admixture  containing 
relatively  fewer  tubercle  bacilli.  Hasenkamp  constructed  a  special  instrument  for 
this  purpose  (" Liingenschleimfaengcr"  pulmonary  mucus  collector)  consisting  of 
an  elastic  rod  with  a  pear-shaped  cup  attached  to  one  end.  The  cup  end  is 
inserted  into  the  esophagus,  the  animal  forced  to  cough  and,  after  swallowing, 
the  "mucus  collector"  is  withdrawn,  filled  with  mucus!  Poels  recommends  trache- 
otomy at  the  lower  end  of  the  trachea  and  the  removal  of  secretion  from  the 
posterior  tracheal  wall  with  a  cotton  swab.  Neuhaus  uses  Dieckerhoflf  's  venous 
trocar,  inserting  the  same  into  the  trachea  and  then,  by  means  of  small  chicken 
feathers  passed  through  the  canula,  causes  the  animal  to  eough,  whereupon  the 
expelled  muciis  is  caught  up  by  the  feathers. 

Forcing  a  cough  impulse  while  the  tongue  is  mechanically  pulled  part  way 
out  of  the  mouth  prevents  the  animal  from  swallowing  and  thus  permits  the 
collection  of  expelled  masses  of  mucus;  bending  the  head  forward  and  downward 
while  the  animal  is  coughing  may  enable  one  to  collect  the  discharged  saliva  on 
a  plate  and  then  examine  the  particles  of  mucus  which  it  may  contain  (Klauwers). 

IMicroscopic  examination  of  discharges  from  the  lungs  does  not  always  give 
positive  results  even  in  open  pulmonary  tuberculosis  Negative  findings,  therefore, 
do  not  necessarily  exclude  the  presence  of  tuberculosis.  Among  77  cases  attended 
with  bronchial  rales,  Ostertag  found  tubercle  bacilli  in  only  27.  In  11  cases 
he  found  bacteria  resembling  tubercle  bacilli  in  appearance  and  in  11  other  cases 
short  thick  acid-fast  rods  were  present  while  the  examination  gave  negative  results 
in  29  instances.  He  succeeded  only  once  in  demonstrating  tubercle  bacilli  in  open 
tidjerculosis  without  rales. 


Dctoniiiiiation   of  Bacilli.  571 

Milk  must  always  bo  drawn  under  aseptic  precautions  (p.  558)  and  allowed 
to  sottio  m  a  i-oniful  vessel  (protected  from  exiiosiire)  for  2-4  hours,  or  centrifuged 
and  the  sediment  examineil. 

Methods  of  Staining.  The  acid  fast  tnliende  baiilli  may  be  demonstratcil 
by  various  means  wlii.ii  are  all  based  on  staininjr  fover^^iass  j. reparations,  fixed 
in  the  usual  manner,  with  anilin  dyes,  the  f;ta:niu<,'  juoperties  of  wlii(di  have  been 
intensified  by  the  ad.lition  of  a  mordant  and  then  treating  with  a  mineral  acid 
or  with  aU'oliol.     The  uu>thods  in  common  use  are  as   follows: 

1.  Metho<l  of  Ziehl  &  Nelsen.  Staining  solution:  1.0  gm.  fuchsin,  10.0  gm. 
absolute  ah-ohol,  iUt.O  gm.  .l^c  earbolic  acid  solution;  stain  a  few  minutes  under 
the  action  of  heat;  decolorize  a  few  seconds  in  o'/r  sulphuric  acid,  wash  in  alcohol 
and  re-stain  in  aqueous  methylene  blue  solution.  (The  prepared  staining  solutions 
keep  well.) 

2.  Cablet's  Method.  Stain  in  hot  carbol-fuchsin  as  above  then  place  for 
a  few  seconds  in  mixture  of  1  to  2  parts  of  methylene  blue  and  100  jiarts  of  5% 
sidphuric  acid  to  decoloriye  and  double  stain;  rinse  thoroughly  in  water.  After 
staining  and  drviug  the  stained  coverglasses  are  mounted  in  Canada  balsam  and 
examineil  under  "a  power  of  500  to  600  diameters,  preferably  with  an  oil  immersion 
objective. 

Material  sujiposed  to  contain  only  small  numbers  of  bacteria  may  be  treated 
with  antiformin  before  staining,  as  follows:  Mix  20  to  .30  parts  of  the  material 
to  be  examined  with  l-l  ])arts  antiformin  and  ")•)  to  65  parts  of  water,  shake  and 
let  stand  for  1  to  2  hours.  The  antiformin  will  dissolve  tissue  cells  ami  all  non- 
acid-fast  bacteria  but  will  not  affect  tubercle  bacilli  or  other  acid-fast  bacteria 
which  accumulate  in  the  sedinuMit  of  the  vessel   (riilenhut  and  Kersten). 

^Much's  non-acid-fast  granular  rods  and  granules  may  lie  stained  by  (Jram's 
method,  but  this  re(|uires  24  to  A^  hours  at  body  temperature.  The  Ilerman-Caan 
method  is  more  rapid,  viz.  Staining  fluid:  3  parts  of  a  1%  ammonium  carbonate 
solution  in  distilled  water  and  one  part  of  a  3%  crystal  violet  solution  in  96% 
alcohol;  stain  with  the  aid  of  heat;  decolorize  with  10%  nitric  acid,  then  with 
96%  alcohol. 

Spengler  and  Betegh  recommend  special  staining  methods  for  the  examination 
of  sputa  by  means  of  which,  it  is  claimed,  human  and  bovine  types  may  be 
differentiated.  These  methoils  undoubtedly  produce  beautiful  pictures  but  whether 
they  are  of  value  for  the  purpose  indicated,  or  in  determining  the  spore  characteristic 
of  the  granules  which  they  bring  to  view,  is  as  yet  a  question, 

■  Acid-fast  Paratubercle  Bacilli.  The  property  of  the  tubercle 
bacillus  which  cnahh^s  it  to  retaiu  staius  Avith  which  its  tissues  have 
once  become  impregnated,  even  after  treatment  with  mineral  acids,  is 
not  an  exclusive  characteristic  of  this  1)acillus.  Soon  after  the  discovery 
of  the  tubercle  bacillus  it  was  found  that,  aside  from  the  human  lepra- 
bacillus,  the  smegma  of  the  genital  organs  and  the  cerumen  of  the 
external  auditory  canal  contained  saprophitic  bacilli  that  had  the  prop- 
erty of  retaining  stains  much  like  the  tubercle  bacillus,  though  not 
as  tenaciously.  Spina,  as  early  as  188.%  demonstrated  acid-fast  bacilli 
in  decomposing  lilood,  in  sewage  and  in  the  sputum  of  healthy  human 
beings.  This  property  of  the  tubercle  bacillus,  however,  was  until  very 
recently  regarded  as  a  distinct  characteristic  in  the  examination  of 
pathological  secretions  until  Petri  (1896)  and  later  Rabinowitsch  found 
bacilli  in  butter  and  milk  that  resembled  true  tubercle  bacilli.  There 
is  no  doubt  that  these  forms  had  previously  frequently  been  mistaken 
for  true  tubercle  bacilli.  Since  that  time  bacteria  with  similar  charac- 
teristics have  been  discovered  in  raw  animal  products,  food  stuffs  and 
in  human  and  animal  secretions  and  excrements.  The  differentiation 
of  these  various  forms  from  true  tubercle  bacilli  becomes  the  more 
difficult  since  some  of  thetn  produce  lesions  in  experiment  animals  that 
are  very  similar  to  those  of  tuberculosis. 

The  bacteria  of  this  class  are  without  exception  saprophytes  that 
may  occur  in  soil,  water  and  dust,  decomposing  substances,  food  stuff's, 
manure,  etc.,  occasionally  gaining  access  to  raw  animal  products,  par- 
ticularly milk,  butter  and  oleomargarine.  Occasionally  they  are  also 
found  in  the  bronchial  secretions,  int<'stinal   evacuations  and  urine  of 


572  Tuberculosis. 

man  and  animals  and,  in  exceptional  cases,  in  pathological  tissues,  e.  g., 
pearly  nodules  of  tuberculosis. 

Of  the  acid-fast  bacilli  now  known  the  following  may  be  men- 
tioned: The  Petri-Rabinowitsch  butter  bacillus  which  was  found  in 
52.9%  of  butter  samples  and  in  6.3%  of  milk  samples  by  Petri,  in 
Berlin,  and  by  Rabinowitsch  in  33'%  of  butter  samples  in  Berlin  and 
in  26%  of  butter  samples  in  Philadelphia;  Korn's  bacillus  friburgensis, 
once  found  in  butter;  Moeller's  milk  bacillus,  found  once  in  a  culture 
made  from  butter;  Moeller's  Bacterium  Phlei,  found  by  the  discoverer 
on  timothy  grass  and  later  also  on  other  grasses;  Moeller's  grass  bacillus 
and  dung  bacillus  found  in  the  dust  of  dwellings  and  in  manure.  Later 
on  the  dung  bacillus  was  also  found  in  the  excrement  of  cattle,  horses, 
mules  and  swine ; — Moeller  's  pearl  disease  bacillus,  which  Moeller  culti- 
vated from  pearl  growths  of  cattle  and  swine ; — an  acid-fast  ])acillus 
which  Preisz  found  in  the  nasal  secretion  of  an  ox  suspected  of  having 
pearl  disease; — Binot's  butter  bacillus; — Beck's  Bac.  tuberculoides  I, 
from  milk  and  Bac.  tuberculoides  II  cultivated  from  the  tonsils  of  a 
tuberculous  woman,  etc. — In  addition  to  these,  acid-fast  bacilli  were 
demonstrated :  By  Cowie  in  the  smegma  of  the  horse,  ox  and  dog  as  well 
as  in  the  epithelium  of  the  udder  of  the  cow;  by  DeJong  in  the  milk 
of  cows  with  udder  tuberculosis  and  by  others  in  various  sulistances, 
comparatively  frequently  in  sputum  of  human  beings  with  pulmonary 
tuberculosis  or  pulmonary  gangrene. 

Acid-fast  bacilli  have  certain  common  characteristics  which  make 
it  possible  to  differentiate  them  from  tubercle  bacilli.  According  to 
the  comparative  investigations  of  Aujeszky  these  characteristics  are  as 
folloAvs :  Morphologically  the  paratubercle  bacilli  in  general  resemble 
the  tubercle  bacillus  and  like  the  latter  they  constitute  transition  forms 
leading  to  the  streptothrix  species.  The  great  majority  is  less  acid-fast 
than  the  tubercle  bacillus  and  they  are  also  easily  stained  by  the  simplo 
anilin  dyes ;  some  of  them  are  acid-fast  only  and  not  alcohol-fast,  others 
show  the  same  tinctorial  characteristics  as  the  tubercle  bacillus;  in 
cultures  on  artificial  media,  in  contrast  to  the  tubercle  bacillus,  they 
grow  rapidly  and,  with  few  exceptions,  grow  luxuriantly  also  at  room 
temperature ;  their  cultures  are  moist  and  shiny  and  have  a  brighter 
color  than  tubercle  bacillus  cultures,  often  a  yellowish-red  color;  on 
the  surface  of  bouillon  a  massive  membrane  forms  within  a  few  days 
and  they  frequently  emit  a  pungent  odor  suggesting  decaying  vegetation 
or  ammonia. 

Most  paratubercle  bacilli  exert  a  slight  pathogenic  action  on  ex- 
periment animals.  This  action,  however,  usually  does  not  manifest  itself 
unless  the  cultures  are  administered  in  conjunction  with  some  "envelop- 
ing" substance  like  sterilized  butter  or  oil.  If  thus  administered  intra- 
peritoneally  they  usually  produce  an  exudative  peritonitis  which  often 
leads  to  massive  accumulation  of  deposits  and  to  adhesions ;  in  addition  to 
this,  pseudo- tubercles  make  their  appearance  which  differ  from  true 
tubercles  in  that  they  do  not  become  caseous,  or  only  rarely  so,  but 
have  more  a  tendency  to  become  purulent  or  become  organized ;  in  ex- 
ceptional cases  only  do  they  contain  cells  of  Langhans ;  finally — and 
this  is  perhaps  the  most  important  difference — inoculation  with  these 
forms  produces  only  local  inflammatory  processes  which  do  not  progress 
from  the  primary  foci.  (The  bacillus  of  chronic  paratuberculous  en- 
teritis of  cattle  seems  to  occupy  a  unique  position  in  this  respect  which 
ia  true  also  of  its  cultures.) 

In  spite  of  these  important  differences  between  these  bacteria  and 


I)i:ii;iHistic   Aiiimnl    IiiDculatioii.  573 

tho  Iruc  tiil)i'nK'  li.Killi  iIhit  exist  eci'liiiii  points  of  close  relationship 
■which  lind  expression  in  peculiarities  referred  to  as  group  reactions. 
These  are,  aside  from  morphological  resemblances,  as  follows :  Tlie  for- 
mation of  tuberculin-like  products  in  cultures  as  well  as  their  mutual 
agglutinating  properties  Avhen  treated  with  sera  from  animals  that  have 
been  treated  with  tubercle  bacilli  or  other  acid-fast  bacilli;  also  their 
property  of  immunizing  animals  against  the  effects  of  true  tubercle 
bacilli,  though  this  is  li'ue  only  in  a  slight  degree.  These  and  many 
others  of  the  abovi'  mentioned  common  cliaracteristics  are  doubtless 
indications  of  a  piiylogenetic  relationship  and  hence  arises  the  possil)ility 
that  tubercle  bacilli  represent  acid-fast  saprophytes  that  have  become 
pathogenic  in  the  course  of  time,  or  that  the  latter  are  tubercle  bacilli 
tiuit  have  been  attenuated  through  the  influence  of  external  agencies. 

In  view  of  the  fact  that  the  term  pseudo-tuberculosis  has  already 
been  applied  to  certain  other  morl)i(l  j^rocesses  it  is  suggested  that  the 
acid-fast  l)acilli  under  discussion  ho  referred  to  as  acid-fast  paratul)ercle 
bacilli. 

Diagnostic  Animal  Inoculation.  These  often  give  a  positive  result 
when  the  presence  of  bacilli  in  material  to  be  examined  can  not  be 
demonstrated  with  the  microscope  on  account  of  their  small  numbers. 
The  demonstration  of  the  infectiousness  of  milk,  in  particular,  is  fre- 
(juently  possible  in  no  other  way.  In  other  cases  diagnostic  inoculations 
of  animals  are  necessary  when  a  microscopical  examination  is  by  itself 
insuf^cient  to  determine  ])eyond  question  that  the  suspected  tubercle 
l)acil]i  are  genuine. 

AVitli  a  diagnostic  inoculation  as  a  basis  the  diagnosis  of  tuberculosis 
is  justifiable  only  when  true  tubercles  (in  a  histologic  sense)  have  been 
demonstrated  in  the  inoculated  animal  or  when  tuberculous  processes 
have  spread  from  the  point  of  infection  to  a  neighboring  lymph  gland 
and  to  internal  organs,  liver,  spleen,  lungs  (see  above:  Pathogenic 
action  of  acid-fast  paratubercle  bacilli). 

The  guinea  pig  is,  aliove  all,  adapted  for  this  purpose.  It  is  so 
extremely  susceptible  to  tuberculosis  that  negative  results  from  the 
inoculation  of  suspected  material  may,  in  practice,  be  looked  upon  as 
positive  evidence  that  the  material  was  free  from  tubercle  bacilli.  This 
does  not,  of  course,  exclude  the  possibility  that  material  taken  from 
the  same  animal  at  another  time  may  contain  the  bacilli. 

If  the  probability  of  contamination  is  excluded  (specially  drawn  milk,  pus 
from  a  closed  aliscess,  tissue  juices  from  internal  lymph  g^lands)  the  material  may 
be  injected  into  the  peritoneal  cavity  without  further  preparation,  or  after  being 
merely  diluted  with  water.  However,  if  contamination  is  probable,  or  suspected 
(nasal  discharge,  bronchial  or  ulcer  secretions),  it  is  advisable  to  inject  a  small 
quantity  subcutaneously  in  the  al)donieu  or  on  the  inner  surface  of  the  thigh  or 
into  the  muscles  of  the  latter.  Tn  such  cases  the  foreign  bacteria  will  cause  a  local 
inflammation  resulting  in  an  aliscess  which  will  break  and  discharge  its  contents 
to  the  exterior  and  if  tubercle  bacilli  were  also  present  the  characteristic  patho- 
logical changes  will  develoj)  as  usual.  (According  to  Ostertag  the  intramuscular 
method  is  just  as  reliable  as  the  intraperitoneal  but  preferable  to  the  latter  because 
results  are  obtained  quicker.     Laurier  recommends  intramammary  inoculation.) 

Tn  from  1.5  to  20  days  after  the  intraperitoneal  injection  of  virulent  material 
the  peritoneum,  spleen,  liver  and  ]^^n]^h  glands  contain  tubercles  and  the  liver 
which  assumes  a  mottled  ap]>earance  undergoes  fatty  degeneration.  After  subcutane- 
ous inoculation  an  ulcer,  which  has  little  or  no  tendency  to  heal,  develops  at  the  point 
of  inoculation;  simultaneously  with  the  develo]iment  of  the  ulcer  the  neighboring 
lymph  glands  become  enlarged,  and  later  on  the  process  spreads  to  the  internal 
organs,  especially  the  peritoneum,  liver  and  spleen,  and  in  these  numerous  tubercles 
may  be  found  from  the  25th  to  the  30th  dav  after  inoculation.  After  intramuscular 
inoculations  the  neighboring  lymph   glands  may  be  recognised    (frequently  as  early 


574  Tuberculosis. 

as  the  tenth  day)  as  hard,  firm,  painless,  distinctly  circnmscrihed  tumors  the  size 
of  small  peas  or  larger  (Ostertag).  Later  on  the  internal  organs  are  also  attacked. 
The  enlarged  lymph  glands  may  be  resected  and  examined  under  the  microscope, 
or  the  inoculated  animals  which  in  positive  cases  gradually  emaciate  and  whose 
fur  becomes  rough,  may  be  killed  after  three  or  four  weeks  for  post-mortem 
examination.  After  intramammary  inoculation  tubercles  appear  in  the  niammary 
glands  as  early  as  the  fifth  day  and  the  milk  contains  numerous  tubercle  bacilli. 

Allergic  Tuberculin  Reactions.  Tuberculous  infection  pro- 
duces certain  changes  in  the  animal  body  as  a  result  of  Avhich 
it  reacts  to  a  second  infection  or  to  the  injection  of  toxins  of 
the  tubercle  bacillus  in  a  diiferent  manner  than  the  hodj  of  an 
animal  that  has  not  yet  been  infected.  This  condition,  referred 
to  by  Pirquet  as  allergla,  i.  e.,  altered  power  of  reaction,  mani- 
fests itself  in  increased  resistance  toward  the  virus  in  question 
(see  pp.  530-535)  and  in  hypersensitiveness  to  its  toxins  (a 
kind  of  anaphylaxis).  This"  latter  manifests  itself  in  more  or 
less  pronounced  symptoms  of  inflammatory  reaction  following 
the  administration  of  very  small  quantities  of  the  toxins  which 
Avould  have  no  effect  on  healthy  animals. 

This  hypersensitiveness  is  particularly  evident  with  re- 
spect to  the  tuberculin  Avhich  Koch  prepared  from  glycerin 
bouillon  cultures  and  which  was  recommended  as  a  curative 
agent  in  tuberculosis.  Expectations  along  this  line  have,  how- 
ever, been  reahzed  only  to  a  limited  degree  but  later  experiences 
and  observations  have  confirmed  Koch's  declaration  that,  on 
account  of  its  specific  action  on  a  tuberculous  animal,  tuberculin 
is  admirably  adapted  as  a  diagnostic  agent.  For  years  the 
general  febrile  reaction  which  usually  follows  the  subcutaneous 
administration  of  tuberculin  was  exclusively  depended  upon  for 
this  purpose.  Eecently  however  the  local  ophthalmic  and 
cutaneous  reactions  also  have  attained  great  diagnostic  im- 
portance. 

Tuberculin  and  Its  Preparation.  Koch  prepared  tuberculin  by  growing 
tubercle  bacilli  at  37-38°  C.  for  eight  weeks  in  veal  bouillon  containing  1%  pepton 
and  5%  glycerin.  The  culture  was  then  evaporated  on  a  water  bath  to  one  tenth 
of  its  original  volume,  sterilized  at  100°  C.  and  then  passed  through  a  clay  filter. 
Crude  tuberculin  thus  produced  is  a  clear  brownish-yellow  oily  fluid  which,  in  its 
concentrated  form,  will  keep  unchanged  for  months  but  loses  its  activity  in  dilute 
solution  (according  to  Jansen  light  and  heat  does  not  affect  the  activity  of  the 
concentrated  tuberculin).  By  repeated  treatment  of  the  solution  with  60%  alcohol 
a  white  powder  may  be  obtained,  the  so  called  purified  tuberculin,  of  which  0.1 
gm.  produces  the  same  effect  as  0.5  gm.  of  crude  tuberculin.  This  powder  is  readily 
soluble  in  water  but  aqueous  solutions  are  not  stable.  In  solution  with  50% 
glycerin  and  water  it  keeps  a  long  time  and  is  not  destroyed  even  at  a  temperature 
of  160°  C.    (Brieger  and  Proskauer). 

Tuberculin  adapted  for  diagnostic  purposes  may  be  prepared  in  other  ways 
also.  Thus  Helman  prepared  it  from  a  glycerin  and  water  extract  of  cultures 
grown  on  potatoes  treated  with  alkaline  serum-glycerin  (this  has  only  one-fourth 
the  strength  of  Koch's  tuberculin  but  a  similar  action).  Bujwid  makes  an  extract 
of  glycerin  agar  cultures  by  repeated  treatment  with  water,  sterilizes  the  fluid 
at  100°  C,  filters  through  clay  and  then  concentrates  on  water  bath  (action  identical 
with  Koch's  tuberculin).  Malm  prepares  tuberculin  by  the  use  of  an  artificial 
culture  medium  that  is  free  from  albumen  (the  tuberculin  thus  prepared  nevertheless 
contains  an  albumose-like  substance). 

In  actual  practice  the  tuberculin  prepared  according  to  the  original  method 
of  Koch  is  generally  used.  Tuberculin  prepared  from  human  tubercle  bacilli  is 
effective  in  animals  as  well  as  such  that  is  prepared  from  cultures  of  the  bovine 
bacilli.     Kanda  found  however  that  tuberculin  prepared  from  bovine  cultures  acts 


Snlx'iilaiiodus   Tiilicrculiii    Test. 


.)/.) 


iiioro  promptly  aii<l  iiioio  onorgetically  thau  that  prepared  from  lifioilli  of  the  human 
typo.  i-Jiit  the  oxpi'iimoiits  of  Weber  and  Dieterlin  on  cattle  and  ^Miinoa  pigs, 
agreeing  with  the  assertions  of  Koeh,  DeJong,  Wolliaidi  and  Krnst,  showed  that 
there  was  no  dilferenc-e  in  the  two  kinds  of  tuhereulin,  provided  that  both  have 
the  same  titrc.  However,  since  this  is  not  ascertained  in  all  {ireparations  it  is 
advisable,  in  order  to  be  safe,  esjieeially  with  ruminants  and  swine,  to  use  tuberculin 
exclusively  that  has  been  prejiared  from  bovine  tubercle  bacilli.  Tuberculin  may 
also  be  prepared  from  avian  tubercle  bacilli  but  this  has  a  considerably  weaker 
action   (Borrel). 

Later  Koch  maile  other  tuberculin  preparations  from  aqueous  extracts  of  dried 
tubercde  bacilli  or  from  dried  bacilli  finely  ground  in  an  agate  mortar.  The 
whitish  opalescent  fluid  obtainetl  by  ceutrifuging  the  first  named  extract  represented 
the  iirei)aration  known  as  • '  T.  O. ;  "  tlie  fluid  obtained  by  repeatedly  mixing  the 
residue  with  water  and  ceutrifuging  produced  the  tuberculin  known  as  "  T.  E. " 
The  latter  contains  only  substances  contained  in  tlie  l)odies  of  the  bacilli,  and 
none  of  their  products  of  metabolism.  Koch  ascribes  to  it  a  special  immunizing 
action,  but  since  it  produces  no  reaction  in  tuberculous  animals  it  has  no  value 
for  diagnostic  purposes. 

The  tuberculol  of  Landmann  is  prepared  by  extracting  the  fat  from  tubercle 
bacilli,  making  further  extracts  by  heating  at  various  temperatures  in  physiological 
salt  solution  and  then  concentrating  the  extracts  in  a  vacuum.  This  preparation  is 
more  toxic  than  other  tuberculins. 

Finally  there  are  also  the  simple  culture  filtrates  of  Denys  and  Detre  which 
have  however  not  as  yet  been  useil  in  veterinary  medicine. 

Standardization  of  Tuberculin.  According  to  Koch  0.5  cc.  of  tuberculin 
injected  subcutaneously  into  a  guinea  pig  that  was  infected  four  weeks  before 
nuist  be  suflicientiy  active  to  kill  the  animal  within  30  hours,  producing  intense 
inflammation  at  the  periphery  of  the  tuberculous  foci.  Yon  Behring  indicates  the 
unit  of  toxicity  of  tuberculin  by  the  minimum  quantity  (L+==Limeswerth)  which 
will  kill  the  test  animals  in  24  to  30  hours.  The  toxicity  of  the  Marburg  tuberculin 
is  sutKcient  for  0.2  gm.  to  kill  a  guinea  pig  weighing  400  gm. 

1.  Subcutaneous  Tuberculin  Test  (Thermal  Tuberculin 
Eeaction).  The  characteristic  thermal  reaction  for  tuberculosis 
consists  in  a  ^'radual  rise  of  temperature  beginning  from  the 
6th  to  the  12th  hour 
after  the  subcuta- 
neous injection  of 
the  tuberculin, 
reaching  its  maxi- 
mum from  the  12th 
to  the  21st  hour, 
thereupon  falling 
with  slight  interrup- 
tions until  tlie  nor- 
mal is  reached  at 
the  24th  to  the  40th 
hour.  In  some  cases 
a  second  rise  of 
shorter  duration  is 
observed  (see  Fig. 
93).  The  difference 
})etween  the  maxi- 
mum temperature 

after  injection  and  the  temperature  recorded  before  injection  is 
usuall}'  from  2°  to  4°  or  5°  F.  In  rare  cases  the  fever  curve  just 
described  may  show  variations  in  that  it  may  begin  sooner  or 
much  later  (14tli  to  18th  hour),  and  then,  particularly  in  the 
latter  case,  reach  the  maximum  at  a  later  hour  also. 


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Fig.  93.     Typical  Tuberculin  Keaction. 


576  Tuberculosis. 

Simultaneously  with  the  elevation  of  temperature  the  joulse 
and  respiration  often  become  accelerated,  but  not  infrequently 
they  remain  practical!}^  normal.  Great  depression  and  loss 
of  appetite  are  equally  frequent  and,  in  addition,  usually  from 
the  6th  to  8th  hour,  muscular  tremors  are  observed  (organic 
reaction).  The  milk  secretion  is  usually  somewhat  diminished 
during  the  period  of  reaction  and  on  the  following  few  days, 
owing  to  the  fever  and  the  diminished  appetite. 

The  decrease  in  the  quantity  of  milk  in  reacting^  cows  varies  according  to 
Zsehokke  from  3.2  to  8%,  according  to  Eber  3.4  to  6.1%,  according  to  Bohm  the 
average  is  9.2%,  according  to  Eber  &  Fehsenmeier  the  maximum  is  15%,  according 
to  Martel  3.1%.  According  to  the  investigations  of  Tiraboschi  the  milk  secretion 
decreases  during  the  first  24  hours  after  injection  and  again  becomes  normal  on 
the  third  day.  Xon-reacting  cows,  however,  also  show  a  slight  decrease  (average 
1  kg.  as  compared  with  2  kg.  [15%.]  in  reactors). 

The  intensity  of  the  reaction  and  the  extent  of  the  lesions 
bear  no  relation  to  each  other  unless  this  is  an  inverse  one  in 
the  sense  that  extensively  tuberculous  cows,  hence  emaciated 
and  weak  animals,  usually  react  with  less  intensity  than  robust 
individuals  in  which  the  tuberculous  process  is  in  its  first  stages, 
or  more  or  less  localized.  In  greatly  advanced  cases  reactions 
may  not  take  place  at  all. 

As  a  rule  the  tuberculin  test  does  not  perceptibly  influence 
the  course  of  the  disease  or  the  health  of  the  animal.  In  ad- 
vanced tuberculosis  the  elevated  temperature  (fever)  may  per- 
sist, though  to  a  slight  degree  only,  and  this  may,  to  a  certain 
extent,  excite  the  tuberculous  process  to  greater  activity  and 
hasten  a  fatal  termination.  Virchow  explained  the  unfavorable 
action  of  tuberculin  by  the  supposition  that  the  thermal  process 
mobilized  or  stimulated  the  bacilli  to  greater  activity,  causing 
them  to  multiply  faster  in  the  congested  areas  surrounding  the 
tuberculous  foci.  In  the  lungs  the  increased  bronchial  secre- 
tions were  supposed  to  play  an  especially  important  part  in 
the  dissemination  of  these  organisms. 

As  a  matter  of  fact  tuberculin  exerts  a  peculiar  action  on  tuberculous  tissues 
without  destroying  the  bacilli  which  manifests  itself,  in  some  cases,  in  hyperemia 
and  increased  juiciness  of  the  tissues  as  seen  in  post-mortem  examinations.  This 
local  effect  explains  to  a  certain  extent  why  tuberculin  injections  occasionally 
result  in  the  development  of  acute  inflammations  in  areas  surrounding  old  tuberculous 
foci,  sometimes  causing  cicatrization  and  "healing"  of  the  lesion.  In  other 
cases,  however,  fresh  tubercles  will  develop  in  this  area  and  the  tuberculous  process 
is  fanned  into  reneweo  activity. 

Healthy  animals  are  not  affected  by  as  large  or  larger 
doses  as  will  produce  violent  reactions  in  tuberculous  animals ; 
there  may  occasionally  be  an  increase  in  temperature  not  ex- 
ceeding 2°  F,  but  general  febrile  symptoms  are  still  less  com- 
mon. According  to  Malm  intravenous  injections  of  25.0  gm. 
of  tuberculin  produce  no  toxic  symptoms.  The  same  indiffer- 
ence to  the  action  of  tuberculin  is  observed  in  animals  affected 
with  other  disease  than  tuberculosis,  reports  to  the  contrary 
are  for  the  most  part  based  upon  incorrect  interpretation  of 


Subcutaneous  Tuberculin  Test. 

tlie  reaction  or  of  tlio  post-mortem  liiidings,  or  possibly 
on  mistakes  in  conducting-  the  test. 

Tuberculin  is  therefore  an  extremely  valuable  cliagnos\ 
agent,  especially  in  the  detection  of  latent  tuberculosis.  A 
positive  reaction  to  the  tuberculin  test  is  a  certain  indication 
of  tlie  existence  of  tuberculosis  wliile  the  absence  of  a  positive 
reaction  justifies  the  exclusion  of  latent  tu))erculosis. 

In  inter])reting  a  tuberculin  reaction  the  following  prin- 
ciples are  safe  to  follow  (according  to  the  authors) : 

Animals  over  6  months  of  age  may  be  regarded  as  tuber- 
culous, (a)  if  the  highest  temperature  indicated  in  the  course 
of  a  typical  reaction  exceeds  the  highest  recorded  temperature 
before  the  injection  of  tuberculin  bv  2.7°  F.  or  more  or  if  the 
rise  was  at  least  .9°  F.,  or  higher  tlian  104°  F.;  (b)  if  the  tem- 
perature is  elevated  1.8  to  2.5  or  exceeds  103.1  with  sjanptoms 
of  an  organic  reaction. 

Calves  under  six  months  of  age  must  show  an  increase 
in  temperature  over  104.9°  or  105°  F.  to  indicate  a  positive 
reaction. 

The  animal  may  be  considered  free  from  tuberculosis  if 
the  rise  of  temperature  was  not  more  than  2.7,  and  did  not 
exceed  103.1  and  if  the  animal  showed  no  organic  reaction,  pro- 
vided that  a  systematic  clinical  examination  revealed  no  evi- 
dence upon  which  to  l)ase  a  suspicion  of  the  disease. 

If  the  results  of  temperature  records  and  clinical  examina- 
tions are  interpreted  according  to  the  above  principles  they 
will  be  found  to  agree  with  post-mortem  findings  in  about  98% 
of  all  cases,  thus  possible  errors  will  hardly  exceed  2%. 

However,  the  rules  variously  laid  down  to  he  followed  in  the  in- 
terpretation of  results  of  tuberculin  tests  are  at  present  not  as  uniform 
as  might  be  desired. 

According  to  Xocard  a  reaction  is  to  be  considered  as  positive  if 
the  highest  temperature  after  injection  exceeds  the  highest  pre-injection 
temperature  l)y  2.7,  while  an  increase  of  1.5  to  2.5  indicates  suspicion 
onh'.  In  the  latter  case  the  animal  should  be  re-tested  after  one  month 
and  given  an  increased  dose  of  tuberculin. 

According  to  Eber  pre-injection  temperatures  not  exceeding  103.1 
followed  by  post-injection  temperatures  of  104  or  more,  or  at  least 
exceeding  103.1  and  in  all  cases  indicating  a  rise  of  at  least  1.8  must 
be  regarded  as  positive  reactions  while  post-injection  temperatures  lower 
than  104  and  exceeding  103.1,  but  not  representing  a  rise  of  0.9  to  1.8 
must  be  regarded  as  pointing  to  suspicion  of  tuberculosis. 

According  to  Ostertag  post-injection  temperatures  exceeding  103.1 
and  representing  a  rise  of  at  least  0.9  above  the  highest  pre-injection 
temperature  points  to  the  existence  of  tuberculosis.  In  calves  under 
six  months  of  age  post-injection  temperatures  exceeding  104  and  rep- 
resenting a  rise  of  at  least  0.9  above  the  highest  pre-injection  temperature 
indicate  tuberculosis. 

According  to  the  decision  of  the  International  Veterinary  Congress 
held  in  Budapest  all  cattle  showing  pre-injection  temperatures  not 
exceeding  103.1   and  post-injection  temperatures  exceeding  104    must 

Vol.  1—37 


578  Tuberculosis. 

be  regarded  as  tuberculous  while  all  post-injection  temperatures  above 
103.1  but  not  exceeding  104  must  be  regarded  as  doubtful  and  be  con- 
sidered individually. 

In  interpreting  the  results  of  a  tuberculin  test  the  highest 
temperature  recorded  after  the  injection  of  the  tuberculin  is 
of  paramount  importance  because  the  existence  of  a  reaction 
is  based  upon  the  presence  of  a  distinctly  febrile  condition.  The 
difference  between  the  highest  pre-injection  and  the  highest 
post-injection  temperatures  is  next  in  importance  though  of 
less  value.  The  highest  pre-injection  temperature  must  of 
course  always  constitute  the  basis  of  our  considerations. 

Tuberculin  reactions  will  occur  in  very  early  stages  of 
tuberculosis.  Nocard  and  Eossignol  observed  reactions  from 
the  32nd  to  the  48th  day  after  alimentary  infection,  from  the 
19th  to  the  32nd  day  after  inhalation  infection  and  on  the  13tli 
day  after  injection  of  the  virus  into  the  udder,  while  experi- 
ments made  by  the  Eoyal  Agricultural  Society  showed  that 
reactions  occurred  on  the  8th  day  after  the  subcutaneous  in- 
jection or  the  alimentary  administration  of  infectious  material. 
According  to  MacFadyean  the  maximum  time  elapsing  between 
infection  and  reaction  to  tuberculin  is  51  days. 

In  some  cases  repeated  injections  of  tuberculin  result  in 
immunity  to  its  action.  Thus  some  cattle  that  are  injected 
subcutaneously  Avith  the  usual  dose,  will  fail  to  react,  or  will 
react  only  slightly  to  a  second  application  of  tul^erculin. 
Accordingly  it  is  only  possible  to  judge  the  results  of  a  tulier- 
culin  test  correctly  when  it  is  positively  known  that  the  animal 
in  question  was  not  treated  with  tuberculin  at  any  time  during 
the  preceding  four  weeks. 

Nocard 's  pertinent  experiments  showed  that  of  24  reacting  cows 
only  33%  reacted  to  a  test  applied  24  to  48  hours  later,  50%  reacted 
after  one  week,  60%  after  two  weeks  and  nearly  all  of  them  reacted 
after  the  lapse  of  one  month.  According  to  results  obtained  at  the 
Prussia  sea-quarantine  stations,  however,  cattle  previously  treated  with 
tuberculin  will  always  react  if  five  times  the  ordinary  dose  is  adminis- 
tered, and  Vallee's  experiments  have  shown  that  cattle  will  react  to 
double  doses  administered  36  to  48  hours  after  a  previous  injection 
of  tuberculin.  In  such  cases,  however,  the  reactions  set  in  earlier  (4th 
to  9th  hour)  and  are  of  shorter  duration,  hence  the  necessity  of  record- 
ing post-injection  temperatures  at  two-hourly  intervals  beginning  im- 
mediately after  the  injection  of  the  tuberculin. 

Malm,  Lignieres,  Mettaru  and  Lneders  report  similar  experienees.  In  experi- 
ments made  by  Klimmer  and  Kiesig  S8.3%  of  cows  receiving  an  ordinary  dose 
of  tuberculin  reacted  to  a  double  dose  administered  aftqa-  one  to  three  weeks. 
The  second  reaction  usually  began  at  or  after  the  7th  hour,  but  earlier  in  18.5% 
of  the  eases  and  usually  lasted  only  two  hours,  occasionally  only  one  hour  and  the 
maximum  temperatures  were  lower  than  in  the  first  reactions.  On  the  other  hand, 
Zabala  observed  that  injections  of  the  usual  dose,  repeated  several  times  at  two 
days'  intervals  would  prevent  reactions  to  subsequent   excessive   doses.     According 


Subcutaneous  Tuberculin   Test.  579 

to  Storch  the  siimiltaneoiis  a<lniinistration  of  an  antipyretic  (e.  g.,  30.0  gin.  acetaiiili<l) 
will  prevent  a  thermal  reaction. 

A  positive  typical  reaction  to  tnbeiciiliii  indicates  the 
presence  of  tuberculosis  witli  a  .t»"reat  (le<>ree  of  certainty,  even 
in  the  initial  stai^-es  of  the  disease.  If  the  evidence  revealed 
at  a  post-mortem  examination  does  not  confirm  the  diagnosis 
it  is  more  than  probal)le  that  the  lesions  were  so  minnte,  or 
restricted  to  so  small  an  area  that  they  escaped  detection.  In 
some  instances  the  morbid  process  is  actually  limited  to  a  single 
focns  as  large  as  a  pea  in  a  hmpli  gland,  or  possibly  to  a  diffuse 
swelling  of  some  lymph  glands  (h^^lphoid  stage,  see  p.  532)  or 
a  spotted  reddening  of  their  tissues  (TTottinger).  (Bang,  in 
the  abundant  matiM'ial  at  his  disposal,  found  three  cases  only 
where  reacting  animals  showed  no  lesions  of  tuberculosis  on 
post-mortem  examination. ) 

Tn  the  past  the  lynipli  glands,  which  are  not  infrequently  the  sole  seat  of 
the  tuberciUous  ]HO("ess,  received  little  attention  and  thus  we  have  an  explanation 
of  the  many  apparent  mistakes  in  <liagnosis.  Even  in  those  eases  where  post-mortem 
examination  of  reactinfj  animals  revealed  the  presence  of  some  other  disease  instead 
of  tuberculosis  (actinomycosis,  hotryomycosis,  abscesses  in  internal  organs,  ver- 
minous bronchitis,  distomatosis,  caseated  echinococcus  cysts,  etc.)  it  would  be  difficult 
to  eliminate  the  possibility  that  tubercidosis  did  not  exist  simultaneously  in  some 
orjjan  of  the  body.  Tn  this  connection  the  fact  should  be  noted  that  nearly  all 
animals  upon  which  observations  were  made,  or  which  served  as  a  basis  for  statistics 
on  this  subject,  where  slaughtered  for  meat  and  that  minute  examinations  of  all 
organs,  bones  and  joints  were  out  of  the  questions  for  economic  reasons. 

The  absence  of  a  tuberculin  reaction  does  not  have  the 
same  decisive  diagnostic  value  because  some  animals  with  ad- 
vanced disease  and  suffering  from  disorders  of  nutrition  will 
not  react,  at  least  not  during  the  usual  period  of  observation. 
This  fact,  however,  is  of  little  practical  importance  because 
cases  of  this  kind  can  be  detected  by  their  clinical  SAniiptoms 
or  they  will  at  least  be  suspected.  In  some  of  these  cases  post- 
mortem examination  has  revealed  calcified  foci  in  which  living 
bacilli  could  not  be  found. 

Tt  is  possible  that  in  many  of  the  cases  referred  to  reactions  actually  occurred 
but  were  not  observed  during  the  usual  period  of  observation  (12th  to  21st  hour 
after  injection).  In  experimental  tuberculosis  of  cattle  and  goats  the  reaction  may 
set  in  as  early  as  the  2d  to  5th  hour  and  reach  its  maximum  at  the  (ith  to  9th  hour 
(Arloing).  In  cattle  that  have  previously  received  injections  of  tuberculin 
the  reaction  may  pass  over  sooner  than  normally  and  in  advanced  disease  it  may 
set  in  very  late.  With  these  possibilities  in  mind  a  careful  clinical  examinatioTi 
should  be  made  in  all  cases  where  the  least  suspicion  may  exist  of  the  ]iossible 
])resence  of  the  disease  (chronic  cough,  barrenness,  intestinal,  uterine  or  udder 
affection,  etc.). 

How  important,  aside  from  the  use  of  active  tuberculin,  a  correct  interpretation 
of  the  reaction  and  the  experience  of  the  ol)server  or  veterinarian  really  is  shown 
by  the  results  of  tuberculin  tests  in  Bavaria  (1S95-1899)  according  to  which  errors 
in  positive  diagnosis  fell  from  13..5%  to  2.6%  in  four  years  and  those  of  negative 
diagnosis  from  11.1%  to  5.7%. 

According  to  Bang  tuberculosis  may  be  recognized  in  96%  of  all  cases  sub- 
jected to  careful  and  accurate  tulierculin  test.  Malm  gives  as  his  estimate  under 
'the  same  conditions  2%  of  failures  in  recognizing  the  disease.  According  to 
Jensen's  compilations,  of  46^  tuberculous  animals  90.8%  reacted,  4.9%  failed  to 
react  and  4..3%  gave  doubtful  reactions;  of  290  non-tuberculous  animals  14.5% 
reacted,    81.7%    did   not    react   and   .3.8%    gave   doubtful    reactions.      According   to 


580  Tuberculosis. 

Eber's  statistics  eovering  563  cases  post-mortem  findings  confirmed  86.9%  of  all 
results  of  tests  and  failed  to  confirm  13.1%.  Carini  reports  still  less  favorable 
results:  In  361  cattle  tested,  post-mortem  findings  failed  to  confirm  17%  of 
diagnoses  based  upon  the  tuberculin  test.  In  a  test  made  by  the  authors  and 
eovering  1.56  cattle,  only  2%  of  the  diagnoses  failed  to  be  confirmed  at  post-mortem 
examination.  Schuetz  reports  results  of  accurately  controlled  tests  including  755 
cattle  in  which  T.  A.  was  used  on  255  and  T.  O.  on  500  animals.  Only  2.9% 
of  unconfirmed  diagnoses  were  noted.  Finally,  of  24,784  positive  reactions  in  cattle 
observed  in  the  United  States  from  1903  to  1908,  98.9%  were  confirmed  on  post- 
mortem examination  (Mohler). — In  echinococcus  disease  and  in  actinomycosis 
Nocard  never  noted  positive  reactions.  The  authors  never  saw  positive  reactions 
in  actinomycosis. 

In  tlie  practical  application  of  tlie  tuberculin  test  the  fact 
should  alwa5^s  be  considered  that  positive  reactions  indicate 
tuberculous  infection  merely  and  neither  the  degree  nor  the  seat 
of  the  tuberculous  process.  It  is  a  notable  fact  also  that  a  posi- 
tive reaction  is  not  necessarily  the  result  of  a  clinically  manifest 
lesion  which  may  be  present,  but  that  it  may  have  l)een  brought 
about  by  an  otherwise  unimportant  and  inconspicuous  lesion 
in  another  organ  of  the  body  (of  especial  importance  in  the 
diagnosis  of  tuberculosis  of  the  udder). 

In  other  species  of  animals  the  tuberculin  test  has,  in  most  instances, 
given  similar  results.  Bang  found  the  test  reliable  in  the  horse ;  Eich- 
horn  obtained  accurate  results  in  three  goats ;  in  swine  the  test  proved 
reliable  in  six  cases  reported  by  Bang,  in  58  eases  by  Mohler  and 
Schroeder,  while  Thiro  found  21  tuberculous  swine  among  24  reactors. 
According  to  Thiro  a  rise  of  temperature  above  103.7°,  providing  it 
exceeds  the  pre-injection  temperature  by  at  least  1.8°,  and  according 
to  Schroeder  and  Mohler  a  rise  of  1°  should  be  regarded  as  a  positive 
reaction.  In  dogs  the  results  seem  to  be  less  reliable.  Although 
Froehner  noted  a  marked  elevation  of  temperature  (1.2°  to  3.7°)  in 
eight  cases,  a  number  of  tuberculous  dogs  did  not  react  and  in  one 
positively  infected  animal  there  was  a  drop  of  0.7°.  In  other  diseases, 
excepting  one  case  of  generalized  sarcomatosis,  no  reactions  were  noted. 
Poenaru  observed  positive  reactions  in  only  6  out  of  13  dogs  affected 
with  tuberculous  exudative  pleuritis.  Finally,  a  tuberculous  monkey 
tested  by  Froehner,  receiving  0.01  gm.  of  tuberculin,  gave  a  reaction 
of  4.5°  F.     Hoch  also  observed  prompt  reaction  in  one  case. 

The  nature  of  the  action  of  tuberculin  is  as  yet  only  imperfectly 
understood.  The  fact  that  healthy  animals  may  receive  comparatively 
large  doses  (guinea  pigs  2.0  gm.,  dogs  1.0  gm.,  cattle  25  gm.)  without 
reacting  or  being  otherwise  injuriously  affected,  and  that  tuberculous 
animals  will  react  upon  the  application  of  much  smaller  doses  but  only 
after  a  certain  time  has  elapsed  after  its  application,  points  to  the 
probability  that  the  reaction  is  due  to  some  sul)stance  which  is  present 
in  the  body  of  an  infected  animal  and  with  which  the  tuberculin  com- 
bines or  in  the  presence  of  which  the  tuberculin  forms  a  new  substance. 

Wassermann  and  Bruck  advance  the  theory  that  the  tuberculous  foci  become 
charged  with  body  fluids  and  nugrating  blood  cells  under  the  influence  of  tuberculin 
and  that  as  a  result  the  diseased  tissue  undergoes  a  breaking  down  process.  Certain 
tubercle  bacilli  in  the  tuberculous  foci  die  off,  are  dissolved  and  extracted  by  the 
neighboring  cells  and  body  fluids,  their  tuberculin  is  taken  up  by  the  surrounding 
fluids  and  the  production  of  antituberculin  is  the  result.  Injected  tuberculin  is 
attracted  to  these  foci  by  virtue  of  its  avidity  for  its  antibody ;  this  combination 
causes  complement  fixation  or  concentration  of  complement  in  the  tuberculous  tissue 
and    as    a    result    albumin    is    dissolved    or    digested.      The    resulting    ])roducts    gain 


8ubfutaiR'ou.s  Tul)er('iiliii    Test.  581 

aecess  into  the  circulation  ami,  together  with  the  pyretic  action  of  the  tuberculin, 
tiring  about  the  general  elevation  of  temperature.  As  a  result  of  in.iecting  tuberculin, 
antibodies  develop  in  the  biooil  and  when  further  injections  of  tulierculin  are  made 
these  antibodies  neutralise  its  effect  before  it  can  reach  the  tuberculous  foci  ami 
thus  no  reaction  takes  place.  In  very  recent  cases  large  quantities  of  antituberculin 
are  present  in  tuberculous  foci,  but  in  ohl  lesions  where  the  cells  are  completely 
destroyed  or  caseated  antituberculin  can  no  longer  be  formed  even  though  tuberculin 
is  present,  heme  the  absence  of  reaction  in  such  cases.  According  to  this  theory 
then,  reaction  is  the  result  of  the  attraction  of  tuberculin  by  its  antibody  into 
the  diseased  centers  and  the  concentration  of  the  tissue-destroying  forces  of  the 
body  at  these  points.  Immunity  to  the  action  of  tuberculin  injections  results 
from  the  production  of  antibodies  following  the  first  injection  which  then  prevent 
later  injections  from  reai  hing  the  diseased  foci  before  the  tuberculin  is  neutralized. 

Weil  and  Nakayama  as  well  as  Dieterlen  also  demonstrate<l  antituberculin 
in  tubcrodous  organs  while,  on  the  other  hand  iforgenroth  an<l  Eabinowitsch 
faileil  in  their  researches  to  find  either  antituberculin  or  any  other  si)ecific  antibody 
in  the  serum  or  tissues  of  tuberculous  animals.  Moiissu  showe<l  that  cattle  that 
received  intraperitoneal  injections  of  cultures  of  tubercle  liafilii  filtered  through 
porcelain  tubes,  also  reacted  when  treated  with  tuberculin,  thus  proving  that  the 
reaction  is  due  to  the  proilucts  of  metabolism  of  the  liacilli  and  not  to  the  bacilli 
themselves. 

According  to  Eber's  view  the  increaseil  physiological  activity  of  the  cells 
causes  tuberculin  to  produce  tuberculopyrin  and  under  the  action  of  the  resulting 
l)vretic  condition  of  the  body  the  auto'tuherculin  already  present  in  the  bo<ly  of 
the  tuberculous  animal  produces  ad<litional  quantities  of  tuberculopyrin.  Acconling 
to  Marmorek  tuberculin  stimulates  the  bacilli  in  the  body  to  the  production  of 
toxins  which,  passing  into  the  circulating  flui.ls  of  the  body,  cause  the  resulting 
fever.  And  since  the  1  odies  of  animals  with  extensive  foci  of  infection  alrea<ly 
contain  these  toxins  in  large  quantities  a  slight  adilitional  amount  has  no  appreciable 
effect  and  hence  no  reaction  follows.  According  to  Behring  the  active  principle  of 
tuberculin  consists  in  tuberculinic  acid  (a  combination  of  phosphorus  free  protamine 
and  phosphoric  nucleic  acid)  the  effect  of  which,  ou  guinea  pigs  is  100  times  as 
violent  as  that  of  tuberculin.  Arloing  and  Bancel  foun<l  that  the  injection  of 
ferum  from  a  tuberculous  cow  or  the  expressed  juice  of  large  masses  of  tubercles 
did  not  pro'luce  reactions  in  tuberculous  cattle,  goats,  dogs  or  guinea  pigs. 

Technic  of  the  Subcutaneous  Tuberculin  Test.  Tuberculin  used  for  diagnostic 
purposes  is  usually  diluted  with  nine  parts  by  weight  of  a  5%  solution  of  carbolic 
acid.  The  ordinary  dose  of  common  tuberculin  (tuberculin  A)  is  as  follows:  Adult 
cattle.  0..30  to  O.oO  gm.  according  to  size,  yearlings  0.20  gm.,  calves  under  six 
months  0.10  gm.,  the  doses  for  horses  are  the  same  as  those  given  for  cattle;  goats 
ami  sheep,  0.02  to  0.03  gm. ;  swine.  0.05  to  0.10  gm.;  dogs,  O.Oo  gm.  The  fluid  is 
preferaldv  injected  at  the  side  of  the  neck  into  the  subcutaneous  connective  tissue 
and  not  "into  the  muscles.  The  hair  should  be  clipped  and  the  skin  disinfected 
over  a  small  area  before  injection  is  made. 

The  test  should  be  conducted  in  well  ventilated  stables  that  are  not  kept  too 
warm.  The  animals  to  be  tested  should  be  perfectly  rested  and  under  normal 
conditions  of  feed,  shelter  and  surroundings.  A  pre-injection  temperature  should 
be  ascertained  immediately  before  injection  and.  if  possible,  twelve  hours  previous 
to  this  time,  preferably  in  the  morning.  (A  more  practical  and  reliable  procedure 
is  to  record  at  least  three  pre-injection  temperatures  at  intervals  of  three  or  four 
hours,  but  not  less  than  two  hours,  the  last  pre-injection  temperature  to  be  taken 
immediately  before  the  tuberculin  is  injected. — Translator.) 

In  animals  affected  with  fever  the  test  .loes  not  give  reliable  results,  it  is 
therefore  advisable  to  wait  with  such  animals  until  they  regain  their  normal  con- 
ilition.  It  is  best  to  make  the  injections  late  in  the  evening  or  some  time  during 
the  night,  reactions  that  may  occur  can  then  be  observed  early  the  following 
morning  or  some  time  during  the  day.  Animals  should  be  kept  at  perfect  rest 
and  under  accustomed  conditions  of  feeding,  stabling  and  watering.  After  injection 
the  temperature,  pulse  and  respiration  should  be  recorded,  if  possible,  every  two 
hours,  but  at  least  every  three  hours.  Where  circumstances  do  not  permit  this 
arrangement  the  animals  should  be  under  observation  at  least  from  the  6th  to 
the  21st  hour  after  injection.  The  uninterrupted  observation  of  the  animal  between 
the  eth  and  Sth  hours  is  of  special  importance  because  muscular  trembling  and 
other  general  svmptonis  usually  appear  at  this  time.  Since  reactions  may  some- 
times set  in  at'  an  unusually  late  hour  animals  must  be  kept  under  observation 
and  have  their  temperature  recorded  after  the  21st  hour,  if  the  temperature  sliows 
a  tendency  to  rise  at  that  time  unless,  of  course,  a  decided  reaction  has  already 
taken  place.     The  recording  of  the  temperatures  should,  in  such  cases,  be  contmue<l 


582  Tuberculosis. 

until  it  l.egins  to  drop  again,  the  object  of  our  observations  being  to  determine 
the  highest  temperature  reached  after  the  injection  of  the  tuberculin  which  is 
possible  only  by  following  this  rule.  In  order  to  obtain  accurate  results  for 
comparison  of  temperature,  the  same  thermometer  should  always  be  used  for  the 
same  animal  throughout  a  test.  Animals  should  not  be  watered  immediately  before 
taking  the  temperature. 

In  sucking  calves  the  results  of  tests  are  less  reliable  for  which  reason  it 
is  best  to  defer  the  test  until  they  are  six  months  of  age.  Animals  with  clinical 
symptoms  of  tuberculosis,  very  old  and  very  emaciated  animals  may  give  very 
unreliable  or  unexpected  results  and  for  practical  purposes  might  as  well  be  excluded 
from  the  test. 

Malm  and  Kitt  recommend  the  intravenous  injection  of  tuberculin  on  account 
of  the  earlier  appearance  of  the  reaction.  If  for  example  the  tuberculin  is  injected 
from  7:00  to  9:00  A.  M.  the  reaction  may  set  in  between  12:00  noon  and  5:00  P.  M. 

(The  dose  of  American  commercial  tuberculins  is  usually  indicated  in  the 
instructions  furnished  by  the  manufacturers.) 

2.  The  Ophthalmic  Tuberculin  Test  (Oplitliahnoreactiuii, 
Coiijiinetival  Reaction).  Wolff-Eisner  (1907)  and  almost  sinml- 
taneously  Calmette  also  observed  that  a  few  drops  of  tnliercnHii 
applied  to  the  conjnnctival  sac  of  tnherculons  j^ersons  produced 
an  inflammatory  reaction  manifesting  itself  in  reddening  and 
swelling  of  the  conjunctiva.  During  the  same  year  Vallee 
demonstrated  that  a  similar  reaction  takes  place  in  cattle  and 
subsequent  investigations  of  other  authors  have  shown  that 
this  test  is  quite  valuable  for  diagnostic  purposes,  especially 
when  concentrated  bovine  tuberculin  is  used.  A  pronounced 
positive  reaction  to  this  test  may  be  considered  as  almost  con- 
clusive evidence  .of  the  presence  of  tuberculosis.  However, 
since  animals  known  to  be  affected  with  tuberculosis  may  not 
very  infrequently  give  negative  reactions  to  this  test,  the  ab- 
sence of  a  positive  reaction  does  not  necessarily  exclude  tuber- 
culosis. 

In  cattle  the  conjunctival  reaction  usually  sets  in  between  the 
6th  and  9th  hour  or  a  little  later.  It  manifests  itself  in  watering  of 
the  eyes,  reddening  and  edematous  swelling.  Later,  between  the  12th 
and  24th  hour  there  is  a  production  of  purulent  secretion  which  accumu- 
lates under  the  nasal  canthus  of  the  eye  in  the  form  of  an  elongated 
mass  (see  Plate  III)  which  finally  drops  off  or  dries  up  to  form  a 
yellow  crust.  The  reaction  continues  until  the  36th  to  48th  hour  or 
even  three  or  four  days.  To  be  positive  the  reaction  must  consist  of 
a  purulent  conjunctivitis  (polynuclear  leucocytes  in  turhid  yellow 
exudate).  A  catarrhal  inflammation  attended  only  with  profuse  water- 
ing of  the  eyes  or  mucous  exudate,  especially  if  concentrated  tuberculin 
has  been  used,  may  follow  in  perfectly  healthy  animals.  The  severity 
of  the  conjunctivitis  is  of  course  no  indication  of  the  extent,  or  stage, 
of  the  tuberculous  process.  A  simultaneous,  or  a  previous  subcutaneous 
injection  of  tuberculin  has  no  effect  on  the  conjunctival  reaction,  except 
that  in  some  instances  the  conjunctivitis  is  even  more  pronounced. 
Occasionally  when  the  subcutaneous  test  is  applied  to  tuberculous  ani- 
mals that  have  previously  reacted  to  the  conjunctival  test  the  ophthalmic 
symptoms  may  again  manifest  themselves.  As  a  result  of  hypersensi- 
tiveness  of  the  conjunctiva  folloAving  the  eye  test  a  repetition  of  the 
latter  may  result  in  a  more  pronounced  reaction  than  before.  The 
conjunctival  reaction,  even  if  excessive  or  severe,  does  not  affect  the 
general  condition  of  the  animal  nor  reduce  the  secretion  of  milk. 


INSERT  FOLDOUT  HERE 


Oplithaliiiic  Tuhereulia   Test.  5g3 

The  first  oonjiinctival  tests  that  wore  made  on  cattle  (Vul  not  give  very 
nniforni  results,  ])rol)alily  bocanse  they  were  made  with  weak  sohitions  of  tuherculin. 
While  Valh'e,  Liynieres,  Ciiorin  and  Delattre  reported  very  satisfactory  results, 
ArloinjT,  Vanderhey<1en,  Oratz  and  Keinecke  would  not  admit  any  practical  value 
whatever  for  this  test.  Subsequently,  however,  (iarth,  Kranich  and  Gruenert  showed 
that  althoutrh  dilute  solutions  of  tuberculin  }jave  unreliable  results,  concentrated 
material  produced  <listinct  and  specific  reactions.  By  using  50%  tuberculol  they 
succeeded  in  demonstrating  the  presence  of  the  disease  in  96.1%  of  reactors  at 
the  time  of  slaughter. 

Since  then  nearly  all  eye  tests  have  ])een  conducted  with  concentrated  bovine 
tuberculin  with  results  corres])ondingly  more  favorable.  Thus  Sekyra  reports  l.'3.9% 
of  errors  in  the  diagnosis  of  S2  cattle,  Eiiditer  14.7%  of  doubtful  results  and 
16%  of  positive  errors  in  7.")  cattle,  Opalka  and  Duering  hail  10%  of  negative 
reactions  in  66  tuberculous  cattle,  while  on  the  other  hand  Klimmer  and  Kiessig 
found  8.3.,S%  of  reactors  tuberculous  at  post-mortem  examination  after  slaughter, 
and  of  14  non-reactors  all  were  found  to  be  free  from  the  disease  at  slaughter; 
of  121  cattle  that  were  tested  by  both  the  conjunctival  and  the  subcutaneous  methods 
S7.6%  gave  the  same  results  for  both  tests,  while  12.4%  gave  different  or  opi)Osite 
results.  Similarly  favorable  results  arc  reported  by  Marinescu  for  820  cattle, 
Meyer  for  1.50  and  Bellini  for  200  test  cattle.  Basing  his  conclusions  on  487 
conjunctival  tests  of  412  Panish  quarantine  cattle  and  66  tests  of  that  number 
of  inland  cattle  Foth  found  that  the  test  gave  pronounced  and  positive  results 
in  about  505  of  such  cattle  as  had  ceased  to  react  to  the  subcutaneous  test  on 
account  of  previous  applications  of  tuberculin. 

Technic  of  the  Ophthalmic  Test.  With  the  head  of  the  animal  secured  by 
an  assistant  a  few  drops  of  tuberculin  are  dropped  into  the  conjunctival  sac  by 
means  of  a  pipette,  or  the  tuberculin  may  be  applied  with  a  camels'  hair  brush 
on  the  lateral  jiortion  of  the  bulbus,  whereupon  the  closed  eyes  are  slightly  massaged 
for  one-half  to   one  minute. 

The  material  used  should  be  50%  of  concentrated  bovine  tuberculin.  In 
Germany  bovotuberculol  D  Sol.  I  and  50%  tuberculin  A  Dohna  has  been  found 
effective.  Foth  however  obtained  good  results  also  with  a  5%  solution  of  dry 
tuberculin.  It  seems  that  tuberculins  containing  ground  or  pulverized  bacilli 
(endotoxins)   are  better  adapted  for  local  tests. 

The  result  of  the  test  is  determined  between  the  12th  to  24th  hour  after 
application  of  the  tuberculin.  The  untreated  eye  serves  as  a  check  or  control. 
Particular  attention  should  be  paid  to  the  character  of  the  exudate  and  to  the 
appearance  of  the  membrana  nietitans.  In  positive  reactions  the  latter  is  intensely 
reildened  and  its  normally  sharp  border  is  swollen  or  thickened.  In  exceptional 
cases  the  reaction  may  persist  for  three  or  four  days. 

Other  mucous  membranes  besides  the  conjunctiva  have  been  found  to  be 
hypersensitive  to  applications  of  tuberlin  in  tuberculous  animals,  Richter  calls 
attention  to  the  special  adaptability  of  the  A-aginal  mucous  membrane  for  this 
purpose.  After  application  of  the  bovotuberculin  to  the  accessible  portion  of 
the  mucous  membrane  of  the  vagina,  the  reaction,  if  positive,  will  manifest  itself 
in  redness,  swelling,  and  the  production  of  a  glairv,  whitish  mucous  or  sometimes 
purulent  exudate.  Although  the  results  are  equally  as  accurate  as  those  of  the 
conjunctival  test  (20%  errors)  this  method  is  hardly  to  be  considered  as  practical 
on  account  of  the  possibility  of  secondary  infection  which  might  interfere  with  the 
diagnosis. 

3.  Tuberculin- Cutaneous  Tests  (Dermo-reaction,  intra- 
dermal reaction).  Since  Pirqnet  (1907)  lias  shown  that  the 
inoculation  of  minimal  quantities  of  tuberculin  into  the  upper 
layers  of  the  cutis  of  tuberculous  persons  produced  local  red- 
dening" and  swelling-  at  the  point  of  inoculation,  Vallee  applied 
this  new  diagnostic  method  in  horses  and  cattle  with  the  same 
satisfactory  and  positive  results.  The  scarified  area,  into  which 
tuberculin  had  been  rubbed,  usually  showed  a  distinct  reaction 
in  tuberculous  animals  while  healthy  animals  showed  sli.g'ht 
inflammatory  reddening  at  the  border  of  the  area  only  in  ex- 
ceptional cases.  Since  then  other  investigators  have  verified 
these  results  and  thus  proved  tlie  specific  value  of  the  cutaneous 
reaction.    Tlie  technic  of  the  method  has  been  variouslv  modified 


584  Tuberculosis. 

and  reactions  were  brought  out  in  different  forms,  but  all  are 
based  upon  the  hypersensitiveness  of  the  cutaneous  tissue  of 
tuberculous  patients.  In  all  of  these  methods  the  reactions 
are  due  to  the  same  underlying*  principles  and  the  results  are 
rather  uniform  especially  in  the  fact  that  distinct  positive 
reactions  have  a  considerably  greater  diagnostic  value  than 
negative  results.  Cutaneous  reactions  differ  from  the  con- 
junctival reaction  in  that  simultaneous  subcutaneous  injections 
of  tuberculin,  or  injections  made  a  short  time  before,  may  pre- 
vent the  development  of  the  former. 

The  cutaneous  reactions  vary  accordmg  to  the  method  of  application 
of  the  tubercuhn.  In  all  cases,  however,  there  is  local  inflammation 
and  serous  infiltration  of  the  tissues,  the  symptoms  usually  becoming 
pronounced  on  the  second  or  third  day,  and  the.v  may  persist  until 
the  fifth  day.  When  the  first  test  gives  a  doubtful  result  it  is  advisable 
to  repeat  it  with  equal  or  double  doses  of  tuberculin.  This  frequently 
brings  out  a  decisive  reaction. 

(a)  Cutaneous  Reaction.  According  to  Vallee  an  area  about  the 
^ize  of  a  silver  dollar,  on  the  shoulder  or  chest  wall  is  shaved  perfectly 
smooth  and  the  cutis  scarified  with  a  sharp  scalpel  (incisions  may  l)e 
parallel  or  intersect  each  other)  whereupon  a  50%  or  concentrated 
tuberculin  is  applied  with  a  brush  to  the  slightly  bleeding  surface. 

If  the  reaction  is  positive  there  will  be  a  distinctly  visible  and 
palpable  infiltration  of  the  border  of  the  wound  and  an  edematous 
infiltration  of  the  area  surrounding  the  field  of  operation.  This  per- 
sists from  one  to  three  days  and  may  occasionally  result  in  a  separation 
of  the  epidermis.  In  negative  cases  the  borders  of  the  wounds  made 
by  the  scalpel  show  only  a  slight  swelling  (mainly  traumatic  reaction) 
Avhich  rapidly  disappears.  As  a  control  or  check  it  is  advisable  to 
prepare  a  similar  scarified  area  to  be  left  untreated  with  tuberculin. 

Vallee,  Moussu  and  Lignieres,  as  well  as  Pirquet  and  Sclmiierer  obtained 
results  of  definite  diagnostic  value  with  this  method  while  Vanderheyden,  Garth, 
Kranich  and  Grunert  as  well  as  Reinecke  express  themselves  unfavorably  in  regard 
to  results  obtained.  Klimmer  and  Kiessig  who  applied  this  method  on  the  udder 
report  42.9%  of  failures  in  diagnosis. 

(b)  Dermoreaction.  Lignieres  applies  the  tuberculin  to  the 
cleansed,  and  shaved  surface  of  the  skin,  without  previous  scarification. 
In  case  of  a  positive  reaction  the  area  in  question  becomes  reddened, 
painful  and  edematous  after  about  twenty-four  hours.  Occasionally 
there  are  small  pustules. 

According  to  Lignieres  from  15  to  20%  of  tuberculous  cattle  fail 
to  react  to  this  test.  Vallee  succeeded  in  obtaining  a  reaction  in  13 
out  of  18  tuberculous  animals  while  Klimmer  and  Kiessig  record  37% 
of  negative  results  in  known  tuberculous  cattle. 

(c)  Intradermal  (intracutaneous)  Reaction.  This  consists  of  a 
circumscribed  edematous  swelling  of  the  skin  following  the  injection 
of  0.1  cc.  of  50%  tuberculin  into  the  tissue  of  the  cutis.  According  to 
Moussu  and  Mantoux  the  folds  of  the  skin  between  the  base  of  the  tail 
and  the  anus,  stretched  tense  by  elevating  the  tail  are  best  adapted  for 
this  test.  In  positive  reactions  the  fold  which  received  the  injection 
of  +uberculin  swells  up  to  the  size  of  a  hulled  walnut  or  more  in  the 
course   of  twenty-four   hours   and   forms   a   sharp    contrast   with   the 


Cutaueuus  Tuberculin  Test. 


585 


opposite  thin  fold  (Fig.  94),  In  some  animals  a  small  hemorrhage 
occnrs  at  the  point  of  inoenlation.  As  a  rule  the  overlying  epidermis 
dries  up  into  a  brown  crust  or  scab. 

A  swelling  appearing  immediately  after  the  injeetion  of  the  tulier- 
culin  but  disappearing  after  a  few  hours  and  which,  according  to 
Vallee  is  due  to  glycerin  and  salts  contained  in  the  tuberculin  must 
not  be  regarded  as  a  positive  reaction. 

Lignieres  as  well  as  Roemer  and  Joseph  inject  the  tuberculin  on 
the  side  of  the  neck  and  as  near  as  possible  to  the  cutis.  In  this  case 
a  i)ositive  reaction  consists  in  the  appearance,  beginning  on  the  following 
day,  of  a  painful  edematous  swelling  around  the  point  of  inoculation. 


Fig.  94.     Intradermal  Tuherculin  Reaction.     Eilematous  swelling  of  the  riglit  anal 
fold  following  injection  of  0.1   cc.   of  50%  tuberculin  into   the  tissue  of  the  cutis. 

For  an  objective  determination  of  a  reaction  the  thickness  of  a.  fold  of 
skin  about  5  cm.  wide  is  accurately  measured  by  means  of  micrometer 
calipers  immediately  before,  and  then  again  three  or  four  days  after 
the  injection  of  the  tuberculin  at  that  point.  If,  during  that  time 
the  fold  has  increased  in  thickness  to  the  extent  of  0.4  cm.  or  more,  the 
reaction  is  to  be  regarded  as  positive,  if  the  increase  is  only  0.2  to  0.3 
cm.  the  reaction  is  to  be  looked  upon  as  doubtful  and  the  test  should 
be  repeated  with  0.1  cc.  of  concentrated  tuberculin  applied  on  the 
opposite  side  of  the  neck. 

By    mean^    of    their    method    (0.1-0.2    cc.    of    10%    tuberculin)    Moussu    and 
Mantoux    obtained    in    70    head   of   cattle    reactions    corresponding    in    all   respects 


586  TubeiTulosis. 

to  the  results  obtained  by  Koch's  subeiitaiieous  test.  Cattle  free  from  tuberculosis 
but  affected  with  other  diseases  (Metritis,  Cancer,  etc.)  did  not  react  to  the  test. 
The  results  of  tests  by  A'alTee  were  equally  satisfactory,  494  cattle  in  521  tests 
giving  the  same  result  for  each  method  (12  cattle  with  positive  thermal  reactions 
gave  no  cutaneous  reaction).  Foth  succeeded  in  detecting  about  one-half  of  the 
tuberculous  individuals  among  the  Danish  quarantine  cattle  by  this  method.  By 
the  method  of  Eoemer  and  Joseph  (0.1  cc.  of  50%  tuberculin)  Joseph  records 
only  one  error  in  126  cattle  as  shown  by  subsequent  post-mortem  examination, 
viz.,  one  animal  out  of  79  tested,  while  no  reactions  occurred  in  27  healthy  animals 
tested.  Zschokke  found  in  his  experiments  with  300  cattle,  which  were  for  the 
most  part  slaughtered  afterwards,  that  neck  and  tail  inoculations  were  of  about 
equal  value  and  that  both  were  subject  to  about  15%  error,  only  85%  of  known 
tuberculous  cattle  giving  positive  reactions. 

The  intracutaneous  method  is  applicable  also  for  swine,  the  tuber- 
culin being  injected  into  the  skin  at  the  base  of  the  ear  near  the  median 
border  on  the  dorsal  surface.  If  the  animal  is  tuberculous  a  flat  swell- 
ing with  central  reddened  zone  will  develop  after  twenty-four  hours. 
In  some  cases  there  may  be  a  hemorrhage,  the  size  of  a  silver  dollar, 
in  the  center  of  the  swelling,  which  may  lead  to  necrosis  of'the  overlying 
skin. 

This  method,  recommended  by  Moussu  and  Mantoux,  was  tried  by  Zschokke 
on  266  pigs  with  ther  result  that  90%  of  the  tuberculous  animals  gave  positive 
reactions. 

(d)  Local  Subcutaneous*  Reaction.  According  to  Vallee  and 
Fernandez  dead  bacilli  with  their*  fat  contents  removed,  mixed  with  four 
parts  of  finely  pulverized  glass  and  injected  in  amounts  of  1  mg.  into 
the  subcutis  of  the  ear  produce,  in  tuberculous  cattle,  in  addition  to 
the  edematous  swelling  which  occurs  simultaneously  with  the  thermic 
reaction  in  the  subcutaneous  method,  a  very  painful,  edematous  swelling 
which  is  valuable  for  diagnostic  purposes.  This  condition  results  from 
the  slow  absorption  of  the  injected  mass  at  this  point.  This  method  has 
not  yet  been  used  in  actual  practice. 

Comparative  value  of  the  various  tuberculin  tests.  Accord- 
ing to  collected  experiences  the  best  results  are  obtained  by 
K'ocli's  subcutaneous  method.  In  this  test  a  positive  reaction 
is  a  certain  indication  of  tuberculosis  while  a  negative  reaction 
incficates  with  the  greatest  probability  the  absence  of  the  disease. 
A  great  advantage  offered  by  this  method  consists  in  the 
possibility  of  recognizing  the  presence  or  absence  of  a  febrile 
reaction  by  the  maximum  temperature  recorded  after  injection 
of  the  tuberculin.  The  intradermal  or  intracutaneous  test  is  next 
in  value  to  the  subcutaneous  method.  This  produces  with  the 
use  of  50%  tuberculin  good  and  clear  results  in  both  positive 
and*  negative  cases.  The  ophthalmic  test  is  of  less  diagnostic 
importance,  errors  being  much  more  frequent  than  in  the  fore- 
gioing  methods,  especially  in  that  even  tuberculous  animals  not 
infrequently  give  no  reactions  whatever.  The  cutaneous  test 
has  the  least  practical  value,  errors  occurring  much  more  fre- 
quently than  in  any  of  the  others;  this  is  due,  in  part,  to  the 
fact  that  the  positive  reaction  is  frequently  impossible  of  differ- 
entiation from  a  simnle  traumatic  roaction. 

Under  these  circumstances  it  is  advisable,  in  all  cases  Avhere 
an  accurate  diagnosis  is  the  first  consideration,  to  use  the  sub- 


Comparative  Value  of  Tests.  587 

cutaneous  tost.  It  cannot  be  denied,  of  course,  tliat  tlie  applica- 
tion of  tliis  method  is  attended  with  certain  objections  or  at 
least  inconveniences,  viz.,  the  lon,i>'  time  recpiired  to  make  tlie 
observations,  the  repeated  recordin.ns  of  temperature  retiuired, 
and  finally  the  fact  that  positive  reactions  reduce,  temporarily, 
the  yield  of  milk  from  the  animals  in  question. 

Since  none  of  these  disadvantai^es  are  presented  by  tlie 
various  local  tests,  it  is  advisable,  in  practice,  where  lar<i:e 
lierds  are  to  be  tested,  to  apply  a  local  test  first,  preferably 
the  intradermal  (intracutaneous)  or  the  ophthalmic  test.  Thus, 
after  the  ii'reat  majority  of  tuberculous  animals  have  been  recoi;-- 
nized  the  remainder  of  the  herd  may  be  subjected  to  the  sub- 
cutaneous test  and  the  examination  of  the  herd  be  completed. 
Such  a  procedure  is  the  more  admissible  since  the  occurrence 
of  a  thermic  reaction  is  in  no  way  prevented  or  interfered  with 
by  the  previous  local  test. 

(The  above  arguments  ■n-ouM  hardly  apply,  with  equal  force,  to  pomlitioiis  as 
they  exist  in  Ajiieriea  at  the  present  time. — Translator.) 

Agglutination  Test.  According  to  the  investigations  of  Arloing  &  Courniont 
the  blood  serum  or  pleural  exudate  of  tuberculous  persons  or  animals  when  added 
to  homogeneous  liquid  cultures  causes  clumping  of  the  tuliercle  bacilli  and  their 
jirecipitation  to  tlie  bottom  of  the  ve!<;-el,  leaving  the  previously  turbid  fluid  clear 
and  transparent  (agglutination)  while  the  blood  serum  of  healthy  individuals  does 
not  possess  this  property.  On  the  basis  of  those  observations  these  authors  recom- 
mended the  agglutination  test  as  a  practical  means  of  diagnosing  latent  tui.'erculosis. 
Jn  one  of  their  series  of  experiments  the  blood  serum  of  thirty  healthy  calves  did 
jiot,  in  any  case,  agglutinate  a  culture  when  added  in  proportions  of  one  to  five 
while  the  serum  from  70  mature  cows,  with  only  one  exception,  agglutinate.]  cultures 
when  added  in  volumetric  proportions  of  one  to  ten  or  even  thirty. 

Other  authors  (Beck  k  Kabinowitsch,  Panisset)  could  not  confirm  the  diagnostic 
value  of  this  method  nor  has  the  same  been  found  of  any  practical  importance  in 
human  medicine. 

Precipitation  Reaction.  According  to  Bonome  the  blood  serum  of  tuberculous 
]>erPons  or  animals  produces  a  more  or  less  conspicuous  clouding  and  precipitation 
when  added  to  a  filtered  emulsion  made  of  fresh  cheesy  tubercles  or  cultures  of  dried 
tubercle  bacilli  mixed  with  5%  glycerin.  The  serum  of  healthy  individuals  either 
does  not  possess  this  property  at  all  or  only  to  a  slight  degree.  It  is  claimed 
for  this  test,  also,  that  when  pure  cultures  of  tubercle  bacilli  are  used  it  is  possible 
to  differentiate  between  infection  with  human  tubercle  bacilli  and  infection  with  the 
bovine  type. 

Calmette  &  Massol,  Vallee  and  also  Jousset  found  that  the  serum  of  highly 
immune  animals  contained  a  thermolabile  substance  which  produces  decided  precipita- 
tions in  solutions  of  tuberculin  as  well  as  in  non-concentrated  tuberculosis  bouillon 
and  in  bacillus  extracts.  In  the  bodies  of  tuberculous  animals,  however,  it  seems 
to  be  present  in  such  small  and  variable  quantities  that  precipitation  exi^eriments 
give  too  irregular  results  to  be  of  value  for  <liagnostic  purposes.  In  corresjiondence 
with  this  statement  the  results  obtained  by  Zwick  in  his  exjieriments  with  the  serum 
of  a  cow  with  advanced  tuberculosis  were  negative  throughout. 

Complement  Fixation  and  Opsonins.  Vallee  was  able  to  demonstrate  anti- 
bodies in  the  i-cium  of  hijj:hly  iuimunizod  horses  (Hennepe  the  same  in  the  serum 
of  calves  treated  with  liovovaccine)  which  had  the  power  to  fix  guinea  pig  couqile- 
ments  with  strains  of  the  tubercle  bacilli  that  had  been  used  in  the  immunising 
process  as  antigen.  Bach,  however,  found  that  sera  from  cattle  free  from  tuberculosis!, 
as  well  as  that  from  slightly  or  extensively  affected  cattle  manifested  the  same 
peculiarities  in  complement  fixation  experiments  and  that  this  action  was  not  specific. 
At  present,  therefore,  this  method  has  no  more  diagnostic  value  than  the  opsonic 
index  of  the  blood  of  tuberculous  animals,  the  study  or  investigation  of  which  latter 
has  as  yet  received  very  little  attention  in  veterinary  medicine 

Strubell  &  Feller  have  conducted  a  series  of  investigations  alon»-  this  line  with 
SO  beef  cattle,  without  however  getting  clear  or  decisive  results.  Of  the  tuberculous 
cattle   8.3.3%    showed   tuberculo-opsonic    indexes  to   human   tubercle   bacilli    ranging 


588  Tuberoilosis. 

between  0.90  and  1.10  of  the  normal,  .57.8%  giving  the  same  results  with  bovine 
tubercle  bacilli,  while  21%  of  the  healthy  animals  had  indexes  above  the  normal. 
Moderately  subnormal  indexes  (0.80-U.yu)  were  observed  in  8%  of  diseased  as  well 
as  in  8%  ot  the  healthy  animals.  Marked  subnormal  indexes  were  obser\ed  in  such 
cattle  only  as  had  been  experimentally  infected. 

Differential  Diagnosis.  Of  the  diseases  resembling  tuber- 
culosis in  clinical  sj^mptoms  or  anatomical  changes  the  following 
are  of  most  importance. 

Contagious  pleuro-pneumonia  of  cattle  in  its  chronic  or  sub- 
acute form :  In  this  disease  solidification  of  large  continuous 
areas  of  lung  tissue  may  be  recognized  by  the  dullness  revealed 
upon  percussion,  bronchial  respiration  or  the  entire  absence  of 
respiratory  sounds,  the  pulmonary  affection  is  always  attended 
with  an  acute  pleuritis  indicated  by  pain  upon  percussion,  fric- 
tion bruits,  weak,  suppressed  and  painful  cough.  There  is  less 
secretion  from  the  respiratory  passages  and  the  disease  takes 
a  less  insidious  course  than  that  observed  in  tuberculosis.  In 
very  chronic  cases  a  differential  diagnosis  is  hardly  possible 
from  the  clinical  symptoms  alone,  irrespective  of  the  fact  that 
suspicion  of  the  existence  of  pleuro-pneumonia  does  not  exclude 
the  presence  of  tuberculosis,  or  that  both  diseases  may  exist  at 
the  same  time. 

Lung-worm  disease  in  ruminants  and  swine.  This  is 
usuall}^  an  affection  of  younger  animals,  the  cough  is  strong, 
spasmodic  and  occasionalh'  attended  with  attacks  of  choking; 
there  is  rarely  an  elevation  of  temperature,  auscultation  reveals 
fine  rales  and  friction  bruits,  and  the  general  condition  of  the 
animals  is  usuall,y  little  affected  even  after  the  otherwise  pro- 
nounced s^nnptoms  of  disease  have  continued  for  some  time. 
Finally,  the  parasitic  filaria  may  be  demonstrated  in  the  secre- 
tions of  the  lungs  and  nostrils. 

A.ctinomycosis  in  cattle  and  swine.  In  this  disease  the 
tumors  of  the  udder  and  in  the  pharyngeal  region  are  frequently 
firmly  attached  to  the  overlying  skin;  if  the  tumors  rupture 
the  characteristic  raj  fungus  may  be  readily  demonstrated 
under  low  magnifyiug  power  without  previous  staining.  In 
actinomycosis  of  the  tongue  the  subliugual  and  pharyngeal 
glands  are  not  enlarged.  Post-mortem  examination  reveals 
yellowish  granules  imbedded  in  soft  foci  which  are  surrounded 
by  an  abundant  connective  tissue. 

Ecchinococcus  disease  of  the  lungs.  In  this  affection  the 
cough  is  weak  and  coarse,  febrile  symptoms  absent;  the  affected 
animals  may  be  in  good  condition  in  spite  of  the  respiratory 
troubles  which  may  have  persisted  for  a  long  period.  Finally, 
the  disease  is  most  frequently  observed  in  young  animals. 

Traumatic  pericarditis.  In  contrast  with  tuberculous  peri- 
carditis, symptoms  of  accumulation  of  fluids  (friction  bruits, 
dulled  heart  sounds  in  later  stages,  splashing  and  weak  cardiac 
sounds)  are  rarely  absent.  There  is  usually,  also,  more  or 
less  swelling  in  the  anterior  thorax. 


Differential  Diajiiiusis.  580 

Leiicemia  aiul  psendo-leucemia.  On  account  of  tlie  cachexia 
and  the  enhiri;ecl  lynipli  ghmds  which  ucciir  in  the  course  of 
these  diseases  they  nuiy  be  confused  with  tuberculosis,  in  them, 
however,  tiie  lyniph  glands  are  enlarged  to  an  equal  degree 
throughout  the  body  and  an  examination  of  the  ))l()od  in  leucemia 
will  reveal  the  abnornud  increase  of  the  white  blood  cells. 

Chronic  nieteorisni  resulting  from  non-tuberculous  affec- 
tions of  the  abdominal  organs.  When  (hie  to  tuberculous 
changes,  meteorism  does  not  develop  to  the  same  intensity 
and  after  each  tem])orary  attack  the  accompanying  digestive 
disturbances  innnediately  subside   (Albrecht). 

Glanders  in  horses,  especially  that  form  which  is  confined 
to  the  internal  organs.  The  ])resence  of  large  tumors  in  the 
abdonnnal  cavity  contraindicate  glanders  but  otherwise  a 
differential  diagnosis  must  be  based  upon  the  results  of  a  mallein 
or  tul)erculin  test.  Chronic  enlargement  of  the  submaxillary 
glands  does  not  m  itself  justify  the  exclusion  of  tuberculosis 
(see  p.  562). 

Distemper  may  be  confused  with  tuberculosis  when  it  is 
localized  in  the  internal  lymph  glands  and  assumes  a  chronic 
character.  In  the  clinical  examination  the  anamnesis  alone  may 
enable  us  to  make  a  differential  diagnosis.  At  post-mortem 
examination  the  presence  of  abscesses  only  and  the  absence 
of  sarcoma-like  structures  eliminates  tuberculosis. 

Hog  cholera.  In  chronic  cases  the  morbid  picture  of  this 
disease  is  very  similar  to  that  of  tuberculosis.  The  anamnesis, 
however,  especially  if  this  shows  that  the  animals  in  question 
have  previously  suffered  from  acute  pulmonary  or  intestinal 
affections,  will  indicate  hog  cholera  as  the  probable  disease  while 
the  existence  of  chronic  enlargement  of  the  h^nph  glands  or 
inflannnation  of  the  bones  and  joints  will  point  to  the  tuber- 
culous nature  of  the  affection.  At  post-mortem  small  gray 
or  yellowish  nodules  in  the  neighborhood  of  cheesy  foci  or  in 
the  lymph  glands  indicate  tuberculosis.  The  simultaneous  af- 
fection of  a  large  nundier  of  pigs  that  have  been  fed  with  milk 
or  whey  is  in  itself  a  probable  indication  of  tuberculosis. 

Rachitis,  especially  in  young  swine.  In  this  disease  the 
epiphyses  of  the  bones  are  enlarged  generally  while  the  joints 
themselves  show  no  symptoms  of  inflannnation.  In  tuberculosis 
of  the  joints  the  affection  is  confined  to  a  few  joints  and  there 
is  also  swelling  of  the  capsular  ligaments. 

Aside  from  the  above  named  diseases  suspicion  of  tuber- 
culosis may  l)e  aroused  in  other  chronic  affections  that  gradually 
produce  cachexia,  especially  chronic  lung  affections.  Finally, 
tuberculous  meningitis  has  many  SAinptoms  in  common  with  in- 
flammation of  the  cerebral  meninges  from  other  causes  and, 
similarly,  cerebral  tuberculosis  with  neoplasms  of  the  brain,  or 
with  coenurosis.  The  same  may  be  said  with  reference  to  acute 
miliary  tuberculosis  and  severe  acute  infectious  diseases. 

In  contrast  with  inflammatorv  affections  of  the  udder  from 


590  Tuberculosis. 

other  causes  in  tuberculosis  of  that  organ,  the  milk  retains  its 
normal  appearance  for  a  long  period.  When  in  the  later  stages 
changes  do  occur  in  the  j^hysical  appearance  of  the  milk,  they 
are  characterized  hy  the  absence  of  i)us  and  mucus  (sliminess). 
Irregular  nodules  in  the  tissue  of  one  or  more  quarters  of  the 
udder  and  enlargement  of  the  super  mammary  glands  indicate 
the  tuberculous  nature  of  the  aifection.  ^  Actinomycosis  and 
botriomycosis  produce  similar  swellings  in  the  tissue  of  the 
udder  but  are  apt  to  be  firmly  adherent  to  the  overlying  skin, 
they  frequently  break  open  and  discharge  their  contents,  and 
the  mammary  glands  are  unaffected  or  only  slightly  and  evenly 
enlarged.  In  inflammation  of  the  udder  caused  by  streptococcus 
infection  the  firm  swelling  bears  a  close  connection  with  the 
indurated  base  of  the  teat  while  tul)erculous  disease  usually 
occurs  higher  up  in  the  tissue  of  the  udder.  In  the  former 
case  also  the  milk  is  purulent  from  the  beginning,  and  while 
the  mammary  lymph  glands  may  ])e  swollen  or  enlarged  they 
are  never  irregular  or  nodular  in  form.  Finally,  the  secretion 
of  the  udder  contains  streptococci.  Milk  cysts  may  be  differ- 
entiated from  tuberculosis  by  their  elastic  consistency.  A 
definite  diagnosis  of  tuberculosis  of  the  udder,  especially  in  the 
less  pronounced  cases,  cannot  be  made  without  a  bacteriologi- 
cal examination  and  demonstration  of  the  tul)ercle  bacilli  in 
the  milk  (see  p.  558)  or  in  the  tissue  of  the  udder  (p.  570). 

For  the  anatomical  diagnosis  of  tuberculous  processes  the 
presence  of  small  gray  transparent  or  yellowish,  firm  nodules 
(tubercles),  which  usually  occur  either  exclusively  within  or 
in  the  neighborhood  of  cheesy  foci  and  ulcers  may  be  accepted 
as  definite  evidence.  Accepting  this  as  a  basis,  other  processes 
that  resemble  tuberculosis  (actinomycosis,  botriomycosis, 
caseated  parasitic  nodules,  chronic  inflammations  of  the  lungs, 
etc.)  are  easily  differentiated  from  tuberculosis.  In  all  cases, 
however,  the  demonstration  of  the  tubercle  bacillus  is  necessary 
as  final  evidence  of  the  tuberculous  nature  of  any  morbid  product 
or  tissue. 

Prognosis.  I^ocal  morbid  fjrocesses  brought  about  by  nat- 
ural infection  may,  under  favoral)le  conditions,  not  infrequently 
remain  restricted  to  a  definite  area  or  end  in  recovery  through 
an  inflammatory  reaction  in  the  surrounding  tissue.  Healthy 
adult  animals  are  almost  always  met  with  even  in  badly  infected 
herds  and  it  seems  that  their  condition  of  health  is  due,  not 
to  a  natural  individual  immunity  but  rather  to  repeated  infec- 
tion with  tuberculosis  followed  by  recovery  and  consequent  im- 
munity to  later  infections.  The  encapsuled  and  calcified  cheesy 
foci  which  are  not  infrequently  met  with  on  inspection  of 
slaughtered  animals,  in  certain  organs,  especially  Ijnnph  glands, 
point  to  such  a  favorable  course  of  local  infections.  The  results 
of  tuberculin  tests,  especially  in  the  case  of  young  animals  fre- 
quently point  to  this  possibility,  as  in  certain  cases  where  the 


Prognosis,    Troatiuont.  591 

animals  in  (inestion  i»i'rniam'iillv  cease  to  react  to  tlio  tuberculin 
test. 

Altiioug-li  the  possibility  of  recovery  from  tuberculosis  has 
thus  been  domonstratod  tlie  course  or  final  termination  of  the 
disease  cannot  be  ])redicted  even  "with  a  de,G:ree  of  prol)ability. 
In  general,  favorable  sun'oniidini^s,  especially  ])ure  fresh  air, 
good  food  and  care,  moderate  exercise  and  middle  age  have 
a  favorable  influence  on  the  course  of  the  disease.  Not  in- 
free  [uently,  however,  the  disease  makes  rapid  strides  toward 
a  fatal  termination  in  spite  of  favorable  external  conditions. 
Under  o])posite  conditions  a  gradual  spread  of  the  morbid 
process  is  the  rule  and  the  unfavorable  effect  of  hard  work  in 
this  respect  is  well  demonstrated  b}^  the  frequency  of  advanced 
tuberculosis  among  the  otlierwise  naturally  tough  working  oxen 
of  the  range  breeds  of  Europe.  The  unfavorable  course  of 
the  disease  in  these  cases  is  no  doubt  also  associated  "with  the 
fact  that  these  animals,  "when  kept  with  infected  herds,  are 
almost  continually  exposed  to  infection  and  reinfection,  result- 
ing in  aggravation  of  already  infected  centers  and  in  the  pro- 
duction of  new  areas  in  healthy  organs. 

According  to  the  intensity  and  the  frequency  of  reinfections 
the  disease  advances  with  increasing  certainty  to  its  fatal  ter- 
mination. When  clinical  s;^niiptoms  have  made  their  appearance, 
recovery  may  be  considered  as  entirely  out  of  the  question. 

Treatment.  Since  the  incurability  of  tuberculosis  of  do- 
mestic animals,  after  clinical  symptoms  have  made  their  ap- 
pearance, has  been  recognized  from  time  immemorial,  serious 
attempts  to  bring  about  recovery  are  hardly  ever  made  in  recent 
times.  The  immediate  use  of  evidently  affected  animals  for  food 
purposes  has  now  been  generally  accepted  as  the  best  method 
of  dealing  with  this  prol)lem.  In  human  medicine,  also,  in  spite 
of  numberless  attempts  in  this  direction,  reliable  curative 
methods  are  unknown.  On  the  other  hand,  careful  observations 
made  in  recent  years  have  shown  that  favorable  hygienic  con- 
ditions, especially  living  in  pure  fresh  air,  nutritious  food  and 
physical  rest  may  check  the  progress  of  the  disease  in  the  early 
stages  and  not  infrequently  bring  about  a  cure.  Similar  con- 
ditions would  probably  have  the  same  favorable  effect  in  ani- 
mals. Among  these,  however,  favorable  opportunities  for  sys- 
tematic treatment  along  the  lines  suggested  would  rarely  be 
offered  while,  on  the  other  hand,  the  successful  treatment  of 
an  occasional  individual  bears  no  comparison  with  the  beautiful 
results  that  are  obtained  by  prophylactic  measures  in  the  sup- 
p^-ession  of  the  disease.  Xevertheless  the  proper  regulation 
of  hygienic  conditions  in  infected  herds,  and  especially  the 
restriction  of  stable  life  to  the  mininnnn,  as  well  as  cleanliness 
in  stables  where  these  are  a  necessity,  are  of  immense  im- 
portance in  the  solution  of  the  problem  of  the  suppression  of 
tuberculosis. 

The  systematic  treatment  with  tuberculin,  in  spite  of  the 


592  Tuberculosis. 

undeniable  favorable  results  occasionally  obtained  along  this 
line  in  human  medicine,  is  of  course  out  of  the  question  with 
animals  both  on  account  of  the  attending  expense  and  the  im- 
practicability of  the  treatment. 

Hauptmann  claims  to  have  obtained  curative  effects  in  tuberculous  cattle  by 
treatment  with  iodipin  (50  to  100  gm.  of  25%  iodipin  repeatedly  injected  subcu- 
taneously)  while  Jacob,  Bongert  &  Eosenberg  observed  good  results  following  in- 
trabronchial  injections  of  tuberculin  and  creosote  (500  gm.  of  a  0.1  to  0.4%  solution 
or  0.1%  solution  intratracheally).  These  apparently  favorable  results,  however, 
require  further  confirmation.  The  same  may  be  said  of  Burow's  assertion  that  500 
cattle,  treated  with  bacterial  preparations  of  unspecified  character,  showed  "definite 
improvement"  with  few  exceptions,  in  the  course  of  a  few  weeks.  The  i^reparations 
made  from  tubercle  bacilli  (Tulase,  tulaselaktin,  tulou,  tuberculase,  etc.)  and  recom- 
mended by  V.  Behring  for  the  treatment  of  human  tuberculosis  have  thus  far  given 
no  tangible  results.  Under  the  direction  of  Koemer  extensive  experiments  conducted 
in  Argentine  with  tulaselaktin  as  a  curative  agent  for  bovine  tuberculosis  gave 
uniformly  negative  results.  Arloing  also  found  tuberkulase  inert  in  his  cattle  experi- 
ments. The  same  is  probably  also  true  with  respect  to  the  use  of  attenuated  or 
avirulent  tubercle  bacilli. 

Prevention.  The  establishment  of  the  most  favorable  ex- 
ternal conditions  plays  an  important  role  in  the  control  of 
tuberculosis.  Out  of  door  life,  especially  on  pasture,  diminishes, 
on  the  one  hand  the  chances  of  infection  and  on  the  other  hand 
prevents  the  tubercle  bacilli  from  obtaining  an  easy  foothold 
in  the  bronchioles  and  alveoli  by  thorough  ventilation  of  the 
air  passages  and  therefore  by  preventing  the  development  of 
chronic  catarrhal  conditions.  The  customary  healthy  condition 
of  young  cattle  in  hilly  and  mountainous  countries  and  the  great 
infrequency  of  tuberculosis  in  range  cattle  is  due  to  the  condi- 
tions just  referred  to. 

In  order  to  prevent  the  too  rapid  spread  of  tuberculosis 
in  already  infected  herds  it  is  advisable  to  keep  them  out  of 
doors  as  much  as  possible  during  the  day  time  and,  when  the 
weather  permits,  at  night  also.  In  addition  the  stables  should 
be  equipped  with  modern  systems  for  ventilation  and  thor- 
oughly cleaned  and  disinfected  at  least  every  two  weeks.  Stal)le 
arrangement  whereby  cattle  are  compelled  to  face  each  other, 
and  continuous  watering  troughs  and  mangers  should  be  avoided 
as  these  conditions  favor  the  dissemination  of  the  disease. 
Above  all,  animals  with  clinical  symptoms  of  tuberculosis  or 
symptoms  of  chronic  pulmonary  aifections,  chronic  diarrhea, 
chronic  discharge  from  the  uterus,  emaciation,  etc.,  that  point 
to  the  probable  existence  of  open  tuberculosis  should  be 
slaughtered  or  otherwise  disposed  of  at  once  in  order  to  check 
at  least  the  principal  disseminators  of  tubercle  bacilli.  Among 
such  animals  those  affected  with  udder  tuberculosis  are  of 
course  the  most  dangerous.  (Where  attempts  are  made  to  con- 
trol the  disease  according  to  the  rather  conservative  plan  here 
suggested  it  should  ever  be  borne  in  mind  that  animals  without 
clinical  symptoms  of  disease  and  otherwise  in  apparent  per- 
fect health  may  be  suffering  with  advanced  tuberculosis  and 
distribute  tubercle  bacilli  in  enormous  numbers  through  the 
medium  of  their  solid  excrement. — Translator.) 


Prevention.   Exteruiination.  593 

In  this  conncetioii  care  siiould  lie  taken  lliat  the  young  offspring 
from  sueh  lierds  are  not  fed  on  infected  milk.  This  is  accomplished 
by  heating  ail  skim  milk  to  85°  C,  or  })etter,  to  the  hoiling  point,  before 
feeding  to  calves  or  swine.  In  all  cases,  however,  the  milk  from  evi- 
dently infected  udders  should  be  destroyed. 

in  feeding  sucking  calves  it  is  all  important  that  the  milk  be  free 
from  tubercle  bacilli.  Infection  is  most  successfully  prevented  by 
having  young  calves  suck  dams  that  are  known  to  be  free  from  tuber- 
culosis as  indicated  by  physical  examination  and  tuberculin  tests.  If 
for  economic  reasons  tiiis  arrangemcMit  is  impracticable  the  calves  should 
be  fed  Avith  fresh  raw  milk  obtained  from  healthy  cows  Avith  every 
possible  aseptic  precaution.  ]Milk  sterilized  l)y  heat  shouhl  be  used 
only  as  a  last  resort.  ]\Iilk  thus  treated  has  lost  the  ferments  so  im- 
portant for  digestion  and  for  the  prevention  of  al)normal  gas  production 
in  the  intestines.  For  this  reason  every  po.ssible  precaution  should,  be 
observed  that  the  vessels  used  and  the  hands  of  the  persons  in  charge; 
of  this  work  are  kept  scrupulously  clean.  Heat  sterilization  is  of  course 
always  vastly  preferable  to  the  use  of  formalin  (see  p.  155)  or  of 
hydrogen  peroxide,  because  milk  thus  treated  (perhydrase  milk,  budder- 
ized  milk),  aside  from  the  fact  that  it  may  contain  virulent  tubercle 
bacilli,  is  unsuitable  for  sucklings  on  account  of  its  low  fat  content  (2% ) . 

By  careful  compliance  with  these  instructions  it  is  possible 
at  least  to  check  the  too  rapid  progress  of  the  disease  and  to 
prevent  for  years  the  occurrence  of  very  great  losses.  The 
measures  referred  to  are  however  recommended  for  considera- 
tion only  in  cases  where  for  economic  or  other  insurmountable 
reasons  the  complete  extermination  of  the  disease  is  out  of  the 
question. 

Extermination  of  Tuberculosis.  Investigations  shomng 
that  tuberculosis  is  an  infectious  disease,  transmissible  from 
animal  to  animal,  and  demonstration  of  the  fact  that  heredity 
plays  only  an  unimportant  role  in  its  transmission  has  placed 
the  warfare  against  tuberculosis  upon  a  new  and  safe  basis. 
The  aim  and  object  of  this  warfare  now  is  to  protect  healthy- 
born  animals  from  infection  during  life;  if  we  are  successful 
in  this  effort  the  animals  will  remain  free  from  tuberculosis, 
irrespective  of  whether  they  are  the  offspring  of  diseased 
parents  or  otherwise. 

Upon  the  basis  of  this  principle  Bang  has  worked  out  a 
plan  for  the  extermination  of  tuberculosis  from  dairy  herds 
which  has  been  put  into  successful  practical  operation  since 
1892.  The  very  satisfactory  results  already  obtained  have 
demonstrated  not  only  the  correctness  of  this  theory  but  also 
its  practical  worth. 

Bang's  Method  of  Extermination.  This  consists,  in  effect,  in  the 
destruction  of  clinically  affected  animals,  the  separation  and  isolation 
of  reactors  to  the  tuberculin  test  which  are  otherwise  clinically  of 
healthy  appearance,  and  the  artificial  feeding  of  calves  from  the  latter 
with  milk  free  from  tubercle  bacilli.  The  details  of  the  method  are 
as  follows: 

Vol.  1—38 


594  Tuberculosis. 

Every  animal  in  the  infected  herd  is  subjected  to  careful  examina- 
tion and  each  animal  which  shows  clinical  evidence  of  tuberculosis, 
but  particularly  those  animals  with  symptoms  of  pulmonary,  intestinal, 
iiterine  or  mammary  disease  are  condemned  and  slaughtered,  to  be 
used  as  food,  subject  to  inspection  under  the  laws  of  the  country,  or 
condemned  as  food  as  the  case  may  be.  The  remainder  of  the  herd 
consisting  of  clinically  healthy  appearing  animals  is  then  subjected 
to  the  tuberculin  test.  All  nonreactors  which  are  free  from  all  other 
symptoms  that  might  possibly  point  to  the  existence  of  tuberculosis 
are  then  separated  and  isolated  from  the  remainder  of  the  herd.  Each 
herd  is  now  placed  in  an  entirely  separate  stable,  the  quarters  for  the 
nonreactors  or  healthy  portion  of  the  herd  having  previously  been 
thoroughly  cleaned  and  disinfected.  In  the  absence  of  separate  build- 
ings a  single  building  may  be  utilized  by  separating  the  quarters  of 
the  two  herds  by  means  of  a  tight  board  wall  and  providing  separate 
exits  for  each  herd.  Young  stock,  calves,  and  working  oxen  should  have 
quarters  of  their  own.  Each  herd  or  group  must  have  separate  at- 
tendants that  have  absolutely  no  contact  whatever  with  the  other  herd. 
If  an  animal  in  the  reacting  herd  at  any  time  develops  clinical  symptoms 
of  tuberculosis  it  must  be  removed  at  once  and  disposed  of  preferably 
by  slaughter.  The  remaining  animals  in  the  reacting  herd  may  be 
used  as  before  for  breeding  and  dairy  purposes,  providing  they  exhibit 
no  clinical  evidence  of  tuberculosis.  Yearlings  and  other  young  stock 
reacting  to  the  tuberculin  test  had  best  be  discarded  for  breeding  pur- 
poses at  once  and  for  all  time.  "Where  special  reasons  exist  for  desiring 
to  breed  certain  reacting  young  heifers  this  may  be  permitted  but  only 
on  the  condition  that  they  be  quartered  with  the  reacting  portion  of 
the  herd.  Reacting  calves  under  six  months  of  age  should  always  be 
destroyed  or  disposed  of  by  slaughter. 

The  calves  dropped  by  the  healthy  "non-reacting"  cows  should 
remain  with  their  dams  while  those  from  the  reactors,  after  being  per- 
mitted to  suck  for  twenty-four  hours  so  that  they  may  get  the  colostrum, 
are  removed  from  their  dams  and  quartered  with  the  healthy  portion 
of  the  herd  and  provided  with  nurse  cows  or  fed  by  hand  with  fresh 
milk  from  nonreactors  or  with  milk  obtained  from  other  sources,  but 
sterilized  by  heating  to  at  least  85°  C.  Particular  attention  should 
be  paid  to  the  cleanliness  of  utensils  used  as  well  as  to  the  hands  of 
the  attendants  in  charge  of  the  feeding  of  these  young  animals.  It  is 
self-evident,  of  course,  that  the  quarters  where  these  calves  are  kept 
should  be  kept  scrupulously  clean  and  occasionally  disinfected.  Wher- 
ever it  is  possible  to  do  so,  the  calves  might  be  kept  in  separate  quarters 
for  the  first  few  weeks  after  birth.  If  any  of  the  calves  become  affected 
with  diarrhea,  they  should  be  isolated  at  once  and  the  former  quarters 
thoroughly  cleaned,  disinfected  and  treated  with  a  hot  solution  of  lye. 

As  soon  as  weaned  the  calves  should  be  subjected  to  the  tuberculin 
test  and  all  reactors  disposed  of  (the  loss  in  this  process  hardly  ever 
exceeds  one  or  two  per  cent).  After  this  they  may  be  added  to  the 
free  herd  or  kept  in  separate  calf  quarters  or  with  the  other  young 
stock.  Until  used  for  breeding  purposes  they  should  be  kept  out  of 
doors  or  on  pasture  as  much  as  possible  and  under  no  conditions  may 
they  be  allowed  to  come  in  contact  with  the  reacting  portion  of  the 
herd.  The  young  heifers,  after  being  bred,  should  be  retested  with 
tuberculin  and  if  found  free  from  disease,  added  to  the  free  herd, 
otherwise  isolated  with  the  reactors.  (It  is  only  occasionally  that  it 
is  found  necessary  to  add  an  animal  to  the  reacting  herd.) 


Methods  of  Extennination.  595 

Tho  free  herd  slioiild  ho  retested  with  tuberculin  every  year  so 
that  animals  that  were  infected  and  failed  to  react  at  a  previous  test, 
or  that  have  become  infected  since  that  time,  may  be  removed  and 
added  to  the  (|uarantine  herd.  Newly  ac(|uired  animals  should  under 
no  circumstances  be  added  to  the  free  herd  unless  they  havt;  been  found 
free  from  evidences  of  tuberculosis  by  physical  examination  and  tuber- 
culin test  made  inuuediately  before. 

]\[ales  used  for  breeding  pur])oses  should,  if  at  all  i)ossi])le.  be 
free,  not  only  from  every  suspicion  of  tuberculosis,  but  should  other- 
wise be  in  perfect  health.  If  unavoidable,  a  reacting  male  may  be 
used  but  such  animals  should  at  least  be  free  from  clinical  evidence  of 
disease.  Such  an  animal  nuist,  of  course,  be  kept  under  constant  super- 
vision during  the  act  of  coitus  and  never  be  permitted  to  run  with 
the  free  herd. 

By  this  method  the  nonreacting  or  free  portion  of  the  herd  will 
constantly  increase  in  numbers  while  the  reacting  herd  may  be  cor- 
respondingly reduced  in  size  without  interfering  with  the  amount  of 
business  transacted  with  the  products.  Eventually  the  reactors  can 
be  entirely  eliminated  and  a  herd  free  from  tuberculosis  remain  in 
place  of  the  original  infected  herd.  This  can  be  accomplished  with 
comparatively  light  expense,  and  with  proper  attention  and  occasional 
retests  with  tuberculin  the  herd  may  then  be  kept  free  permanently 
from  tuberculosis. 

The  extermination  of  tnben-nlosis  after  the  niethofl  of  Bang  has  found  its 
widest  application  in  Denmark,  Sweden  and  Norway  where  government  support 
is  liberally  extended  and  favorable  results  have  been  quite  general.  As  a  result 
of  the  personally  conducted  campaign  of  Bang,  in  Denmark,  the  average  percentage 
of  reacting  animals  in  1893  (40%)  has  been  reduced  in  1008,  to  8.5%.  Among 
calves  the  average  percentage  in  1893  (15..5<^)has  been  reduced  to  10.6  in  1898. 
Vp  to  the  year  1904,  66  badly  infected  herds  comprising  1,04.5  reactors  and  780 
healthy  animals  have  been  entirely  freed  from  disease,  the  66  herds  consisting  at 
that  time  of  1,896  healthy  animals.  In  Norway,  according  to  ^lalm,  the  percentage 
of  reactions  has  been  reduced  from  8.4%  in  1896  to  4.9%f  in  1903,  and  the  proportion 
of  inspected  herds  that  were  found  infected  was  reduced  from  26.1%  to  13.6%. 
In  Sweden,  where,  in  the  beginning  of  the  campaign  of  extermination  (in  1897-98) 
11,089  out  of  33.000  animals  reacted  to  the  tuberculin  test,  i.  e.,  33.6%,  reports  for 
the  year  1904  showed  that  among  34,996  cattle  tested  only  1,664,  i.  e..  4.7%  reacted. 
During  this  interval  214  herds  comprising  8,20.5  animals  were  freed  from  the  disease 
(Regn§r.) — In  Finland  reactions  reached  25%  in  1894  while  they  were  reduced  to 
10.1%  by  1900  (Hojer).  In  Hungary  there  exists  now  a  number  of  large  dairies 
in  which  the  percentages  of  reactors  have  been  reduced  in  the  course  of  a  few  years 
to  2  or  3  per  cent  without  any  reduction  in  the  si/e  of  the  herds.  Thus  on  the 
Mezoehegyeser  government  estate  the  first  tuberculin  test  which  was  conducted  in 
the  spring  of  1898  in  a  herd  of  329  cows  revealed  44.8%  of  reactors  while  26.6% 
of  the  total  nund)er  tested  (647)  reacted.  In  the  fall  of  the  year  1903  a  test  of  502 
cows  on  the  same  estate  gave  only  2.8%  of  reactors  and  a  test  of  all  of  the  cattle 
on  the  estate  (1,132)  gave  1.8%  of  reactors.  During  this  period  of  five  years  the 
herd  on  this  estate  was  increased  75%  in  numbers  by  addition  of  its  own  offspring, 
while  the  prevalence  of  tuberculosis  was  reduced  88%    (Hutyra). 

The  favorable  results  of  feeding  calves  with  sterilized  milk  are  illustrated  by 
the  following:  In  Sarvar  93.8%  of  the  calves  thus  reared  gave  no  febrile  reaction 
to  Behring's  protective  inoculation  while  only  42.1%  of  the  calves  reared  under 
usual  conditions  responded  similarly.  (Behring's  protective  inoculation,  when  applied 
to  tuberculous  animals,  gives  a  reaction  similar  to  that  of  tuberculin.)  On  several 
German  estates,  where  similar  experiments  were  conducted,  the  proportions  were 
74.2%  and  48.1%  respectively. 

Modification  of  Bang's  Method.  In  only  slightly  infected  herds 
where  the  question  of  expense  is  not  the  first  consideration  the  quickest 
results  may  be  obtained  by  slaughtering  all  reacting  animals  at  once. 
In  this  way  the  necessity  of  maintaining  two  herds,  one  healthy  and 


596  TubeiTulosis. 

the  other  diseased,  and  the  artificial  rearing  of  the  calves  on  nurse 
cows  or  "with  sterilized  milk  is  obviated.  The  herd  may  then  be  kept 
permanently  free  by  replacing  the  reactors  with  newly  purchased  ani- 
mals that  iiave  been  subjected  to  the  tu])erculin  test,  and  repeating 
the  test  annually  in  order  to  remove  any  affected  animal  that  may 
have  gained  an  entrance  to  the  herd. 

Where  the  separate  maintenance  of  two  herds  and  the  artificial 
rearing  of  the  calves  from  the  infected  dams  meets  with  insurmouutabl.e 
objections  a  modified  form  of  Bang's  method  may  l)e  applied.  Thus, 
if  a  herd  is  so  badly  infected  that  it  is  known  in  advance  that  only 
a  comparatively  few  animals  would  be  found  free  from  disease,  the 
tuberculin  test  of  the  adult  animals  may  be  dispensed  Avith  but  applied 
to  the  young  stock  and  the  calves  reared  with  the  same  precautions 
prescribed  under  the  regular  Bang  method.  As  the  healthy  young 
heifers  drop  their  calves  and  come  into  milk  they  may  be  used  as  a 
nucleus  to  build  up  a  new  free  herd  to  which  nothing  but  healthy 
cows  are  added,  while  the  number  of  infected  animals  in  the  original 
herd  may  be  correspondingly  reduced. 

Ujhelyi  provides  healthy  nurse  cows  for  the  newly  born  calves  or, 
where  necessity  demands,  leaves  the  calves  with  their  infected  dams 
and  subjects  them  to  the  tuberculin  test  when  they  are  weaned,  slaughter- 
ing all  reactors.  (In  this  method  the  loss  is  somewhat  greater  than 
in  the  former.)  In  this  case  the  Bang  method  is  strictly  adhered  to  in 
so  far  as  separation  of  the  herd  into  a  free  and  an  infected  group  is 
concerned  and  in  so  far  as  all  animals  with  clinical  evidence  of  disease 
are  removed  at  once  and  slaughtered.  This  modification  of  Bang's 
method  may  be  practiced  where  the  rearing  of  calves  with  sterilized 
milk  meets  with  insurmountable  difficulties.  It  has  the  advantage  that 
calves  remain  free  from  diarrhea  even  when  under  the  care  of  less 
careful  attendants. 

By  means  of  this  method  U.ihelyi  has  snceeedeil  in  bringing  about  a  considerable 
reiUietion  in  the  percentage  of  reactions  in  a  number  of  large  herds.  Thus  on  the 
estates  of  Yaal,  Szent-Laszlo  and  Martonvasar  in  March,  1899,  of  1,031  adult  cattle 
884  reacted  (85.7%)  of  626  head  of  yearlings  3-33  (.53.3%)  reacted,  while  in 
September,  1903,  of  898  adult  cattle  only  37  or  4.1%  and  of  710  yearlings  only  19 
or  2.6%  reacted  to  the  tuberculin  test.  On  eight  other  estates,  at  the  beginning 
of  the  campaign  (1898-1902),  of  1.715  cattle  tested  1,011,  i.  e.,  59%,  reacted  while 
a  few  years  later   (1904  and  1905)   only  63  head,  3.0%,  reacted. 

Method  of  Ostertag.  Ostertag  abandons  the  tuberculin  test  en- 
tirely for  adult  animals  and  conseciuently  also  the  separation  of  the 
herd  into  reactors  and  nonreactors.  He  lays  special  stress  upon  the 
importance  of  an  early  disposition  of  all  cattle  with  so  called  open  tuber- 
culosis and  the  rearing  of  all  calves  Avith  milk  sterilized  at  85°  C.  or 
raw  milk  from  cows  free  from  tuberculosis.  When  the  calves  are 
weaned  they  are  subjected  to  the  tuberculin  test  and  the  reactors  are 
slaughtered.  In  order  to  dispose  of  all  eases  of  open  tuberculosis  at 
the  earliest  possible  opportunity  affected  herds  are  subjected  every 
six  months  to  examination  by  a  veterinarian  and  all  suspicious  cows 
are  removed  at  once.  In  addition  to  this  the  milk  (of  the  individual 
coAvs  as  Avell  as  the  mixed  product  from  the  entire  herd)  is  subjected 
to  periodical  bacteriological  examination  as  are  also  any  morbid  secre- 
tions that  may  become  e\ndent. 

This  method,  which  has  been  made  obligatory  in  182  herds  of  the  East 
HoUandish-Prussian  Herd-Book  Association  since  1900  and  since  then  has  been 
introduced   into   other  German   districts,   can   hardly  be   expected  to   bring   about   a 


^It'tluxls  of   Ivxicniiiiiation.  597 

coniploto  oxtoniiination  of  tlio  disease.  By  removing  the  necessity  of  maintainiii;^ 
two  separate  lienls  it  is  less  objectcil  to  by  tiie  owner  luit  the  results  achieved  are 
torresj.oiKlinjily  unsatisfactory,  l-'roni  1!»()()-01  to  lltn;i-04  among  Ll^ooO  a.liilt  cattle 
1,117 1  cases  of  open  tuiereiilosis  were  diagno-ed,  during  wlivli  time  the  percentage 
was  reduced  to  1.^5 9t  but  since  that  time  an<l  up  to  190,>-u!t  it  has  been  reiluced 
only  to  1.2%  (Mueller,  Ostertag).  Jn  the  herds  of  the  East  Prussian  Herd  Book 
Association  for  Mottled  Ked  Cattle  the  percentage  has  leen  reduced  from  3.2  to 
1.24  in  the  course  of  si.\  years;  in  Pommerania,  in  the  course  of  five  years,  from 
2.93  to  ().3!)7(  ;  in  Brandenburg,  in  the  cour^e  of  five  years,  from  2.2s  to  0.7% 
(in  the  first  2(i  herds,  incduding  2,1.'U  animals,  wliich  were  subjected  to  this  method, 
the  percentage  was  reduced  from  4.1  to  0.23%).  Jn  Schleswig-IIolstein,  in  four 
years  the  reduction  was  from  2.S  to  1.47%  and  in  the  Province  of  Sa.xony,  in  four 
years,  from  :?.()  to  1.1S%  (Ostertag).  These  percentages,  ot  course,  all  refer  to 
open  tuberculosis.  Whether  or  not  the  total  number  of  all  cases  of  tuberculosis 
were  corresi>ondingly  diminislied  or  whether  there  may  have  been  an  actual  increase 
is  not  recorded!  At  ail  events  tlie  figures  furnished  show  that  the  results  obtained 
bear  no  comparison  whatever  with  those  obtaine<l  by  the  Bang  method. 

Til  inl'tM-ted  luM'ds  of  swine  the  disease  may  l)e  sueeessfully  stamped 
out  l)y  eliminating  the  affected  animals  upon  the  basis  of  the  outoomo 
of  the  tubereidin  test,  sul)se(|uent  thorough  disinfection  of  (|uarters 
and  the  oliservation  of  the  necessary  precautions  to  prevent  the  ]-ein- 
troduction  of  tlie  disease  (Thiro). 

Immunization.  Basing-  his  observation  npon  tlio  specific 
identity  but  vaiyiiiii'  ])atliOiienic  action  of  human  and  l)Ovine 
tul)ercle  bacilli,  v.  Behrini^-,  in  1901,  declared  that  In'  treatiim" 
cattle  with  the  less  virulent  liuman  tubercle  bacilli  they  would 
be  protected  against  the  more  actively  virnlent  bovine  tubercle 
bacilli  and  thus  also  against  natural  infection  with  tuberculosis. 
On  the  basis  of  this  assertion  several  metliods  of  immunization 
for  cattle  have  been  recommended  and  actually  carried  out  in 
practice.  More  or  less  satisfactory  results  however  were  ob- 
tained in  such  cases  only  where  hygienic  and  prophylactic 
measures,  effective  in  themselves,  were  instituted  at  the  same 
time. 

Double  Immunization  with  Human  Tubercle  Bacilli  (Inununization 
with  bovo-vaccine :  Behring's  method).  The  immunizing  material  con- 
sists of  nearly  full-virulent  human  tubercle  bacilli,  dried  in  a  vacuum 
and  injected  into  the  blood  circulation  of  calves.  The  first  tests  con- 
ducted after  these  treatments  showed  that  two  intravenous  injections 
of  l)ovo-vaccine.  or  of  any  fresh  culture  of  the  human  type  of  tubercle 
bacillus  into  cattle  resulted  in  a  considerable  and  inunediate  increase 
in  their  power  of  resistance  to  artificial  infection.  Calves  thus  treated 
would,  as  a  rule,  resist  successfully  four  months  later  intravenous 
injections  of  virulent  bovine  bacilli  in  do.ses  that  proved  invariably 
fatal  in  untreated  calves.  Further  experiments,  however.  shoAved  that 
resistance  thus  artificially  increased  was  of  short  duration,  suffering 
considerable  reduction  at  the  end  of  one  year  and  disappearing  entirely 
six  months  later.  On  the  other  hand,  the  results  of  the  practical 
application  of  the  method  in  herds  showed  that  it  had  no  noticeable 
effect  on  the  improvement  of  the  health  of  infected  herds.  Since  im- 
munization produces  no  harmful  effect  upon  previouslv  healthy  calve; 
it  might  he  possible  to  prolong  their  immunity  indefinitely  by  annual 
vaccinations.  The  objection  to  this  plan,  aside  from  its  attendant  trouble 
and  expense,  lies  in  the  fact  that  the  bacilli  introduced  by  the  act 
of  vaccination  remain  alive  and  active  in  the  bodies  of  the  animals 


598  Tuberculosis, 

for  a  long  time  (according  to  Lignieres,  von  Weber  &  Titze  for  two 
years)  thus  making  the  slaughter  of  such  animals  for  food  a  procedure 
of  doubtful  propriety.  In  addition  to  this  objection,  there  is  the  possi- 
bility that  the  bacilli,  circulating  freely  in  the  blood  stream,  may  lodge 
in  the  tissue  of  the  udder  and  set  up  local  tuberculous  processes  (Weber 
&  Titze). 

Control  experiments  conducted  by  Hutyra  showed  that  intravenous  injections 
of  2  to  2.5  eg.  of  highly  virulent  bovine  tubercle  bacilli  (doses  which  would  invariably 
kill  control  animals  within  two  months)  made  in  calves  that  had  been  imnumiied 
two  months  before,  usually  produced  only  a  very  few  tuberculous  foci  confined  almost 
exclusively  to  the  lungs  and  showing  a  tendency  to  encapsulation  and  healing.  On 
the  other  hand,  injections  of  the  ?anie  doi^es  made  subcutaneously  resulted  in  lesions 
confined  to  the  area  of  injection.  Administration  of  the  same  virus  by  the  way  of  the 
alimentary  canal  to  animals  previously  imnmnized  resulted  in  rather  extensive  affec- 
tion of  the  tonsils.  Similar  results  were  obtained  not  only  with  Behring's  original 
bovo-vaccine  but  also  with  culture  of  human  tulierele  bacilli  4  to  6  weeks  old.  When 
the  resistance  of  the  vaccinated  animals  was  tested  7t^  and  17  months  later  the  con- 
trol infections  resulted  in  extensive  and  partly  in  fatal  general  tuberculosis. 

Eber  tested  the  resistance  of  four  animals  immunized  by  Behring's  method 
by  repeatedly  exposing  them  to  animals  with  experimental  tuberculosis.  Two  years 
later,  when  they  were  slaughtered  they  were  without  exception  found  to  be  affected 
Avith  focal  tuberculosis  of  a  more  extensive  nature  than  that  affecting  the  control 
animals. 

In  exjieriments  conducted  with  20  vaccinated  animals  by  Eossignol  &  Vallee 
in  Melun,  with  the  same  numlier  of  controls,  while  giving  gratifying  results  three 
months  later  when  13  animals  of  each  group  were  subjected  to  control  infection, 
iurther  observation  disclosed  that  two  of  the  vaccinated  animals  became  tuberculous 
and  another  died  within  50  days  from  the  effects  of  subsequent  intravenous  infection. 
Furthermore,  experiments  carried  out  by  Degive,  Stulibe,  Mullie  &  Lienaux  in  Belgium 
and  under  Mazzini's  direction  in  Italy,  gave  more  cr  less  unsatisfactory  results. 
Finally,  in  an  experiment  made  by  Weber  &  Titze  with  12  calves  treated  according 
to  Behring's  instructions  and  which  were  exposed  to  infection  from  2%  to  9  months 
later  by  subcutaneous  or  intravenous  injections  by  inhalation  and  alimentary  adminis- 
tration of  l>ovine  virus,  and  in  three  instances  exposed  to  natural  infection,  only  one 
animal,  and  that  of  the  last  group  mentioned,  remained  free  from  tuberculosis. 

On  experiences  in  practice,  Eoemer  (1905)  reports  on  statistics  covering  5,576 
animals  with  the  conclusion  that  vaccination  resulted  in  a  considerable  deci-ease 
in  the  prevalence  of  tuberculosis  in  the  herds  treated.  Very  evidently,  however,  this 
favoralde  showing  must  be  ascrilied  to  the  improved  hygienic  conditions  that  were 
established  because  other  reports  have  been  almost  unanimously  unfavorable.  Thus 
Hutyra  failed  to  discover  any  imiuovement  in  the  course  of  one  to  three  years  in 
three  herds  that  had  been  subjected  to  the  Behring  treatment.  Eber,  in  1907,  in 
testing  148  animals  that  had  been  treated  strictly  according  to  the  prescribed 
Behring  method,  found  56  reactors,  i.  e.,  37.8%.  Tuberculin  tests  conducted  during 
the  two  following  years  on  seven  estates  gave  52.2%  of  positive  reactions  among 
90  immunized  cattle.  The  percentages  increased  with  the  age  of  the  animals  in 
the  same  pi'oportion  as  is  usually  observed  in  extensively  infected  herds  (among 
55  vaccinated  animals  30.9%  reacted  at  the  first  test,  two  years  later,  at  the  second 
test,  58.2%  reacted).  Of  36  of  the  vaccinated  cattle  that  died  in  the  interval  or 
were  slaughtered,  16  were  tuberculous. 

The  results  obtained  on  four  estates  in  Galicia  by  Nowack  were  similarly 
unsatisfactory.  Of  105  vaccinated  cattle  44%  reacted  at  the  end  of  the  first  year 
and  of  138  vaccinated  cattle  68%  reacted  at  the  end  of  the  second  year.  Thirteen 
of  the  reactors  were  slaughtered  and  all  found  tulierculous. 

In  Sweden  Regner  and  Stenstroem  conducted  vaccination  experiments  since 
1904  in  8  infected  herds  enforcing  no  other  hygienic  measures.  Of  142  animals 
vaccinated  61.2%  reacted  to  a  subsequent  tuberculin  test.  After  deducting  33 
animals  that  were  possibly  infected  at  the  time  of  vaccination  49.5%  of  the  remaining 
109  animals  gave  positive  reactions,  while  59%  of  the  61  control  animals  gave 
positive  reactions  to  the  tuberculin  test.  On  one  estate  57%  of  16  animals  vaccinated 
reacted  to  a  subsequent  test  while  only  20%  of  the  15  control  animals  reacted.  In 
a  few  cases,  however,  vaccination  seemed  to  have  a  favorable  influence  and  even 
produced  curative  effects  in  already  tuberculous  animals. 

Finally,  Weber  &  Titze  report  on  the  Aaccination  of  206  cattle  located  on 
6  different  estates.  The  results  are  summarized  by  the  statement  that  while  some 
of  the  animals  became  more  resistant  by  the  treatment  the  ex])eriment  was  by  no 
means  a  conspicuous  success.     In  one  herd  that  had  previously  been  entirely  freed 


Iiiimuiiization.  599 

from  tlio  .liscaso  l.v  the  Bang  iiiothoa  the  disease  spreail  just  as  rapidly  among  the 
vaccinated  as  it  had  spread  among  the  unvaccinated  animals  at  the  time  when  the 
Bang  method  was  introduced.  . 

A  favorable  report  is  made  hv  Strelinger  with  reference  to  his  experience  of 
five  vears  on  the  Domain  of  Siirvar  in  Hungary.  During  this  time  the  percentage 
of  reactors  was  reduced  to  9.0%,  however,  not  without  the  simultaneous  enforcement 
of  general  iirophvlactic  ami  hygienic  measures.  _  .     ■■       ^^, 

Pearson  &  "Cilliland  as  well  as  de  Schwelnitz  &  Schroeder  immunized  cattle 
in  the  I'nitod  States  hv  the  intravenous  injection  of  human  tul)ercle  bacilli.  Detailed 
reports  of  the  practical  results  obtained  have,  however,  not  yet  been  published. 

2.  Single  Vaccination  with  Human  Tubercle  Bacilli  (Vaccination 
with  Tanniinan:  incthoti  of  Koch  &  Seliuetz).  Accordiiif?  to  tho  oxperi- 
ments  of  Koeh,  Selmetz,  Neufeld  &  ^liessnor  it  is  possible  to  immunize 
cattle  a^^ainst  highly  virulent  bovine  bacilli  by  means  of  a  single  in- 
jection of  1  to  3  eg.  of  human  tubercle  bacilli  (one  close  of  Tauruman 
contains  0.01  gm.  of  virulent  human  tubercle  bacilli  in  emulsion). 
The  resistance  of  animals  thus  immunized  has  been  tested  after  a 
period  of  at  least  169  days  in  only  three  cases.  If  we  consider  that 
a  more  durable  immunity  can  hardly  be  expected  from  a  single  intra- 
venous injection  of  human  tubercle  bacilli  than  from  a  double  injection 
of  even  larger  doses  of  the  same  bacilli  and  further,  that  Tauruman 
bacilli  mav  remain  active  in  the  body  of  the  treated  animal  for  a 
period  of  '214  vears  the  results  of  experimental  investigations  above 
referred  to  as  to  the  practical  value  of  bovovaccine  would  probably 
apply  with  equal  force  to  the  practical  value  of  Tauruman. 

Although  Tauruman  has  been  used  for  vaccination  since  1905  extensive 
reports  on  the  practical  results  of  its  use  are  not  obtainable.  Eber  reports  on 
the  vaccination  of  48  caf-le  on  four  different  estates;  after  about  two  years  10 
out  of  21  of  the  vaccinated  animals  reacted  to  the  tuberculin  test.  Weber  & 
Title  vaccinated  63  calves  on  two  estates  and  achieved  apparently  good  results 
which,  however,  were  brought  about  by  the  fact  that  simultaneously  with  the 
introduction  of  the  vaccination  one  cow,  affected  with  mammary  tuberculosis 
was  removed  from  the  herd  and  all  calves  were  thereafter  reared  upon  boiled  milk. 
The  onlv  temporary  character  of  the  resistance  following  treatment  with  Tauruman 
is  showii  bv  an  experiment  of  Hutyra,  in  which  a  vaccinate.l  calf  received  eleven 
months  after  treatment  an  intravenous  injection  of  0.02  gm.  of  bovine  bacilli 
an<l  died   IS  days  thereafter  of  acute  miliary  tuberculosis. 

3.  Immunization  with  Avirulent  Human  Tubercle  Bacilli  (Dresden 
Method  of  Klimmer).  According  to  Klimmer  cattle  may  be  immunized 
for  a  period  of  one  year  either  with  human  tubercle  bacilli  that  have 
been  attenuated  by  "heating  at  52^  to  53°  C.  or  with  pure  cultures 
of  avirulent  tubercle  bacilli  that  have  been  passed  through  salamanders 
(originally  virulent  human  tubercle  bacilli  repeatedly  passed  through 
salamanders)  in  the  same  manner  as  with  virulent  human  tubercle 
bacilli.  Both  of  the  viruses  referred  to  are  said  to  be  nonpathogenic 
for  animals  (even  guinea  pigs)  and  do  not  regain  their  pathogenicity 
by  simple  passage  through  animals.  On  account  of  this  nonpatho- 
g'enicity  and  the  fact  that  bacilli  introduced  subcutaneously  into  tho 
liodies  of  cattle  are  soon  destroyed  and  completely  removed,  this  method 
of  vaccination  may  be  repeated  every  year  \\nthout  jeopardizing  the 
health  of  persons  that  consume  the  meat  of  animals  disposed  of  by 
.slaughter  at  anv  time,  and  thus  the  period  of  immunity  mav  be  pro- 
longed indefinitely  and  at  will.  In  addition,  vaccination  by  this  method 
is  said  to  exert  a  curative  influence  upon  already  infected  animals. 

Tattle  twice  treated  with  the?e  viruses  successfully  resisted  experimental 
infection  with  virulent  bovine  bacilli  after  a  period  of  from  2  to  9  months.  No 
difference  was  noted  in  the  protective  value  of  the  two  forms  of  virus.     According 


600  Tuberculosis. 

to  Klimmer's  reports  about  10,000  cattle  were  treated  sueoessfully  by  this  method 
(strict  prophylactic  aud  hygienic  measures,  however,  were  always  enforced — rearing 
calves  with  pasteurized  milk  or  the  milk  of  healthy  nurse  ccws,  removal  of  all 
cows  with  open  tuberculosis,  isolation  of  vaccinated  animals  as  much  as  possible, 
etc.)-  In  the  course  of  this  work  43  vaccinated  animals  were  destroyed  and  found 
free  from  tuberculosis  on  post-mortem  examination.  Gloeckner  also  reports  favorable 
results  from  the  vaccination  of  23  cattle,  four  of  which  were  slaughtered  at  a 
later  date,  one  of  these  a  non-reactor  before  vaccination  was  found  to  be  free 
from  tuberculosis,  and  the  other  three  reactors  at  the  time  of  vaccination,  showed 
post-mortem  evidence  of  the  curative  effect  of  the  treatment. 

On  the  other  hand  Eber  is  of  the  opinion  that  the  good  results  obtained  are 
to  be  attributed  to  the  simultaneous  prophylactic  and  hygienic  measures.  Weber 
&  Titze  hold  the  same  opinion.  The  latter  exposed  two  vaccinated  and  two 
unvaecinated  control  calves  to  infection  from  a  cow  with  pulmonary  tuberculosis, 
after  three  months  all  were  slaughtered  and  found  affected  with  tuberculosis  in 
approximately  the  same  degree.  These  experimenters  are  inclined  to  regard  the 
bacilli  contained  in  the  avirulent  vaccine  as  so  called  piscine  tubercle  bacilli  or 
reptilian   bacilli. 

4.  Immunization  with  the  Products  of  Metabolism  of  Tubercle 
Bacilli  (Heymans'  Method).  Heymans  introduces  human  or  bovine 
tubercilli,  enclosed  in  the  membrane  of  reeds  under  the  skin  of  cattle, 
assuming  that  the  bacilli  will  continue  to  vegetate  and  diffuse  their 
products  of  metabolism  through  the  membrane,  whereupon  they 
pass  into  the  circulation,  and  immunize  the  body  of  the  animal 
thus  impregnated  with  them  even  exerting  a  curative  effect  upon 
already  existing  tuberculous  processes.  In  the  effort  to  maintain  an 
effective  degree  of  immunity  by  annual  repetition  of  the  immunizing 
process  it  is  found  that  the  degree  of  sensitiveness  to  tuberculin  is 
gradually  diminished  and  that  50  to  60%  of  the  animals  will  cease 
to  react  to  the  third  test.  With  the  aid  of  this  method  it  is  claimed 
to  be  possible  to  exterminate  tuberculosis  without  resort  to  other 
hygienic  measures,  in  80%  of  the  herds  treated.  In  badly  infected 
herds,  however,  this  is  possible  only  with  the  aid  of  other  prophylactic 
measures. 

As  to  the  possibilities  of  this  method  which  has  been  applied  to  over  20,000 
cattle  in  Belgium,  thus  far  only  Heymans'  reports  have  been  available.  According 
to  these  the  percentage  of  reactors  in  the  vaccinated  herds  has  been  consideraldy 
reduced  year  after  year.  Thus,  for  example,  of  18  herds  comprising  188  cattle 
tested  in  1907,  and  retested  in  the  two  following  years,  the  percentages  of  reactors 
were  45.32%  and  21%,  respectively.  Only  50%  of  the  reactors  of  the  first  test 
responding  positively  two  years  later  at  the  third  test.  That  the  tuberculin  test 
retains  its  diagnostic  value  after  the  subjection  of  animals  to  this  treatment  is 
evidenced  by  the  fact  that  on  post-mortem  inspection  more  than  1,400  treated  cattle, 
which  had  given  negative  reactions  to  the  test,  were  found  free  from  tuberculosis. 

Experiments  with  18  vaccinated  and  13  control  animals  showed  that  vaccinated 
animals  possessed  a  higher  degree  of  resistance  to  subcutaneous  as  well  as  to 
intestinal  infection  than  not  vaccinated  cattle.  Moussu,  however,  found  that  four 
cattle  that  had  clay  tubes  containing  cultures  of  tubercle  bacilli  imbedded  in  their 
tissues  for  some  time,  were  affected  just  like  cattle  not  thus  treated  when  subjected 
to  intravenous  infection  with  virulent  bacilli.  The  serum  of  similarly  treated 
experiment  animals  showed  no  evidence  of  possessing  any  immunizing  properties. 
However,  animals  with  culture  tubes  of  bacilli  imbedded  in  their  tissues  will  react 
to  the  tuberculin  test.  After  the  bacilli  have  died  off,  or  after  their  removal  from 
the  body,  the  animals  cease  to  react. 

Technic  of  Immunization.  Tn  the  first  two  methods  discussed  the  virus 
or  vaccine  is  injected  into  the  blood  stream  while  in  the  third  and  fourth  methods 
it  is  applied  subcutaneously. 

1.  Behring's  Method.  The  virus  (bovovaccine)  consists  of  cultures  of 
hiunan  tubercle  bacilli  of  a  certain  strain  dried  in  a  vacuum.  The  powder  like 
substance  thus  obtained  is  prepared  for  use  in  quantities   sufficient   for  immediate 


Immunization.  601 

requirements  by  triturating  in  a  mortar  with  sterilized,  lukewarm  normal  nalt 
solution,  to  form  an  emulsion.  The  eiinilsion  should  be  prepared  in  two  strengths. 
That  used  for  the  lirst  vaccination  should  contain  0.0U4  gni.  of  dried  culture  per 
2  cc.  of  Uuid,  while  that  for  the  second  vaccination  should  Vie  doulde  this  strength 
or  contain  (I.U04  gm.  per  one  cc.  of  Uuid  (1  I.-U.  =  U.U04  of  dry  vaccine).  These 
emulsions  are  used  in  i'  cc.  doses,  i.  e.  1  l.-U.,  for  the  tirst  treatuuMit  and  in  5  cc. 
doses,  i.  e.  5  1  I.-U.,  for  the  second  treatment,  in  each  case  injection  being  made 
into  the  jugular  vein. 

The  most  suitable  age  for  vaccination  is  from  one  to  four  months.  Calves 
otherwise  in  good  health  are  not  injured  in  any  way  by  the  treatuieut.  If  tiio 
calves  are  tuberculous  at  the  time  of  the  first  treatment  a  reaction  follows,  similar 
to  that  ]n-oduceil  bv  tuberculin,  while  the  second  treatment  ^ives  rise  to  a  febrile 
reaction  in  healthv*  calves  as  well.  After  this  reaction  has  subsided  the  animals 
continue  to  develop  and  increase  in  weight  in  a  normal  manner.  Unfayorable 
results  are  obtained  only  in  auiuials  aft'octed  with  some  disease  at  the  time  of 
treatment,  especially  so  called  calf-pneumonia.  Eoemer  recommends  that,  in  addition 
to  the  vaccination  "of  calves,  as  soon  as  possilde  after  birth  all  calves  should  b(- 
fe.l  with  milk  free  from  tubercle  bacilli,  and  that  all  cows  with  open  tuberculosis 
should  he  removed  from  the  herd  at  once.  Yallee  &  Rossignol  recommend,  also. 
that  calves  should  not  be  exposeil  to  infection  from  the  first  vaccination  or  until 
6  weeks  after  the  second  vaccination. 

Later  Behring  introduced,  or  recommended,  a  new  method,  Tauro-vaccina- 
tion,  in  which  an  agent  with  anti-tulierculous  properties  (?)  is  added  to  the  vaccine, 
resulting  in  marke<l  attenuation  of  the  latter  which  is  injected  subcutanoously 
instead  of  intravenously.  According  to  Lignieres  oily  emulsions  are  better  a(lapted 
for  vaccination  than  aqueous  emulsions.  These  methods  have  not  been  applied  in 
practice. 

2.  Method  of  Koch  it  Schuetz.  Tauruman,  a  rea(hi-for-7(sc  enuilsion  of 
bacilli,  (0.01  g.  virulent  human  tuliercle  liacilli  in  emulsion)  after  breaking  off  the 
point  of  the  glass  tube  containing  the  vaccine,  is  drawn  out  with  a  hypodermic 
syringe  and  injected  into  the  jugular  vein  in  a  manner  similar  to  that  followed 
in  the  use  of  bovo-vaccine.     A  second  application  is  uot  made  in  this  method.  _ 

What  has  been  stated  in  regard  to  immunization  with  bovo-vaccine  might 
also  be  applicable  in  this  case.  Since  both  vaccines  contain  virulent  tubercle 
bacilli  the  greatest  caution  should  be  observed  in  their  manipulation  (Moeller 
reports  repeated  serious  infection  of  his  assistant  with  Tauruman). 

3.  Method  of  Klinimer.  In  the  "'Dresden  IMethod  of  Immunization  to 
Tuberculosis''  emulsions  of  attenuated  human  tubercle  bacilli  (TH)  or  avirulent 
tubercle  bacilli  (AY)  (the  latter  especially  for  milk  cows)  were  formerly  used. 
More  recently,  however,  avirulent  material  only,  known  to  the  trade  as  Antiphy- 
matol,  has  been  in  use.  Of  this  material  doses  of  5  cc.  are  injected  subcutaneously 
on  the  side  of  the  neck.  The  vaccine  must  be  preserved  in  a  cool  dark  ]dace  and 
used  within  three  weeks.  Cattle  may  be  treated  from  the  age  of  three  days  to  IS 
months,  or  older  animals  that  are  free  from  tuberculosis.  Vaccination  must  be 
repeated  after  three  months  ami  annually  thereafter  (young  animals  suspected  of 
being  tuberculous  are  advantageously  treated  four  times  during  the  first  year  at 
intervals  of  three  months).  It  is  recommended  to  protect  animals  from  exposure 
to  infection  and  to  feed  calves  previous  to  immunization,  and  for  two  months 
after  with  milk  that  is  free  from  any  infection.  All  animals  should  also  be  sub- 
jected to  the  ophthalmic  tuberculin  test  before  treatment.  The  non-reactors  should 
ithen  be  placed  in  the  most  favorable  positions  in  the  stables,  particular  care  being 
observed  that  healthy  animals  are  not  stabled  so  as  to  face  leactors. 

4.  Heymans'  Method.  The  vaccine  consists  of  dried  human  tubercle  bacilli 
enclosed  in  gelatinized  rccd  sacs.  The  process  of  vaccination  consists  in  the  intro- 
duction of  one  of  these  sacs  under  the  skin  of  the  croup  or  back  by  means  of  a 
specially  constructed  trocar. 

Cattle  of  either  sex  or  of  any  age  may  be  vaccinated  whether  they  are  free 
from  tuberculosis  or  infected,  but  in  order  to  obtain  permanent  results  the  vaccina- 
tion must  be  repeated  every  year.     Special  hygienic  measures  are  not  necessary. 

Other  Methods  of  Immunization.  Aside  from  the  very  numerous,  more 
or  less  successful  lalioratory  experiments  in  the  iunnunization  of  small  animals  for 
which  purpose  variously  attenuated  or  dead  tubercle  bacilli  as  well  as  toxic  sub- 
stances and  secretions  have  been  chiefly  used,  a  few  other  methods  that  have  been 
recommended  for  actual  practice  will  be  briefly  mentioned. 

Lignieres  introduced  sidicutaneons  vaccination  with  living  human  tubercle 
bacilli    into    practice    in    Argentine.      (The    human    tubercle   bacilli   were   either    in 


602  Tuberculosis. 

emulsion  or  homogeneous  liquid  cultures).  Baumgarten  had  then  already  shown 
that  a  single  subcutaneous  vaccination  with  human  tubercle  bacilli  increased  the 
resistance  of  cattle  to  a  marked  degree.  Hutyra  had  also  shown  that  cattle  thus 
vaccinated  would  be  protected  for  a  time  against  infection  by  intravenous  injection 
of  0.04  gm.  bovine  tubercle  bacilli  but  that  such  immunity  diminished  noticeably 
after  six  months.  According  to  Arloing  's  experiences  subcutaneous  vaccination 
does  not  produce  as  high  a  degree  of  resistance  as  the  intravenous  administration 
of  vaccine. 

2.  Friedmann  recommended  a  strain  of  tubercle  bacilli  for  vaccination  of 
cattle  which  he  had  cultivated  from  a  turtle,  and  successfully  protected  rabbits 
against  bovine  bacilli.  After  Libbertz  and  Kuppel  and  also  Orth  failed  to  con- 
iirni  the  favorable  results  claimed  by  Friedmann,  Weber  &  Titze  showed  that  while 
the  repeated  intravenous  administration  of  large  masses  of  bacilli  derived  from 
cold-blooded  animals,  or  of  acid-fast  grass  bacilli,  no  doubt  might  increase  the 
resistance  of  cattle  to  infection  with  bovine  bacilli  to  a  slight  extent,  the  effect 
is  so  slight  that  the  practical  application  of  the  method   is  of  questionable  value. 

.3.  According  to  Behring  as  well  as  Calmette  &  Guerin  it  is  possible  to 
immunize  cattle  against  intestinal  infection  by  the  administration  of  a  small 
quantity  of  bovine  bacilli  per  os.  Eoux  &  Vallee  obtained  good  results  by  two 
ailministrations,  per  os,  to  young  calves,  at  intervals  of  three  months,  of  0.20  gui. 
(loses  of  equine  tidjercle  bacilli  or  of  viruient  bovine  bacilli.  Animals  thus  treated 
were  found,  in  some  eases  to  possess  greater  resistance  to  subsequent  infection  than 
those  immunized  by  the  intravenous  method.  The  advantage  of  this  method  of 
immunization  is  claimed  to  be  that  bacilli  thus  administered  are  completely  absorbed 
in  a  period  not  longer  than  7  months.  On  the  other  hand,  alimentary  infection 
occurring  during  or  immediately  preceding  the  period  of  preventive  treatment  will 
give  rise  to  a  progressive  tuberculous  condition.  Even  Vallee  himself  admits  that 
attenuated  human  tubercle  bacilli,  the  alimentary  administration  of  which  gives 
similar  results,  £.re  perhaps  more  suitable  for  this  purpose. 

4.  Arloing  uses  homogenized  cultures  of  human  or  bovine  bacilli  grown  on 
6%  glycerin  bouillon  for  the  immunization  of  cattle.  These  cultures  do  not 
produce  microscopic  tubercules  in  small  experimental  animals  or  in  calves  but  only 
microscopic  changes  of  the  Yersin  type.  The  cultures  are  administered  intraven- 
ously, subcutaneously  or  per  os.  According  to  the  first  method  young  calves  receive 
0.5  cc.  for  the  first  dose;  two  months  later  1.5  cc.  of  a  culture  one  month  old  is 
injected  into  the  jugular  vein  (older  animals  receive  1.0  to  1.5  cc).  In  the 
subcutaneous  method  both  the  first  and  s-econd  applications  are  made  subcutane- 
ously (2  cc.  of  culture  being  injected  each  time  in  the  side  of  the  neck  or  in  the 
flank).  According  to  the  third  method  the  first  dose  consists  of  15  cc.  and  the 
second  dose,  two  months  later,  of  20  cc.  of  culture  carefully  injected  into  the 
mouth  so  that  the  animal  will  swallow  the  same.  In  all  thi'ee  methods  it  is  neces- 
sary to  follow  up  the  treatment  with  annual  subcutaneous  injections  of  2.0  cc.  of 
culture  in  order  to  maintain  an  effective  degree  of  immunity.  These  treatments 
always  result  in  tuberculin-hypersensitiveness  which,  however,  gradually  leads  in 
about  six  or  eight  months  to  the  opposite  condition,  that  is  a  tolerance.  Moderate 
fever  of  short  duration  follows  the  intravenous  as  well  as  the  subcutaneous  admin- 
istration of  the  virus  and  in  the  latter  method  a  local  tumor  with  frial)le  cheesy 
contents  develops  at  the  point  of  injection.  This  usually  disappears  in  the  course 
of   several   months. 

Results  of  the  vaccination  of  60  cattle  ranging  in  age  from  4  to  12  months, 
with  30  control  animals  in  the  experiment,  were  only  partly  successful.  After 
exposure  to  infection  only  about  50%  of  the  vaccinated  animals  remained  healthy; 
of  the  infected  animals  some  were  only  slightly  affected  but  others  were  extensively 
diseased.  Nevertheless  the  results  as  a  whole  were  in  favor  of  immunization.  The 
fact  that  the  cultures  iised  were  harmless  for  cattle,  as  well  as  for  monkeys,  also, 
deserves  favorable  consideration  of  the  method.  The  intravenous  method  gave  the 
1  est  results,  the  ingestion  method  came  second  and  the  subcutaneous  method  last  in 
efficacy. 

5.  Vallee  immunized  horses  by  intravenous  injections  of  successively  increas- 
ing doses  of,  first,  equine  bacilli  avirulent  for  guinea  pigs,  which  then  were  followed 
by  human  tubercle  bacilli  slightly  virulent  for  guinea  pigs.  The  injections  pro- 
diiced  no  tuberculous  processes  whatever.  After  treatment  for  one  or  two  years  the 
serum  of  these  horses,  though  possessing  only  slight  agglutinating  power,  con- 
tained protective  substances  that  could  be  demonstrated  by  the  complement  fixation 
method,  and  which  in  doses  of  100  to  200  cc.  protected  young  cattle  against  experi- 


Police  Pleasures.  gQ3 

Tiicntal  infeotioii  with  tiibeiriilosi^.  A'allee  oxpicsf-os  tlic  liope  that  siu-li  sevinn  may 
lo  iisoil  for  thiMapoutic  jmrposos,  in  fact  some  hiiiidreds  of  jicrsoiis  hn\v  alreaiiy 
))ceii  treatoil  with  this  inatorial  hut  reports  on  results  have  not  as  yet  1  ecu  available. 

Veterinary  Sanitary  Police  Measures.  Tlio  cxiraoidinnry 
l)ievaleiic'e  of  tuijcrculosis,  especially  among  the  ini})rov(Ml 
l)reeds  of  cattle,  and  the  consequent  enormous  losses  liave  been 
the  motive  of  govorumeut  interfereuco  for  the  pur])ose  of  the 
coutroliing,  and,  as  may  be  p()ssi1)le,  oom])letely  extei'iiiiuatin.u" 
tlie  disease.  On  the  very  account  of  tlie  great  prevalence  of 
the  disease  however,  measures  of  protection  and  extermination 
that  have  proved  successful  for  other  aninuil  plagues  can 
hardly  be  a]i])lie(l  to  tul)erculosis.  "Witli  the  exception  of 
states  and  countries  v.diere  tlie  disease  lias  as  yet  made  little 
headway,  general  measures  for  compulsory  slaughter  can  not 
be  considered  because  such  a  procedure,  aside  from  the 
enormous  financial  sacrifice,  would  otherwise  most  seriously 
affect  the  best  interests  of  the  live  stock  industry  of  the  country 
and  of  other  interests  generally.  Under  existing  conditions, 
therefore,  and  for  a  long  time  to  come,  government  activity 
must  be  confined  to  gradually  enforced  measures  of  repression 
and  the  extension  of  every  possible  aid  to  such  owners  of 
live  stock  whose  earnest  endeavors  are  aimed  at  the  extermina- 
tion of  the  evil. 

In  order  to  reduce  the  danger  of  exposure  and  infection 
official  regulations  should  require,  above  everything  else,  that 
animals  with  open  tuberculosis,  and  particularly  cows  with 
tuberculosis  of  the  udder,  be  excluded  from  trade  by  rigid 
quarantine  and  destroyed  as  soon  as  possible,  subject  to 
reasonable  compensation  to  the  owner  from  government  ap- 
propriations or  from  funds  provided  by  a  system  of  obligatory 
live  stock  insurance.  To  aid  in  the  enforcement  of  this  measure 
it  should  be  made  the  duty  of  meat  inspectors  to  report  every 
case  of  tuberculosis  to  the  proper  authorities  whereupon  it 
would  devolve  upon  the  latter  to  make  an  official  investigation 
of  the  herds  from  which  the  diseased  animals  originated  and 
cause  any  and  all  evidently  diseased  remaining  animals  to 
be  disposed  of  by  slaughter  subject  to  proper  inspection. 

The  permanent  professional  supervision  of  all  herds,  but 
particularly  and  primarily  of  dairy  herds,  is  justified  by  the 
importance  of  an  early  recognition  of  clinically  affected  or 
snspected  animals  so  that  the  milk  from  these  animals,  which 
is  dangerous  to  the  health  of  human  beings,  shall  not  be  put 
on  the  market  unsterilized.  Aiilk  from  infected  herds  should 
not  be  permitted  to  be  sold  unless  previously  heated  to  at 
least  80""  C,  and  the  product  of  animals  with  affection  of  the 
udder  should  under  no  circumstances  be  permitted  to  be  sold, 
given  away  or  other^\^se  utilized.  In  addition,  official  reuida- 
tions  should  provide  that  all  skim  milk  and  other  by-products 
from  creameries  and  skimming  stations  must  be  heated  to 
at  least  80°  C.  before  they  may  be  returned  to  the  producer 


604  Tuberculosis. 

or  to  other  persons.  Further,  governments  shouhl  offer 
premiums,  and  otherwise  aid  in  the  acquisition  of  such  male 
animals  only  as  have  been  shown  to  be  free  from  tuberculosis 
]3y  the  tubercuUn  test  or  by  protective  inoculation.  This  would 
have  the  additional  advantage  of  stimulating  the  breeders  to 
make  every  effort  to  produce  healthy  animals  because  of  the 
greater  value  of  the  young  annuals.  Finally,  a  properly 
organized  and  effective  system  of  meat  inspection,  aside  from 
its  value  in  locating  centers  of  infection,  would  add  to  the 
success  of  the  whole  undertaking  by  insuring  the  destruction 
of  badly  infected  animals  or  their  diseased  organs,  and  pre- 
venting their  sale  as  food. 

The  government  may  assist  or  support  efforts  on  the  part 
of  private  individuals  by  paying  the  expenses  of  professional 
advice  or  supervision  where  the  Bang  system  for  the  extermina- 
tion of  the  disease  is  attempted,  and  by  furnishing  the  neces- 
sary tuberculin  free  or  at  cost  of  production.  Such  aid,  how- 
ever, should  be  extended  only  on  condition  that  the  owners 
of  the  herds  carry  out  to  the  letter  all  necessary  measures 
to  insure  successful  prevention  of  infection  of  healthy  animals, 
dispose  of  all  clinically  affected  or  suspicious  animals  by 
slaughter  within  a  specified  time  and  exclude  all  reactors  from 
trade.  In  this  connection  it  is  advisable  and  necessary  to 
provide  proper  means  of  identification  of  all  reacting  animals 
because  without  this  the  tuberculin  test  may  merely  serve  to 
assist  certain  owners  to  dispose  of  their  diseased  animals  by 
sale  and  thus  bring  about  a  still  wider  dissemination  of  the 
disease.  For  the  same  reason  the  manufacture  and  sale  of 
tuberculin  and  its  importation  from  other  countries  should  be 
controlled  by  the  government.  Finally,  the  dissemination  of 
information  by  the  state  or  government  in  regard  to  the 
nature  and  control  of  tuberculosis  would  he  of  great  aid  in  a 
campaign  of  suppression  directed  against  this- disease. 

Since  1909  the  live-stock  sanitary  laws  of  Germany  require  owners  to  report 
to  the  proper  authorities  all  clinically  recognizable  forms  of  the  disease  affecting 
the  lungs,  udder,  uterus  or  intestines.  Provision  is  made  for  the  ofiBcial  condemna- 
tion and  destruction  of  such  animals  or  their  safe  quarantine,  disinfection  of 
infected  premises  and  the  marking  of  quarantined  cattle  for  future  identification. 
The  milk  from  such  animals  must  be  sterilized  by  heat  before  being  sold  or  given 
away  and  in  case  of  tuberculosis  of  the  udder  it  is  absolutely  excluded  from  use  as 
food  for  human  beings. 

Austria  has  enforced  very  similar  laws  since  1909,  requiring  the  notification 
of  all  cases  of  clinical  tuberculosis  to  the  authorities,  isolation  and  marking  of 
animals  thus  affected,  disinfection  of  infected  staljles,  compulsory  slaughter  of 
calves  ( ! )  from  diseased  cows  and  government  support  for  the  control  and 
extermination  of  the  disease. 

In  Hungary,  since  1910,  cattle  with  tuberculosis  of  the  udder  are  confiscated 
by  the  government  and  immediately  slaughtered.  In  addition,  the  use  of  milk  for 
human  food  from  cows  with  open  tuberculosis  is  forbidden  and  all  skim  milk  from 
freameries  and  skimming  stations  must  be  pasteurized  before  it  may  be  sold  or 
given  away. 

The  most  successful  results  in  the  control  and  extermination  of 
tuberculosis  are  to  be  found  in  the  northern  states  of  Denmark,  Norway, 


Police  ]\reasinos.  005 

Sweden  aiul  Fiiiljuul,  where  individual  ell'orts  on  llie  part  of  owners 
have  for  years  received  the  support  of  legislative  measures  (see  also 
statistics  on  jiage  502). 

The  endoavors  of  tlio  Danish  Clovprnment  for  the  extermiiialion  of  tubercu- 
losis, which  are  worthy  of  enuilation,  began  in  liHlIS  when  annual  api>ro{>riations 
of  50,000  crowns  were  made  for  tlie  support  of  the  work.  These  ajiiJropriations 
were  later  increased  to  ](Mi,(lOO  crowns.  At  first  tuberculin  was  furnislied  free  of 
expense  for  young  animals  only,  later  it  was  furnished  for  all  cattle  upon  the 
same  basis,  and  beginning  with  ISitS  the  government  assumed  all  exi)ens;es  con- 
nected witli  the  control  and  extermination  of  the  disease.  The  laws  of  1898 
prescribe  obligatory  Pasteurization  at  85°  C  for  all  skim  and  buttermilk  intended 
for  feeding  animals.  This  resulted  in  an  immediate  reduction  in  the  percentage 
of  tuberculosis  in  calves  and  even  more  so  in  swine.  Jn  1904  the  prescribed 
temperature  of  85°  C  was  reduced  to  80°  C.  The  laws  of  1898  also  require  the 
compulsory  slaughter  of  all  cows  with  tidterculosis  of  the  udder  and  ])roviile  com- 
)>eiisation  to  the  owners.  This  resulted  in  the  annual  witlnliawal  from  trade  of 
000  cows  with  udiler  tuberculosis  out  of  a  total  of  about  one  million  cattle.  For 
seven  years  (1898-1904)  the  annual  losses  were  as  follows;  407,  592,  610,  584,  615, 
583  and  689  respectively. 

In  Sweden  methods  of  extermination  inaugurated  in  1897  along  lines  similar  to 
those  upon  which  Danish  ojierations  were  based  gave  ecpially  happy  results.  While, 
for  example,  tuberculin  tests  of  1370  henis  comprising  48,576  animals  gave  14,225 
reactors    (29.3'^!)    in   the   beginning   of   the   campaign,   tests   of  the   same   herds   in 

1908,  then  comprising  57,6()()  animals  gave  only  1765  reactions  (3.1';y).  This 
result  was  obtaineil  at  a  cost  to  the  government  of  830,000  crowns. 

On  account  of  the  diflicvdties  or  olistacles  above  discussed  the  compulsory 
official  destruction  of  all  animals  affected  with  tuberculosis  has  not  given  satis- 
factory practical  results.  Thus,  in  Belgium,  in  1895,  all  animals  affected  with 
clinical  tuberculosis,  as  well  as  all  reactors  to  the  tuberculin  test  were  ordered 
killed  within  a  prescribed  time.  As  a  result,  of  2,905  herds  comprising  19,004 
cattle  in  1896,  9280  were  slaughtered.  The  surprisingly  enormous  expense  of  this 
I)rocedure  and  the  opposition  offered  by  the  owners  brought  aliout  a  modification 
of  this  order  so  as  to  apply  to  clinically  affected  animals  only.  Even  with  this 
restriction  the  enforcement  of  the  order  resulted  in  the  destruction  of  10,269  cattla 
in  19(»2  at  a  cost  to  the  state,  in  indemnification  expenses,  of  about  one  and  one 
half  million  franks.  In  the  North  American  State  of  Massachusetts  a  similar 
radical  attempt  inaugurated  in  1895  was  abandoned  at  the  end  of  the  first  year. 

The  official  tuberculin  testing  of  import  animals  before  they  are  permitted 
entrance  within  the  borders  of  a  country,  a  practice  in  force  in  a  number  of 
states  has  not  been  found  effective  except  from  a  purely  sanitary  police  point  of 
view.  This  is  due  to  the  fact  that  injections  of  tuberculin  made  immediately 
I:efore  shipment  (plugging)  robs  the  tuberculin  test  subsequently  applied  of  its 
diagnostic  value.  A  measure  of  this  kind  is  in  effect  along  the  North  German 
border  for  all  imported  cattle.  AVhile  30.8''/-  of  the  74,813  quarantine  cattle 
reacted  to  the  tuberculin  test  during  the  first  year  of  the  enforcement  of  this 
measure  the  percentage  of  reactions  has  fallen  off  heavily  in  the  following  years 
although  a  considerable  percent,  of  the  animals  were  found  tuberculous  at  the  time 
of  slaughter.  Thus,  of  772,037  cattle  subjected  to  the  tuberculin  test  in  1899  to 
1908  onlv  9,197,  i.  e.  1.2'/  reacted,  although  176,554  tuberculous  animals  were 
found  at  the  subsequent  slaughter  of  748,628  non-reactors,  1.  e.  22.2'%,  and  of 
these  2407  were  affected  with  generalized  tuberculosis   (!) 

Literature.  Yili,i:mix.  Rec,  1867.  5.  —  Chauveau,  Ibid.,  1869.  202;  Eev. 
gen.,  1907.  IX.  497.  —  Semmer,  D.  Z.  f.  Tm.,  1876.  II.  209.  —  Virchow,  B.  kl. 
W.,  1880.  Nr.  14.  —  Koni.  B.  kl.  W.,  1882.  221;  Mitt.  d.  G.-A.,  1884.  II.  1;  D. 
m.  W.,  1897.  207.  —  Johne,  D.  Z.  f.  Tm.,  1883.  IX.  1  (History,  with  Lit.).  — 
Bang,  Ibid.,  1885.  XI.  45;  1890.  XVT.  353;  Z.  f.  Tm.,  1902.  81.  —  He.ss,  Schw.  A., 
1889.  155;  1896.  XXXYIIT.  210.  —  Jensen,  D.  Z.  f.  Tm.,  1891.  XYII.  255  (Lit. 
on  tub.  of  dogs  and  cats).  —  Cadiot,  La  tub.  du  chien.  Paris.  1893  (Lit.)  ;  Monh., 
1894.  V.  97.  —  Cadkac,  J.  vet,  1894.  723;  1905.  577;  1907.  65.  —  Kitt,  Monh., 
1896.  \U.  216;  1905,  XVT.  267;  1907.  XVIIL  385  (Review).  —  Malm,  Rev. 
de  la  Tub.,  1898.  337.  —  Nocard,  Diet,  de  med  vet.,  1892.  XXI.  426;  A.  P.,  1892. 
\l.  44;   Rec,  1090.  721.  —  Arloing,  C.  R.,  *1898.  CXXVI.  u.   XXVIIT;   Rev.  gen., 

1909.  XIY.  781.  —  Ern.st,  Monh.,  1900.  XI.  229.  (Review  on  Law  in  Milk). 
—  Fluoge,  Z.  f.  Hvg.,  1901.  XXXVTIL  1.  —  Behring,  Beitr.  ?..  exp.  Ther.,  1902. 
1;  D.  m.  W.,  190.3.  689;  Tuberkulose,  1905.  lY.  371.  —  Ostertag,  Z.  f.  Hyg., 
1901.  XXXVIII.  45;   Z.  f.  Tnfkr.,  1910.  VII.   1.  —  Eber,  Z.  f.  Tm.,  1905.  IX.  81; 


()(}g  Tuberculosis. 

Cbl.  f.  Bakt.,  1097.  XLIV  463;  1909.  LIT.  .'589.  —  Calmette  &  Guerik.  A.  P.,  1905. 
XIX.  601;  1906.  XX.  353  u.  609.  —  Ostertag,  Breidert.  Kaestker  &  Kraut- 
STRUNK,  Arb.  d.  hjg.  Inst.  d.  tierarztl.  II?eh.  Berlin,  Y.  H.  1905   (Lit.  on  Diagnosis). 

—  Pearson  &  GiLlilaxd,  J.  of  comp.  Path.,  1905.  XVIII.  207.  —  Koch,  BcHtTZ. 
Neufeed  &  Miessner,  a.  f.  Tk.,  1905.  545.  —  Moussu,  Eec,  1905.  777;   1907.  701. 

—  Heymans,  Arch,  internat.  de  pharmacodynaniie,  1905  —  1910.  XYII  —  XX.  — 
Meyer,  Z.  f.  Tm.,  1906.  X.  241.  —  Fischer,  Ibid.,  1906.  X.  82   (Lit.  on  Uternstiab.). 

—  Hutyra,  Z.  f.  Tm.,  1907.  XL  241.  — ■  Pirquet,  Yakzination  n.  vak?.  Allergie. 
Wien  1907.  —  Weber  &  Titze.  Tbk.-Arb.  d.  G.-A.  7.,  9.  ii.  10  H.  1907,  1908  ii. 
1910  (Lit.  on  Imnninization).  —  Yallee,  Bull.,  1907.  ISO;  Eev.  gen.,  1908.  XI. 
318;  1909.  XTII.  355;  A.  P.,  1909.  XXYIL  585.  —  Ligxi^res.  Bull.,  1908.  112  u. 
517;  1909.  146.  —  Mohler  &  Washburn,  An.  Ind.,  1907.  215.  —  Schroeder  & 
Cotton,  An.  Ind.,  Bull.  Nr.  99.  —  Much,  Beitr.  z.  Kl.  d.  Tb.,  1907.  YIII.  85; 
19C8.  XL  175.  —  Wyssmann,  Scliw.  A.,  1908.  L.  90  (Lit.  on  Tub.  after  Contrac- 
tion). —  Titze  &  Weidanz,  Tbc.-A.  d.  G.-A.,  9.  H.,  1908,  —  Mayer,  Diss.  Bern.  1908 
(Lit.  on  sheep  tub.).  —  Calmette  &  Guerin,  A.  P.,  1908.  XXII.  1.  —  Klimmer, 
Z.  f.  Tm.,  1908.  XII.  81.  —  Klimmer  &  Kiessig,  Monh.,  1908.  XX.  97;  Z.  f.  Tm., 
1909.  XIII.  313.  —  Eomer,  Z.  f.  Infkr.,  1909.  YL  393,  —  JoEST.  Ibid.,  1909.  Y. 
224.  YL  257;  1910.  YIL  131.  —  Albien,  Z.  f.  Tm.,  1909.  XIII.  109  (Lit.  on  Con- 
genial Tub.).  —  BoNGERT,  A.  f.  Ilvg.,  1909.  LXIX.  263.  —  Forster,  Cbl.  f.  Bakt., 
1909.  LI.  417  (Lit.  on  sterlization"  of  milk.).  —  Henschel,  Diss.  Bern.  1909  (Lit. 
on  anatomical  statistics).  —  Wolff-Eisner,  Friihdigan.  u.  Tbc.-Imm.  Wiirzburg 
1909.  —  Richter,  Z.  f.  Infkr.,  1909  V.  243  (Lit.  on  local  reaction).  —  Joseph,  B. 
t.  W.,  1909.  847.  —  Goedecke,  Tbc.  d.  Pferdes,  Hannover,  1909.  —  Flugge, 
Yerbreitungsw.  u.  Bekampfg.  d.  Tub.  Leipzig.  1908.  —  Nowak,  Z.  f.  Infkr.,  1909. 
YL   313    (Lit.   on   immunization). 

Tuberculosis  in  Man.  At  the  present  day  tuberculosis  is 
the  most  destructive  disease  of  mankind,  estimates  sliowin^j< 
that  one-seventh  of  all  deaths,  and  one-third  of  all  deaths 
occurring-  during-  the  'Svorking  age"  of  human  beings,  are  due 
to  this  disease. 

In  the  majority  of  cases  it  manifests  itself  as  a  chronic 
destructive  affection  of  the  lungs  (consumption,  phtliisis 
pulmonum).  In  cases  where  the  disease  appears  primarily  as 
an  affection  of  the  peripharyngeal  and  cervical  lymph  glar.ds, 
the  digestive  organs  or  the  bones,  the  development  of  puhnonary 
tuberculosis  is  usually  only  a  question  of  time.  In  a  certain 
number  of  cases  the  disease  confines  its  entire  course  to  the 
abdominal  organs  (al)dominal  l>anpli  glands,  especially  in 
children).  In  exceptional  cases  the  disease  terminates  as  a 
generalized  acute  miliary  tuberculosis. 

As  has  been  found  to  be  the  case  in  animals,  man  also 
with  few  exceptions  acquires  the  disease  in  extra-uterine  life. 
Infection  is  caused  as  a  rule  by  the  human  type  of  tubercle 
bacillus  which  is  disseminated  in  large  quantities  by  diseased 
human  beings,  particularly  through  the  medium  of  expectorated 
secretions  from  the  lungs.  The  l)acilli  are  then  inhaled  or 
ingested  by  persons  that  come  into  contact  with  the  patients, 
particularly  when  they  live  with  them  in  the  same  close,  dirty 
and  poorly  ventilated  dwellings. 

The  virus  of  animals,  and  especially  that  of  bovine  tuber- 
culosis plays  a  less  important  role  in  the  infection  of  man. 
Experimental  investigations  "of  recent  years  have  shown,  how- 
ever, that  man  is  susceptible  to  infection  with  bovine  virus. 
This  has  been  demonstrated  by  well  authenticated  cases  where 
human  beings  became  affected  after  consumption  of  milk  from 


Tiibi'ivulosis  ill  Mail. 


607 


tnl)orciiloiu;  cows  or  after  injuries  acciiiired  wlioii  itiakiiif?  post- 
morteiii  examinations  of  tuberculous  animals.  Even  more 
positive  in  this  respect  has  been  the  evidence  furnished  by 
the  fact  that  tubercle  bacilli,  a,i;reein^  in  their  pathoi^^enic 
properties  in  every  particular  with  those  of  the  bovine  type, 
have  been  isolated  from  the  lesions  of  tuberculous  persons, 
especially  children  (see  p.  GlI.'J). 

If,  in  spite  of  this,  bovine  tuberculosis  plays  oidv  a 
secondary  role  in  the  dissemination  of  tuberculosis  in  man 
the  cause  for  this,  may  in  part  at  least,  be  found  in  the  fact 
that  human  beings  do  not  live  in  as  close  association  nor  come 
in  as  intimate  contact  with  tuberculous  cattle  as  tliev  do  with 
their  fellow  beings. 

Pulmonary  consniiiptioii,  Ihe  eoiiiinoiicst  form  of  human  tuber- 
culosis. ai)pears  to  bo  caused  almost  always  by  the  human  type  of 
the  l)acillus.  Koch  only  recently  emphasized  the  fact  that  up  to  that 
time  the  hovnie  type  of  bacillus  had  not  been  demonstrated  in  a  single 
ease  of  human  pulmonary  tuberculosis.  Indeed  Kitasato  could  find 
only  the  human  type  of  bacillus  in  152  and  Dieterlen  in  50  examina- 
tions of  sputum  from  consumptives.  But  Mohler  &  AVashl)urn  as 
well  as  Beitzke  report  each  one  case  in  which  thev  succeeded  in  ob- 
taining pure  ciiltures  of  the  bovine  type  from  such  material.  In 
n'eneral  the  l)acilli  of  the  l)ovine  type  seem  to  possess  only  a  slight 
tendency  to  spread  in  the  human  ])ody,  consequently  they  produce, 
111  tlie  majority  of  eases,  only  local  lesions  in  the  region  of  the  point 
of  infection   (peripharyngeal,  cervical  and  mesenteric  glands). 

The  danger  which  threatens  man  in  the  direction  of  bovine 
infection  demands  the  maintenance  of  every  measure  of  pro- 
tection by  means  of  which  this  danger  may  be  averted. 

In  this  respect  all  raw  animal  products,  and  particularlv 
milk,  demand  adequate  consideration.  There  seems  to  be  no 
question  as  to  the  justification  of  the  demand  that  all  cows 
witn  open  tuberculosis  and  such  as  have  affected  udders  be 
unconditionally  excluded  from  dairy  purposes  and  that  all  milk 
offered  for  sale  to  the  public  should  be  subject  to  professional 
or  expert  supervision.  Herds  supplying  creameries  and  skim- 
ming stations  should  be  subjected  to  particularlv  stringent 
regiilations  for  the  reason  that  a  single  infected  herd  or  anmial 
may  be  the  means  of  contaminating  the  entire  product  of  a 
large  station.  Control  of  this  character  should  confine  itself 
not  merely  to  the  exclusion  of  diseased  animals  but  also  to 
enforcement  of  general  sanitary  regulations  in  the  production 
and  handling  of  the  milk,  thus  insuring  the  healthfulness  of 
the  various  other  dairy  products,  butter,  cheese,  etc. 

Since  suitable  measures  of  control  of  this'  kind  are  at 
present  enforced  in  very  few  localities,  it  is  incumbent  upon 
every  individual  to  observe  certain  measures  for  his  own  pro- 
tection."  T^ncertified  milk  should  not  be  used  as  food  without 
previous  boiling  or  at  least  heating  to  80°   C.     Children    in 


608  Tuberculosis. 

particular,  should  be  fed  exclusively  on  pasteurized  milk  on 
account  of  their  susceptibility  to  infection. 

The  possible  danger  attending  the  consumption  of  meat 
from  tuberculous  animals,  though  of  much  less  consequence 
than  that  attending  the  consumption  of  dairy  products,  may 
be  entirely  overcome  by  a  general  system  of  obligatory  meat 
inspection.  Aside  from  the  destruction  of  tuberculous  organs, 
all  tuberculous  meat  should  be  condemned  and  all  suspicious 
carcasses  should  be  sterilized  by  heat  before  they  are  per- 
mitted to  be  placed  on  sale. 

Since  human  beings  are  exposed  to  the  danger  of  contract- 
ing disease  in  infected  stables,  attendants  should  not  remain 
in  them  for  longer  periods  than  necessary  and  under  no  cir- 
cumstances use  such  stables  as  dormitories.  In  dwellings, 
adequate  measures  should  be  taken  to  protect  residents  from 
possible  infection  by  tuberculous  dogs  and  birds  (parrots). 

Finally,  persons  employed  in  the  care,  or  otherwise,  of 
tuberculous  animals  and  in  the  examination  of  tuberculous 
carcasses  should  always  be  on  their  guard  in  the  observation 
of  ordinary  precautionary  measures. 

Literature.      S.  Cornet,  Xothnagels  Handbnch,  1900.  XIV. 


(b)      Tuberculosis    of   Fowls.      Tuberculosis    avium.      Avian 

Tuberculosis. 

Historical.  After  Paulicki  had  recognized  the  similarity  between 
this  disease  in  birds  and  tuberculosis  of  human  beings  and  mammals 
even  before  the  discovery  of  the  tubercle  bacillus,  Koch  showed  in 
1882  that  a  disease  of  fowls  existed  which  was  caused  by  a  bacillus 
similar  in  its  morphological  and  staining  characteristics  to  the  tubercle 
bacillus.  Koch  as  w^ell  as  Ribbert  looked  upon  the  disease  as  identical 
with  mammalian  tuberculosis  and  occasional  observations  that  fowls 
apparently  became  infected  from  the  expectorations  of  sick  persons 
(Johne  and  others)  seemed  to  confirm  this  view.  Rivolta  (1888)  how- 
ever could  not  succeed  in  his  efforts  at  experimental  infection  of  fowls 
Avith  mammalian  bacilli  and  therefore  declared  tuberculosis  of  mammals 
and  of  birds  to  be  etiologically  distinct  diseases.  Since  this  time  avian 
tuberculosis  has  been  the  subject  of  numerous  investigations  which, 
however,  have  not  led  to  uniform  results  and  the  question  of  the  identity 
or  relationship  of  the  two  forms  of  disease  is  still  an  open  one.  While 
Strauss  and  others,  also  the  pupils  of  the  former,  Gamaleia  and  Wuertz, 
and  more  recently  Koch  also  stood  for  the  non-identity  of  the  two 
diseases  on  account  of  the  difference  in  virulence  of  the  bacilli,  Maffucci 
took  the  same  stand  on  the  basis  of  the  morphological  and  cultural 
differences;  more  recently  Weber  &  Bofinger  (1904)  have  expressed 
themselves  as  accepting  the  same  view  but  Cadiot,  Gilbert  &  Roger, 
Fischel,  Hueppe,  Johne,  Nocard,  Behring,  Roemer  as  well  as  M.  Koch 
&  Rabinowitsch  have  taken  the  opposing  position  in  claiming  specific 
identity  for  the  two  forms  of  bacilli  (see  p.  617). 

Occurrence.  Avian  tuberculosis  occasionally  appears  en- 
zootically  among  fowls  and  pigeons,  causing  enormous  losses 


Avian    TulxTculiisis.  fiOO 

(Ziioi-n  found  tiilxMVulo.sis  in  lO^c  of  (l<'ntlis  in  tliosc  animals). 
Anions'  water  fowls  the  disease,  tlion^li  j^enevally  mncli  less 
prevalent,  also  a])pears  as  an  enzootic  (PIuss).  Birds  kept 
in  captivity  ni-e  also  affected  (M.  Koch  and  Rabiiiowitsch  found 
118  tuberculous  subjects  anion",-  459  birds  that  died  in  the 
Zoological  (Jarden  in  Berlin). 

Etiology.  The  bacillus  tuberculosis  avium  ol)tained  from 
tissues  is  usually  shorter  and  stains  more  evenly  than  the 
bacillus  of  mammalian  tuberculosis,  but  otherwise  agrees  with 
the  latter  in  staining  characteristics  (see  Fig.  95). 

Cultivation.  On  glycerin  blood  serum  the  baeilhis  thrives  much 
better  than  tlie  mammalian  variety,  glassy,  transparent,  roundish 
colonies  being  visible  on  the  surface  of  the  nutrient  medium  as  early 
as  the  8th  and  sometimes-even  the  5th  day.  Later  they  become  confluent 
and  form  a  grayish-white  or  yellowish-red,  moist,  slimy,  stringy,  smeary 
scum  that  is  easilv  emulsified  in  water.  The  bacillus  thrives  best  be- 
tween 30°  and  40°  C,  ])ut  will  grow  also  at  25°  and  at  45°  C.  In 
cultures  grown  at  a  high  temperature  we  find  aside  from  short  rods 
also  longer  forms  that  stain  uniformly  or  exhibit  a  granular  appearance, 
some  of  them  thick  and  club-shaped  or  even  branched  (Maffucci).  On 
potatoes  they  form  a  grayish-white,  blackish  or  reddish,  moist,  smeary, 
crumpled  layer  (Matzuschita ;  see  Plate  II);  in  glycerin  bouillon 
granules  develop  on  the  floor  and  wall  of  the  vessel  while  only  some 
of  the  strains  form  a  dry  wrinkled  membrane  on  the  surface  of  the 

liquid  (Weber  &  Bofinger) .  On  some  media, 
e.g.,  glycerin  chicken  bouillon,  egg  yolk,  etc., 
occasionally  also  on  ordinary  media,  the 
cultures  of  some  strains  present  an  appear- 
ance similar  to  that  of  mammalian  tubercle 
bacilli. 

Xot  all  tiibercle  bacilli  obtained  from  birds 
will  show  the  above  culture  characteristics,  but 
the  greatest  variety  of  transition  forms  occur, 
including  the  dry  scalv  cultures  of  mammalian 
bacilli.      (M.   Koch  &   Eabinowitsch). 

Tenacity.     The     bacillus    of    avian      tuber- 

culosis  is  on  the  whole  more  resistant  to  external 

Fig.95.  Bac.tubcrcidosi-^ariuvu  influence  than  Koch's  bacillus.  Thus  a  culture 
Aiticular  exudate  from  chicken;  two  years  old  "'ay  still  contain  living  bacilli. 
Stain  according  to  Ziehl-Xelsen.        Temperatures    ot    -0      C.    require    lo    minutes    to 

ilestroy    them.      (Maffucci). 

Pathogenicity.  Experimental  infection  of  fowls  is  most 
certain  by  introduction  of  the  virus  into  the  blood  stream. 
One  or  two  months  later,  upon  the  appearance  of  s^^nptoms 
of  marasmus,  small  tubercles  are  found  in  the  spleen  and 
liver,  while  the  blood  vessels  of  these  organs  are  filled  with 
masses  of  bacilli.  Intraperitoneal  or  subcutaneous  inoculation 
give  less  certain  results.  These  are  followed  by  local  foci 
only,  but  the  alTected  animal  may  die  from  the  toxic  effects 
of  tlie  lesion.  A  single  injection  of  culture  masses  suffices 
as  a  rule  for  infection.    The  fowls  die  after  one  or  two  months 

Vol.  1-39 


610  Tuberculosis. 

with  characteristic  symptoms  of  abdominal  tuberculosis. 
Geese  and  ducks  may  be  infected  in  the  same  manner  (Weber 
&  Bofinger).  Pigeons  possess  a  much  greater  power  of  re- 
sistance to  experimental  infection.  Articular  tuberculosis  is, 
however,  readily  produced  by  injection  of  the  bacilli  into  the 
articulations. 

Rabbits  are  very  susceptible  to  experimental  inoculation, 
and  the  feeding  of  cultures  to  these  animals  produces  symptoms 
very  similar  to  those  following  infection  with  bovine  tuber- 
culosis (intravenous  administration  of  the  virus  is  frequently 
followed  by  tuberculosis  of  the  joints  and  of  the  adjacent  bones 
and  tendon  sheaths).  On  the  other  hand,  guinea  pigs  offer 
a  somewhat  greater  resistance  to  such  infections ;  although 
they  get  sick  after  treatment  with  rather  large  amounts  of 
virus,  morbid  changes  (nodules  and  ulcers)  usually  develop 
only  around  the  masses  of  bacilli  found  in  the  body  and  which 
always  develop  rather  slowly  (much  the  same  as  lesions  oc- 
curring around  other  foreign  bodies).  A  progressive  tuber- 
culosis is  a  rare  occurrence.  Intraperitoneal  infection,  how- 
ever, produces  death  from  tuberculous  septicemia  ("Type 
Yersin")  (0.  Bang).  The  virulence  of  the  bacilli  is  frequently 
completely  destroyed  in  the  bodies  of  guinea  pigs  (M.  Koch  & 
Rabinowitsch).  Of  the  larger  mammals,  cattle  and  goats 
respond  to  subcutaneous  injection  much  like  guinea  pigs.  In- 
traperitoneal administration  causing  death  from  tuberculous 
septicemia.  Animals  of  mature  age  are  very  resistant  to  the 
alimentary  administration  of  avian  tubercle  bacilli  while  very 
young  animals  (calves,  kids  and  colts)  develop  acute  tuber- 
culosis which  affects  the  intestines  and  mesentery  with  par- 
ticular severity,  occasionally  also  the  lungs,  and  which  ter- 
minates fatally  (0.  Bang).  Swine  seem  to  be  only  slightly 
susceptible,  dogs  and  cats  not  at  all,  while  mice  and  rats  are 
readily  infected  through  the   alimentary  tract. 

Natural  infection  of  healthy  fowls  is  brought  al)out  by 
taking  up  the  droppings  of  infected  birds.  When  intestinal 
ulcers  are  present  such  droppings  contain  enormous  masses 
of  bacilli.  Still  more  frequently  is  infection  brought  about  by 
permitting  healthy  fowls  to  have  access  to  tuberculous  cadavers 
that  have  been  consigned  to  the  manure  pile.  The  liver  and 
spleen  of  such  cadavers  contain  large  masses  of  bacilli. 

Infection  from  tuberculous  persons.  In  view  of  the  very 
slight  susceptibility  of  fowls  to  infection  with  mammalian 
tuberculosis  (which  has  been  demonstrated  experimentally) 
infection  from  the  sputum  of  human  beings  probably  occurs 
only  in  such  rare  cases  in  which  the  lung  secretions  of  con- 
sumptives contain  avian  tubercle  bacilli  (see  p.  618).  Infec- 
tion from  tuberculous  mammals  is  undoubtedly  also  a  rare 
occurrence  (parrots,  however,  are  an  exception  in  this  respect. 
See  p.  615).     On  the  other  hand,  the  possibility  exists  that 


Avian   Tuberculosis.  611 

spontaiioonsly    infected   mice    or    rats   may   l)e   the   means   of 
spreadiui^-  the  disease  (Rabinowitsch). 

Infection  may  also  take  phice  thron.^h  injuries  of  the  mouth 
or  of  the  skin;  the  possibility  of  an  infection  through  the  air 
passages  by  means  of  inhaled  air  containing  the  bacilli  must 
also  be  admitted. 

Heredity  plays  only  a  sul)ordinat('  role  in  the  dissemination  of 
the  disease.  '  ^MafTucei  demonstrated  tliat  the  eml)ryo  of  experimentally 
infected  eggs  is  eaind)le  of  development  and  tlie  possibility  also  exists 
that  they  may  become  infected  through  tuberculous  ovaries.  Accord- 
ing to  Lichtenstein,  who  found  that  all  th<'  progeny  of  an  infected 
cock  had  the  disease,  there  exists  also  the  possibility  of  a  germinative 
infection  through  the  male  parent.  Chicks  however  that  have  been 
hatched  from  infected  eggs  live  at  most  only  a  few  months  before 
they  succumb  to  the  effects  of  the  disease.  On  the  other  hand  the 
plague  may  be  introduced  into  healthy  flocks  through  the  means  of 
infected  eggs  the  albumen  of  which  occasionally  contains  bacilli  fiMohler 
&  Washburn).  Rabinowitsch  observed  the  hatching  of  8  chicks  from 
32  experimentally  infected  eggs.  Of  the  eggs  infected  with  avian 
tuberculosis  the  embryos  died  in  90%,  of  those  infected  with  guinea  pig 
tuberculosis  70%  and  of  those  infected  with  bovine  tuberculosis  407© 
died. 

Pathogenesis.  The  bacilli,  wdiich  usually  gain  entrance  into 
the  alimentary  canal  with  the  food,  usually  pass  through  the 
solitary  and  agminated  lymph  follicles  of  the  large  and  small 
intestines  into  the  intestinal  walls  and  thence,  with  the  blood 
of  the  portal  vein,  enter  the  liver  or  they  gain  access  into_  the 
general  circulation  and  lodge  in  other  organs  and  portions 
of  the  body,  thus  in  the  spleen,  lungs,  joints  and  tendon 
sheaths,  causing  the  development  of  specific  lesions.^  The  in- 
testinal mucous  membrane  may  remain  perfectly  intact  or 
small  nodules  may  develop  in  its  tissue.  The  overlying  villi 
may  present  no  changes  in  the  beginning  but  ulceration  follows 
at  a  later  time.  These  ulcers  may  heal  with  the  formation  of 
granulation  tissue  (Schern).  The  nodules  occurring  in  the 
intestinal  walls  under  the  serosa  develop  from  the  h^llph  nodes 
in  the  peripheral  layers  of  the  intestinal  walls,  or  between 
the  serosa  and  muscularis  of  the  cecums,  or  from  the  agminated 
follicles  in  the  mucous  membrane  \vithout  causing  any  observa- 
ble changes  in  the  intestinal  mucous  membrane  wdiich,  how- 
ever, they  perforate  at  a  later  stage  and  then  communicate 
with  the  lumen  of  the  intestine  (M.  Koch  &  Rabinowitsch). 

The  symptoms  of  cachexia  observable  in  diseased  fowls 
(emaciation,  anemia,  marasmus)  are  a  result  of  the  toxic  ac- 
tion of  the  chemical  products  of  the  bacilli.  These  toxins, 
which  kill  guinea  pigs  with  the  same  sjonptoms  as  those  ob- 
served in  chickens,  may  be  produced  from  artificial  cultures, 
particularly  those  growm  on  liquid  glycerin  serum  (]\Iaffucci, 
Hericourt   &   Richet).     The   death  of   dogs   and   gaiinea   pigs 


612  Tuberculosis. 

following  the  administration  of  large  masses  of  virns  is 
ascribed  to  the  same  cause  since  no  tubercles  develop  in  the 
body.  The  same  is  true  of  the  excessive  irritation,  fever, 
suppuration  at  the  point  of  injection  and  the  temporary  swell- 
ing of  the  regional  lymph  glands  which  are  observed  after  the 
subcutaneous  administration  of  avian  tubercle  bacilli  in  cattle 
(Kossel,  "Weber  &  Heuss). 

Anatomical  Changes.  On  post-mortem  examination  the 
liver  and  spleen  are  most  frequently  found  affected  and  this 
is  not  rarely  the  case  when  the  intestine  and  peritoneum  are 
entirely  free  from  changes.  As  a  rule  there  are  nodules  rang- 
ing in  size  from  that  of  a  lentil  to  that  of  a  pea,  and  some- 
times approaching  that  of  a  hazelnut,  with  colorless,  gelatinous 
or  yellowish,  friable,  cheesy  and  occasionally  calcified  contents 
and  surrounded  or  enclosed  by  a  connective  tissue  capsule.  In 
rare  cases  minute  gray  or  pale  yellow  points,  here  and  there 
collected  into  groups  under  the  serosa,  are  scattered  through 
the  tissue  of  the  liver.  The  diseased  liver,  especially  in  chronic 
cases,  is  considerably  enlarged  and  may  be  rather  frial)le  on 
account  of  fatty  degeneration.  Now  and  then  hemorrhagic 
areas  occur  near  the  surface  of  the  organ. 

Affection  of  the  intestine,  especially  near  the  cecums,  is 
comparatively  common.  The  mucous  membrane  is  covered 
with  small  yellowish  nodules  among  which  funnel-shaped  ulcers 
with  finely  nodulated  or  raised  borders  may  be  present.  On 
the  serous  surface  there  may  be  firmly  attached  coarsely 
nodulated  roundish  tumors  that  may  approach  the  size  of  a 
hazelnut.  These  may  also  occur  in  the  mesentery  (Fig.  96). 
These  tumors  or  nodes  may  have  a  wide  or  narrow  base  or 
they  may  be  pedunculated,  but  they  are  always  clearly  differen- 
tiated from  the  surrounding  tissue  and  covered  by  peritoneum. 
The  interior  of  the  small  nodules  consists  of  a  homogeneous 
grayish-yellow,  tough,  almost  hornlike  or  cartilaginous  tissue, 
while  "in  the  larger  nodules,  which  are  otherwise  of  similar 
structure,  there  are  also  cheesy  foci,  or  the  nodules  may  con- 
sist throughout  of  a  yellowish,  crumbly  substance.  The  interior 
of  these  nodules  may  communicate,  at  the  apex,  Avitli  the  lumen 
of  the  intestine  by  means  of  a  fistulous  canal  (Volkmann  found, 
at  the  end  of  the  left  cecum,  a  cheesy  tumor  of  the  size  of 
a  hen's  egg;  the  remaining  portion  of  the  cecum  was  thickened 
and  covered  with  nodules).  The  abdominal  lymphatic  glands 
are  much  enlarged  and  caseated.  In  a  few  cases  the  visceral 
layer  of  the  peritoneum  is  covered  with  nodules. 

In  tuberculosis  of  the  bones  and  joints,  Avliich  is  rather 
common,  the  articular  cavities  are  filled  with  cheesy  masses ; 
the  cartilaginous  covering  of  the  enlarged  epiphyses  shows 
erosions  while  the  bone  substance  and,  occasionally  the  peri- 
articular connective  tissue  contains  cheesy  foci. 

Tuberculosis  of  the  lungs  is  much  less  frequent.  These 
may  present  the   picture   of   a  miliary  tuberculosis   or   their 


Avian   Tubeirulusi? 


Gi:5 


tissue  iiuiy  coiitaiii  large,  yellowish-white,  cheesy  foci.  The 
])('ri('ar(Ua"l  sac  may  contain  imich  fluid  while  the  surface  of 
the  heart  may  be  covered  with  ilat,  grayish-red,  raspherry-iike 
or  almost  wart-like  proliferations  (Tietz).  Among  the  other 
organs,  we   find,   now   and   then,   tub(>rculous  caseous  foci   on 


Hm^ 


Fig.  OG.     Avian  Tuhcrculosis. 
inU'stinal  wall. 


Caseatod  foci  in  the  liver   and  nodules  on  tlio 


the  peritoneum,  in  the  kidneys,  in  the  ovaries,  in  the  testicles, 
in  the  pericardium  and  the  nmscle  tissue  of  the  heart,  in  the 
air  cells,  in  the  gizzard,  as  well  as  under  the  skin  and  the 
balls  of  the  feet. 


The  histolojrieal  structure  of  the  avian  tubercle  is  similar  in  character  to 
that  of  the  niainnialian  tubercle  with  the  unimportant  exception,  that  by  far  the 
greater  part  of  it  consists  of  large  epithelioid  cells  of  the  foreign-body  giant-cell 
type  containing  tubercle  liacilli  and  disposed  in  radial  or  wreathlike  scaly  fashion 
(as  seen  in  section)  around  the  central  necrotic  mass.  The  degenerative  jirocess  of 
the  tubercle  also  corresponds  more  to  the  hyaline  type.  Tubercle  bacilli  are  always 
present  in  large  nund)ers  in  the  fresh  tubercles  as  well  as  in  the  cheesy  nodules 
and  in  the  contents  of  the  involveil  joints.  They  are  readily  demonstrated  by  means 
of  the  usual  methods  of  s-taiiung   (See  p.  ofiO). 


614  Tuberculosis, 

Symptoms.  Tuberculosis  of  the  internal  organs  results 
in  gradual  emaciation  without  attendant  characteristic  symp- 
toms of  specific  disease.  This  condition,  which  is  readily 
recognized  by  palpation  of  the  pectoral  muscles,  progresses  in 
spite  of  the' good  appetite  that  exists  in  the  beginning  until 
the  symptoms  of  anemia,  evidenced  by  the  paleness  of  the 
mucous  membranes,  wattles  and  comb,  l3ecome  more  and  more 
pronounced.  At  a  later  stage  the  appetite  is  affected,  the 
animals  become  listless,  are  easily  captured,  etc.  Finally  the 
onset  of  diarrhea  leads  to  complete  exhaustion. 

The  symptoms  of  tuberculosis  of  the  bones  and  ;joints 
are  more  characteristic.  The  tarsal,  knee  and  shoulder  articula- 
tions are  most  frequently  affected.  They  begin  to  swell 
gradually  and  palpation  reveals  enlargement  of  the  epiphyses. 
Pain  and  attendant  disturbance  of  function  (lameness,  and 
drooping  of  the  affected  wing)  is  slight  at  first,  but  soon  be- 
comes more  conspicuous  if  for  no  other  than  mechanical 
reasons.  Occasionally  the  articular  swelling  breaks  open  and 
discharges  a  cheesy  secretion  filled  with  bacilli. 

In  rare  instances  small  painless  nodules  develop  in  the 
subcutaneous  connective  tissue.  At  a  later  stage  they  may 
ulcerate.  Finally,  large  caseous  masses  may  collect  in  the 
cella  infraorbitalis,  causing  enormous  distension  of  the  same 
and  attendant  pressure  atrophy  of  the  eye  ball. 

Tuberculosis  of  the  internal  organs  can  hardly  be  differentiated 
from  chronic  disorders  of  nutrition  due  to  other  causes,  particularly 
worms.  As  a  rule  the  disease  is  suspected  only  upon  the  ground  of 
the  apparent  infectious  nature  of  the  malady.  Tuberculosis  of  the 
joints  is  very  similar  in  appearance  to  rheumatic  arthritis  or  to  that 
form  of  arthritis  which  is  met  with  in  chronic  chicken  cholera.  These 
three  diseases,  however,  may  readily  he  differentiated  by  microscopic 
examination  of  the  contents  of  the  joints  which  are  easily  procured 
in  sufficient  quantity  by  making  an  incision  into  the  tumefactions. 

The  body  temperature  has  no  value  from  a  diagnostic  point  of 
view  since  it  does  not  vary  beyond  the  normal  limits  (39.5°  to  41.5°  C.) 
even  in  tuberculous  animals   (Klimmer  &  Saalbeck). 

The  tuberculin  test  is  also  not  applicable  because  tuberculous  fowls 
will  not  give  specific  reactions  to  tuberculin,  no  matter  whether  this 
is  prepared  from  avian  or  mammalian  bacilli  or  whether  injected  sub- 
cutaneously,  dropped  into  the  conjunctival  sac  or  applied  to  the  scarified 
skin  (Babes,  "Weber  &  Bofinger,  Moore,  Saalbeck). 

Prevention.  Since  medicinal  treatment  is  practically  out 
of  the  question  and  segregation  of  the  diseased  animals  from 
the  healthy  ones  is  hardly  possible  on  account  of  the  insidious 
character  of  the  disease  the  most  practical  and  economical 
method  of  procedure  is  to  kill  the  entire  flock  as  soon  as  the 
disease  is  recognized.  All  animals  in  good  flesh  may  be  utilized 
as  food.  The  diseased  products  and  organs  as  well  as  the 
entire  carcasses   of  badlv  affected  animals   should  of  course 


Tul)erculosi.s    of   Paiiots.  Gl~) 

he  destroyi'd.  The  poultry  yar<I  as  wvU  as  tlie  lioiises,  coops, 
etc.,  slioiihl  1)0  thoroughly  cleaned  and  disinfected  before  new- 
stock  is  acquired. 

Literature.  Iv'olofV.  Ma<r..  ISOS.  XXXIV.  lOo.  —  Paulicki.  IM.l.,  1S72. 
XXXVI I  [.  —  Ziiorii.  Krankli.  d.  Colliicsels.  Woiiiiar  iss2.  1!>7.  —  Ril)bert,  D.  ni. 
W.,  ISsH.  4i:?.  —  MafTiKH-i.  Z.  f.  IIv^^,  1n02.  XI.  44.">.  —  Wolfl'hiiOf,rol.  Monh.,  19(14. 
XV.  4.-)7.  —  WebiT  A:  Bofiimor,  Tl>k.-ArV).  .1.  C.-A.,  10(i4.  1.  II.  IVJ  (Lit).  — 
Sehern,  Z.  f.  Tin.,  1905.  IX.  419  (Lit.).  —  M.  Koch  &  Kal.inowitsch.  V.  A.,  1907. 
CXC.  Beiheft  (Lit.).  —  Toetz,  B.  t.  W.,  190G.  244.  —  Moore,  Z.  f.  Infkrkh.,  19(i<-,. 
L  3.33.  —  Volkiiiann,  W.  f.  Tk.,  19os.  Llf.  Xr.  20.  —  O.  Bang,  CM.  f.  Bakt., 
190S.   XLVr.  4tU.  —  Saall.eck,  Diss.  Leipzig   1909    (Lit.). 

Tuberculosis  of  Parrots.  Since  Cadiot  &  Ro^er  found  tuluTclc 
bacilli  in  the  organs  of  a  parrot  that  were  pathogenic  for  guinea  pigs, 
others  also  have  shown  (the  authors  in  five  cases)  that  tuberculosis 
of  these  animals  (tiiough  tliey  are  susceptible  also  to  avian  tuberculosis) 
is,  in  most  cases,  caused  by  tiie  human  type  of  tubercle  bacillus.  These 
reports  confirm  the  view  entertained  long  ])efore  that  parrots  become 
infected  in  the  dwellings  of  consumptive  persons,  and  convin-sely  justify 
the  assumption  that  persons  may  be  infected  by  tuberculous  parrots. 
Infection,  however,  usually  procec^ds  from  injuries  in  the  skin  of  the 
head  or  of  the  mucous  mendirane  of  the  mouth  cavity;  primary  affection 
of  the  lungs  is  much  less  fretpient  and  intestinal  infection  is  only 
occasionally  observed.  The  bones  or  joints  may  sometimes  become  in- 
volved through  metastasis. 

After  M.  Koch  &  Rabinowitseli  demonstrated  by  experimental 
infection  Avith  pure  cultures  that  parrots  are  susceptible  also  to  the 
virus  of  avian  tuberculosis,  AVeber,  Titze  &  AVeidanz  showed,  by  more 
extensive  experiments,  that  parrots  could  be  fatally  infected  with  in- 
travenous injections  of  0.001  gm.  of  pure  culture  of  any  of  the  three 
types  of  tubercle  bacilli.  A  single  ingestion  of  human  or  bovine  bicilli 
resulted  in  infection  just  as  readily  while  it  required  from  10  to  V-l 
ingestions  of  avian  tubercle  bacilli  to  produce  fatal  generalized  tuber- 
culosis. 

Tuberculosis  of  parrots  is  a  comparatively  common  disease.  Thus  Froehner 
fouml  that  170  of  the  700  parrots  treated  at  the  Berlin  Klinik  and  Poliklinik  from 
1886  to  1894  -n-ere  tuberculous,  i.  e.  24.3%. 

Tuberculosis  of  the  skin  and  subcutaneous  connective  tissue  is  mani- 
fested by  the  appearance  of  globular  or  oval,  rather  firm  nodules  and 
tumors  with  smooth  surface,  ranging  in  size  from  that  of  a  pin  head 
to  a  hen's  egs;.  In  the  course  of  time  these  become  caseous  and  the 
overlying  epithelium  becomes  horny  and  forms  thick  scabby  layers, 
sometimes  growing  into  structures  several  centimeters  long  (Eberlein). 
Some  of  these  nodules,  especially  those  of  the  palpebral  conjunctiva, 
are  soft  and  bleed  upon  the  slightest  provocjition.  When  they  develop 
near  the  angle  of  the  mouth  they  interfere  with  the  movements  of  the 
bill,  while  those  in  the  region  of  the  angles  of  the  eyes  may  push  aside 
or  di.slocate  the  eyeball ;  those  developing  on  the  top  of  the  hi^ad  may 
perforate  the  skull  (Cadiot),  If  these  nodules  are  broken  by  scratchijig. 
ulcers  covered  with  cheesy  masses  form  in  their  place. 

Similar  nodules,  though  usually  smaller  and  of  softer  consistency, 
are  comparatively  fi'equent  in  the  mouth  cavity,  especially  cm  the 
tongue,  near  the  frenum,  on  the  hard  palate,  more  rarely  also  in 
the  nasal  cavities.     According  to  their  seat  or  their  size  they  may  in- 


616  Tuberculosis. 

terfere  with  the  acts  of  deglutition,  respiration  or  the  movements  of 
the  tongue   (speech)    (!), 

The  symptoms  of  tuberculosis  of  the  bones  and  joints  are  similar 
to  those  observed  in  other  birds  and  an  affection  of  the  internal  organs 
is  manifested  only  by  emaciation  and  anemia. 

The  diagnosis  of  the  disease  which  offers  no  particular  difficulties 
is  definitely  confirmed  by  demonstration  of  the  tubercle  bacilli  in  the 
nodules  and  in  the  secretions  of  the  ulcers  in  which  they  are  usually 
quite  numerous. 

When  the  affection  is  localized  on  the  skin  or  in  the  anterior  por- 
tion of  the  mouth  cavity,  it  is  possible,  in  a  portion  of  the  cases,  to 
bring  about  definite  recovery  by  extirpating  the  swellings.  Not  in- 
frequently however  relapses  occur  and  the  surgical  treatment  must 
be  repeated.  Cauterization  of  the  ulcers  is  seldom  followed  by  satis- 
factory results. 

Canary  birds  are  also  susceptible  to  infection  with  mammalian  tubercle 
))acilli;  while  M.  Koch  &  Eabinowitsch  obtained  positive  results  in  two  instances 
by  feeding  human  tubercle  bacilli,  Weber,  Titze  &  Weidanz  succeeded  only  with 
bovine  and  avian  bacilli  in  their  attempts  to  infect  canary  birds  per  os.  The  first 
named  investigators  succeeded  also  in  obtaining  cultures  of  the  human  type  of 
tubercle  bacillus  from  118  birds  of  different  species  furnished  by  a  zoological 
garden,  fi'om   two  birds  of  prey  and  from  one   sparrow. 

Literature.  Cadiot,  Gilbert  &  Eoger,  Soc.  biol.,  1890.  542.  —  Cadiot,  Bull., 
1894.  197 ;  1898.  2.54.  —  Eberlein,  Monh.,  1894.  V.  248.  —  M.  Koch  &  Eabinowitsch 
\'.-A.,  1907.  CXC.  Beiheft  (Lit.).  —  Weber,  Titze  &  Weidanz,  Tb.-Arb.  d.  G.-A., 
1908.  9.  H.    (Lit.). 

(c)     Etiological  Relations  Between  Human  and  Animal 

Tuberculosis. 

The  practical  similarity  of  anatomical  clianges  produced 
in  rabbits  and  guinea  pigs  with  tuberculous  material  ob- 
tained from  consumptive  human  beings  or  from  cattle  affected 
Avith  pearl  disease  in  itself  points  to  the  close  relationship  of 
these  two  diseases.  The  correctness  of  this  view  has  been 
emphasized  by  the  successful  production  of  lesions  very  similar 
to  those  of  human  tuberculosis  by  feeding  tuberculous  organs 
of  man  to  cattle,  typical  pearl  disease  having  indeed  thus  been 
produced  (Klebs,  Bollinger),  and  further,  by  the  fact  that 
the  feeding  of  tuberculous  material  from  cattle  will  produce 
tuberculosis  in  other  animals,  horses,  swine,  dogs,  cats 
(Chauveau,  Guenther  &  Harms,  Gerlach,  Klebs,  Bollinger, 
Toussaint,  Puetz,  etc.).  After  Koch  liad  demonstrated  the 
presence  of  morphologically  similar  bacilli  in  the  tuberculous 
organs  of  man,  monkeys,  cattle,  horses,  swine,  goats,  sheep 
and  fowls,  as  well  as  in  rabbits  and  guinea  pigs,  and  after  he 
had  failed  to  recognize  any  material  diiferences  in  their  cultural 
or  pathogenic  characteristics,  the  etiological  identity  of  the 
tuberculous  affections  of  the  various  animal  species  was 
generally  accepted  as  a  demonstrated  fact.  More  recently, 
however,  the  correctness  of  this  view  has  been  questioned  from 
several  sources. 

Tuberculosis  of  Mammals  and  Fowls.    The  continued  and 


Tuberculosis  ol'   Maiiiiiials  and    Fowls.  QI'J 

persistent  investift-atioii  and  study  ol"  Koch's  tubercle  l)aeillus 
lias  at  least  east  doubt  upon  the  supi)osed  relationsliip  ol' 
nuunnuilian  and  avian  tuberculosis.  It  has,  for  instance,  been 
found  that  the  l)acilli  causing  these  two  morbid  processes 
possess  nuirked  cultural  dilTerences,  that  the  diseased  organs 
ol'  tuberculous  nuiinnials,  as  well  as  the  cultures  of  bacilli 
obtained  from  them  (with  rare  exceptions)  possess  only  slight 
])atliogenicity  for  fowls,  and  that,  on  the  other  hand,  the  bacilli 
of  avian  tuberculosis  have  a  different  effect  upon  mannnals  than 
the  bacilli  of  mammalian  tuberculosis. 

On  account  of  these  facts  some  authors  (Rivolta,  Maffueci, 
Strauss  tV:  Gamaleia,  more  recently  also  Weber  &  Bolinger) 
regard  these  two  forms  of  bacilli  as  distinct  species  and  con- 
sequently also  look  upon  mammalian  and  avian  tul)erculosis 
as  two  etiologically  distinct  diseases.  On  the  other  hand  there 
is  weighty  evidence  pointing  to  a  close  relationship  between 
these  two  forms  of  bacilli. 

In  this  connection  the  cultural  differences  between  the  two 
organisms  are  of  slight  significance  for  the  reason  that  cultures  of 
bacilli  from  the  lesions  of  tuberculous  fowls  freciuentlv  reseml)le  those 
obtained  from  mammals.  Thus  Weber  &  Bofinger  occasionally  obtained 
dry  crumpled  cultures  from  fowls,  a  culture  that  had  been  kept  up 
for  years  could  not  be  distinguished  from  cultures  of  human  bacilli, 
but  after  a  single  passage  through  a  fowl  or  a  mouse  this  charac- 
teristic was  lost.  And  again  0.  Bang  has  observed  many  strains  of 
avian  bacilli,  grown  on  glycerin  potato  medium,  to  produce  dry,  uneven 
ma'sses,  while  one  liovine  strain  o])served  by  this  author,  when  cultivated 
on  glycerin  serum  resem])led  an  avian  culture  in  appearance.  In 
addition  to  these  observations  it  is  known  that  some  avian  strains 
when  cultivated  on  bouillon  can  hardly  be  differentiated  from  bovine 
varieties.  Among  95  strains  obtained  from  70  different  birds  Rabino- 
witsch  found  occasional  strains  that  exhibited  characteristics  of  growth, 
on  solid  as  well  as  on  liquid  media,  very  similar  to  those  of  manniialian 
bacilli.  Three  of  these  strains,  however,  belonged  undoul)ted]y  to  tliat 
group  (pathogenic  for  guinea  pigs,  nonpathogenic  for  fowls).  Finally, 
it  is  possible,  by  means  of  special  methods,  to  obliterate  these  differences. 
Thus  Fisehel  obtained  a  material  by  cultivating  human  tubercle  l)acilli 
on  egg  medium  and  on  boracic-acid-glycerin-agar  that  would  produce 
moist  smeary  cultures  on  the  ordinary  media.  Nocard  cultivated  human 
tubercle  bacilli  in  collodion  capsules  filled  with  bouillon  which  he 
imbedded  in  the  abdominal  cavity  of  fowls.  After  several  months  these 
capsules  were  removed,  the  bacilli  transferred  to  solid  culture  media 
and  cultures  produced  that  resembled  avian  cultures  in  every  respect. 

The  marked  differences  in  the  pathogenicity  of  the  two  forms  of 
bacilli  are  of  vastly  greater  importance.  It  is,  for  instance,  impossible 
to  infect  any  of  the  various  species  of  fowls  by  feeding  with  organs 
of  tuberculous  manuiials.  Straus  and  AVuertz  have  fed  chickens  for 
months  with  tuberculous  organs  and  sputum  of  tuberculous  persons, 
and  although  some  of  them  received  as  much  as  58  kg.  of  such  material 
they  remained  healthy.  Similarly  negative  results  were  obtained  by 
Esser,  Peroncito,  Nocard  and  others.  Since,  however,  tuberculosis 
among  fowls  frefjuently  occurred  under  circumstances  pointing  to  in- 


618  Tuberculosis. 

fection  with  sputum  of  tuberculous  persons  (Joline,  Noeard,  Roemer, 
Darmagnac,  Siegel  and  others)  and  since  Zschokke  cultivated  a  bacillus 
from  tuberculous  fowls  that  had  all  the  cultural  characteristics  of 
the  bacillus  of  mammalian  tuberculosis,  the  possibility  that  fowls  may 
occasionally  become  infected  with  mammalian  tuberculosis  does  not 
seem  excluded. 

Intravenous  and  intraperitoneal  inoculation  of  cultures  of  mam- 
malian tubercle  bacilli  does  not,  as  a  rule,  produce  tuberculosis  in 
fowls.  Contrary  to  the  numerous  negative  results  of  experimental 
inoculations  Cadiot,  Gilbert  &  Roger  have  obtained  positive  results 
in  10' A  in  all  cases  where  they  simultaneously  fed  tul^erculous  organs 
or  injected  horse  serum  into  the  tissues  of  the  fowls.  Furthermore, 
Fischel  obtained  positive  results  with  intraocular,  and  Courmont  & 
Dor  l)y  subcutaneous  administration.  Finally,  0.  Bang  produced  fatal 
tuberculosis  in  fowls  in  three  cases  by  intravenous  inoculation  and 
in  one  case  by  subcutaneous  inoculation  of  bovine  strains  of  bacilli. 
He  found  also  that  12  out  of  18  strains  of  bovine  bacilli  were  m.ore 
or  less  virulent  for  fowls. 

Mature  mammals,  with  the  exception  of  rabbits,  guinea  pigs  and 
mice,  are  either  only  slightly  susceptible  or  entirely  immune  to  avian 
tubercle  bacilli.  Noeard,  however,  found  bacilli  in  several  cases  of 
abdominal  tuberculosis  of  horses  that  resembled  avian  tubercle  bacilli 
in  their  cultural  characteristics  as  well  as  in  their  pathogenicity  while 
0.  Bang  demonstrated  that  very  young  mammals  (colts,  calves,  kids) 
are  very  susceptible  to  the  avian  virus,  becoming  affected  with  acute 
tuberculosis  after  intestinal  infection  (see  p.  608).  Mohler  &  Washburn 
also  succeeded  in  infecting  swine  with  material  obtained  directly  from 
chickens.  Bacilli  of  the  avian  type  have  also  been  found  in  the  sputum 
of  tuberculous  persons  (Straus,  Noeard,  Kruse,  Loewenstein ;  Rabino- 
witseh  obtained  cultures  from  a  man  that  died  from  generalized  tuber- 
culosis) also  in  apes  (Fischel,  Rabinowitseh),  in  the  tuberculous  lungs 
of  cattle  (Sanfelice,  Kruse,  Pansini)  as  well  as  in  the  caseous  lymph 
glands  of  a  pig  (Weber  &  Bofinger),  while  Karlinski  produced  tuber- 
culosis of  the  tracheal  glands,  diaphragm  and  spleen  of  a  goat  after 
intravenous  injection  of  avian  material.  On  the  other  hand,  Hueppe 
cultivated  bacilli  identical  with  human  bacilli  from  a  pheasant  and 
from  a  fowl.  Tuberculosis  of  parrots,  however,  is  in  most  instances 
caused  by  human  tubercle  bacilli. 

The  specific  virulence  of  avian  tu])ercle  bacilli  is  rather  constant 
and  is  not  easily  altered.  Thus  Weber  &  Bofinger  were  unable  to 
increase  by  passage  through  guinea  pigs  the  virulence  of  bacilli  from 
fowls  sufficiently  to  approach  that  of  mammalian  bacilli.  Similarly, 
the  attempts  of  Kossel,  Weber  &  Heuss  to  transform  avian  tubercle 
bacilli  into  mammalian  bacilli  by  continued  cultivation  or  growth  in 
the  bodies  of  mammals  were  unsuccessful.  On  the  other  hand,  how- 
ever, Cadiot,  Gilbert  &  Dor  produced  a  virus  by  oft  repeated  passage 
of  avian  bacilli  through  guinea  pigs  that  would  cause  lesions  very 
similar  to  those  of  human  tuberculosis  and  was  also  virulent  for  dogs 
and  no  longer  pathogenic  for  fowls.  M.  Koch  &  Rabinowitseh  also 
succeeded,  by  cultivation  continued  for  years,  in  giving  an  avian  strain 
the  appearance  of  human  bacilli.  Noeard  succeeded  by  three  or  four 
passages  of  human  tubercle  bacilli  through  chickens  in  transforming 
them  into  a  strain  that  would  produce  disease  in  fowls.  These  results 
have  recently  been  confirmed  by  careful  experiments  conducted  by 
0.   Bang   who  succeeded   in   transforming  bacilli   of  the   human   and 


Tuberculosis  of  Man  and  of  Animals. 


619 


bovine  typos  into  the  avian  type.  This  was  particularly  evident  when 
a  fowl  passage  was  preceded  and  followed  hy  a  guinea  pig  passage. 
Bang  observed  also  tiiat  a  bovine  strain  which  luid  lost  its  virulence 
after  long  continued  or  oft  repeated  passage  through  fowls,  regained 
its  virulence  by  passage  through  goats. 

These  positive  results  of  experimental  investi^-ations,  even 
tlioitgh  not  very  numerous,  cause  doubts  to  arise  in  regard  to 
the  supposed  speeilic  differences  between  the  bacilli  of  mam- 
malian and  avian  tuberculosis.  If  we  consider  in  connection 
with  the  foregoing  that  liericourt  &  Richet  immunized  monkeys 
and  dogs  against  human  tuberculosis  with  avian  virus  and 
that  MacFadyean  and  Behring  immunized  cattle  against  bovine 
tuberculosis  by  the  same  means,  and  furtlier  that  effective 
tuberculin  may  be  prepared  from  avian  bacilli  (according  to 
Maffucci  cattle  and  sheep  Avill  react  to  human  tuberculin,  no 
matter  whether  they  were  infected  in  the  first  place  with  bovine 
or  with  avian  bacilli),  that  mammalian  and  avian  bacilli  ex- 
hibit reciprocal  agglutination  characteristics,  and  finally  that 
it  is  possible  to  produce,  experimentally,  avian  tuberculosis 
in  mammals  and  mammalian  tuberculosis  in  birds,  the  conclu- 
sion that  the  avian  bacillus  is  merelv  a  variety  of  Koch's 
bacillus  resulting  from  prolonged  growth  for  numberless 
generations  in  the  bodies  of  fowls  is  probably  justified.  Ac- 
cordingly, avian  tuberculosis  might  be  looked  upon  as  bearing 
a  similar  relation  to  mammalian  tuberculosis  as  human  tuber- 
culosis bears  to  bovine  tuberculosis. 

Tuberculosis  of  Man  and  Tuberculosis  of  Mammals.  These 
two  diseases  have  in  recent  times  been  looked  upon  as  etiolog- 
ically  identical  notwithstanding  the  fact  that  conspicuous  dif- 
ferences have  been  observed  to  exist  in  the  pathogenicitv  of 
strains  of  different  origins.  Though  Puetz,  as  early  as  1882, 
doubted  the  identity  of  human  and  bovine  tuberculosis  because 
he  w^as  unsuccessful  in  infecting  calves  either  bv  feeding  or 
with  intravenous  or  subcutaneous  injections  of  liuman  tuber- 
culous material  and  Semmer  (1893)  expressed  the  opinion  that 
pearl  disease  and  miliary  tuberculosis  of  man  w-ere  not  identical 
morbid  processes,  later  authors  assumed  upon  the  basis  of 
occasional  negative  results  in  the  experimental  transmission 
of  tlie  two  diseases  to  other  animals  that  this  difference  must 
be  due  to  modifications  in  the  vinilence  of  an  essentially 
identical  virus  and  to  the  variable  relative  susceptibility  of 
the  different  species  of  animals. 

Th.  Smith  had  observed  certain  morphological  and  cultural  differ- 
ences between  human  and  bovine  bacilli  and  demonstrated  that  the 
bacillus  of  pearl  disease  had  a  considerably  greater  and  more  constant 
pathogenic  action  on  experiment  animals  than  that  of  human  tuber- 
culosis. He  believed,  therefore,  that  the  bacillus  of  bovine  tuberculosis 
occupied  a  unique  position  among  the  various  mammalian  bacilli  and 


620  Tuberculosis. 

that  human  beings  were  only  slightly  susceptible  to  the  contagion 
of  pearl  disease ;  in  view  of  all  this,  however,  he  did  not  regard  the 
possibility  of  human  infection  with  bovine  bacilli  (especially  in  children 
ingesting  large  quantities  of  bacilli  with  milk  from  cows  with  tuber- 
culosis of  the  udder)  as  out  of  the  question.  Even  before  Theobald 
Smith,  Sidney  Martin,  Frothingham  and  Dinwiddle  had  made  similar 
observations  in  regard  to  the  variability  in  the  pathogenic  action  of 
these  two  types  of  bacilli,  although  Frothingham  oljserved  rather  ex- 
tensive morbid  changes  in  the  peritoneum  and  in  the  mesenteric  lymph 
glands  of  calves  that  were  infected  with  bacilli  from  a  tuberculous 
child  while  Dinwiddle,  on  the  other  hand,  found  that  in  one  case  material 
obtained  from  a  tuberculous  cow  proved  avirulent  for  a  calf.  Accord- 
ing to  Dinwiddle  the  differences  exhibited  by  the  two  forms  of  bacilli 
manifest  themselves  only  in  horses,  cattle,  dogs  and  cats,  while  the 
human  as  well  as  the  bovine  types  of  bacillus  produce  generalized 
tuberculosis  in  swine.  Finally  Vagedes  succeeded  in  procuring  human 
cultures  that  had  pathogenic  properties  very  similar  to  those  obtained 
from  cattle. 

The  question  of  identity  or  non-identity  attracted  renewed 
attention  when  Robert  Koch  announced  it  at  the  London 
Tuberculosis  Congress  in  1901  as  his  emphatic  view  "that 
human  tuberculosis  differed  from  bovine  tuberculosis;"  that 
the  former  was  not  transmissible  to  cattle  and  "that  accord- 
ingly it  did  not  seem  necessary  to  take  any  measures  whatever 
for  the  protection  of  milk,  butter  and  cheese  from  tuberculous 
cattle  against  infection  with  the  germs  of  this  disease." 

Koch  based  this  view  on  the  results  of  infection  experiments  that  he  had  con- 
ducted with  the  co-operation  of  Schuetz.  19  calves  were  treated  with  the  pulmonary 
discharges  of  tuberculous  persons  and  with  cultures  of  human  tubercle  bacilli  which 
material  was  administered  with  the  food,  with  the  inhaled  air,  or  the  cultures  were 
injected  intravenously,  subcutaneously  or  iutraperitoneally ;  all  of  the  calves 
remained  perfectly  healthy,  increased  steadily  in  weight  and,  at  post  mortem 
examination  several  months  later  only  caseous  abscesses  could  be  detected  at  the 
point  of  inoculation.  On  the  other  hand,  six  calves  given  subcutaneous,  intra- 
peritoneal or  intravenous  injections  of  bovine  cultures  of  bacilli  developed  fever 
and  became  very  sick.  At  post-morten  examination  tuberculous  changes  were 
found  not  only  at  the  point  of  inoculation  and  in  the  regional  lymph  glands  liut 
there  was  extensive  tuberculosis  of  the  internal  organs,  especially  in  the  lungs  and 
spleen.  Of  six  pigs  that  had  been  fed  for  104  days  with  tuberculous  sputum 
mixed  with  the  food,  small  scattered  tuberculous  nodules  developed  in  the  cervical 
glands  and  in  the  lungs  and  mesenteric  glands  of  two  of  the  animals  while  the 
remaining  pigs  remained  unaffected.  On  the  other  hand,  of  six  pigs  that  had 
been  fed  for  70  days  with  cultures  of  bovine  bacilli,  all  contracted  extensive 
lesions  of  tuberculosis.  Subcutaneous,  intraperitoneal  and  inti'avenous  injections  of 
human  tubercle  bacilli  proved  harmless  in  5  pigs  while  the  6th  animal,  which 
received  an  intravenous  injection,  developed  miliary  tuberculosis  of  the  lungs  and 
mediastinal  glands.  Two  sheep  were  unaffected  by  subcutaneous  injections  of 
cultures  of  human  bacilli  while  one,  receiving  an  intravenous  injection,  developed 
Blight  tuberculous  changes  in  the  lymph  glands  of  the  lungs.  On  the  other  hand, 
sheep  treated  in  a  similar  manner  with  cultures  of  bovine  bacilli  became  very 
sick. 

The  large  number  of  experimental  animal  inoculations  that 
have  been  made  since  Koch's  epoch  making  address,  according 
to  which  the  bacillus  of  human  tuberculosis  as  compared  "with 
that  of  bovine  tuberculosis  is  only  slightly  or  not  at  all  patho- 
genic for  cattle,  as  shown  by  the  investigations   of  Koch  & 


Traiisiiiissibility  ol'   llimian  Tiihciculosis.  (521 

Sclmetz,  have,  in  a  general  way,  confirmed  this  assertion  other- 
wise, however  they  have  not  snhstaiitiated  the  claim  for  the 
specific  differences  hetween  the  two  forms  of  bacilli,  but  rather 
that  the  difference  in  their  biological  characteristics  was  sulli- 
cient,  at  most,  to  establish  them  as  varieties  or  types  of  the 
same  species. 

Transmissibility  of  Human  Tuberculosis  to  Cattle.  As  a  rule 
human  tulxTclc  Itaeilli  an-  hannless  for  eallle  or  they  produce  local 
lesions  only.  In  exceptional  instances,  however,  they  may  produce 
grave  and  even  fatal  disease. 

Thus  Chauvoau  (1^02)  oliseived  tu1)oreuloiis  foci  in  the  intestinal  mucous 
membrane,  in  tlie  mesenteric  glands,  in  the  pharynx  and  in  the  lunf^s,  in  three 
cases  foliowinij  the  alimentary  administration  of  infected  material  from  a  human 
lunp;  Schottelius  observed  the  develoiuiient  of  a  caseous  imeumonia  as  well  as 
tuberculous  chantjes  in  the  intestines,  in  tlie  mesenteric  glands  and  on  the  pleura 
after  the  ingestion  of  tuberculous  sputum,  -nhile  in  three  out  of  five  calves  similarly 
treated  by  Hamilton  and  McLaughlan  Young,  the  cervical  and  mesenteric  glands 
were  affected.  Wolff  observed  typical  pearl  disease  in  a  calf  following  the  sub- 
cutaneous injection  of  human  virus,  Fibiger  and  Jensen,  general  tuberculosis  in  two 
calves,  Hamilton  and  IMcLaughlan  Young  extensive  tuberculous  lesions  in  7  out  of  9 
calves  (in  three  the  lungs  also  were  affected  and  the  spleen  in  one  case)  ;  8tuur- 
mann  saw  death  follow  from  generaliyed  tuberculosis  in  a  calf  56  days  after 
injection  with  a  culture  olitained  from  the  tuVierculous  wife  of  a  peasant  and  Eber 
observed  the  same  result  from  miliary  tuberculosis  37  days  after  infection.  Death 
in  calves  following  intraperitoneal  infection  has  been  observed  by  Prettner  as 
occurring  on  the  4()th  day,  by  Eavenel  on  the  27th,  by  Orth  on  the  26th  day;  in 
a  second  case  reporte<l  by  Prettner  and  in  one  case  observed  by  each  of  Delepine, 
Fibiger  &  Jensen,  extensive  tuberculosis  of  the  abdominal  organs  was  noted ;  in 
one  case  of  Eber 's  there  was  typical  pearl  disease  of  the  pleura  and  peritoneum 
(Klebs  and  Bollinger  each  produced  typical  pearl  disease  in  a  cow  before  this  time 
by -intraperitoneal  injection  of  tuberculous  sputum  and  Bollinger,  in  addition,  pro- 
duced the  same  condition  in  a  goat  by  intraperitoneal  injection  of  material  from 
a  cheesy  tuberculous  hnnph  from  a  man).  In  one  case  each  reported  by  Prettner 
and  DeJong  and  in  two  cases  reported  by  Eavenel  intravenous  infection  caused 
death  in  from  17  to  37  days  as  a  result  of  generalized  tuberculosis.  Hamilton  and 
McLaughlan  Young  succeeded  in  producing  extensive  tuberculous  pleuro-pneumonia 
in  two  calves  by  inhalation  infection  with  human  tuberculous  material.  A  calf 
infected  by  Stuurmann  by  the  iutrapulmonary  method  died  on  the  31st  day  while 
Thomassen  observed  development  of  tuberculosis  of  the  cervical  and  pectoral  glands 
and  of  the  lungs  following  intraocular  administration. 

The  results  of  very  extensive  investigations  along  these  lines  that 
were  conducted  by  special  commissions  appointed  by  the  governments 
of  Germany,  England  and  Sweden  afforded  particular  information 
upon  the  biologic  and  pathogenic  peculiarities  of  those  forms  of  tubercle 
bacilli  which  occur  in  man. 

According  to  investigations  by  Kossel,  "Weber  &  Heuss  of  the 
German  Imperial  Board  of  Health  two  types  of  mammalian  tubercle 
bacilli  could  be  obtained  from  the  organs  of  tuberculous  persons.  These 
types,  aside  from  their  morphological  differences  (see  p.  504)  also 
po.ssessed  individual  peculiarities  with  respect  to  this  virulence  in 
rabbits  and  cattle,  the  human  type,  which  was  less  virulent  for  rabbits, 
did  not  produce  progressive  lesions  in  cattle,  while  the  bovine  type 
exhibited  a  pronounced  pathogenic  character  in  both  rabbits  and  in 
cattle,  causing  generalized  tuberculosis  in  both  species  of  animals. 

Among  67  cases  of  tuberculosis  in  human  beings  the  human  type  of  bacillus 
alone  could  be  cultivated  from  56,  the  bovine  type  alone  in  9  cases  and  both  of 
these  types  in  two  cases.     The   9  cases  in  which  the  bovine  type  alone   could  b© 


622  Tuberculosis. 

demonstrated  were  all  children  under  eight  years  of  age,  three  of  them  having 
generalized  miliary  tuberculosis.  Among  12  cases  in  children  under  10  years  of 
age  five  were  due  to  infection  by  the  bacillus  of  the  human  type  alone,  six  to 
infection  by  bacilli  of  the  bovine  type  alone  and  one  to  infection  by  bacilli  of 
both  types.  (Up  to  April,  1907,  pure  cultures  of  the  human  type  of  bacillus  were 
obtained  from  117  out  of  138  cases  of  human  tuberculosis  [Steffenhagen]).  The 
bacillus  of  the  bovine  type  was  found  exclusively  in  11  tuljerculous  cattle,  in  seven 
tuberculous  swine  and  in  one  tuberculous  sheep. 

From  the  aliove  noted  results  the  authors  draw  the  conclusion 
that  in  those  rare  cases  where  tuberculous  human  beings  can  discharge 
bovine  bacilli  they  may  be  the  means  of  infecting  cattle  and  that,  on 
the  other  hand,  infection  of  human  beings  is  caused  primarily  from 
man  to  man,  but  that  the  possil)ility  must  be  admitted  that  human 
beings  may  be  infected  with  meat  or  milk  from  tuberculous  cattle 
(and  swine).  They  further  admit,  or  assume,  that  tuberculous  cattle 
are  always  infected  with  bacilli  of  the  bovine  type  only  and  that  swine 
and  other  domestic  animals  while  generally  infected  with  this  type  may 
occasionally  also  be  infected  with  bacilli  of  the  human  type. 

The  results  of  the  experiments  above  referred  to  were  augmented 
by   Oehlecker  who  obtained   45  pure   cultures   of  human  bacilli    and 

5  pure  cultures  of  bovine  bacilli  from  50  different  surgical  cases  of 
tuberculosis. 

The  British  Commission   (Foster,  "Woodhead,  Martin,  McFadyean 

6  Boyce)  arrived  at  similar  results  in  so  far  as  they  found  pure 
cultures  of  tubercle  bacilli  obtained  from  human  beings  to  possess 
different  degrees  of  virulence  while  in  pure  cultures  obtained  from 
cattle  this  variation  was  not  as  pronounced. 

Pure  cultures  obtained  from  60  cases  of  human  tuberculosis  could 
be  classified  into  two  general  groups.  Group  I  included  14  strains 
which  agreed  in  that  they  did  not  grow  readily  on  artificial  culture 
media  (dysgonic  strains)  and  that  all  of  them  produced  generalized 
and  progressive  (though  not  always  equally  pronounced)  tuberculosis 
in  cattle  as  well  as  in  other  animals.  Group  IT  included  40  strains 
that  were  characterized  by  their  ready  growth  on  artificial  media 
(eugonic  strains)  and  by  the  production,  in  cattle,  of  local  disease 
only  or,  at  most,  isolated  tuberculous  foci  of  a  retrogressive  character 
and  by  not  producing  generalized  tuberculosis  even  when  administered 
in  large  amounts,  nor  being  very  virulent  even  for  rabbits.  Finally, 
this  commission  recognized  six  strains  which,  on  account  of  the  variable 
character  of  their  virulence,  could  not  be  classed  in  either  of  these 
groups. 

In  30  instances  cultures  which  agreed  in  their  cultural  and  patho- 
genic characteristics  with  the  strains  of  Group  I  were  found  in  cattle. 
All  of  these  had  a  decided  pathogenic  action  not  only  for  cattle,  but 
also  for  other  mammals,  including  monkeys. 

Among  60  cases  of  human  tuberculosis  there  were  28  in  which  the  clinical 
symptoms  indicated  that  infection  occurred  through  the  intestinal  tract  and  of 
these  the  bacillus  of  the  Group  I  type  was  found  in  13 ;  of  9  cases  of  tuberculosis 
of  the  cervical  glands  3  belonged  to  this  group  and  of  19  cases  of  tuberculosis  of 
the  peritoneum  10  were  caused  by  the  bacillus  of  Group  I. 

In  view  of  the  existence  of  intermediary  forms  as  well  as  the 
variable  virulence  even  of  strains  classified  in  each  group  the  com- 
mission has  not  found  it  advisable  to  recognize  two  distinct  types  of 
bacilli.  Nevertheless  Cobbett  called  attention  to  the  fact  that  it  is 
possible,  even  with  only  limited  experience,  to  recognize  in  advance 


Pathojjenic  Action  of  Bovino  Racijli.  023 

the  virulence  of  a  given  strain  in  its  first  generation  hy  its  cnllni-iil 
cliaracteristies  alone.  In  its  suunnary  tlie  repoi-t  of  tlie  eomniission  lays 
stress  upon  tlie  fad  lliat  the  bacillus  of  Grou])  1  dilfers  from  thai 
of  Group  11  not  only  in  its  lesser  degree  of  virulence,  but  also  in 
its  manner  of  growth  and  that,  in  view  of  this  two-f.ild  ditfercMic*' 
it  seems  impossible  to  believe  that  human  tuberculosis  (TT)  is  one  and 
the  same  disease  as  bovine  tuberculosis  (I).  Finally,  the  practical 
conclusion  is  expressed  that  a  certain  number  of  cases  of  tuberculosis 
of  man  and  es})ecially  of  children  is  the  direct  result  of  infection  by 
the  bacillus  of  bovine  tuberculosis. 

Of  otluM-  iiivostijiatioiis  iiiado  aloiig  those  linos  the  following  may  also  bo 
nientioiioil. 

Hamilton  rojioatoil  the  exueiinionts  of  Koch  &  Schiiotz,  nsiiijr  the  same  iniiii- 
her  of  cattle  and  was  able  to  demonstrate  tiilieiciiloiis  lesions  in  15  animals  infected 
with  human  material.  Dammann  &  Muesseineier  di<l  not  sncceed  in  making  calves 
very  sick  liy  foodinij  s]>utum  ami  pure  cultures  of  human  bacilli  but  they  succeeded 
in  producinjj  jirojirossivo,  though  in  most  cases  only  slight  tuloi-culosis  in  13 
calves  by  the  subcutaneous  administration  of  S  cultures  out  of  a  total  of  IS  pre- 
pared from  every  possible  affected  organ.  One  stiain  killed  a  calf  in  2<S  days 
ami  another,  after  intravenous  injoction,  in  17  days.  These  authors  could  not 
recognize  two  distinct  and  scparalile  types  with  transition  forms  of  bacilli  and 
believe  rather  that  the  different  strains  are  merely  varieties  of  the  same  species 
that  have  adapte<l  themselves  to  conditions  existing  in  the  bodies  of  each  species  of 
animal. 

Filiiger  &  Jensen  investigated  seven  cases  of  une(|uivocal  ])rimary  tuber- 
culosis of  the  alin;entary  canal  of  children  from  4  months  to  12  years  of  ago.  They 
found  five  cases  in  which  the  bacilli  possessed  a  very  pronounced  virulence  for 
cattle  (in  throe  cases  the  children  in  question  had  for  some  time  consumed  raw 
milk  from  nninsj)ectod  dairies).  Other  authors  (Schwoinitz  &  Schrooder,.  Westcn- 
hoeffer,  Lignioros,  Hchwoinitz,  Mohler,  Eabinowitsch)  also  have  found  bacilli  from 
tuberculous  children  (especially  from  primary  intestinal  tuberculosis)  highly 
virulent  for  cattle.  Thus  Mohler  &  Washburn  examined  twelve  strains  from  man, 
one  from  monkeys,  four  from  cattle,  two  from  dogs  and  one  from  sheep  and 
found  that  bacilli  virulent  for  cattle  may  and  do  occur  in  human  beings.  They 
were  of  the  ojjinion,  however,  that  two  types  could  be  recognized  although  there 
were  intermediate  transition  forms  and  that  the  individual  types  were  not  neces- 
sarily confined  to  definite  species  of  animals.  Finally,  Behring  maintains  that 
there  are  human  strains  of  tubercle  bacilli  that  are  more  virulent  than  material 
obtained  directly  from  cattle  and  Dorset,  also,  found  many  strains  of  bacilli  of 
human  tuberculosis  that  were  .just  as  virulent  as  those  of  bovine  tuberculosis. 

Eber  tested  the  virulence  of  the  bacilli  in  seven  cases  of  intestinal  tuber- 
culosis of  chiMren  and  found  only  two  cases  in  which  they  were  only  slightly  or 
not  at  all  virulent,  two  cases  in  which  the  virulence  was  of  average  intensity  and 
three  cases  in  which  the  bacilli  were  highly  virulent  for  cattle.  In  later  investiga- 
tions only  two  out  of  S  cases  of  human  tuberculosis  proved  non-virulent  for  cattle 
while  repeated  attempts  with  the  remaining  G  strains  wore  uniformly  successful  in 
producing  serious  and  in  some  cases  fatal  tuberculosis  in  cattle  (especially  after 
combined  subcutaneous  and  intraperitoneal  administration  of  the  virus).  Two 
strains  exhibited  only  a  medium  degree  of  virulence  for  cattle  but  after  being 
transferred  to  another  animal  they  became  highly  virulent.  Since  both  strains 
showed  atypical  characteristics  from  a  morphological  point  of  view  also,  as  well 
as  in  their  action  on  rabbits,  Eber  is  inclined  to  look  upon  them  as  transition 
forms  which  seem  to  constitute  a  connecting  link  between  the  two  extreme  types 
and  make  the  gradual  transition  from  one  form  to  the  other  seem  possible. 

Pathogenic  Action  of  Bovine  Tubercle  Bacilli  on  Cattle.  The 
inoculation  of  the  pathologic  products  of  tuberculous  cattle  or  cultures 
of  bovine  tubercle  bacilli  is  usually  followed  by  the  development  of 
a  severe  tuberculous  affection,  which  frequently  ends  fatally  within 
4  to  8  weeks.  Cases  are  observed,  however,  in  which  local  lesions 
only  result. 

Thus  Arloing  was  able,  in  some  eases,  to  produce  onlv  local  changes 
at  the  point  of  inoculation  or  in  the  regional  lymph  glands  by  sub- 


624  Tuberculosis. 

cutaneous  injection  of  bovine  bacilli.  In  the  investigations  of  the 
Imperial  Board  of  Health,  1  out  of  11  strains  of  bovine  bacilli  had 
a  similar  mild  action  (injected  intravenously,  however,  it  was  quite 
virulent),  while  Dammann  &  Muessemeier  found  the  injection  of  5  eg. 
of  a  culture  of  bacilli  into  a  calf  absolutely  ineffective.  According 
to  the  report  of  the  British  Commission  the  subcutaneous  injection 
of  bovine  bacilli  occasionally  produces  only  local  changes,  which,  when 
they  become  more  general  (as  may  sometimes  occur)  are  limited  to 
occasional,  small  foci  in  internal  organs  usually  in  an  arrested  stage 
of  development.  Between  the  two  extremes  of  rapidly  progressive 
generalized  tuberculosis  and  of  well  marked  regressive  forms,  every 
possible  intermediate  form  may  be  observed. 

The  feeding  of  bovine  virus  frequently  fails  to  result  in  severe 
disease.  Thus  Nocard  failed  to  get  positive  results  in  four  attempts, 
Hutyra  failed  to  produce  serious  infection  of  calves  six  months  of 
age  by  feeding  cultures  of  bacilli,  and  the  British  Commission  observed 
tuberculous  changes  only  in  the  immediately  adjacent  regions  of  the 
intestinal  tract  following  alimentary  administration  of  milk  containing 
tubercle  bacilli.  Schweinitz,  Schroeder,  Nocard  and  Eber  have  obtained 
bacilli  from  cattle  that  were  only  slightly  virulent  for  calves,  while 
Preisz  produced  in  one  calf  tuberculous  changes  in  one  peribronchial 
lymph  gland  only  and  failed  to  cause  any  observable  changes  whatever 
in  a  second  calf,  both  of  which  received  intravenous  injections  of 
a  mixture  of  six  different  strains  of  bovine  bacilli  (see  also  experiments 
of  Kossel,  "Weber  &  Heuss,  p.  508), 

Pathogenic  Action  of  the  Two  Types  of  Tubercle  Bacilli  on 
Other  Animals.  More  recent  investigations  have,  above  all,  confirmed 
the  observations  of  the  past  that  the  human  type  of  tubercle  bacillus 
is  decidedly  less  virulent  for  rabbits  and  guinea  pigs  than  the  bovine 
type,  and  that  it  is  frequently  impossible  to  infect  rabbits  at  all  with 
bacilli  of  the  former  type  (Smith,  Ravenel,  Kossel,  Weber  &  Heuss). 
Similar  observations  have  been  made  also  with  regard  to  sheep  and 
goats  (Dinwiddle,  Ravenel,  Beck)  ;  Karlinski,  however,  successfully  in- 
fected pregnant  goats  with  intravenous  and  intramammary  injections, 
and  kids  by  alimentary  administration  of  human  bacilli  while  Dammann 
&  Muessemeier  observed  slight  tuberculosis  of  the  lymph  glands  of 
lambs  following  feeding  of  human  material  and  in  one  case  fatal  tuber- 
culosis followed  within  44  days  after  alimentary  administration  of 
0.1  gm.  of  bovine  culture. 

In  regard  to  the  susceptibility  of  other  species  of  animals  the 
results  of  experiments  have  varied.  While,  for  instance,  according 
to  Dinwiddle  and  Gratia  the  two  forms  of  bacilli  possess  much  the 
same  action  toward  horses,  swine,  dogs  and  cats,  Ravenel  noted  the 
same  differences  that  are  mentioned  above.  Aside  from  the  fact  that 
bovine  bacilli  are  always  present  in  the  organs  of  tuberculous  swine 
the  virulence  of  this  type  of  bacilli  is  abundantly  demonstrated  by 
the  rapid  and  certain  infection  of  large  herds  of  swine  that  have 
been  fed  on  skim  milk.  On  the  other  hand  Dean  &  Todd  infected 
swine  by  feeding  tuberculous  pus  from  man  and  Dammann  saw  a 
pig  die  within  42  days  after  subcutaneous  infection  with  a  culture  of 
human  tubercle  bacilli.  In  the  feeding  experiments  of  Kossel,  Weber 
&  Heuss,  the  result  of  infection  was  alwaj^s  a  chronic  general  tuber- 
culosis of  slow  evolution.  Th.  Smith  and  Ravenel  produced  cultures 
of  typical  bovine  bacilli  from  swine,  the  same  from  one  horse  and 
an  intermediate  form  from  a  second  horse. 


Susceptibility  ul"  Monkeys.  (J25 

The  susceptibility  of  dogs  to  the  vinis  of  hunian  luhcrcnlosis 
was  deinonst rated  by  the  experiments  of  Tappeiner,  Weiehselbauin, 
Leudet  &  Petit  and  F.  Arloing  Avho  were  almost  invariably  successful 
in  infecting  dogs  by  the  alimentary  administration,  and  occasionally 
also  by  inhalation  of  sputum  or  pure  cultures  of  human  bacilli,  oii 
the  other  hand  Titze  &  Weidanz  found  that  dogs  generally  had  a 
considerable  resistance  toward  inf(H'tion  with  any  kind  of  tuberculous 
material,  but  that  this  could  be  overcome  by  administering  excessive 
doses  of  both  types  of  the  l)acilli.  Th.  Smith  obtained  cultures  froin 
three  cats  that  agreed  morphologically  in  every  respect  with  bovine 
bacilli,  l)ut  only  one  of  them  was  moderately  virulent  for  cattle. 

Susceptibility  of  Monkeys  to  the  Virus  of  Bovine  Tuberculosis. 

Experiments  relative  to  this  ((uestion,  so  important  because  the  results 
permit  conclusions  in  regard  to  the  suscepti])ility  of  man,  have  been 
rather   uniform  and  almost   entirely   positive  in   their  results.     Years 
ago  Tmbach  successfully  infected  monkeys  by  feeding  milk  from  tuber- 
culous  cattle.      Of   the    more    recent   investigations,    besides   those    of 
Gruenbaum,   Salmon,   DeJong.   Cipollino  and  others,  the  following  in 
particular  are  worthy  of  mention :    In  two  series  of  experiments  Xocard 
fed  four  monkeys  with  bovine  bacilli  and  two  with  human  bacilli ;  all 
of  the  six  animals  became  affected  with  a  severe  form  of  generalized 
tuberculosis,   but  the  infections  with  bovine  bacilli  produced  a   more 
rapid   development    of    disease    (Schweinitz   &    Schroeder   observed    a 
similar  difference  in  the  pathogenic  action  of  the  two  types  of  bacilli). 
Gratia  fed  four  apes  with  the  organs  of  tulierculous  cattle,  four  more 
received  the  tuberculous  organs  of  guinea   pigs  infected  with  bovine 
tuberculosis,  two  were  fed  on  organs  from  similarly  infected  monkevs 
and  three   were   fed   with  milk  from  cows  with   tuberculous  udders; 
of  -these  13  monkeys  12  died  from  generalized  tuberculosis  while  one 
(from    the   first   group)    only    contracted    an    intestinal    catarrh.      In 
MacFadyean's  experiments  five  monkeys  that  were  fed  on  organs  from 
tuberculous  human  beings  died  between  the  33d  and  65th  davs,  three 
others  that  had  been  fed  on  sputum  died  between  the  30th "and  the 
65th  days  (all  from  tuberculesis)  while  the  feeding  of  infected  material 
from  tuberculous  cows  resulted  in  death  from  generalized  tuberculosis 
m  a  similar  or  in  a  still  shorter  period  of  time.     Dungern  &  Smith 
inoculated  three  gibbons  with  human,  six  with  bovine  cultures   (each 
0.01  gm.)   and  another  lot  of  three  received  repeated  decigram  doses 
of  cultures  of  both  types;  all  of  these  animals  became  ill  with   the 
only   difference   that  those   receiving  the   bovine   virus   had   intestinal 
ulcers  and  caseous  mesenteric  glands,  while  those  receiving  the  human 
virus  had  a  solitary  caseous  focus  in  one  lung  and  caseation  of  the 
corresponding   bronchial    gland.      The   British   Commission   tested   the 
virulence  of  bovine  bacilli  on  over  one  hundred  monkeys  and  all  animals, 
whether  they  received  subcutaneous  or  intra vepo^s  injections,  or  were 
fed  upon  cultures  (in  some  instances  only  0.001  gm.)  contracted  severe 
generalized   tuberculosis.     Experiments   with   anthropoid   apes    (chim- 
panzees)   also  gave  positive  results  and  Eastwood  is  of  the  opinion 
that   their   susceptibility  to   infection   with  tuberculosis   is   materiallv 
greater  than  that  of  cattle.     Rabinowitsch   found  on  examination  of 
33  monkeys,  most  of  them  affected  with  human  tuberculosis,  while  onlv 
a  relatively  small  number   (3)   had  bovine  bacilli  in  the  lesions.     In 
one  case  both  forms  were  associated    (one  an  avian  culture)    and  in 
a  tew  other   cases   there   were  transition   forms  of  bacilli.     Kraus  & 

Vol.  1—40 


(72n  Tuberculosis. 

Grosz  noted  a  considerable  difference  in  the  two  types  after  infection 
of  the  scarified  skin,  the  human  type  producing  changes  limited  to 
the  area  of  inoculation  and  showing  no  tendency  to  become  destructive 
while  the  bovine  type  resulted  in  the  formation  of  local  ulcers  followed 
by  involvement  of  the  regional  lymph  glands  and  later  of  the  internal 
organs  also,  as  a  rule,  with  fatal  termination.  (Cutaneous  inoculation 
with  the  typus  gallinaceus  resulted  in  very  slight  local  changes  only.) 

Susceptibility  of  Man  to  Tuberculosis  of  Animals.  lender  ordinary 
conditions  this  question  is,  of  course,  beyond  the  possibility  of  experi- 
mental demonstration.  Nevertheless,  our  literature,  and  especially  that 
of  more  recent  date,  contains  numerous  reports  of  observations  that 
seem  to  justify  the  assumption  of  such  susceptibility  without  even 
taking  into  consideration  of  numerous  instances  in  which  typical  bovine 
bacilli  were  found  in  the  lesions  of  tuberculous  human  beings. 

Tuberculous  disease  proceeding  from  injuries  to  the  skin  has 
repeatedly  been  observed  in  persons  who  had  the  care  of  tuberculous 
cattle  or  in  veterinarians  and  meat  inspectors  who  were  employed 
in  inspecting  or  making  post-mortem  examinations  of  tuberculous 
cattle.  In  the  vast  majority  of  cases  (DeJong,  Ravenel,  Ostertag, 
Jensen,  Gratia,  etc.)  an  injury  of  the  finger  or  hand  under  such  con- 
ditions (in  one  instance  injury  of  the  face)  resulted  in  the  develop- 
ment of  a  tuberculous  nodule  or  ulcer  at  the  point  of  infection,  very 
similar  to  those  occurring  from  infection  following  injuries  received 
in  the  post-mortem  examination  of  tuberculous  human  bodies.  Occa- 
sionally ( Johne,  Krause,  Trojo)  these  local  affections  have  been  followed 
by  swelling  of  the  lymph  glands  of  the  elbows  and  axillae.  Tn  a  case 
reported  by  "Weber  the  primary  affection  spread  from  the  mucous 
membrane  of  the  gums  to  the  tongue  and  the  sulmiaxillary  gland. 
Lassar  calls  attention  to  the  fact  that  dermatitis  verrucosa  cutis  is 
a  particularly  frequent  occurrence  among  persons  employed  in  slaughter 
houses,  having  himself  observed  7  cases  among  3().'5  persons  examined, 
while  otherwise  the  rate  of  morbidity  is  only  0.03%.  In  several  cases 
repeated  applications  of  milk  to  the  face  resulted  in  dermal  tuberculosis 
(Grothau,  Priester,  Leloir,  Salmon),  while  in  one  case  60  cold  abscesses 
developed  on  various  portions  of  the  body  following  an  injury  received 
during  milking.  In  this  case  there  was  also  tuberculosis  of  the  iris 
which  resulted  in  destruction  of  the  eyeball  (Coppez).  Infections 
of  this  character  that  have  their  origin  in  wounds  of  the  articulations 
are  particularly  dangerous  and  infections  of  finger  articulations  have 
been  observed  to  result  in  death  from  consiimption  (Pfeifer,  Hartzell, 
Salmon,  Rich). 

On  the  other  hand  the  experiments  of  an  unknown  physician  are 
worthy  of  mention,  who  treated  persons  affected  with  carcinoma  with 
cultures  of  bovine  bacilli  injected  subcutaneously,  with  no  observable 
injurious  results  (Baumgarten).  F.  Klemperer.  in  experiments  per- 
formed on  himself  and  on  five  tuberculous  persons  by  repeated  sub- 
cutaneous injections  of  0.25  cc.  of  an  emulsion  containing  many  bovine 
bacilli,  observed  only  local  inflammatory  symptoms  but  in  no  case 
tuberculous  lesions,  while  the  injected  bovine  bacilli  disappeared  from 
the  tissues  in  a  short  time.  Spengler  also  injected  himself  with  lA  mg. 
of  a  bovine  culture  (subcutaneously)  which  resulted  in  an  abscess  that 
broke  after  34  days ;  suppuration  continued  for  8  months  and  was 
sometimes  quite  profuse,  but  the  lesion  remained  localized  and  the 
regional  lymph  glands  remained  free. 


Susceptibility  of  Man.  (joy 

In  geiu'i-iil.  Itovino  l)aeilli  scorn  to  have  little  tendency  to  spread 
in  the  human  body,  nsnally  eausin^  local  disease  at  the  point  of  in- 
fection and  the  neif^hhoring  tissues  (mesenteric  and  cervical  glands), 
hut   in   some  cases  the  disease  may  hccome  generalized. 

In  regard  to  the  fre(|uency  of  primary  intestinal  infection  and 
its  relation  to  the  ing(>stion  of  tuberculous  milk,  reliable  data  have 
as  yet  not  accumulated  in  sufficient  quantity.  In  the  past  too  little 
attention  has  been  paid  to  this  form  of  disease  and  besides,  there  is 
no  definite  agreement  as  to  the  exact  characteristics  of  primary  in- 
testinal tuberculous  disease.  "While,  for  instance,  some  authors  recognize 
only  primary  intestinal  ulcers  as  such,  others,  and  probably  correctly 
so,  regard  the  ]>rimary  affection  of  the  mesenteric  glands  with  intact 
intestinal  mucous  membrane  also  as  such.  According  to  modern  views 
in  regard  to  the  pathogenesis  of  tubercnlosis  (see  p.  526)  many  eases 
of  priniai-y  tuberculosis  of  the  thoracic  and  cervical  glands  as  well 
as  scrofulosis  must  be  looked  npon  as  the  result  of  primary  intestinal 
infection.  The  variable  conceptions  of  this  question  is  a  sufficient 
explanation  of  the  conflicting  statistical  reports.  While,  for  example, 
Koch  regarded  primary  intestinal  infection  (intestinal  ulcers)  as  very 
rare,  and  Baginsky  noted  oidy  10  such  cases  in  the  course  of  five 
years  in  the  Charite  Hospital  in  the  city  of  Berlin,  Heller  reports 
37.8%  of  primary  intestinal  infection  in  post-mortem  examinations 
of  tubej'culous  children  in  Kiel;  TTueppe  25  to  35^^  in  Prague;  Council- 
man 37.1%  in  l^oston;  Wagener,  Eder  and  Tpsen  in  Kiel,  Berlin  and 
Copenhagen,  report  44  cases  in  289  bodies  of  children  examined.  Ac- 
cording to  Ashby  and  Woodhead  70%  of  children  that  die  of  tuberculosis 
show  affection  of  the   mesenteric   glands. 

Weber,  in  a  statistical  report  authorized  by  the  German  Imperial 
Board  of  Health,  shows  that  among  360  persons,  among  them  151 
children,  who  had  consumed  raw  milk  and  dairy  products  from 
69  cows  affected  with  tuberculosis  of  the  udder  the  presence  of  "pearl 
disease"  could  be  demonstrated  in  only  two  of  the  children  (tuber- 
culosis of  the  cervical  glands).  This  result  by  no  means  harmonizes 
with  the  fact  that  the  numerous  authenticated  cases  of  tuberculosis 
in  human  beings,  demonstrated  to  be  caused  by  bacilli  of  the  })ovine 
type  have  in  most  instances  been  tuberculosis  of  the  glands  in  children 
that  had  evidently  been  infected  by  the  milk  of  tuberculous  cattle. 

Constancy  of  Virulence  of  Tubercle  Bacilli.  The  virulence  of 
the  different  types  of  bacilli  seems  to  be  very  constant.  It  has  always 
been  a  difficult  matter  to  change  this  artificially.  Although  according 
to  Orth,  Hamilton,  Karlinsky,  Hamilton  &  M'Laughlan  Young  the 
passage  pi  human  bacilli  through  cattle,  according  to  v.  Behring, 
Karlinski,  BeJong  and  Dammann  &  IMuessemeier  the  passage  through 
goats  and  according  to  :\Iohler  the  passage  through  cats  and  rabbits 
increases  the  virulence  for  cattle,  experiments  made  bv  the  German 
Imperial  Board  of  Plealth  gave  negative  results  throughout.  Thus 
Weber,  in  particular,  was  unsuccessful  in  increasing  the' virulence  of 
the  human  type  of  tubercle  bacilli  by  five  or  eight  consecutive  passages 
through  goats,  the  passage  of  15  strains  through  pigs  for  a  period 
extendnig  over  300  days,  and  by  four  consecutive  passages  through 
cattle  for  a  period  of  685  days.  This  type  also  fullv  retained  its  cultural 
characteristics.  Jancso  &  Elfen  in  their  experiments  with  18  strains 
of  human  bacilli  to  increase  their  virulence  for  chickens  bv  passage 
through  fowls,  or  their  virulence  for  rabbits  by  passage  through  the 
latter  animals,  obtained  negative  results. 


628  Tuberculosis. 

The  negative  character  of  experimental  attempts  does  not,  of  course, 
exclude  the  possibility  of  a  modification  in  the  course  of  many  genera- 
tions under  favorable  natural  conditions.  This  possibility  has  recently 
been  demonstrated  by  Eber  who  succeeded  in  producing  in  three  in- 
stances an  acute  fatal  tuberculosis  in  cattle  with  bacilli  of  the  human 
type  obtained  from  phthisical  sputum.  The  bacilli,  after  first  a  passage 
through  guinea  pigs  followed  by  intraperitoneal  injection  in  cattle, 
produced  only  a  circumscribed  peritoneal  tuberculosis,  but  cultures 
obtained  from  this  affection  and  which  had  all  the  characteristics  of 
bovine  bacilli,  produced  death  in  from  21  to  34  days. 

Experimental  investigations  thus  far  carried  out  have 
therefore  not  resulted  in  the  discovery  of  fundamental  differ- 
ences between  the  causes  of  human  tuberculosis  and  tubercu- 
losis of  the  various  domestic  animals  that  would  justify  any 
modification  of  our  former  views  as  to  the  specific  identity  of 
all  tubercle  bacilli. 

The  differences  in  the  form  or  structure  of  bacilli  of  various 
origin  are  least  constant  because  they  usually  disappear  within 
a  very  short  time  when  grown  on  artificial  media. 

Their  cultural  differences,  however,  are  more  constant. 
These  may  remain  unchanged  through  many  generations,  even 
after  passage  through  the  bodies  of  other  species  of  animals. 
In  this  respect,  however,  gradual  variations  are  observed 
which  make  it  impossible  at  times  to  classify  certain  strains 
of  bacilli  in  their  proper  group. 

The  remarkable  difference  in  virulence  of  strains  of  bacilli 
of  different  origin  is  still  less  adapted  for  the  determination 
of  their  specific  character.  Great  variation  in  virulence, 
especially  with  respect  to  different  species  of  animals,  with 
otherwise  great  constancy  of  character,  has  also  been  observed 
in  other  pathogenic  bacteria  (very  marked  in  the  bipolar 
bacilli  of  hemorrhagic  septicemia)  while  their  specific  identity 
has  never  been  questioned  on  that  ground. 

The  inadmissibility  of  such  a  view  is  further  emphasized 
by  the  fact  that  variations  ranging  from  the  highest  degree  of 
virulence  (with  respect  to  certain  species)  to  complete  aviru- 
lence  may  be  artificially  produced  by  successive  animal  passages 
or  by  artificial  cultivation  and,  on  the  other  hand,  by  the  fact 
that  strains  of  the  same  type,  obtained  from  different  indi- 
viduals of  the  same  species  may  show  variations  in  virulence 
of  no  inconsiderable  degree. 

The  similar  form  and  the  similar  staining  characteristics 
of  the  various  strains  of  tubercle  bacilli,  the  general  re- 
semblance of  their  cultures,  the  identity  of  the  pathological 
changes  caused  by  them,  the  gradual  differences  observed  be- 
tween the  different  strains  as  well  as  the  occurrence  of  transi- 
tion forms,  the  similar  effect  of  tuberculins  prepared  from 
strains  obtained  from  different  species  of  animals,  the  fact 
that  cattle  may  be  immunized  with  strains  of  bacilli  obtained 
from  human  beings   or  fowls   and,   finally,  the  fact  that  the 


Constancy  of  Virnlcnco  of  Bacilli.  (529 

bacilli  from  one  species  of  animal  (at  least  in  exceptional 
cases)  may  produce  local  or  even  generalized  tuberculosis  in 
other  species,  all  point  to  the  conclusion  that  tubercle  bacilli 
obtained  from  various  sources  all  belong  to  the  same  species, 
bacillus  tuberculosis,  and  only  represent  varieties  of  "habitat" 
which  differ  from  each  other  in  unimportant  characteristics. 
These  characteristics  are  evidently  the  result  of  prolonged 
growth,  generation  after  generation,  in  different  hosts  and  may, 
under  favorable  conditions,  again  be  obliterated. 

The  pathogenic  action  of  the  bacilli  of  human  tuberculosis, 
pearl  disease  and  tuberculosis  of  fowls  is  always  most  pro- 
nounced for  the  species  of  animal  from  which  they  have  been 
respectively  obtained,  but  none  of  them  are  harmless  for  other 
species.  In  addition  to  guinea  pigs  and  rabbits  the  virus  of 
human  tuberculosis  is  pathogenic,  in  general,  for  all  carnivora, 
slightly  so  for  swine  and  for  many  species  of  birds  (birds  like 
canaries  and  parrots  kept  as  pets  in  dwellings,  in  particular). 
The  bacillus  of  bovine  tul)erculosis  is  quite  virulent  for  swine 
and  is,  in  general,  more  pathogenic  for  other  domestic  animals 
than  the  human  type.  The  bovine  bacillus  is  also  occasionally 
the  cause  of  fatal  generalized  tuberculosis  in  human  beings, 
especially  in  children.  The  bacillus  of  avian  tuberculosis  is, 
in  general,  only  slightly  pathogenic  for  mammals,  but  may  oc- 
casionally produce  tuberculous  disease  in  man,  in  the  ox  and 
the  horse. 

In  view  of  the  experimentally  demonstrated  possibility  of 
the  transmission  of  tuberculosis  from  one  species  to  the  other, 
including  man,  the  fact  that  this  occurs  in  part  only  occasionally 
is  of  subordinate  importance.  Neither  does  the  fact  that  bovine 
bacilli  that  have  been  the  cause  of  tuberculous  lesions  in  the 
human  body  (or  avian  virus  found  in  lesions  of  the  horse,  or 
human  virus  found  in  parrots  inhabiting  the  dwellings  of  human 
beings)  have  retained  for  a  time  their  original  characteristics, 
detract  from  the  force  of  the  argiiment.  As  a  matter  of  fact, 
the  vast  majority  of  medical  and  veterinary  medical  investiga- 
tors admit  the  etiological  entirety  of  tuberculosis  in  general 
and  the  specific  identity  of  the  various  forms  of  tubercle  bacilli 
and  to  this  day  accept  Koch's  original  point  of  view,  viz. :  *'In 
spite  of  the  anatomical  and  clinical  differences  observed  in 
the  course  of  the  disease,  tuberculosis  of  animals,  and  particu- 
larly bovine  tuberculosis,  must  be  regarded  as  identical  with 
tuberculosis  of  man  on  account  of  the  identity  of  the  parasites 
that  are  the  cause  of  the  disease. 

For  practical  purposes  the  recognition  of  a  typus  humanus,  a 
typus  bovinus  and  a  typus  gallinaceus  may  be  justified  in  order  to 
designate  the  morphological,  cultural  and  pathogenic  characteristics 
of  the  different  groups  of  hacilli,  providing  the  fact  is  kept  in  mind 
that  tliese  types  represent  merely  habitat  varieties  of  the  same  species 
and  that  the  occurrence  of  transition  forms  be  kept  in  mind. 


630  Tuberculosis. 

Literature.  Smith,  Transactions  of  the  Assoc,  of  Anier.  Physicians,  1896;  J. 
of  exp.  med.,  1898.  III.  —  Koch,  D.  m.  W.,  1901,  549.  —  Szekely,  Cbl.  f.  Bakh., 
1902.  XXXII.  167;  1903.  XXXIV.  161  (Review).  —  Gratia,  Tub.-Kongr.  Briissel, 
1904  (Eeview).  —  Kossel,  Weber  &  Heuss,  Tub.-Arb.  d.  G.-A.,  H.  1  (Lit).  — 
Dammann  &  Mussemeier,  Bez.  zw.  d.  Tub.  d.  Menschen  u.  d.  Tiere,  Hannover 
1905.  —  Eber,  Cbl.  f.  Bakt.,  1906  XXXVIII.  449;  B.  t.  W.,  1910.  317.  —  Eabino- 
wiTSCH,  B.  kl.  W.,  1906.  Xr.  24.  —  Fibiger  &  Jensen,  Ibid.,  1907.  4.  —  Second 
int.  Eapport  of  the  E.  Comm.  appointed  to  inqu,  into  the  relations  of  human  and 
animal  tuberculosis.  Vol.  1 — 4.  London  1907,  —  Mohler  &  Washburn,  An.  Ind., 
1907.  Bull.  96  (Lit.).  —  O.  Bang,  Cbl.  f.  Bakt.,  1908.  XLVL  461.  —  Zwick,  Z.  f. 
Infkr.,   1908.   IV.    161    (Lit.). 

Tuberculosis  of  Fish  and  Reptiles  and  Other  Cold  Blooded 
Animals.  The  acid  and  alcohol-fast  bacilli  that  Silby  obtained  from 
a  garter  snake,  Bataillon,  Dubard  &  Terre  from  a  carp,  Moeller  from 
a  hazel  worm  (Anguis  fragilis),  and  Friedmann  from  a  turtle,  are 
regarded  by  these  authors  as  closely  related  to  Koch's  tubercle  bacillus. 
The  two  first  named,  however,  grow  only  at  room  temperature,  like 
saprophytes,  but  the  turtle  bacillus  grows  also  at  37°  C,  producing 
cultures  very  similar  to  mammalian  cultures.  It  seemed  also,  that 
Friedmann 's  experiments  in  successfully  immunizing  rabbits  against 
human  tubercle  bacilli  (see  p.  599)  as  well  as  Moeller 's  success  with 
the  Anguis  fragilis  bacillus  point  to  a  close  specific  relationship  with 
mammalian  tubercle  bacilli.  Weber  &  Taute,  however,  concluded  from 
the  results  of  their  experiments  that  the  so  called  reptilian  tubercle 
bacilli  belonged  to  the  group  of  acid-fast  saprophytic  bacilli  which 
gain  access  into  the  bodies  of  cold  blooded  animals  and  produce  local 
disease.  (True  tubercle  bacilli  inoculated  into  frogs  remain  virulent 
for  a  long  time  and  produce  nodules  of  tubercles  similar  to  those 
produced  by  dead  tubercle  bacilli  in  other  animals.) 

The  bacilli  of  piscine  tuberculosis  are  nonpathogenic  for  warm- 
blooded animals.  Nevertheless  Dubard  was  successful  in  making  the 
fish  bacillus  very  virulent  for  guinea  pigs  and  Aujesky,  by  growing 
the  same  bacillus  at  a  temperature  of  37°  C.  and  by  repeated  passage 
through  the  bodies  of  guinea  pigs  succeeded  in  producing  a  strain  that 
differed  in  no  essential  from  the  bacilli  of  guinea  pig  tuberculosis. 

The  transformation  of  mammalian  tubercle  bacilli  into  reptilian 
or  cold-blood  bacilli  has,  as  yet,  not  been  accomplished  (the  reported 
positive  results  of  Sorgo-Suess  were  not  confirmed  by  Tsukiyama). 

Literature.  Weber  &  Taute,  Tub.-Arb.  d.  G.-A.,  1905.  H.  3  (Lit.).  — 
Aujeszky,  Orvosi  Hetilap.,  1906.  Nr.  8.  —  Sorgo-Suess,  Wien.  klin.  W.,  1907.  Xr. 
38.  —  Tsukiyama,  Diss.  Gieben  1908. 


2.    Pseudotuberculosis. 

Since  the  discovery  of  Koch's  bacillus  siicli  patholoe^ical 
processes  only  are  classified  under  the  head  of  tuberculosis 
as  can  be  demonstrated  to  be  due  to  this  bacillus.  Changes 
that  resemble  those  of  tuberculosis  from  an  anatomical  point 
of  view  and  especially  those  that  are  associated  with  the 
formation  of  nodules  which  bear  a  resemblance  to  true  tuber- 
cles, but  are  due  to  the  pathogenic  action  of  other  bacteria 
are  occasionally  observed  as  occurring  in  the  internal  organs. 
Sometimes,  also,  such  pathological  changes  are  due  to  spiro- 
chsetae  or  animal  parasites.     Such  cases  are  usuallv  classed 


Pseiulotubereulosis.  631 

under  the  general  name  of  pseudotuberculosis.  Preisz,  how- 
ever, suggested  that  this  term  be  limited  exclusively  to  morl)id 
processes  that  are  produced  by  bacteria  other  than  Koch's 
bacillus.    In  this  sense  the  subject  will  be  discussed  below. 

^Mahissoz  &  Vignal  (1883)  found  tiiborcle-like  nodules  following 
subcutaneous  administration  of  a  nodule  obtained  from  a  child  that 
died  with  tu])ereulous  meningitis.  The  nodules  in  the  guinea  pig,  how- 
ever, contained  zooglcca  masses  composed  of  cocci  and  short  bacilli 
instead  of  Koch's  bacillus.  Since  then  other  nodular  structures,  some 
of  them  the  results  of  experimental  inoculation  of  animals  with  various 
substances,  others  accidentally  discovered,  have  been  described.  After 
a  careful  study  of  the  literature  up  to  1891  and  a  comparison  of 
the  bacteria  found  by  Nocard,  Pfeiffer,  Parietta  and  Zagari,  Preisz 
designated  the  following  three  species  of  bacteria  as  independent  causes 
of  i)seudotuberculous  processes: 

1.  Streptococcus  Pseudotuberculosis  Rodentium  Dor;  a  thick, 
short,  iininotile  ])acillus  witli  l)lnnt  round  ends;  friMjuently  form  long 
cliains  in  tissue  as  well  as  in  artiticial  media,  particularly  in  bouillon; 
easily  stained  with  aqueous  aniline  dyes,  but  not  according  to  (Jram's 
nietliod:  does  not  liquefy  gelatin,  forms  an  iridescent  membrane  on 
agar  and  emits  a  disagreeable  odor ;  on  potatoes  yellowish-brown  colonies 
develop,  the  medium  taking  on  a  greenish-gray  color  in  the  surrounding 
areas.  Inoculation  of  pure  cultures  produce  pseudotuberculosis  in 
rabbits  and  guinea  pigs  with  fatal  termination  in  8  to  10  days. 

This  bacillus  is  identical  with  the  bacillus  described  by  Malassez 
&  Vignal,  Charrin  &  Roger,  Pfeiffer,  Zagari  &  Parietti  under  various 
names,  tuhfrculosczooglciquc,  pseudotuherculose  hacillaire,  tuhercuose 
strepiohacUlaire,  etc.,  and  to  the  action  of  which  various  morbid 
processes  in  guinea  pigs  and  rabbits  have  been  ascribed.  It  is  also 
very  similar  to  Bact.  pseudotuberculare  orchitophlogogenes  recognized 
by  Cagnetto  as  the  cause  of  a  certain  guinea  pig  enzootic.  This  bacillus 
seems  to  be  widely  disseminated  in  nature ;  Chantemesse  found  it  in 
the  dust  of  dwellings,  Grancher  «&  Ledoux-Lebard  found  it  in  garden 
soil,  Lignieres  in  hay  infusion,  Parietti  in  milk.  According  to  Nocard 
it  occasionally  causes  epizootic  afifections  of  fowls  (emaciation,  tubercles 
in  the  lungs).  Nocard  also  found  this  organism  in  the  nasal  discharge 
of  a  cow  while  Pfeiffer  cultivated  the  same  from  the  organs  of  a 
horse  affected  with  glanders.  In  addition  to  this  it  is  probable  that 
the  liacilli  found  by  Labrazes  in  subcutaneous  cheesy  foci  in  the  neck 
of  a  pigeon,  and  by  Galavielle  and  t'Hoen  in  nodules  of  a  cat's  liver, 
are  identical,  forming  chain-like  structures  in  bouillon  and  causing 
pseudotuberculosis  in  cats  and  guinea  pigs.  Those  mentioned  by 
Galavielle  also  produced  pseudotuberculosis  in  the  testes  of  guinea 
pigs. 

2.  Courmont's  Bacillus.  I^p  to  the  present  time  this  has  been 
found  only  in  nodules  resembling  those  of  pearl  disease  observed  on 
the  pleura  of  a  cow.  This  is  a  short,  thick  bacillus,  actively  motile, 
does  not  form  chains  in  cultures.  It  grows  well  on  artificial  media, 
does  not  lifiuefy  gelatin  and  forms  long  threads  at  40°  C.  These  latter 
contained  broken  plasma  masses.  Fresh  cultures  cause  the  develop- 
ment   of    pseudotuberculosis    in    rabbits    while    in    guinea    pigs    acute 


G3l2  Pseudotuberculosis. 

septicemia  results.  On  the  other  hand  cultures  of  three  weeks'  growth 
produce  pseudotuberculosis  in  guinea  pigs  and  are  non-pathogenic  for 
rabbits. 

3.  Bacillus  Pseudotuberculosis  Ovis.  Preisz  cultivated  this 
bacillus  from  nodules  in  the  kidney  of  a  sheep  (described  on  page  638). 
According  to  later  investigations  this  bacillus  is  identical  with  that 
causing  ulcerous  lymphangitis  in  horses  (see  this)  and  probably  also 
to  that  causing  contagious  acne  of  horses  (see  Vol.  2).  Kitt  demon- 
strated its  presence  in  broncho-pneumonia  of  cattle,  Sivori  in  broncho- 
pneumonia of  sheep  (see  p.  636),  Nocard  in  catarrhal  pneumonia  of 
calves  (see  p.  165)  and  Carre  &  Bigoteau  in  mal  rouge  of  sheep  (see 
p.  637),  Seres  &  Guillaume  in  swine,  and  finally  Lignieres  found  this 
organism  in  rabbits  and  guinea  pigs. 

In  addition  to  the  three  above-named  bacilli  more  recent  investiga- 
tions have  resulted  in  the  discovery  of  other  bacteria  as  causes  of 
pseudotuberculous  processes.     Some  of  these  are  as  follows : 

4.  Bacillus  of  Pseudotuberculosis  of  Calves  described  by  Vallee 
(see  p.  638). 

5.  Bacillus  Pseudotuberculosis  Murium  found  by  Kutscher  in  a 
mouse  that  died  of  pseudotuberculosis ;  it  is  immotile,  sometimes  staining 
according  to  Gram's  method,  forms  club-shaped  growths  in  cultures 
and  is  pathogenic  for  mice  only. 

6.  Corynethrix  Pseudotuberculosis  Murium  described  by  Bongert 
as  a  short  rod,  Gram  positive  in  old  cultures,  its  products  are  violently 
toxic. 

Structure  of  the  Pseudotubercle.  Nodules  developing  in 
the  internal  organs,  on  serous  membranes  or  in  subcutaneous 
connective  tissue  and,  on  being  viewed  by  the  unaided  eye, 
bearing  a  perfect  resemblance  to  true  tubercles,  but  having 
a  different  internal  structure,  are  characteristic  of  pseudo- 
tuberculosis. While  degeneration  and  necrosis  of  the  tissue 
elements  does  not  occur  in  true  tubercles  except  at  an  advanced 
stage  of  their  development,  the  tubercles  of  pseudotuberculosis 
undergo  cheesy  degeneration  at  an  early  stage.  Pseudotubercles 
develop  more  rapidly  and  consist  throughout  of  necrotic 
detritus  encased  by  a  narrow  peripheral  layer  of  round  cells. 
Vie\ved  with  the  unaided  eye  even  the  smallest  nodules  appear 
white  or  yellowish  white ;  in  addition  to  this  they  are  of  rather 
soft  consistency,  the  larger  ones  usually  being  creamy  or  mushy. 
Lime  salts  are  occasionally  deposited  in  the  substance  which 
is  encased  by  a  gray,  translucent,  comparatively  thick,  tissue 
capsule. 

Pseudotuberculous  processes  in  the  sense  above  referred  to  manifest  them- 
selves, according  to  location,  in  the  most  variable  morbid  pictures.  The  Preisz- 
Nocard  bacillus  in  particular  produces  affections  in  horses  that  have  long  been 
looked  upon  as  well  characterized  specific  forma  of  disease.  For  practical  reasons 
they  will  be  discussed  under  separate  headings  (See  lymphangioitis  ulcerosa  w. 
below  and  acne  pustulosa  contagiosa  in   \"ol.   II 


Pseiidoliihciciildsis   nl'  Slit'i'j). 


633 


Literature 
—  Preisz 
Ca^netto 
(Lit.). 


.erature.  rifiHor,  (l).  il.  haiilliire  pseuds  tub.  lioi.  Majjctioron,  Leips^ic  1889. 
z,  A.  1'.,  lJ<it4.  Vili.  231.  —  Bongert,  Z.  f.  Hyg.,  1901,  XXXV.  449  (Lit.).  — 
I,  A.   P.,   1905.  XIX,   449    (Lit.).  —  Glasser,  A.   f.  Tk.,   1909.   XXXV.   471 


(a)     Pseudotuberculosis  of  Sheep.     Pseudotuberculosis  ovum. 
{Cheesi/  Broiiclio-piiciinioHia;   Lli/inplidflcuifis  rascosa   onnu.) 

Occurrence,  Tlic  disoaso  oecurs  in  sonic  (locks  in  tlio  foi'in 
of  an  epizootic,  Tims  Tnrsivi  observed  it  in  44  sheep  in  a 
herd  of  150  in  western  Prussia;  von  Zeeb  in  the  abattoir  of 
Langensalza,  in  small  lierds  frequently  every  animal  l)eing 
affected.  The  disease  has  also  l)een  reported  from  the  ])rovinces 
of  Hanover  and  Silesia,  Cherri  &  Bull  observed  the  disease 
in  the  abattoirs  in  Melbourne,  Australia,  in  from  15  to  707o 
of  all  slaughtered  sheep.  According'  to  Norgaard  &  Moliler 
it  is  very  common  in  the  western  United  States  of  North 
America  and  according-  to  Sivori  it  is  very  fre(iuent  in  adnlt 
sheep  in  the  Argentine  Republic  (the  last  named  authorities 
have  furnished  exact  anatomical  and  clinical  descriptions  of 
the  disease). 

Etiology.  The  disease  is  caused  l)y  the  Bacillus  pseudo- 
tuberculosis ovis  (bacillus  of  Preisz  and  Nocard).  This  appears 
as  a  delicate  immotile  rod  (Fig.  97),  which  is  non-sporulating 
and  easily  stained  with  aqueous  aniline  dyes  as  well  as  according 
to  Gram's  method.  In  cultures  the  bacilli  are  somewhat  thicker 
and  longer  and  have  a  tendency  to  develop  oval,  club-shaped 
and  pear-shaped  forms  which  appear  cross-striated  when 
stained. 

Cultivation,  This  facultative  aerobic 
bacillus  thrives  only  at  body  temperature 
( aecordiiii?  to  Carre  &  Bigoteau,  also  at 
room  temperature)  ;  on  agar  it  forms  gray 
or  yellowish-white  colonies  which  resemble 
minute  scales  and  which  are  not  readily 
emulsified ;  iu  the  deep  portions  of  the  me- 
dium they  form  a  white  streak,  rather  thick 
above  and  attenuated  below,  gradually  end- 
ing in  minute  white  points;  in  bouillon 
small  granules  develop  on  the  bottom  of  the 
vessel  while  the  surface  of  the  litjuid  is 
covered  with  a  white,  rigid  meml)rane ;  on 
coagulated  blood  serum  the  areas  surround- 
ing the  colonies  li(iuefy  and  l)ecome  yellow- 
ish in  color ;  no  growth  takes  place  on  po- 
tatoes ;  it  causes  fermentation  of  grape  sugar,  does  not  produce  indol  or 
phenol.     Cultures  remain  alive  and  virulent  for  months. 


Fig.  97.  Hue.  i)scud(jliibcrcii- 
hjsisvfis.  Agar  culture  ;  Gram's 
Stain. 


Pathogenicity.  In  sheep  the  subcutaneous  inoculation  of 
the  pure  culture  may  produce  only  a  local  cheesy  focus  which 
will  break,  discharge  its  contents  and  heal,  or  there  results 
extensive  swelling  of  the  regional  lymph  glands,  whereupon 


634  Pseudotuberculosis. 

excessive  emaciation  gradually  sets  in;  at  post-mortem  examina- 
tion cheesy  foci  are  found  in  the  lungs  and  occasionally  in 
the  liver.  Intravenous  infection  is  followed  by  a  development 
of  numerous  cheesy  foci  in  the  lungs  and  extensive  swelling 
of  the  bronchial  lymph  glands.  According  to  Nocard  and 
(jlasser  it  is  possible  also  to  infect  lambs  and  kids  by  inhala- 
tion or  ingestion  of  pure  cultures.  In  both  instances  the  morlnd 
process  may  become  localized  exclusively  in  the  lungs.  Swine 
succumb  to  the  effects  of  intravenous  infection  in  4  to  10  days, 
to  intraperitoneal  infection  in  8  to  15  days;  post-mortem  ex- 
amination revealing  many  cheesy  foci,  particularly  in  the  lungs 
and  in  the  liver,  wdiile  the  lymph  glands  are  found  to  be  greatly 
enlarged  and  partly  caseated  (Nocard  &  Mohler).  Intra- 
peritoneal infection  may  also  result  in  nodule  formation  on  the 
peritoneum  and  in  the  lungs,  while  subcutaneous  infection  causes 
nodule  formation  and  destruction  of  the  tissue  at  the  point  of 
inoculation  (Noack).  In  guinea  pigs  and  rabbita  subcutaneous 
inoculation  results  in  the  formation  of  cheesy  nodules  at  the 
point  of  inoculation,  while  administration  of  the  virus  into 
the  abdominal  cavity  is  followed  by  the  formation  of  caseo- 
purulent  foci  in  the  lymphatic  glands,  the  spleen,  the  liver  and 
the  mesentery;  occasionally  small  pseudotubercles  wdll  also 
develop  on  the  peritoneum.  In  male  guinea  pigs  w^e  have,  in 
addition,  an  inflammation  of  the  enveloping  membrane  of  the 
testes  with  the  production  of  a  purulent,  fibrinous  exudate, 
but  the  inflammation  is  usually  not  as  extensive  as  that  follow- 
ing infection  with  glanders  (Preisz,  Nocard).  Pigeons  and 
fowls  are  not  readily  infected  experimentally,  and  passage 
through  their  bodies  causes  attenuation  of  the  virus. 

According  to  Carre  &  Bigoteau  the  bacillus  produces  toxins  in 
peptone  bouillon  in  the  course  of  5  or  6  days.  The  filtrate  of  such 
cultures  injected  subcutaneously  into  sheep  in  doses  of  1.0  cc.  produces 
a  diffuse  subcutaneous  edema,  extravasation  of  bloody  serous  fluid  into 
the  body  cavities,  swelling  of  the  spleen  and  intestinal  hemorrhages ; 
following  acute  injections  into  the  milk  ducts  there  was  swelling  of 
the  udder,  serous  exudate  in  the  pleural  cavities  and  bronchial 
hyperemia;  intravenous  administration  is  followed  by  excessive  con- 
gestion of  the  lungs  and  death  within  8  hours.  The  toxin  possesses 
a  similar  action  on  rabbits  and  guinea  pigs,  while  injection  of  large 
(luantities  of  dead  bacilli  produces  abscesses  and  cachectic  symptoms 
in  guinea  pigs.  Goats  are  less  susceptible  and  dogs  and  cats  are 
immune  to  the  action  of  the  toxin,  while  in  horses  and  cattle  it  pro- 
duces only  a  local  inflammatory  edema.  Sheep  that  have  been  im- 
munized against  the  toxin  may  be  infected  with  live  bacilli.  Dassonville 
demonstrated  in  cultures  the  presence  of  a  toxin  resembling  diphtheria 
toxin  (see  also  p.  637). 

Noaek  believed  to  have  dispovered  a  certain  relationship  existing  between  the 
form  of  the  baeillus  and  its  virulence  in  the  sense  that  short  oval  rods  such  as 
occur  in  the  soft  cheesy  nodules  and  in  other  cultures,  exert  a  much  stronger 
pathogenic  action  than  longer  and  more  slender  forms,  which  are  found  in  the 
dry  cheesy  and  calcified  broken  down  foci.  However,  thes-e  vaiious  forms  may 
occur  side  by  side  in  the  same  lesions. 


Pstnulotuberculosis  nf  Sheep.  (^35 

Dimkel,  in  his  comparative  invcstipations,  arrived  at  the  conclusion  that  the 
bacillus  pseuilotubereuiosis  ovis  and  the  liacllius  pyogenes  hovis  et  siiis  are  varieties 
of  the  same  species  because  they  are  reciprocally  aj^ylutinated  by  their  respective 
immune  sera;  l)ecause  mice,  after  treatment  with  one  bacillus  become  immune  to 
tlie  other,  and  further,  because  the  Bacilbis  pyogenes  after  being  passed  through 
the  rabbit  assumes  the  appearance  of  Bacillus  pseudotuberculosis  when  inoculated 
into  sheep.  Ciliisser  also  suspected  a  close  relationship  between  the  two  bacilli 
and  in  addition  is  iiitdined  to  look  upon  the  bacillus  of  jjseudotuborcidosis  of 
sheep  and  that  of  rodents  as  varieties  of  the  same  species.  Finally,  according  to 
Kocard,  Vallee,  Panisset  &  Loiseau  a  certain  relationship  existed  between  the 
pseudotuberculosis  bacillus  and  the  bacillus  of  diphtheria  of  man,  while  Dunkel,  on 
the  other  hand,  doubts  the  identity  of  the  i)seudotuberculosis  bacillus  and  the 
bacillus  of  ulcerous  lymphangitis  of  horses,  basing  his  belief  upon  an  experimental 
inoculation  of  a  horse.  As  a  result  of  these  various  views  the  proper  classification 
of  the  bacteria  referred  to  is  in  such  an  unsatisfactory  state  that  a  thorough 
revision   of  this   question   is   very  <lesirable. 

The  natural  modo  of  infection  is  as  yet  not  definitely 
known.  Probably  it  oeeurs  most  frequently  through  the  in- 
testinal tract,  and  possibly  also  through  the  respiratory  pas- 
sages. The  bacilli  may  also  gain  an  entrance  through  wounds 
of  the  skin  and  through  the  navel  of  newborn  animals.  In 
older  lambs  infection  may  occur  following  amputation  of  the 
tail,  the  germs  entering  the  lymph  channels  of  the  su])cutis. 
The  droppings  of  infected  sheep  seem  to  be  a  prolific  means 
of  disseminating  the  disease,  Carre  having  found  large  masses 
of  pseudotubercle  bacilli  in  the  droppings  of  apparently  healthy 
sheep. 

Anatomical  Changes.  In  the  majority  of  cases  the  morbid 
processes  even  in  animals  that  have  died  w^ith  s^miptoms  of 
cachexia  is  confined  to  the  intrathoracic  and  the  external  hTiiph 
glands,  or  to  the  latter  only,  while  the  mesenteric  glands  are 
only  very  rarely  affected.  The  glands  appear  to  be  considerably 
enlarged  and  contain  circumscribed  foci,  or  they  have  become 
transformed  into  greenish-yellow,  sticky,  smeary,  cheesy  masses 
which  may  consist  of  concentric  layers  resembling  the  structure 
of  an  onion,  and  surrounded  by  a  thick  connective  tissue  wall 
with  smooth  inner  surface.  Subsequently  lime  salts  are  de- 
posited in  this  caseous  mass  giving  it  a  grayish-white  color 
and  a  mortar-like  or  gypsum-like  consistency. 

In  some  cases  small  gray,  or  grayish-green  nodules  or  even 
large  tumors  of  a  structure  similar  to  that  of  the  cheesy  glands 
are  found  scattered  through  the  lungs. 

In  addition  we  may  occasionally  find  diffuse,  lardaceous, 
indurated,  lobar  and  lobular  pulmonary  lesions  with  soft, 
greenish  cheesy  foci.  This  condition  is  usually  attended  with 
an  adhesive  pleuritis  and  normal  appearance  of  the  regional 
hinpli  glands   (Sivori,  Noack). 

Noack  mentions,  as  a  rare  observation,  oval  groups  of 
nodules  the  size  of  a  pea  arranged  in  a  manner  resembling 
coral,  in  the  walls  of  the  large  and  small  intestines.  Finally, 
the  liver,  the  spleen  and  the  kidneys  may  occasionally  contain 
similar:  cheesv  or  caseo-calcareous  nodules. 


(336  Pseudotuberculosis. 

According  to  compilations  made  by  Noaek  including  ISO  cases,  the  lungs 
were  affected  in  98.3%,  the  lyniph  glands  in  general  in  80.6%,  the  muscle  lymph 
glands  in  33.3%   and  the  liver  in    17.2%. 

Symptoms,  If  the  morbid  clianges  are  limited  to  the  in- 
ternal organs  the  disease  is  nsually  not  discovered  until  the 
animals  are  slaughtered.  Such  animals  may,  however,  appear 
perfectly  healthy  or  show  only  indefinite  symptoms  of  gradually 
increasing  anemia  or  cachexia.  In  other  cases,  on  the  contrary, 
the  affection  of  the  lymph  glands  may  be  recognized  during 
life  by  the  presence  in  various  regions  of  the  body  of  painless 
tumors  as  large  as  a  man's  fist.  These  tumors  occur  most 
frequently  in  the  prescapular  and  precrural  regions.  The 
general  health  of  the  animals  is  affected  only  in  so  far  as  the 
enlarged  lymph  glands  may  produce  more  or  less  conspicuous 
disturbance  of  locomotion.  In  some  animals,  however,  cough 
and  marked  dyspnea  develop  in  the  course  of  the  disease,  at- 
tended with  progressive  emaciation  and  anemia,  thus  indicat- 
ing the  existence  of  subacute  or  chronic  broncho-pneumonia. 

The  disease  always  develops  very  gradually  and  fatal  re- 
sults have  as  yet  not  been  observed  in  adult  animals. 

Carre  &  Bigoteau  report  an  enzootic  among  lanihs  a  few  weeks 
oif  age,  which  is  evidently  identical  with  pseudotuberculosis.  In  some 
of  these  animals  post-mortem  findings  were  absolutely  negative,  while 
in  others  multiple  absecssi's  were  found  in  the  connective  tissue  and 
sero-fibrinous  inflammation  in  the  carpal  and  tarsal  articulations.  In 
addition,  the  incompletely  healed  navel  of  some  of  the  animals  con- 
tained pus,  the  urine  always  contained  albumen.  The  contents  of  the 
abscesses  consisted  of  a  creamy,  greenish-yellow  pus  from  which  the 
Preisz-Nocard  bacillus  could  be  obtained  in  pure  culture. 

Bridre  described  a  disease  among  lambs  which  proved  fatal  at 
about  the  age  of  three  weeks.  Post-mortem  examination  revealed  ab- 
scesses, principally  confined  however,  to  the  liver  and  the  lungs.  A 
small  bacillus  similar  to  the  one  mentioned  aliove,  could  be  cultivated 
from  the  abscess  contents.  This  bacillus  would  curdle  milk,  liquefy 
coagulated  blood  serum,  was  non-pathogenic  for  ra])]uts  and  guinea 
pigs  but  caused  local  abscesses  when  injected  subcutaneously  into  sheep, 
and  was  followed  by  death  within  15  to  20  days  when  pure  cultures 
were  injected  into  the  navel  of  newborn  lambs. 

Prevention.  Since  the  active  cause  of  this  disease  seems 
to  be  widely  disseminated  in  the  litter  or  bedding,  or  on  the 
ground  where  infected  herds  have  lived,  infection  per  os  can 
hardly  be  effectively  prevented,  the  disease  can  only  be  checked 
by  careful  aseptic  or  antiseptic  treatment  of  the  navel  after 
birth  and  of  the  wounds  resulting  from  amputation  (docking) 
of  the  tails.  By  this  method  (washing  of  the  navel  with  Lugols' 
solution  and  treatment  with  1%  iodine  collodion)  Carre  reduced 
the  percentage  of  deaths  in  one  herd  from  50  to  0.3%.  Bridre 
also  achieved  good  results  by  this  method. 


r.st_ni(l(iliil)iTcul()sis   nl'    Shci'ii.  (537 

Immunization.  Cjii-iv  i-cixx-ts  very  lavorahlo  results  following  the 
treatment  of  yoiiiij;  laiiihs  in  a  badly  iiifeeled  herd,  as  follows:  Two 
vaceines  were  used,  one  of  wliieli  produced  only  local  edema  in  guinea 
})igs,  the  other  oeeasional  su|)i)urati()ii  oidy.  while  in  sheep  no  morhid 
changes  Avhatever  followed  its  administration  (the  manner  of  prei)ara- 
tion  was  not  indicated).  As  to  results:  In  herds  where  the  losses 
of  ]aiid)s  had  formerly  reached  70',',  the  treatment  of  318  lambs  was 
followed  by  abscess  formation  only  in  5. 

Literature,  l^oisz  &  Gninaid,  J.  Vet.,  ISO].  HO.^.  —  Zeeb,  Z.  f.  Flhyfj  189.3 
Xm.  117.  —  Tuiski,  Z.  f.  FUiyff.,  1S97.  Vlt.  178.  —  CheiiT  &  Bull,  The  Vet.', 
ISOS).  :>-2:\. —  Xorgaaid  &  Mohlor,  Xn.  Iiid.,  1X09.  (i:5S.  —  Sivori,  Rec,  1S99.  ()o7. 
—  Bridre,  Bull.,  19(t5.  .3.18.  —  Carre  &  Bi^roteau,  Rev.  gen.,  Ibi.l.  3f)9.  u.  433 
(Lit.).  —  Xoac-k,  T>iss.,  Bern  1908  (Lit.).  —  Glasser,  A.  f.  Tk.,  1909.  XXV.  471 
(Lit.).   —  Carre,   Rev.   gen.,    1910.   XV.   6.j. 

Mai  rouge.  Carre  &  Bigoteau  made  a  bacteriological  study  of 
a  disease  of  sheep  that  had  been  described  in  1876  hy  Teissier,  and 
since  then  hy  several  French  authors,  especially  Delafoiul,  and 
generally  classed  with  anthrax.  The  di.sease,  known  in  the  infested 
regions  as  pourriture  aigue.  null  de  Sologue,  nud  rouge,  eaux  rousses, 
jaunisse,  etc.,  is  prevalent  in  southern  France  and  causes  losses  that 
nuiy  reach  107c  in  infected  flocks. 

The  symptoms  consist  of  dullness,  paleness  of  the  nnicous  mem- 
branes, muco-serous,  and  later  bloody,  nasal  dischai'ge,  increased  thirst, 
bloody  diarrhea  and  hematuria.  Toward  the  termination  of  the  disease 
there  is  edematous  swelling  of  the  intramuscular  region  and  of  the 
extremities.  The  disease  terminates  fatally  after  2  or  3  or,  sometimes, 
after  from  8  to  15  days.     Occasionally  death  occurs  (luite  suddenly. 

,  At  post-mortem  examination  we  find  hemorrhagic  and  serous  edema 
in  the  sulicutis  and  mesentery,  excessive  hyperemia  of  the  membranes 
of  the  stomach  and  intestines,  marked  acute  swelling  of  the  spleen 
and  lymph  glands,  dark  red,  almost  l)lack  discoloration  of  the  kidnevs, 
hemoglol)in  in  the  urine  of  the  bladder  and  finally  there  are  usually 
large  masses  of  bloody  fluid  in  the  serous  l)ody  cavities.  The  di.sease 
may  be  differentiated  from  anthrax  by  the  paleness  of  the  muscles,  the 
comparative  emptiness  of  the  small  blood  vessels,  the  pale  color  and 
the  coagulated  condition  of  the  blood  and  finally  the  negative  results 
of  experimental  inoculations. 

^Microorganisms  can  he  demonstrated  in  the  body  fluids  by  means 
of  bacteriological  examination,  although  in  somewhat  protracted  cases 
small  abscesses  may  be  found  in  the  pharyngeal  ami  retropliaryngeal 
lymph  glands.  The.se  contain  the  pseudotul)ei-culo.sis  bacillus  of  Prei.sz 
and  Xocard  which  may  be  obtained  from  them  in  pure  culture.  Carre 
&  Bigoteau  are  inclined  to  regard  the  disease  as  an  intoxication  cau.sed 
by  the  toxic  products  of  metabolism  of  the  bacilli  in  (juestion. 

In  animals  of  considerable  power  of  resistance  the  bacillar  toxins 
found  in  the  lymph  glands  are  supposed  to  produce  a  chronic  intoxica- 
tion resulting  in  the  familiar  clinical  condition  known  as  cachexia 
ariuosa,  and  it  is  further  assumed  that  the  weakened  condition,  the 
anemia  and  hydremia  observed  in  any  distomatosis  is  not  caused 
by  distoma  but  rather  by  bacterial  toxins  (?j.  According  to  this 
view  cachexia  aquosa  is  merely  a  chronic  form  of  the  aliove  disease. 

Finally  Carre  is  of  tlie  oi>inion  that  many  eases  of  colic  in  horses,  especially 
that    form    .Icscril  ed    as   cotujtuiion    intcsf inale' hy   French   authors,   which    is    char- 


(538  Pseudotul)erciilosis. 

acterized  by  very  severe  paius,  rapid  course,  extreme  liypereniia  and  hemorrhagic 
serous  infiltration  of  the  intestines  with  acute  swelling  of  the  spleen,  may  be 
ascribed   to   the   toxins   of  the  bacillus  of   pseudotuberculo!-is. 

Literature.      Carre    &   Bigotean,   Eev.    gen.,    1908.    XI   3G9   u.    433    (Lit.).   — 
Carre,  C.  K.,   1910.   CL.  350. 


(b)     Pseudotuberculosis  of  Calves. 

{Pseudotuherculosis  vitulorym.) 

This  disease  was  observed  by  Vallee  on  an  estate  which 
had  for  a  number  of  years  suffered  serious  losses  among  calves. 
They  usually  became  infected  one  or  two  weeks  after  birth, 
showing  s^miptonis  of  great  weakness,  complete  loss  of  appetite; 
death  following  without  exception  in  the  course  of  8  to  10  days. 
Post-mortem  examination  revealed  in  all  cases  numerous  tuber- 
cle-like, gray,  and  partly  confluent  nodules  in  the  liver,  while 
other  organs  as  well  as  the  portal  lymph  glands  were  appar- 
ently healthy. 

Many  other  bacteria  and  a  very  small  immotile  non-sporu- 
lating  bacillus  which  readily  stained  according  to  Gram,  have 
been  cultivated  from  the  liver.  Tiiis  latter  bacillus  does  not 
liquefy  gelatin  and  produces  minute  translucent  colonies  on 
coagulated  blood  serum,  agar  and  potatoes.  Cultures  in  bouillon 
cause  cloudiness  of  the  medium  and  accumulation  of  a  slimy 
sediment  does  not  cause  fermentation  of  sugar  nor  coagulate 
milk.  Intravenous  injection  of  the  pure  culture  is  fatal  to 
guinea  pigs,  rabbits  and  dogs  in  which  cases  small  tubercle- 
like nodules  may  be  found  in  the  liver  and  occasionally  also 
in  the  lungs.  Guinea  pigs  become  affected  after  their  adminis- 
tration per  OS  or  intraperitoneally.  Pigeons  are  affected  only 
after  intravenous  injection  of  cultures. 

The  natural  mode  of  infection  has  as  yet  not  been  satis- 
factorily explained,  probably  it  results  through  the  digestive 
canal  (possibh^  from  infected  milk). 

In  the  livers  of  calves  slaughtered  in  an  apparently  healthy  condi- 
tion in  which  post-mortem  inspection  revealed  swelling  of  the  spleen, 
punctiforin  hemorrhages  of  the  kidneys  and  occasionally  bronchial 
catarrh,  Langer  found  numerous  minute,  grayish-white  nodules  which 
contained  a  facultative  aerobic  Gram  negative  bacillus  of  the  paratyphoid 
group,  and  the  cultures  of  which  were  agglutinated  by  typhoid  serum 
(Bac.  nodulit'aciens  bovis).  Pure  cultures  produced  no  toxins  but  on 
administration  to  experiment  animals  resulted  in  the  formation  of 
nodules  in  the  liver,  in  rare  cases  also  in  the  lungs  and  kidneys.  Pitt. 
who  observed  one  case  in  which  the  navel  and  the  umbilical  cord  were 
considerably  enlarged  and  edematous  the  mesentery  glands  swollen 
;md  of  a  marrow-like  consistency,  recognized  as  the  causative  agent  a 
bacillus  belonging  to  the  group  of  Gartner's  Enteritis  bacilli. 

Literature.  Vallee,  Eec,  1898.  400.  —  Langer,  Diss.,  Gieszen  1904,  —  Litt, 
Cbl.   f.   Bakt.,    1909.   XLTX.   593. 


Paiatiibcmilosis  of  Cattle.  (^f>9 

3.     Specific  Paratuberculosis  of  Cattle. 

{E)itrntiSi   pdidfiilx'rciilosis    Jioris    sprcifica.     Jolnic's    disease 

[Enc/lisJi];  Knf('ri/is  cliroiiicd  horis  pseudotubcrculosa  s. 

specified:   Kitlcritis  chrouiea  Jnfpertrophica  boris.) 

History.  In  iSii.")  .lolnu'  &  Frotliiiighiim  ohscrvcd  a  ]>('('uliar  affec- 
tion of  tlie  intestinal  mucous  uuMnhrane  in  an  ox  wliicli  manifosted 
itself  in  extensive  maculate  swell inj^  and  reddening,  and  a  profuse 
secretion  of  nnieus;  tubercles  and  nleers  were  absent.  On  account  of 
the  presence  of  numerous  masses  of  aeid-fast  tuliercle  bacilli  they  re- 
grarded  this  affection  as  a  special  form  of  intestinal  tuberculosis,  possibly 
broujjht  about  by  infection  with  avian  bacilli.  More  recently  this  dis- 
ease has  also  been  o])served  in  other  countries,  occasionally  in  the  form 
of  an  enzootic,  and  has  been  made  the  object  of  special  investigation 
by  ]\rarkus,  Lienaux  &  van  der  Eeckhout,  Bongert,  Bang  and  von 
]\Ieyer. 

The  name  enteritis  paratuberculosis  bovis  specifioa  is  probably  best  adapted 
for  (lesijrnatin^  tliis  disease,  since  other  names  that  have  been  suggested  also 
apply  to  other  enterites  of  cattle  and  because  the  term  paratuberculosis  is  generally 
understood  to  refer  to  acid -fast  bacteria  which  must  be  differentiated  from  true 
tubercle  bacilli,  thus  clearly  indicating  the  non-identity  of  this  disease  and  tuber- 
culosis  (better  than  pseudotuberculosis). 

Occurrence.  T^p  to  the  present  time  the  disease  has  been 
observed  in  Germany,  Denmark,  Holland,  Belgium,  France, 
Norway,  Sweden,  Hanover  and  North  America.  Tt  occurs 
principally  in  young  cows,  but  also  in  calves  and  lie^fers  as 
well  as  in  older  cattle,  usually  sporadically  but  not  infrecjuently 
as  an  enzootic.  In  Switzerland  80%  of  the  cases  of  chronic 
gastro-intestinal  catarrh  might  be  ascribed  to  this  disease,  while 
losses  occurring  in  Denmark  probably  approach  10%. 

Etiology.  The  disease  undoubtedly  bears  a  certain  rela- 
tionship to  the  presence  of  small  acid-fast  bacilli  which  exist 
in  large  numbers  in  the  intestinal  mucous  membrane,  since, 
how^ever,  it  has  not  yet  l)een  possible,  in  spite  of  numerous 
atteinpts,  to  cultivate  the  bacilli  and  i)roduce  specific  affection 
with  their  pure  cultures,  the  views  expressed  in  regard  to  this 
matter  are  rather  divergent,  while  for  example  Johne  & 
Frotliiiighani,  Boiii-geaud  and  Stuurman  regarded  them  as 
avian  tubercle  bacilli,  Lienaux  &:  van  der  Eeckhout,  and  also 
Bongert  looked  upon  tliem  as  attenuated  mammalian  tubercle 
bacilli.  More  recently  Lienaux  considered  them  as  a  sapro- 
]ihytic  variety  of  bovine  bacillus,  while  Markus,  Bang,  Mac- 
Fadyean,  Meyer  tS:  Miessner  expressed  the  opinion  that  it  is  a 
matter  of  a  specific  disease  caused  b^^  acid-fast  bacteria  of  an 
entirely  different  nature  than  the  true  tubercle  bacilli.  It  was 
impossible  to  produce  a  true  progressive  tuberculosis  in  ex- 
periment animals  (guinea  pigs,  rabbits,  goats  and  fowls)  by 
means  of  material  obtained  from  naturally  infected  animals. 
The  results  of  inoculations  consisted  merely  in  the  development 


G40  Paratubereulosis  of  Cattle. 

of  local  cheesy  foci  or  abscesses,  and  in  most  cases  they  were 
of  a  completely  negative  character.  This  disease  occurs  oc- 
casionally also  m  herds  that  are  entirely  free  from  tuberculosis. 
Many  of  the  animals  do  not  react  to  tuberculin  and  upon  post- 
mortem examination  are  found  absolutely  free  from  any  tuber- 
culous lesions  whatever  (Bang). 

Recently  Stuurman  reported  that  he  has  succeeded  in  producing  pure  cultures 
of  the  organism  from  guinea  pigs  and  rabbits  that  had  been  infected  with  material 
from  naturally  infected  animals.  These  cultures  were  similar  in  many  respects 
to  those  of  the  avian  tubercle  bacillus.  The  results  of  alimentary  administration 
of  i)uie  cultures  were  however  negative. 

The  fact  that  the  disease  is  contagious  was  demonstrated 
by  Bang  when  he  succeeded  in  infecting  six  calves  by  feeding 
the  scrapings  of  the  intestinal  mucous  membranes  of  infected 
cows  in  large  quantities  (300  to  1,500  gm.).  Miessner  also 
succeeded  in  infecting  cattle  in  this  manner  as  well  as  by  in- 
travenous administration.  These  positive  results  point  to  the 
probability  that  natural  infection  results  from  ingestion  of 
contaminated  feces.  However,  the  pathogenicity  of  the  disease 
is  also  demonstrated  by  the  observation  of  its  introduction 
into  herds  previously  free  from  the  same. 

Anatomical  Changes.  At  post-mortem  examination  we  find 
the  following:  The  cadavers  are  frequently  excessively 
emaciated,  the  walls  of  the  small  intestine  considerably 
thickened,  either  uniformly  through  its  entire  extent  or  in  local 
areas  only.  These  changes  may  extend  also  to  the  cecum  and 
colon.  The  surface  of  the  intestines  is  smooth  and  pale.  The 
mucous  membrane  of  the  affected  regions  is  increased  to  from 
4  to  5  times  its  normal  thickness,  being  transformed  into  ir- 
regular folds  running  longitudinally  or  transversely  so  as  to 
resemble  the  convolutions  of  the  brain  (Fig.  98).  These  areas 
are  covered  with  a  dirty  looking,  grayish-white  or  grayish- 
green,  slimy  fluid  resend)ling  meal  soup.  At  the  crest  of  the 
folds  the  mucous  membrane  is  reddened  in  spots  or  dotted 
with  hemorrhages,  and  usually  smooth  on  the  surface;  between 
the  folds  it  has  a  delioisktely  warty  appearance  (no  nodules) 
as  though  gnawed  by  fine  teeth.  The  mesenteric  glands  and 
Peyer's  patches  are  slightly  swollen. 

Meyer  found  specific  changes  in  the  fourth  stomach  in  50%  of  the  eases 
examined.  Of  the  various  regions  of  the  intestines,  the  duodenum  was  macro 
scopically  infected  in  13%,  the  jejunum  in  (58%,  the  ileum  in  82%,  the  cecum  in 
36%,  the  colon  and  I'ectum  in  32''/r,  the  mesenteric  glands  in  60%.  Microscopical 
examination  of  the  hypertrophied  areas  of  the  mucous  membrane  revealed  extensive, 
diffuse,  cellular  infiltration,  the  villi  having  assumed  irregular  and  clumsy  forms. 
The  diseased  cell  masses  frequently  contained  great  numbers  of  large  epitheloid  as 
well  as  giant  cells  and  great  masses  of  small  acid-fast  rods. 

These  rods  are  occasionally  found  also  in  great  numbers  in  the  feces  in 
which  they  are  easily  demonstrated  by  staining  processes  adapted  for  tubercle 
bacilli  (the  bacilli  also  stained  according  to  Gram's  method  and  with  carbo- 
methylene  blue).  When  the  rectal  mucous  memlirane  is  atfected  the  diagnosis  can 
readily  be  made  intra  vitam  by  removing  a  small  ]iortion  of  the  mucous  membrane 
with  the  aid  of  the  fingernail  or  with  a  curette  and  examining  it  microscopically. 


Aiiatoiiiicn'    ( 'liauiies.  Syinpfoiiis. 


641 


Symptoms.  The  symptoms  of  this  disease  consist  in 
gradual  t'liiaciation  unattended  with  fever  or  pain,  occasional 
diarrhea  (when  present  usually  persistent),  the  evacuations 
being  thin  or  watery,  fre(iuently  containing  gas  bubbles.  The 
affected  animals,  though  very  anemic,  do  not  always  show  symp- 
toms of  exhaustion  even  when  emaciation  has  become  excessive. 
On  the  other  hand,  the  api)etite  is  quite  variable,  milk  produc- 
tion diminishes,  and  the  disease  terminates  fatally  after  a  condi- 
tion of  collapse  often  lasting  several  days.  In  rare  cases 
diarrhea  is  absent  but  in  spite  of  this,  the  disease  terminates 
with  sjTnptoms  of  excessive  emaciation  and  ancnua. 


Fig.  98.     Enteritis  chronica  panituberculoaa.     11\  ])ci  i  i(ii)liy 
brane  of  the  Small  Intestines. 


if  tlif  Mucous  Mein- 


The  course  of  the  disease  always  extends  through  several 
months.  Excessive  feeding  of  root  crops,  and  parturition 
exert  an  unfavorable  influence  on  its  course,  while  pasturing 
has  a  beneficial  effect. 


Diagnosis.  In  some  cases  where  the  peculiar  intestinal 
evacuations  arouse  suspicion  of  the  disease,  the  diagnosis  may 
be  made  by  a  microscopical  examination  of  the  intestinal  con- 
tents or  of  portions  of  mucous  membrane  (see  p.  639;  Meyer 
obtained  positive  results  in  60  to  70%  of  such  cases).  The 
tuberculin  test  is  also  of  value  in  this  connection,  although 
tuberculin  prepared  from  avian  tubercle  bacilli  must  be  used. 

Vol.  1-41 


642  Paratnberculosis  of  Cattle. 

0.  Bang  found  (except  in  advanced  cases)  that  tuberculin  of 
this  kind  when  ajjplied  subcutaneously,  would  produce  an  ele- 
vation of  temperature  up  to  41.0°  C,  frequently  attended  w^ith 
great  depression,  diminished  milk  yield,  chills  and  diarrliea. 
While  tuberculous  cattle  always  react  to  this  treatment  the 
condition  may  be  differentiated  by  an  application  of  mammalian 
tuberculin  either  before  or  after  the  use  of  the  avian  material. 
However,  this  disease,  especially  in  its  more  pronounced  form, 
is  hardly  ever  associated  watli  tuberculosis. 

The  suspicion  expressed  by  Bang  that  the  disease  in 
England  is  frequently  confused  with  gastro-intestinal  strongu- 
losis  seems,  according  to  Meyer,  not  to  hold  wdth  respect  to 
so  called  cold  gangrene  (Kaltbrandigkeit)  observed  in  Switzer- 
land and  the  presence  of  filaria  in  the  stomach  and  intestines 
does  not  necessarily  exclude  paratuberculous  enteritis  since 
these  two  diseases,  particularly  in  the  more  serious  affections, 
may  co-exist. 

Prevention.  Since  all  attempts  to  treat  the  disease  medi- 
cinally have  led  to  unsatisfactory  results,  and  since  means  for 
immunization  are  unknown,  the  best  course  to  pursue  with  our 
present  state  of  knowledge  is  the  isolation  and  destruction  of 
affected  animals  as  soon  as  possible  after  recognition  of  the 
disease,  thorough  cleansing  of  the  stables  and  raising  the  off- 
spring on  new  or  uninfected  pastures.  This  is  usually  attended 
by  more  or  less  success. 

Literature.  Johne  &  rrothingham,  D.  Z.  f.  Tm.,  1895.  XXI.  438.  —  Markus. 
Z.  f.  Tm.,  1904.  VIII.  68.  —  Lienaiix  &  Van  der  Eeckhout,  Ann.,  1905.  LIV.  65; 
1906.  LV.  84.  —  Lienaux,  Ibid.,  1905.  LIV.  598.  —  Bourgeaud,  Sehw.  A.,  1905. 
XLIV.  221  —  Bongert,  D.  t.  W.,  1906.  231.  —  Bang,  B.  t.  W.,  1906.  759.  — 
Mac  Fadyean,  J.  of  comp.  Path.,  1907.  XX.  48  —  Meyer,  Arb.  d.  Seruminstituts 
Bern  1908.  —  Stuurmanj  Miessner,  Kongr.  Haag  1909. 


4.    Actinomycosis.    Lump  Jaw,  Big  Jaw. 

Actinomycosis  is  a  non-contagious  infectious  disease  of 
cattle,  occasionally  affecting  other  domestic  animals  and  man, 
which  manifests  itself  either  in  the  appearance  of  connective 
tissue  tumors  or  in  chronic  processes  of  suppuration  and  is 
caused  by  the  Eay  fungus,  Streptothrix  actinomyces. 

History.  The  Ray  fungus  has  been  known  since  the  middle  of  the 
last  century  and  demonstrated  by  a  niimher  of  authors;  in  man,  in 
the  contents  of  chronic  abscesses  (Langenheck,  1845;  Lebert,  1848; 
Laboulbene,  1853;  Robin,  1871),  in  diseased  maxillae  (Davaine,  1850; 
Rivolta,  18G8;  Perroncito,  1875),  and  in  woody  tongue  in  cattle  (Hahn, 
1870).  Its  etiological  significance,  however,  M^as  not  demonstrated 
until  1877  (Bollingers'  work  on  Actinomycosis  of  the  Jaw  of  Cattle). 
After  the  botanist  Harz  demonstrated  the  fungus  nature  of  the  cause 
of  this  disease,  the  latter  assumed  greater  prominence  through  the  works 
of  Israel   (1878)    and  Ponfick   (1880)    who  found  this  fungus  also  in 


Actinoinyoosis.  643 

the  niorhid  products  of  man,  and  Ponfiek  domonstrated  the  etiological 
identity  of  tliis  disease  in  man  and  animals. 

The  literature  of  recent  years  (Johne,  Hanjj:,  Harms,  A/.ary,  Jakob) 
has  adiled  much  infoniuition  concerning?  the  fjfreal  varial)ility  of  the 
clinical  appeai-anee  of  this  disease.  On  tiie  olJK^r  hand,  Wolll',  Israel, 
and  more  particularly  Bostrom,  Lignieres  &  Spitz  havi;  added  mucli 
to  our  knowledge  of  tlie  etiology  of  tiie  disease,  while  Tlioinassen  (1885) 
discovered  an  effective  internal  treatment. 

Occurrence.  A(*tinoiny(M)sis  is  of  froqiioiit  oecnrroiieo  in 
cattU',  paiticularly  in  yoiuii^-  animals,  especially  in  low,  swampy, 
damp  rei>"ions,  or  regions  subject  to  periodical  flooding,  and 
occasionally  appears  as  an  enzootic.  However,  it  is  in  general 
more  frequently  met  with  in  stable-fed  animals  than  among 
those  kept  on  pasture. 

The  disease  in  general  is  more  common  in  regions  where  the  live-stock 
industry  is  conducted  on  an  extensive  scale  (as  in  the  western  states  of  North 
America)  than  in  regions  where  this  industry  is  carried  on  under  opposite  condi- 
tions. In  some  regions  the  disease  appears  almost  annually  among  young  stock  in 
the  form  of  j)eripharyngeal  tumors. 

The  disease  is  very  common  in  Russia,  especially  in  southern  Eussia  where, 
according  to  Tgnatjew  10%  of  all  cattle  are  attacked  by  the  disease,  affecting 
]u-incipally  the  lips.  It  is  common  also  in  certain  regions  of  Denmark,  Englaml, 
Holland  (according  to  Schouten  10%  of  all  cattle)  as  well  as  in  North  America. 
The  disease  is  much  less  frequently  met  with  in  France  and  Germany  but  is 
occasionally  quite  prevalent  in  western  Prussia  (Preusse)  and  in  the  mountainous 
regions  of  Bavaria  (Imminger).  Ollendorf  observed  the  disease  in  7G  annals  in 
a  herd  of  320  cattle  in  western  Prussia,  and  according  to  Franck  it  was  so  com- 
mon in  certain  regions  that  it  was  formally  included  in  the  list  of  diseases  which 
under  the  German  laws  were  considered  sufficient  when  present,  to  annul  a  contract 
of  sale.  Plot  assumes  that  3%  of  all  cattle  in  the  Nile  A'alley  of  Egypt  are 
affecteil  with  this  disease. 

According  to  statistics  compiled  by  Jelenevski  the  morbidity  as 
established  in  the  various  abattoirs  from  1896  to  1911  was  as  follows : 
Berlin  3.1,  Vienna  0.1,  Moscow  33.4,  Kief  6.7,  Warsaw  6.5  per  thousand, 
respectively  (the  mild  form  of  tongue  actinomycosis  is  evidently  not 
included  in  these  statistics). 

In  horses,  swine,  sheep  and  goats  actinomycosis  is  i-arely  observed, 
and  occurs  only  sporadically. 

Etiology.  The  Ray  fungus  (streptothrix  actinomyces 
Rossi  Doria,  actinomyces  bovis  Harz)  according  to  tlic  latest 
views,  is  a  thread-like  schizomycete  belonging  to  the  group 
oi  streptothrix  (Fig.  99).  It  forms  branching  growths,  propa- 
gates by  sporulation  and  under  favoral)le  conditions  produces 
characteristic  colonies  (granules)  consisting  of  numerous  in- 
dividuals (Fig.  100). 

Morphology.  The  size  of  these  colonies  varies  from  0.15  mm.  to 
0.75  mm.  Under  the  micro.scope  colonies  0.01  mm.  in  diameter  may  be 
observed.  On  the  other  hand  many^  small  colonies  may  unite  to  form 
characteristic  large  granules  2.0  mm.  in  diameter.  The  more  recent 
and  usually  the  smallest  colonies  are  translucent  gray,  with  a  greenish 
tinge,  resembling  a  globule  of  gelatin  or  mucus  or  a  granule  of  sago, 
soft  and  smooth  upon  the  surface.     The  older  colonies  are  whitish-gray 


644 


Actinomycosis. 


and  subsequently  assume  different  shades  of  yellow  and  blackish-gray 
(commonest  form),  varying  from  light  yellow  to  yellowish-brown,  and 
in  rare  cases,  a  blackish-gray.  These  granules  or  colonies  have,  as 
a  rule,  an  irregular  or  warty  surface ;  the  older  structures  unite  to 
form  masses  which  are  visible  to  the  unaided  eye  and  bear  some  re- 
semblance to  a  blackberry.  They  are  firm,  not  easily  crushed,  and 
sometimes  hard  as  a  result  of  calcification. 

In  each  granule  these  may  usually  be  recognized  by  a  central  por- 
tion consisting  of  filaments,  rods  and  spores  and  a  peripheral  portion 
composed  of  the  club-shaped  ends  of  the  parasite. 

The  in-dividual  filament  consists  of  a  membrane  enclosing  a  body 
of  protoplasm  and  shows  a  distinct  tendency  to  dichotomous  branching, 
each  branch  in  its  turn  possessing  the  same  habits.  Transverse  parti- 
tions divide  these  filaments  into  short  rods  and  the  latter  seem  to  be 
divided  by  similar  partitions  into  coccus-like  structures,  the  so  called 


Fig.  99.  {^trepiothrix  Actino- 
myces. Agar  culture  in  dilute 
fuchsin  solution. 


Fig.  100.  Actitioinyces  colonies 
and  single  club-sha])ed  individ- 
uals. From  tumor  of  maxilla  ; 
examined  in  caustic  potash  so- 
lution. 


spores  which,  however,  may  also  be  found  in  the  interior  of  the  filament 
(according  to  Domec,  at  the  ends  only),  thus  producing  torula-like 
structures.  (These  spore-like  bodies,  unlike  the  spores  of  bacteria  or 
those  of  some  mold  fungi,  e.  g.,  those  of  the  Oidium  species,  are  readily 
stained  with  aniline  dyes.)  The  so  called  spores,  after  separation  from 
the  filament,  develop  into  rods  which  finally  form  new  branching 
filaments. 

Filaments  thus  developed  intertwine  and  produce  mycelium-like 
colonies,  on  the  periphery  of  which  the  radially-arranged  club-shaped 
ends  project.  In  the  old  colonies  in  particular,  these  club-shaped  ends 
constitute  a  continuous  envelope  surrounding  the  central  mycelium, 
thus  giving  the  colony  the  characteristic  mulberry  appearance.  In 
colonies  obtained  from  infected  tissue  the  envelope  referred  to  is 
usually  broken  and  interrupted  at  some  point,  from  which  a  thick 
strand  of  filaments  projects  from  the  central  mass  and  to  a  certain 
extent  penetrates  the  surrounding  tissue  walls  (radical  filaments).  The 
club-shaped  ends  which  are  not  infrequently  constricted  so  as  to  resemble 
the  fingers  of  a  hand  were  formerly  looked  upon  as  buds  (gonidia) 
(Harz,  Bollinger,  Johne,  Ponfick).  At  present,  however,  the  view  of 
Bostrom  is  probably  looked  upon  as  more  correct.  According  to  this 
view  these  so  called  gonidia  are  the  result  of  a  specific  hyaline  degenera- 


IVInipliuIojiy,   Cull iva( ion.  Qt- 

tion  nnd  swolling  oi  tlio  i-xtornal  luciuhrano  of  tho  filamonts  (These 
eJiih-sliaped  ends  may  be  entirely  absent  when  growth  is  prolifie  ) 
W  lien  the  conditions  for  development  are  unfavorable,  gramdes  of  lime 
sa  ts  are  deposited  in  the  colonies,  sometimes  also  granules  of  iron 
sulphate. 

The   lyi)ic-al    form  of  colony   thus   described  which   consists   of   a 
central    inass   ot    fihiments    with    a    perii)heral    envelope   or   mantle    is 
usually  found  well  d('veloi)ed  only  in  the  actinomvces  of  human  beings 
w.nle  thos."  lound   m  cattle  usually  consist  in  the  main  of  masses  of 
club-shaped,  swollen  filaments. 

A.-eor.linff  to  the  investi<rations  of  Lifjniores  &  Spitz  the  property  of  forniin.r 
.lu-ho  o.nous  lUan.ents  is  characteristic  of  a  n.unl.er  of  species  of  l>acteria  "Sh 
may  W  relerre.l  to  as  actinophytes.  while  the  .liseases  cause.1  hv  their  p^se.ue  are 
known   as  actinophytoses    (See  page   667).     An.ong  the  actinophvtoses  ^we  have    1 

■leii  tn  I   ^    fhr^7"  ,  '^'l,     '"■    '^t'-^l't^thrix    actinoniyces;     2.     the    Streptothrix 
jsiaen   ami   ,?.   the  actniobacilius. 

Staining  The  filaments  and  spores  stain  readilv  bv  Gram's  metiiod 
or  by  tiiat  ot  Gram-AVeigert.  The  club-shaped  ends'mav  ].<.  slain.'.!  with 
carmine,  eosin,  etc. 

Cultivation.     The  Ray  fungus  tiirives  on  the  usual  artificial  media 
m   tlie   pr.'sence   of  oxygen,    but   only   moderately  so   under   anaerobic 
conditions    (cultures   will  not  develop   unless  the  colonies  are  crushed 
and   the.l.'tritus   thus  produced  transferred  to  the  culture   medium) 
On  gelatin  or  agar,  Imt  still  more  beautifully  on  coagulated  blood  serum' 
it  forms  small  points  resembling  dewdrop,  which  graduallv  become  white 
and  project  above  the  surface  like  buds.     Tn  gelatin  tliev  sink  to  the 
hottoin  ot  the  medium  as  a  result  of  li.iuefaction  of  the"  latter      Sub 
se.iuently    the    granules    assume    a    yellowish    or    reddish    (the    latter 
especially  in  blood  serum),  occasionally  also  a  decided  brick  red  color 
are  rather  hard  and,  being  provided  with  radical  filaments  thev  become 
firmly  attached  to  the  bottom  of  the  vessel;  finally  thev  become  con- 
fluent   and    form    large,    dry,    wrinkled    and    prominentlv    projecting 
colonies.     A\  hen  not  too  thickly  sown  on  potatoes  thev  form  ^ravish 
granules    which    finally    develop   into   prominent,   pitted    colonies    with 
crumpled    borders    and    depressed    centers,    usuallv    having    a    suli)hur 
yellow,   reddish-yellow  or  moldy  color    (Fig.   101 )",  while  on  the  other 
hand,   when  the  material   is  thickly  sown,  a   continuous  growth  occurs 
irom  1  to  2  mm.  thick,  delicately  folded  on  the  surface,  vellowi.sh-^rav 
m    the    beginning,    and    later    becoming    reddish-vellow.  *    In    bounion 
whitish  granules  occur  which  form  a  mem})ranous  mass  on  the  surface 
ot  the  fluid,  or  confluent  masses  imbedded  in  a  slimv  substance  at  the 
bottom  of  the  vessel,  while  the  fluid  itself  alwavs  remains  clear      In 
fluid  serum  or  m  pleural  exudate  a  capsule  is  formed  around  the  fila- 
ments (Wright).     The  Ray  fungus  will  grow  also  on  eggs,  in  sterilized 
milk,  in  Avater  and  in  other  media. 

Tenacity.  Cultures  are  quite  resistant  to  the  effects  of  drvinff-  if  kept  at 
ordinary  room  temperature  they  remain  active  for  a  vear  or  more."  The  spores  are 
not  .lestroved  by  boiluifi:  for  14  minutes;  5%  carbolic  aci,l  solutions  are  harmless 
in  their  effect;  corrosive  sublimate  solutions  of  l:nOO  will  kill  them  in  five  minutes 
pi;^«,r!T^;i,  •'  ,^Pf/^'-P"\a'"  active  for  six  years  an,l  withstan.l  continuous 
exposure  to  the  sunlight  for  2.?^  hours  fBerar.l  S:  Xicolas).  According  to  Xocard 
the  arlrlition  of  1%  potassium  ionide  to  the  medium  does  not  retard  the  develop- 
So  the  funcm«.  bnt  aecordme  to  Rajewsky  the  addition  of  U%  of  potassium 
iodide  completely  checks  development. 


646 


Actinomycosis. 


Pathogenicity.  Thus  far  it  has  been  impossible  to  produce 
absohitely  positive  results  in  the  transmission  of  the  disease 
from  man  to  animals.  These  experiments  have  usually  con- 
sisted in  the  subcutaneous  administration  of  colonies  of  the 
parasite  from  man  to  animals.  Submucous 
membrane  inoculations  and  administration 
into  the  abdominal  cavity  or  the  anterior  of 
the  eye  have  also  been  tried.  Jolme,  Ponfick, 
Israel,  Eotter  and  Hanau  believed  to  have 
obtained  positive  results  in  calves  and  guinea 
pigs  in  which  nodules,  ranging  in  size  from 
a  i^ea  to  that  of  a  hazelnut,  developed  on  the 
serous  membranes.  These  lesions,  however, 
were  invariably  of  a  benigii  and  never  of  a 
progressive  character.  (Similar  nodules  are 
ol)served  to  develop  when  other  foreign 
bodies  had  been  introduced  into  the  serous 
cavities.)  Affanassjew,  and  subsequently 
also  Israel  and  AVolif  attempted  experimental 
infection  with  pure  cultures  which,  however, 
were  also  without  convincing  results,  al- 
though Wright  observed  growth  and  club  for- 
mations in  the  filaments  found  in  the  center 
of  the  resulting  local  abscesses. 

Biagi  succeeded  in  detecting  an  endogenes  toxin  in  cul- 
tures, which  produced  marasmus  in  animals  while  Poneet, 
Lacomme  &  Theveuot  failed  to  recognize  the  presence  of 
soluljle  toxins. 

Natural  infection  takes  place  through 
the  mucous  membranes,  usually  that  of  the 
mouth,  through  the  medium  of  gramineae, 
particularly  the  awns  of  the  heads  of  barley 
(Joline).  Bostrom  found  in  the  examina- 
tion of  5  cases  of  human  actinomycosis  por- 
tions of  awns,  only  0.2  mm.  in  length,  im- 
bedded in  the  more  recent  portions  of  the 
tumors,  in  the  center  of  masses  of  leucocytes 
and  granulation  tissue,  which  in  turn  were 
surrounded  on  all  sides  by  mycelium  and 
cliaracteristic  fungus  colonies.  In  one  case 
he  demonstrated  that  the  fungus  had  orig- 
inally existed  in  the  air  spaces  of  the  awns 
where  it  had  proliferated,  penetrated  the 
walls  of  the  air  spaces  and  found  its  way 
into  the  surrounding  tissue  elements. 
_  This  result  of  Bostrom 's  microscopical  examination  ex- 
plains the  manner  of  infection  in  these  and  similar  cases.  Awns 
of  grasses  which  accidentally  come  in  contact  with  the  mucous 
membrane  of  the  upper  digestive  tract  force  themselves  through 


Fig.  101.  Potato  Cul- 
ture of  Streptothrix 
actinomyces  six  weeks 
old. 


Xatiuiil   liil't'ctiuii.  647 

tlio  innoons  mem])raiie  by  means  of  a  pocnliar  boriiiG,-  motion, 
particularly  ])y  way  of  the  excretory  duets  of  the  salivary 
glands  or  through  the  depressions  on  the  surface  of  the  tonsils 
into  the  deeper  tissues  where  they  are  iinnly  held  by  numerous 
fine  barbs,  the  contraction  of  the  neighboring  muscles  serving 
to  draw  them  still  deeper  into  the  tissues.  The  characteristic 
tissue  changes  may  be  ol)served  to  develop  along  the  path  of 
invasion  of  the  awn  by  subsequent  irritation  through  the 
fungus  contained  in  the  latter  (this  explains  the  frequently 
observed  metastases  of  the  actinomyconuita  from  the  base  of 
the  mouth  cavity  to  the  region  under  the  skin  of  the  inter- 
maxillary space.  The  Ray  fungus  exists  as  a  saprophyte  on 
grass  and  especially  the  various  species  of  grains  and  accord- 
ing to  Bostrom  has  a  special  preference  for  the  air  tubes  in 
the  stems  of  these  plants.  Its  pro])agation  is  favored  by  damp 
soil  and  moist  atmospheric  conditions,  while  the  considerable 
resisting  power  of  the  spores  insures  the  perpetuation  of  the 
species  under  unfavorable  climatic  conditions.  Infected  plants, 
especially  barley,  when  fed  dry,  may  produce  injuries  of  the 
mucous  membranes  and  thus  afford  opportunity  for  the  en- 
trance of  the  fungus  into  the  tissues.  The  disease  is  in  fact 
most  frequently  observed  in  winter,  and  in  spring,  correspond- 
ing to  the  seasons  of  dry  feeding.  On  the  other  hand  a  similar 
entrance  may  be  effected  on  pasture,  particularly  in  stubble 
fields,  and  give  rise  to  infection  at  the  lips. 

Breuer  olisorved  aotiiioinvcosis  during  tlie  latter  portion  of  winter  and  early 
part  of  the  spring  months  (period  of  dry  feeding)  in  33%  of  adult  animals,  while 
during  the  summer  months  only  a  frequency  of  16%  is  recorded.  Liebmann 
observed  the  development  of  the  Bay  Fungus  on  wheat  and  barley  straw  that  had 
been  grown  on  infected  soil.  Berestnew  observed  the  development  of  the  fungus 
on  the  straw  and  heads  of  grains  that  had  been  kept  moist  for  some  time,  while 
according  to  Bang  they  have  been  observed  to  thrive  on  grains  and  straw, 
particularly  barley.  According  to  Brazzola  the  fungus  thrives  most  luxuriantly 
on  a  certain  species  of  wild  barley. 

The  enzootic  development  of  the  disease  following  feeding  with 
barley  or  barley  straw  points  to  the  intermediary  role  played  by  the 
awns  of  barley  in  the  dissemination  of  this  disease.  Thus  on  an  estate 
near  the  Danish  seacoast  the  majority  of  a  herd  of  cattle  became  affected 
with  actinomycosis  after  having  been  fed  for  some  time  with  straw 
and  grain  that  had  been  grown  on  a  drained  area  of  the  seacoast.  At 
a  subsequent  date  when  similar  material  was  fed,  the  disease  appeared 
anew  (Jensen).  According  to  Xieolaus  the  disease  occurs  in  regions 
of  Silesia  where  barley  is  grown  extensively,  apparently  ;!S  a  result  of 
the  practice  of  feeding  barley  straw,  especially  chaff,  without  prelimi- 
nary steaming  or  scalding. 

Barley  awns  have  been  found  in  the  diseased  tongues  of  cattle 
as  Avell  as  in  the  tonsils  of  swine  and  in  a  few  instances  ( Johne.  Neuwirth, 
Piana.  Korsak)  it  was  possible  to  demonstrate  the  presence  of  the  "Ray 
fungus  on  the  surface  or  in  the  interior  of  the  awns  as  well  as  in  the 
surroundincr  tissues. 

fonfrary  to  tVio  ofenerany  accepted  view  that  the  Ray  fundus  is 
a  saprophyte  or  facultative  parasite,  "Wright  has  expressed  the  opinion 


648  Actinomycosis. 

that  the  cause  of  actinomycosis  of  man  and  animals  is  an  obligatory 
parasite  which  will  not  grow  at  room  temperature  and  exists  as  a  per- 
manent inhabitant  of  the  digestive  tract  from  which  it  occasionally 
penetrates  the  underlying  tissues.  Foreign  bodies,  according  to  the 
latter 's  view,  play  a  part  in  this  process  only  in  so  far  as  they  assist 
the  parasite  in  gaining  an  entrance  into  the  tissue  substance.  According 
to  Wright  the  saprophytic  fungi  that  are  found  on  grains,  etc.,  should 
be  differentiated  from  the  true  actinomyces  as  belonging  to  the  group 
"Nocardia." 

Infection  is  favored  on  the  other  hand  by  the  soft  and 
swollen  condition  of  the  mucous  membranes  of  the  mouth  and 
gums  or  by  injuries  such  as  occur  during  the  shedding  of 
the  teeth  ('Roger,  Imminger,  Schouten),  or  in  the  course  of 
foot  and  mouth  disease  (Faletti).  On  the  other  hand  infection 
is  favored  by  the  anatomical  structure  of  the  tongue.  The 
remarkable  frequency  of  actinomycosis  of  the  tongue  in  mature 
cattle  bears  a  certain  relationship  to  the  fact  that  the  forma- 
tion of  the  so  called  ''groove"  of  the  tongue  begins  at  that 
time  as  a  result  of  atrophy  of  the  filiform  papillae  on  the  cres- 
cent-shaped surface  of  the  tongue,  causing  the  mucous  mem- 
brane to  become  thinner  and  drawn  into  transverse  folds.  Hard 
particles  of  food  become  lodged  in  this  groove  and  are,  by  the 
muscular  contraction  of  the  tongue,  forced  into  its  interior 
(A.  Breuer).  According  to  Henschel,  Falk  and  Nicolaus  par- 
ticles of  plant  food  are  retained  especially  in  young  animals 
by  the  horn-like  filiform  papillae,  and  are  thus  afforded  a 
favorable  opportunity  for  entering  the  pocket-like  depressions 
which  are  located  just  anteriorly  to  the  dorsal  prominence  of 
the  tongue.  In  the  more  posterior  portions  of  the  digestive 
tract  this  method  of  infection  is  not  as  frequently  observed, 
which  is  explained  by  the  fact  that  food  particles  Avhen  they 
reach  these  regions  have  been  moistened  with  the  saliva  and 
become  softer  in  consistency.  In  spite  of  this  fact  infection 
occasionally  occurs  in  the  esophagus  and  even  in  the  intestinal 
wall,  especially  in  the  region  of  the  cecum  where  the  feces 
are  dryer  and  are  retained  for  a  longer  time. 

Infection  by  means  of  the  inhaled  air  may  be  assumed  in 
such  cases  only  where  the  lungs  are  the  primary  seat  of  the 
disease. 

The  skin  affords  an  effective  protection  and  consequently 
infection  is  possible  only  through  injuries.  Castration  wounds 
in  horses,  more  rarely  in  cattle  and  swine,  constitute  the  most 
frequent  ports  of  entrance  for  the  contagion.  So  called  scirrhus 
cord  is  the  result  at  least  in  a  part  of  the  cases  of  contact 
with  infected  straw  (Johne).  The  development  of  actinomyco- 
mata  in  other  regions  of  the  body  as  a  result  of  superficial  or 
deeper  injuries  of  the  skin  are  much  more  rare  (Gooch  ob- 
served tiiem  in  cattle  treated  with  setons,  Lienaux  after 
rumenotomy).     Finally,  this  parasite  may  gain  entrance  into 


Patlioiienesis.  649 

the  luldcr  tliroii.i;li  the  milk  duets  tliiis  causing-  the  comparative 
frequency  of  alfection  of  this  organ  in  swine. 

Of  the  domestic  animals  cattle  are  most  susceptil)le  to 
infection.  The  disease  occurs  much  less  frequently  in  swine 
and  only  rarely  in  horses,  sheep,  goats  and  dogs  (according 
to  Schouten  it  is  quite  prevalent  among  the  goats  in  the  Nether- 
lands). Breed  or  sex  have  no  influence  on  the  development  of 
the  disease,  although  the  seat  of  the  morbid  process  is  de- 
terniined  by  the  age  of  the  animal.  Thus  in  young  cattle 
actinomycosis  of  the  pharjnigeal  region  is  quite  common  while 
actinomycosis  of  the  tongue  is  usually  observed  in  mature 
cattle  only. 

Pathogenesis.  As  a  result  of  the  inflammatory  reaction, 
nodules  composed  of  small  round  cells  form  around  the  para- 
site. Some  of  the  mycelia  penetrate  the  tissue  cells  which 
become  eiilarged  and  develop  into  epithelioid  cells  which,  in 
their  turn,  by  division  of  their  nuclei,  develop  into  giant  cells. 
The  cells  in  the  interior  of  the  nodule,  which  resendjles  a 
tubercle,  degenerate  and  thus  the  center  of  these  nodules  are 
composed  of  cell  detritus,  nucleated  and  free  fat  globules. 
These  primary  nodules  are  surrounded  by  granulation  tissue 
on  the  periphery  of  which  new  nodules  develop  which  are  again 
enclosed  by  newly  formed  connective  tissue.  In  this  manner 
large  spherical  and  lobulated  tumors  so  called  actinomycomata 
( Johne)  are  developed.  These  may  resemble  in  structure  either 
a  soft  sarcoma  or  have  the  appearance  of  a  dense  fibroma. 
Accordingly  a  section  of  the  tumor  may  appear  homogeneous, 
grayish-white,  marrow-like,  or  fibrinous  and  reddish-gray.  In 
this  ground  substance  there  may  be  found  pale  gray  or  yellow 
foci  of  loose  consistency  in  which  are  imbedded  grayish  or 
sulphur  colored  actinomyces  imbedded  in  a  mucous  or  purulent 
substance  and  having  the  appearance  of  grains  of  sand.  These 
foci  may  become  confluent  and  thus  give  rise  to  fistulous  canals 
filled  with  granulation  tissue  of  a  gelatinous  consistency  and 
penetrating  the  substance  of  the  tumor 

Actinomyces  which  have  gained  access  through  the  mucous 
membrane  of  the  tongue  become  disseminated  by  means  of 
the  lymph  channels  and  give  rise  to  the  development  of  small 
nodules  surrounded  l)y  an  area  interstitial  inflannnation.  These 
nodules  gradually  increase  in  size,  finally  breaking  abruptly 
through  the  mucous  membrane  from  which  they  project  like 
a  mushroom  or  cauliflower.  In  the  so  called  groove  of  the 
tongue,  on  the  other  hand,  simultaneous  infection  with  pyogenic 
bacteria  may  give  rise  to  deep  ulcers. 

AMien  these  tumors  develop  in  the  interior  of  flat  bones 
the  granulation  tissue  causes  destruction  of  the  bone  lamellae. 
At  the  same  time  the  production  of  new  bone  tissue  proceeds 
from  the  periosteum,  while  on  the  other  hand  the  development 


650 


Actinomycosis. 


of  abundant  fibrinous  tissue  may  cause  the  destruction  of  tlie 
actinomyces  and  thus  bring  about  spontaneous  recovery. 

Occasionally  in  loose  connective  tissue  generally,  especially 
in  swine,  but  also  in  man,  there  occurs  emigration  of  lai^ge 
numbers  of  leucocytes  from  the  surrounding  vessels  as  a  result 
of  the  irritation  produced  by  the  parasite.  Following  this, 
large  areas  of  the  tissue  surrounding  the  nodules  undergo 
purulent  softening,  become  confluent  with  other  similar  areas 
and  thus  produce  large  abscesses  or  fistulae  which  are  always 
surrounded  by  a  thick  and  usually  very  firm  connective  tissue 
wall.  Occasionally  the  suppurating  process  is  induced  by 
pyogenic  bacteria  which  are  met  with  most  frequently  in  the 
pus  of  the  larger  abscesses. 

The  mycelium  of  the  parasite  may  penetrate  the  cells  of 
the  blood  vessels  and  be  transported  to  other  regions  of  the 
body,  thus  giving  rise  to  the  development  of  metastatic  tumors 
or  abscesses  such  as  are  observed  quite  frequently  in  spongy 
bones,  but  also  in  the  brain  and  other  organs. 

Anatomical  Changes.  The  seat  and  character  of  the 
anatomical  changes  vary  with  the  species  of  animal. 

In  cattle  the  tongue  is  most  frequently  affected,  the  maxillae 
coming  second;  tumors  of  the  skin  in  the  region  of  the  head 
and  neck  as  well  as  larynx  are  also  quite  common,  while  the 
internal  organs  are  only  rarely  affected. 


Fig.  102.     Actinomycotic  Ulcer  on  the  Dorsum  of  the  Tongue  (food  cavity)  in  an  Ox. 


Actinomycosis  of  the  tongue  frequently  takes  the  form 
of  an  ulcer  situated  immediately  anteriorly  to  the  dorsal  promi- 
nence of  the  tongue  (so  called  ''food  cavity").  In  this  con- 
dition there  are  one  or  more  ovoid  lesions,  or  transverse  bands, 
consisting  of  loss  of  tissue  substance;  the  bases  of  these  lesions 
are  surrounded  by  raised  borders  and  are  covered  by  numerous 
small  depressions  wdtli  ragged  outlines.  Hairs,  or  masses  of 
vegetable  fibers  project  from  the  depths  of  these  depressions, 
sometimes  in  such  quantities  that  they  hide  the  entire  lesion 
from  view  (Fig.  102).     Thus  in  a  section  of  tlie  tongue  there 


Anatomical  Changes.  f^5| 

may  be  seen  wliitisli-gray  spots  penetrating-  to  a  certain  extent 
below  the  surface  of  the  mucous  membrane;  when  suljjeeted 
to  pressure  these  will  discharge  greenish-yellow  masses  of  plant 
food  imbedded  in  a  tough  enveloping  substance.  The  borders 
of  these  spots  are  surrounded  by  yellowish-gray,  (inn  nodules 
which  contain  a  cheesy  or  pus-like  mass  in  which  are  found 
gray  or  brownish  actinomyces  colonies  as  large  as  grains  of 
sand.  In  addition  to  this,  fistulous  canals  may  occasionally 
penetrate  the  substance  of  the  tongue.  These  canals  are  sur- 
rounded by  a  linn  connective  tissue  wall  from  which  hairs  and 
small  nodules  project,  the  latter  being  lilled  with  (lecomi)osing 
food  particles  mixed  with  a  cheesy,  fatty  mass  emitting  a 
highly  disagreeable  odor  (Breuer). 

A.ccording  to  Breuer 's  statistics  this  form  of  actinomycosis  of  the  ton^nie 
occurs  in  over  20  to  25%  of  all  cattle  one  year  of  age,  or  more,  an<l  in  the  great 
majority  of  Hungarian  draft  oxen  slaughtered  in  the  abattoirs  of  Budapest.  On 
the  other  haml  Xicolaus  found  in  Silesia  (Glogau)  SS.o%  of  affected  cattle  to 
be  imder  4  years  of  age  and  only  19.5%  above  5  years.  This  difference  is  possibly 
due  to  the  fact  that  Hungarian  ilraft  oxen  are  usually  not  stable  fed  until  after 
they  are  4  years  of  age. 

In  some  cases  nodules  and  tumors  are  found,  varying 
in  size  from  a  millet  seed  to  that  of  a  hazelnut,  scattered 
throughout  the  mucous  membrane  and  in  the  muscle  substance 
of  the  tongue,  especially  the  lateral  portions  of  this  organ. 
These  tumors  may  be  visible  as  prominences  under  the  mucous 


Fig.  103.     Actiiwini/cosis  of  the  Tongue  with  Pyramidal  Tumors  on  the  Surface. 

membrane  of  the  tongue  or  project  in  the  form  of  a  fungoid 
mass  through  the  opening  in  the  mucous  memltrane,  with 
characteristic,  sharply  defined  borders  resembling  holes  madt^ 
by  a  punch  (Johne;  Fig.  103). 

In  a  more  advanced  stage  of  the  disease  the  interstitial 
connective  tissue  of  the  tongue  is  much  proliferated  and  usually 
contains  numerous  nodes  that  have  undergone  softening  while 
the  consistency  of  the  organ  which  is  much  enlarged  is  very 
firm  and  almost  wood-like,  hence  the  name  ''woody  tongue." 
The  upper  surface  of  the  tongue  may  contain  cicatricial  con- 


652  Actinomycosis. 

tractions  which  occasionally  cause  marked  deformity  of  the 
organ,  especially  an  abnormal  upward  curvature  and  a  contrac  • 
tion  of  the  whole  organ  (Axe). 

In  the  maxillary  bones  the  disease  usually  begins  in  the 
marrow  cavity  or  periosteum.  In  the  lirst  instance  the  spongy 
bone  substance  is  replaced  by  a  soft  sarcoma-like  tissue  re- 
sulting in  breaking  down  of  the  bony  trabeculae  and  distension 
of  the  lamellae.  The  affected  bone  appears  much  enlarged 
with  the  external  lamella  considerably  thickened  as  a  result 
of  osteoplastic  inflammation  (periostitis  ossificans),  eventually 
becoming  perforated.  This  is  followed  by  the  projection  of 
soft  cauliflower-like  proliferations  under  the  skin,  into  the 
mouth  or  into  the  pharynx. 

In  the  interior  of  the  tumor  the  bony  substance  has  been 
reduced  to  an  open  network  composed  of  thin  trabecnlae,  as 
may  be  recognized  upon  section  by  its  white  color  and  hard 
consistency.  The  soft  tissue  proliferation  surround  also  the 
roots  of  the  teeth  and  may  cause  them  to  be  forced  out  of 
their  alveoli.  Thns  teeth  with  healthy  crowns  may  be  found 
to  have  their  roots  imbedded  in  the  soft  substance  of  a  tumor. 

The  granulations  which  project  from  the  gums  consist  of 
hemispherical,  irregular  masses  varying  in  size  from  a  pea 
to  that  of  a  walnut.  Sometimes  they  perforate  the  gums  or 
mucous  membranes  and  project  into  the  mouth  cavity.  Fre- 
quently they  present  an  ulcerous  surface. 

After  maceration  the  affected  maxillary  hone  appears  to  consist  of  a  more 
or  less  perforated  external  bony  lamella  and  an  internal  open  spongy  structure. 
This  condition  recalls  vividly  to  mind  the  deformity  formerly  designated  as  ' '  spina 
ventosa ' '  resulting  from  myelosarcomatous  invasion.  It  is  significant  that 
actinomycomata  usually  develop  near  the  molar  teeth  and  are  only  exceptionally 
met  with  on  the  toothless  portion  of  the  gums  or  in  the  region  of  the  incisors 
(Moussu). 

Tumors  originating  in  the  periosteum  of  the  maxillary 
bone  are  usually  much  firmer  and  tougher  in  consistency  while 
upon  section  they  are  found  to  contain  fewer  and  smaller 
centers  of  softening.  They  occur  on  the  external  or  internal 
face  of  the  maxilla,  occasionally  also  near  the  incisors  and 
are  attached  only  loosely  to  the  skin  or  mucous  membrane, 
but  are  firmly  united  with  the  periosteum.  In  exceptional 
cases  they  may  give  rise  to  the  development  of  so  called 
'^ dermal"  horns  with  bony  bases  (Johne). 

Tumors  of  the  superior  maxillary  bone  are  apt  to  spread 
to  the  subparotideal  region  and  to  the  fossa  pterygo-palatina. 
In  exceptional  cases  they  force  themselves  through  the  natural 
foramina,  perforate  the  flat  basal  bones  of  the  cranium,  and 
enter  the  cranial  cavity,  affecting  the  meninges  and  even  the 
brain  itself.  On  the  other  hand  they  may  extend  from  the 
alveolar  process  to  the  antrum  of  Highmore.  The  disease  may 
also  develop  primarily  in  the  latter  (Bang).  In  such  cases 
after  filling  out  the  antrum  and  breaking  down  the  bony  tissue, 


Anatomical  Changes.  653 

the  tumor  may  perforate  the  skin  of  the  face  in  the  temporal 
region,  or  the  hard  pahite,  and  project  into  the  oral  cavity. 

When  occurring  in  the  pharynx,  actinomycomata  consist 
of  nmsliroom-hke  polypous  tumors,  slightly  pedunculated  and 
occasionally  filling  the  entire  pharyngeal  space.  On  the  other 
hand  they  may  he  ohserved  as  more  or  less  prominent,  irregular, 
or  lohulated  tumors  under  the  skin  on  either  side  of  the  throat. 
In  some  instances  these  retroj)haryngeal  tumors  which  consist 
almost  wholly  of  granulation  tissue  containing  soft,  grayish- 
yellow  foci,  may  also  contain  large  abscesses  which  may  per- 
forate to  the  interior  or  to  the  exterior,  as  the  case  may  be. 

Actinomycosis  of  the  esophagus  is  very  rare.  Siedam- 
grotzky  it  Joline  observed  small  Hat  subepithelial  nodules,  the 
larger  nodules  containing-  a  yellowish  transparent  focus.  The 
confluence  of  the  smaller  nodules  gave  rise  to  larger  irregular 
groups  which  projected  into  the  esophagus.  In  rare  instances 
large  polypi  may  be  observed,  or  roundish  tumors  with  smooth 
surface  may  occur  on  the  esophageal  wall  near  the  larjTix 
(Joest). 

In  exceptional  cases  actinomycosis  has  been  observed  in 
the  omasum  (Bollinger),  in  the  reticulum  (Johne),  in  the 
abomasum  and  small  intestine  (Perroncito,  Jensen,  Axe),  occur- 
ring either  in  the  form  of  tumors  resembling  fibromata  or 
sarcomata,  roundish  in  form  or  lobulated,  and  containing  soft 
foci  in  the  interior,  or  in  the  form  of  morbid  clianges  resembling 
tuberculous  ulcers.  In  nearly  all  cases  adhesions  had  occurred 
in- the  affected  portions  of  the  intestine. 

In  the  affection  of  the  abdominal  organs  we  occasionally 
find  the  peritoneimi  covered  with  numerous  actinomycomata 
of  various  sizes,  the  latter  also  being  frequently  present  between 
the  tough  pseudo-membranes  which  unite  the  affected  organs 
and  loops  of  intestine.  These  tumors  are  frequently  suppurat- 
ing or  ichorous.  The  liver  often  contains  metastases.  ^Miether 
or  not  actinomycosis  of  the  peritoneum  ever  occurs  (as  is 
assumed  by  Jensen)  is  as  yet  an  open  question. 

Actinomycosis  of  the  respiratory  organs  is  of  inuch  less 
freciuent  occurrence.  Kitt  observed  involvement  of  the  nasal 
mucous  membrane  in  the  form  of  grayish-white  nodules  as 
large  as  millet  seeds  and  containing  yellow  centers.  Bragadio 
observed  excessive  proliferation  and  Eoders,  in  one  instance, 
saw  a  tumor  which  developed  near  the  opening  of  the  nostrils 
and  almost  completely  obliterated  them.  Stadie  and  Kutsera 
each  found  in  one  instance  diffuse  infiltration  of  the  mucous 
membrane  of  the  nose  and  its  sinuses,  the  mucous  membrane 
was  firm  in  consistency,  irregular  on  its  surface  and  in  some 
places  5  mm.  tliick.  Its  substance  contained  numerous  grayish- 
yellow  nodules.  These  nodules,  some  of  which  were  as  large 
as  peas,  were  frequently  confluent,  forming  folds  and  ridges 
or  more  extensive  prominences  (Kutsera  referred  to  this  form 
as  actinomycosis  confluens).     Similar  nodules  m'v  also  occur 


654  Actinomycosis. 

on  the  epiglottis  (Joliiie),  while  sessile  pedunculated  tumors 
as  large  as  a  hen's  egg,  of  spongy  or  firmer  consistency,  may 
form  in  the  larynx. 

In  the  lungs  the  disease  is  manifested  by  numerous  gray 
or  yellowish  tubercle-like  nodules  or  tumors  which  are  present 
in  large  numbers  in  the  lung  tissue  and  contain  a  thick,  mayon- 
naise-like pus  in  their  centers.  Now  and  then  an  atelectatic 
or  marbled  area  of  lung  tissue  may  be  riddled  with  foci  con- 
sisting of  pus  or  tissue  detritus.  In  such  cases  the  pleura  is 
thickened,  occasionally  covered  with  pedunculated  tumors,  or 
the  visceral  and  parietal  layers  are  adherent.  In  exceptional 
cases  there  may  be  hydropneumothorax  (Moussu). 

The  lymph  glands  are  rarely  affected  and  as  a  rule  only 
as  a  result  of  disease  of  the  neighboring  organs.  They  then 
form  firm  tumors  containing  white  or  yellowish,  glistening, 
non-caseated  nodules  surrounded  by  a  connective  tissue  capsule 
and  imbedded  in  the  tough  connective  tissue  of  the  substance 
of  the  gland.  The  submaxillary,  pharyngeal,  subparotidial  and 
mediastinal  glands  are  most  frequently  affected. 

In  eoutrast  to  the  not  infrequent  occurrence  of  this  disease  in  the  lynipli 
glands  of  cattle,  actinomycosis  of  these  oi'gans  has  never  been  observed  in  man 
(Ponfick,  Israel,  Bostrom,  etc.).  Schuhewitsch  has  observed  the  disease  in  the 
lymph  glands  and  its  dissemination  through  the  medium  of  the  lymph  vessels  in 
from  15  to  20%  of  all  cases  observed  in  cattle  at  the  abattoir  of  Moscow. 

Actinomycosis  is  occasionally  observed  also  in  the  follow- 
ing organs:  In  the  liver  (Rasmussen  observed  20  cases  in  the 
course  of  one  year  in  the  abattoir  of  Copenhagen;  in  a  case 
described  by  Balas  infection  was  produced  by  a  piece  of  wire 
in  the  reticulum),  in  tlie  spleen,  in  the  kidneys,  in  the  brain, 
in  the  basal  meninges,  in  the  diaphragm,  in  the  testicle 
(Kowalewsky  observed  one  case  in  which  this  organ  was  ex- 
tensively affected),  in  the  uterus,  in  the  vagina,  in  the  bladder, 
in  the  bones  and  in  the  muscles.  In  the  muscles  the  disease 
appears  in  the  form  of  fibroma-  or  sarcoma-like  masses  and 
in  the  form  of  pus  foci  containing  yellow,  sandy  formations 
and  enclosed  by  means  of  a  thick,  tough  connective  tissue 
capsule. 

Actinomycomata  in  the  skin  appear  either  as  primary 
lesions  or  as  a  result  of  the  extension  of  lesions  in  the  under- 
lying tissues.  This  is  particularly  common  in  young  animals 
in  which  they  occur  below  the  ear  and  behind  the  lower  jaw. 
They  are  much  more  rarely  met  with  in  the  subcutaneous  con- 
nective tissue,  for  instance,  near  the  larynx  where  they  appear 
in  the  form  of  firm  nodules,  or  in  other  regions  of  the  body 
where  they  appear  as  whitish,  soft,  but  firm,  foci.  Infection  of 
the  lips  manifests  itself  by  thickening  and  induration  of  this 
organ. 

Primary  actinomycosis  of  the  udder  is  rare,  but  when 
present,  it  appears  in  the  form  of  nodes  varying  in  size  from 
a  bean  to  that  of  a  walnut,  enclosing  soft  purulent  contents  and 


Anatomical   C'lianges.  g55 

imbedtled  in  one  or  more  lobes  of  the  ftland.  In  rare  cases 
tlie  i^'land  is  oidarn'od ;  section  of  the  nddor  sliows  ('H]ar,i»-ement 
of  the  affected  kihides  which  contain  small,  yellow  points  in 
their  centers  so  that  the  cnt  snrface  appears  gTainilatod  and 
suggests  the  picture  of  miliary  tuberculosis  (Jensen). 

Generalized  actinomycosis  is  very  rare.  In  such  cases 
metastases  are  present  cliiefly  in  the  lungs,  in  the  liver,  in 
the  kidneys,  in  the  bra_in,  in  the  subcutaneous  connective  tissue, 
in  the  udder  and,  finally,  also  in  the  internal  as  well  as  external 
lymph  glands. 

Localization  of  the  lesions  of  aotinomyoosis  secnis  to  vary  according  to  its 
geogra])lu('al  oceunence.  Tn  the  compilations  made  by  Mittelflorf  for  Bavaria, 
inchuliiijj'  'MV21  cases,  the  head  and  neck  were  alTeeted  in  75.5%;  the  tongue  in 
23.3%,  the  abdominal  organs  in  0.77%,  the  udder  in  0.05%.  Iinminger  found  the 
head  ami  neck  aft'ected  in  85  to  90%,  the  tongue  iu  only  4  to  8%  of  all  eases 
observed.  In  the  abattoir  of  Budapest  on  the  other  hand,  actinomycosis  of  the 
tongue  is  much  more  fretpient  than  disease  of  the  maxellae  (Breuer).  In  Eussia, 
according  to  Jelenenszki,  disease  of  the  lips  is  conspicuously  frequent,  thus  37.9% 
of  all  cases  observed  in  Moscow,  85.9%  in  Titlis,  81.0%  in  Jelisawetgrad. 
Kowalewsky  also  found  the  head  aflPecteil  in  99%  (14(55  cases)  of  which  number 
57%  were  afTectious  of  the  submaxillary  lymph  glands  0%  of  the  retropharyngeal 
lymph  glands,  8%  of  the  lower  lips.  According  to  Mari  (Moscow)  on  the  other 
hand,  the  skin  is  the  most  frequent  seat  of  the  disease  (271  out  of  541  cases), 
ne.\t  in  order  being  the  parotid  gland,  177  cases,  and  last  the  bones  of  the  head, 
117  cases  (this  author  classifies  tumors  extending  from  the  skin  or  from  the  glands 
to  the  maxillary  bones  according  to  the  original  point  of  infection).  According 
to  Schouten  the  tongue  is  the  most  common  seat  of  the  disease  in  England,  Ger- 
many and  Italy,  the  maxillary  bones  iu  France  and  the  lips  in  Eussia,  the  liver  in 
Denmark,  the  submaxillary  and  sublingual  glands,  the  lungs  and  the  maxillary 
bones  in  Holland.  In  the  abattoir  of  Amsterdam  33  to  65%  of  all  cases  were 
affections   of   the   udder. 

In  horses  actinomycomata  develop  most  frequently  in  the 
inguinal  canal  where  they  may  attain  the  size  of  a  child's  head 
and  may  extend  into  the  abdominal  cavity.  Their  tough  con- 
nective tissue  contains  yellowish  gelatinous  foci  in  which  are 
imbedded  the  actinomyces  colonies  (the  anatomical  structure 
is  much  the  same  as  that  in  botryomycosis  of  the  spermatic 
cord).  Actinomycosis  has  also  been  observed  in  the  superior 
and  inferior  maxillae  and  in  the  sulmiaxillary  hmipli  glands 
(Schmidt),  in  the  cervical  and  bronchial  glands,  in  the  tongue, 
the  lips,  the  udder,  the  bones  and  the  muscles  (Struwe,  in 
generalized  form),  in  the  lung,  liver  and  spleen  (Bruschettini) 
as  well  as  in  the  skin  and  in  the  subcutaneous  connective  tissue. 

In  swine  primary  actinomycosis  of  the  mammary  glands 
is  the  most  frequent  form  of  the  disease  (Rasmussen  observed 
in  Copenhagen  52  cases  in  the  course  of  3  months).  The 
mammary  glands  l)ecome  partially  or  wholly  transformed  into 
a  firm  swelling  approaching  the  size  of  a  man's  head,  and  on 
the  surface  of  which  the  teats  seem  shrunken  and  not  infre- 
quently gangrenous.  The  main  mass  of  the  tumor  in  these 
as  in  other  animals  consists  of  a  very  tough  connective  tissue 
structure,  lardaceous  in  appearance  and  in  it  are  imbedded 
small  or  large  abscesses  filled  with  greenish-yellow  pus  or  foci 
consisting  of  soft,  marrow-like  tissue.     These  foci  frequently 


656  Actinomycosis. 

contain  minute  yellowisli  points  and  small  cavities  whicli  sug- 
gest on  cross  section  the  appearance  of  a  sieve  or  a  sponge. 
Tumors  occurring  in  the  region  of  the  elbow  or  under  the 
abdominal  wall  have  a  similar  structure. 

Actinomycosis  of  the  tonsils  is  also  frequent  (Johne), 
This  may  be  followed  by  abscess  formation  in  the  peri- 
pharyngeal connective  tissue.  The  maxillary  bones,  the  larynx, 
the  lungs  and  occasionally  other  bones  may  also  become  affected 
in  swine.  Metastatic  infection  may  occur  in  various  internal 
organs,  the  pathologico-anatomical  changes  being  similar  to 
those  observed  in  cattle,  with  the  difference,  however,  that 
actinomycosis  of  swine,  like  the  disease  in  human  beings,  fre- 
quently manifests  itself  in  the  form  of  extensive  suppurations 
which  may  extend  to  the  subcutaneous  retropharyngeal  and 
prevertebral  connective  tissue,  causing  a  breaking  down  of  the 
tissue  elements  and  leading  to  the  ultimate  formation  of  ab- 
scesses and  fistulous  canals  under  the  serous  membranes  and 
the  glands.  This  destructive  process  may  extend  from  the 
prevertebral  connective  tissue  to  the  vertebrae  themselves.  As 
a  result  the  periosteum  of  the  latter  is  destroyed.  They  be- 
come rough  and  soft  from  loss  of  tissue,  and  their  spongy 
substance  contains  small  pus  foci.  In  this  manner  the  process 
may  spread  from  the  retropharyngeal  connective  tissue,  fol- 
lowing the  course  of  the  prevertebral  connective  tissue  along 
the  back  or  to  the  mediastinum,  and  after  destruction  of  the 
bodies  of  the  vertebrae  into  the  vertebral  canal  itself. 

In  actinomycosis  of  the  tongue  its  parenchyma  contains 
abscesses  approaching  a  hazelnut  in  size  and  consisting  of 
coagulated  masses  of  pus  containing  actinomyces  colonies,  or 
of  a  conglomeration  of  actinomyces  colonies  6.0  mm.  or  less 
in  length  and  surrounded  by  a  connective  capsule  (Hollandt 
observed  such  lesions  in  11  out  of  170  tongues). 

In  the  generalized  form  of  actinomycosis  there  are  now 
and  then  metastatic  abscesses  in  almost  any  of  the  organs, 
including  the  brain,  the  bones,  the  lymph  glands  and  serous 
membranes.  The  primary  focus  may  have  its  seat  in  the 
mucous  membrane  of  the  digestive  tract  or  in  the  skin  (Knoll, 
Carl,  Zietschmann,  Assmann). 

In  sheep  and  goats  actinomycosis  is  very  rare,  but  when 
present,  it  is  usually  found  in  the  tongue.  In  exceptional  cases 
the  lips,  the  jaws  and  the  lungs  may  also  be  affected.  (Berg 
observed  three  cases  among  400,000  sheep.  Zala-Szent-Groth 
observed  the  disease  in  the  tongue  of  three  sheep  in  a  flock  of 
42.)     The  pathological  changes  are  similar  to  those  in  cattle. 

Fumagalli  observed  the  disease  in  a  dog  in  the  form  of 
a  firm  swelling  of  the  gums  (epulis)  about  the  size  of  a  walnut, 
while  Rossi  found  numerous  nodules  in  the  lungs  of  two  cats 
40  days  old.  The  lungs  of  one  of  these  contained  a  mass  of 
firm  connective  tissue  studded  with  actinomyces  colonies,  some 
of  which  were  calcified. 


Actinonivcosis  of  Cattle. 


657 


Symptoms.  The  i)atliol()gieal  eliaiigos  described  above  may 
be  recoi!:nized  intra  vitam  as  far  as  tliey  are  accessible  bv 
external  examination. 


of    the    lips 

to  be  found 

to  nnderuo 


Actinomycosis   of   Cattle.      In    actinomycosis 
which  is  quite  common  in  some  reiiioiis,  there  are 
round  or  ovoid,  tirm  tumors  that  liavc  a  tendency 
softening    in    the    center.     These 
tumors    occur   in   the    submucous 
connectn^e  tissues  of  one  or  both 
lips  and  vary  in  size  from  a  ])ea 
to  that  of  a  walnut.  In  exceptional 
cases    excessive    proliferation    of 
fibrinous  connective  tissue  is  noted 
in  the  surrounding  region,  as  a  re- 
sult   of   which    the   upp^'r    lip    is 
transfonned  into  a  firm  and  rigid 
mass  sometimes  56  cm.  in  diameter 
(Fig.  104). 

The  lirst  stage  of  actinomyco- 
sis of  the  tongue,  when  it  occurs 
in  the  fonn  of  a  dorsal  ulcer  as 
already  described,  is  usually  unob- 
served. When  the  muscle  sub- 
stance becomes  affected  to  any  ex- 
tent, the  movement  of  this  organ, 
and  consequently  also  mastication, 
are  interfered  with.  The  animals 
lick  their  noses,  saliva  flows  from 
the  mouth  while  closer  inspection 
reveals  the  presence  of  the  above 
descrilied  ulcers  on  the  rigid  and 
painfully  sensitive  tongue.  The 
secretions  of  the  ulcers  contain 
colonies  of  actinomyces.  In  more 
serious  or  advanced  cases  the 
tongue  becomes  swollen  and  as  a  result  is  forced  out  of  the 
mouth,  its  tip  usually  being  ulcerated  and  covered  with  a  foul 
secretion  emitting  a  disagreeable  odor.  The  surface  of  the 
tongue  is  coarsely  bosselated  and  the  organ  itself  is  firm,  almost 
wood-like  in  consistency. 

Actinomycosis  of  the  jaw  bones  (Figs.  105  and  106)  is 
usually  not  observed  until  the  head  of  the  affected  animal  pre- 
sents more  or  less  of  a  deformity.  Myelogenic  actinomvcomata 
produce  only  a  uniform  swelling  of  the  body  of  the  jaw  bone, 
which  in  itself,  however,  may  prevent  mastication.  If  the 
process  extends  from  the  bone  to  the  masseter  muscles  mastica- 
tion may  be  seriously  interfered  with  and  the  condition  mav 
even  result  in  trismus,  which  is,  however,  in  some  cases,  only 

Vol.  1—42 


Fig.  104.  Actinomycosis  of  the 
Upper  Lip.  Cured  by  internal 
application  of  potassium  iodide. 


658 


Actinoniycosis. 


temporary.  The  general  nutrition  of  the  animal  may  be  in- 
terfered with  as  a  result  of  the  soft  pathological  tissues  in 
which  the  teeth  are  now  imbedded.  In  some  cases  tissue  masses 
project  through  the  external  bony  plate  of  the  maxilla  and 
may  there  be  palpated  under  the  s*kin  as  lobulated  ulcers.  In 
other  cases  the  skin  may  be  ulcerated  at  one  or  more  points, 
resulting  in  the  formation  of  a  purulent  secretion  containing 
actinomyces  colonies  and  covering  the  surface  of  the  cauliflower- 
like mass  of  granulation  tissue.  The  submaxillary  lymph  glands 
may  be  enlarged,  firm,  slightly  movable  and  eventually 
ulcerated. 

In  the  skin  or  subcutaneous  connective  tissue  (Figs.  107 
and  108)  there  is  usually  a  firm,  elastic  tumor  posterior  to 
the  angle  of  the  jaw,  below  the  ear,  on  the  cheek  or  at  the  neck. 
This  firmly  unites  with  the  overlying  skin,  which  it  usually 


Fig.  105.     Actiuomycosis  of  the  Upper  Jinv. 

perforates,  and  discharges  a  thick  creamy  pus  or  pus-like  mass 
containing  tissue  detritus  and  coagailated  pus  elements.  In 
other  cases  the  cavity  thus  formed  becomes  filled  with  granula- 
tion tissue  which  may  project  beyond  the  surface  of  the  skin 
in  the  form  of  a  cauliflower-like  tumor,  the  surface  of  which 
is  covered  with  crust.  Upon  removal  of  the  scab  the  surface 
is  bright  red,  the  slightest  contact  causing  bleeding.  Numerous 
minute  yellowish  points  from  which  small  drops  of  pus  may- 
be pressed  out  may  also  be  observed.    In  some  cases  pus  foci 


Ac'tiiKniivc'osis  (»L'  Cattle. 


659 


may  appear  in  a  niiiulx'v  of  ])lac('s  and  discharge  llioir  con- 
tents, while  tlie  surrounding-  skin  and  subcutaneous  connective 
tissue  is  swollen  and  edematous,  thus  producing  conspicuous 
deformity  of  the  aiTected  region  of  the  body  (in  a  case  o])seived 
by  Moussu  the  head  had  the  appearance  of  the  head  of  a 
hippopotamus,  as  a  result  of  diffuse  infiltration  of  the  skin 
and  subcutaneous  connective  tissue  of  the  face  and  the  entire 
maxillary  space).  In  rare  cases  the  process  is  arrested  spon- 
taneously, whereupon  the  tumor  gradually  recedes,  swelling 
subsides,  the  tenseness  of  the  surrounding  tissue  disappears 
and  finally  recovery  takes  place. 

Large  tumors  may  also  occur  on  the  extremities,  Liipke  observed 
an  iiifcetioii  of  the  fool  ])e^inuing  in  the  iiiterdigital  space  and  resulting 
in  a  condition  resembling  elephantiasis.  In  a  similar  case  reported  by 
Gulyas  the  leg  was  enlarged  from  the  middle  of  the  carpus  down  to 
three  times  its  natural  size,  its  surface  being  wrinkled  and  covered  with 
nodules,  the  flexor  surface  of  the  pastern  containing  a  granulating 
ulcer  as  large  as  a  dinner  plate.  The  calloused  subcutaneous  connective 
tissue  and  the  underlying  muscles  contained  numerous  nodules  ranging 
in  size  up  to  that  of  a  hazelnut,  the  lymph  vessels  were  much  enlarged 
and  numerous  nodules  Avci-e  scattered  along  thf^r  course  to  the  sacrum. 
The  popliteal  glands  formed  an  extensive  cauliflower-like  mass. 

Actinomycomata 
developing  in  the 
wall  of  the  pharynx 
or  in  the  neighbor- 
ing areas  will  ex- 
tend into  the  sub- 
parotideal  region, 
and  interfere  with 
deglutition.  As  a 
result  rumination 
is  interrupted,  ani- 
mals take  less  food, 
there  is  m  ore  or 
less  salivation,  but 
in  spite  of  this,  the 
general  nutrition 
may  not  be  serious- 
ly affected  for  sev- 
eral months.  Res- 
piratory difficulties 
are  more  p  r  o- 
nounced,  the  act  of 
respiration  being 
attended  by  loud 
whistling  or  rat- 
tling sounds  which  are  very  audible  when  the  head  is  depressed. 
When  the  head  is  extended  tumors  in  the  subparotideal  region 
may  be  palpated  with  the  fingers  either  from  the  exterior  or  by 
inserting  the  hand  through  the  animal's  mouth.    Animals  may 


Fig.  106.     Actinomycosis  of  the  Lower  Jaw. 


660 


Actinomycosis. 


also  cough  from  time  to  time,  especially  while  feeding,  some- 
times also  in  the  act  of  swallowing,  the  cough  is  strong,  dry 
and  whistling. 

Sometimes  large  numbers  of  calves  in  the  same  herd  will 
be  found  affected  in  the  region  of  the  larynx  as  manifested 
by  the  appearance  of  firm  tumors  as  large  as  a  man's  fist  in 
the  perilaryngeal  connective  tissue.  The  presence  of  these 
tumors  interfere  with  respiration  much  the  same  as  tumors 
within  the  larynx,  the  presence  of  which  may  be  recognized  by 
the  wliistHng,"  rattling  or  stenotic  sounds  produced  during  in- 
spiration. 

Affection  of  the  esophagus  manifests  itself  in  difficult 
deglutition  (dysphagia)  and  other  symptoms  of  esophagus- 
stenosis.  The  cause  of  this  trouble  which  develops  very 
gradually  is  usually  not  disclosed  until  after  the  death  of  the 
animal,  although  it  may  be  suspected  during  life  when  actinomy- 
cotic tumors  are  present  on  other  parts  of  the  body,  especially 
the  neck.  (In  one  case  reported  by  Ujhelyi  an  affection  of  the 
peribronchial  and  mediastinal  lymph  glands  produced  chronic 
meteorism.) 

The  symptoms  of  actinomycosis  of  the  lungs  are  not  very 
characteristic.  In  eases  thus  far  observed  only  symptoms  of 
chronic  pulmonary  disease  have  been  noted,  the  nature  of  which 

was  not  disclosed  until  post-mortem 
examination.  The  bronchial  secre- 
tions in  such  cases  might  possibly 
contain  actinomyces  and  their  dem- 
onstration would  establish  the  diag- 
nosis with  certainty. 

Actinomycosis  of  the  udder  man- 
ifests itself  either  in  a  firm  enlarge- 
ment of  the  whole  organ  or  in  the 
appearance  of  firm,  sharply  circum- 
scribed, somewhat  painful  nodes  as 
large  as  walnuts,  which  may  be 
scattered  throughout  the  gland,  but 
^particularly  through  the  upper  por- 
tions of  one  or  more  quarters.  In 
case  these  nodes  should  discharge 
their  contents  into  the  milk  ducts, 
the  milk  of  the  corresponding  milk 
eistern  will  contain  pus  and  be  of  a 
ropy  consistency;  in  some  cases 
there  is  merely  a  slight  discharge 
of  a  caseo-purulent  mass.  In  some 
instances  we  may  be  able  to  recognize  actinomyces  colonies  in 
the  milk  with  the  unaided  eye,  though  better  with  a  microscope 
(Klepzow).  The  supraraammary  hanph  glands  are  not  enlarged 
as  they  are  in  tuberculous  disease. 

Actinomycosis  of  the  cerebral  meninges  manifests  itself 


Fig.  107 


Actinomycosis   of   the 
skin. 
(According  to  Plosz). 


Actinomycosis  of  Tattle. 


G(31 


by  tlio  appearance  of  symptoms  of  meningitis  consisting  at 
first  in  disturbanee  of  consciousness,  unsteady  gait,  falling 
down,  climbing  into  the  manger  and  finally,  pronounced  coma 
(Assmann). 

Gorig  observed  one  case  in  wliicli  the  testis  was  consider- 
ably enlarged,  very  firm  and  sensitive.  The  skin  of  the  scrotum 
contained  an  ulcer  as  large  as  a  five  cent  piece,  which  dis- 
charged a  caseo-purulent  secretion.  A  similar  case  has  been 
described  by  Petit.  Disease  of  the  scrotum  exchisively  is  men- 
tioned l)y  ITell. — Poes  observed  one  instance  in  whicli  an 
actinomycoma  penetrated  tlie  spinal  canal  in  the  region  of  the 
seventh  cervical  vertebra,  obliterating  tlie  greater  portion  of 
its  lumen  up  to  the  fiftli  vertebra.  This  was  attended  by  symp- 
toms of  general  muscular  weakness,  fear,  difficulty  in  degluti- 
tion, attacks  of  mania  and  finally  spasms  of  the  muscles  of  the 
anterior  (extremities. 


Fig.  108.     Actinomycosisof  the  Intermaxillary  Space  ami  the  Subparotidcal  Region. 

Among  horses  this  disease  is  quite  rare,  but  when  present, 
usually  affects  the  spermatic  cord  (fistula  of  the  spermatic 
cord).  Affection  of  other  organs  produces  symptoms  similar 
to  those  produced  in  the  corresponding  organs  of  cattle. 

Affection  of  the  intermaxillary  lymph  glands  is  of  par- 
ticular interest.  It  may  be  primary  and  bear  some  resemblance 
to  glanders.  However,  an  actinomj^cotic  tumor  is  more  liable 
to  suppurate,  and  the  retropharyngeal  and  the  superior  cervical 
lymph  glands  are  usually  also  affected  in  this  disease  (Schmidt, 


662  Actinomycosis. 

Roettger).  Tumors  on  the  neck  may  attain  an  enormous  size, 
sometimes  interfering  with  the  lateral  movement  of  the  head 
(Bonchet). — Actinomycosis  of  the  superior  maxilla  was  ob- 
served in  a  mule  by  Aubry,  affection  of  the  spinous  process 
of  the  superior  maxilla  by  Rousselot,  while  in  a  case  descri])e(t 
by  Hamburger  the  clinical  picture  of  actinomycosis  of  the  bone 
resembled  that  of  rachitis. 

In  swine  actinomycosis  of  the  mammary  glands  usually 
appears  in  the  form  of  a  nodulated,  painless  swelling  and  in- 
duration of  the  base  of  the  teat.  Sul)sequently  this  process 
spreads  to  the  neighboring  teats  and  glandular  substance,  thus 
producing  the  deformity  of  the  mammae  already  described. 
Affection  of  the  tonsils  usually  does  not  attract  attention.  In 
rare  cases,  however,  they  may  become  much  enlarged  and  then 
are  accessible  to  palpation  in  the  region  of  the  pharynx.  Cold 
abscesses  which  occur  in  the  pharyngeal  region  and  frequently 
attain  the  size  of  a  cliikr^  head  are  nearly  always  of  an 
actinomycotic  nature.  In  actinomycosis  of  the  ear  the  de- 
formed, firm  concha  may  attain  a  weight  of  3  kg.  (Junack). 

Course.  The  course  of  actinomycosis  is  always  chronic 
and  may  extend  over  months  and  even  years.  Especially  when 
it  has  its  seat  in  the  interior  of  bones,  the  disease  develops 
at  first  very  insidiously,  and  in  such  cases  it  is  usually  not 
recognized  until  conspicuous  deformity  of  some  external  organ 
of  the  body  has  developed,  or,  in  case  of  affection  of  the  maxillae, 
disturbance  of  nutrition  or  respiration  become  evident.  In 
spite  of  the  presence  of  the  disease  of  the  maxillae  or  the 
tongue,  affected  animals  may  nevertheless  remain  for  a  long 
time  in  good  condition,  in  fact  the  presence  of  pharyngeal 
tumors  which  may  interfere  with  deglutition  as  well  as  respira- 
tion, may  not  prevent  the  affected  animal  from  taking  on  flesh. 
Finally,  however,  such  conditions  Avill  exert  an  injurious  in- 
fluence, the  affected  animals  may  no  longer  be  a])le  to  feed 
properly,  they  lose  flesh,  become  emaciated  and  finally  die  from 
exhaustion.  In  rare  cases  polypous  tumors  in  the  pharynx 
may  close  the  lumen  of  the  larynx  and  cause  suffocation. 

The  presence  of  tumors  in  the  skin  and  in  the  subcutaneous 
connective  tissue  may  not  interfere  with  the  general  condition 
of  the  affected  animal  for  a  long  time,  it  is  only  when  they  are 
very  extensive  that  they  disturb  the  functions  of  neighboring- 
organs  or  tissues.  On  the  other  hand  tumors  in  the  region 
of  file  larynx  and  especially  when  they  occur  within  this  organ 
may  produce  serious  disturbance  of  the  function  of  respiration 
before  they  become  very  large. 

The  course  of  the  disease  is  unattended  by  fever  as  long 
as  it  remains  of  a  local  nature;  when  suppuration  becomes 
more  profuse  (mixed  infection)  as  well  as  during  the  develop- 
ment of  numerous  metastases  a  rise  of  the  body  temperature 
is  noted. 


Course,   Diasjuosis,  Piotrnosis.  663 

Diagnosis.  In  doubtful  eases  the  diagnosis  of  actinomycosis 
may  be  confirmed  by  the  demonstration  of  actinomyces  in  the 
tissues  or  secretions.  The  funiiiis  colonies  which  are  usually 
yellowish  and  of  the  size  of  a  ])0])])y  seed,  may  be  seen  by  the 
unaided  eye.  Under  the  microscope,  however,  they  are  readily 
recognized  in  unstained  preparation  by  their  g-listening,  clul)- 
shaped  structure  (in  case  of  existing:  calcification  treatment 
with  hydrochloric  acid  is  necessary).  When  stained  according 
to  Gram's  method  the  central  mycelial  mass  may  be  recognizcil, 
and  in  the  same  manner  branching  threads  of  mycelium  may 
be  found  in  the  purulent  secretion.  The  presence  of  the  latter 
is  sufficient  evidence  upon  which  to  base  a  diagnosis. 

In  regard  to  the  differential  diagnosis  of  superficial  tumors, 
sarcomata,  Ipnphomata  and  botryomycomata  are  of  particular 
importance.  In  affection  of  the  tong-ue,  other  inflammatory  con- 
ditions of  this  organ  as  well  as  tuberculosis  should  be  kept  in 
mind.  The  latter  disease  should  also  be  taken  into  considera- 
tion in  the  occurrence  of  subcutaneous  tumors,  altliough  tuber- 
culous lymph  glands  usually  do  not  in  mature  cattle  become 
adherent  to  the  skin,  and  consequently  do  not  break  open  and 
discharge  their  contents.  There  is  also  no  diffuse  infiltration  of 
the  surrounding  tissues  in  the  latter  disease.  As  a  matter  of 
fact,  however,  the  clinical  pictures  of  tuberculosis  and  actino- 
mycosis, especially  in  affection  of  the  udder,  bones  and  the 
lungs  have  much  in  common,  and  a  positive  ditferentiation 
between  the  two  diseases  is  possible  only  by  an  exclusion  of  the 
presence  of  secondary  affection  of  the  regional  lymph  glands 
as  well  as  tbe  exclusion  of  similar  changes  in  more  remote 
organs.  The  positive  results  of  microscopical  examination  of 
secre^'ons  or  tissue  masses  are  of  course  always  final.  In 
regard  to  other  affections  of  the  udder,  the  differentiating  char- 
acteristics are  similar  to  those  referred  to  under  tuberculosis 
of  the  udder  (see  p.  591).  The  enlargement  of  the  regional 
hinpli  glands  and  the  absence  of  yellowish  granules  in  the  secre- 
tion of  the  ulcers  of  the  tongue  are  sufficient  to  differentiate 
between  actinobacillosis  and  actinomycosis. 

Prognosis.  The  prognosis  may  be  considere^^  us  favorable 
in  those  cases  in  which  the  seat  of  the  disease  is  superficial  and 
accessible  to  surgical  treatment.  Actinomycomata  in  the  sub- 
parotideal  or  cervical  regions  may  in  exceptional  cases  termi- 
nate in  spontaneous  recovery  (Bang,  Jensen).  In  such  cases 
the  tumor  becomes  encapsuled  in  tough,  fibrous  tissue,  which 
checks  the  further  progress  of  the  disease  (cicatricial  contrac- 
tions so  frequently  observed  in  the  tongues  of  cattle  are  evi- 
dently, for  the  greater  part  at  least,  the  result  of  actinomycotic 
lesions).  Since  the  introduction  of  the  potassium  iodide  treat- 
ment for  actinomycosis,  the  prognosis  of  the  affection  of  the 
internal  organs  can  be  made  much  more  favorable.  However, 
the  prognosis  of  the  disease  in  bones  is  always  unfavorable. 


664  Actinomycosis. 

Treatment.  The  quickest  and  most  certain  results  are 
obtained  by  the  total  extirpation  of  the  actinomycotic  tumor, 
but  such  treatment  is  to  be  considered  only  when  the  tumor  is 
sharply  circumscribed  and  surrounded  by  healthy  tissue,  thus 
permitting  easy  removal  (pedunculated  actinomycomata  of  the 
pharynx  may  be  removed  through  an  opening  in  the  subparo- 
tideal  region  [Harms,  Mayer]).  Very  large  cutaneous  tumors 
are  treated  most  satisfactorily  by  deep  incisions  followed  by 
thorough  curetting  and  the  application  of  gauze  or  tow  dipped 
in  tincture  of  iodine.  A  very  practical  method  and  one  which 
frequently  proves  successful,  consists  in  inserting  a  trocar  and 
canula  into  the  apex  of  the  tumor,  permitting  the  purulent  con- 
tents to  escape  after  withdrawal  of  the  trocar,  irrigating  the 
abscess  cavity  with  water  and  then  inserting  witli  the  aid  of 
forceps  a  lump  of  arsenious  acid  1  to  2  g.  in  weight.  This  is 
follow^ed  by  necrosis  of  the  tumor  mass,  whereupon  sequestra- 
tion from  the  surrounding  tissues  and  recovery  follows  (Heine, 
Kovanyi).  Actinomycosis  of  the  tongue,  if  not  too  advanced, 
frequently  terminates  in  recovery  after  simple  scarification  and 
application  of  tincture  of  iodine  or  iodovasogen  (lO^j). 

Moiissu  has  succeeded  in  bringing  about  recovery  in  actinomycosis  of  the  jaw 
by  removal  of  the  superficial  tumor,  curetting  the  interosseous  tissue  and  internal 
iodine  treatment. 

In  cases  wliere  these  methods  are  impracticable  or  im- 
possible, parenchymal  injections  of  antiseptic  remedies  fre- 
quently produce  good  results.  Tincture  of  iodine,  Lugol's  solu- 
tion (10  to  15  gm.)  and  iodovasogen  (8  to  12  gm.  of  a  10% 
solution)  are  w^ell  adapted  for  this  purpose.  External  applica- 
tions of  caustics,  e.  g.,  ung.  arsen.  (1  :  8)  or  cantharides  oint- 
ment w^itli  iodide  of  mercury  (8  :  1)  are  also  recommended. 
After  suppuration  has  resulted  in  breaking  down  of  the  tumor 
mass,  the  latter  should  be  incised  and  the  abscess  thoroughly 
irrigated. 

The  internal  iodine  treatment,  recommended  in  1885  by 
Thomassen  on  the  basis  of  results  obtained  from  80  cases 
treated  by  this  method,  is  very  effective  (a  special  commission 
investigated  the  merits  of  this  treatment  in  the  United  States 
and  reported  131  complete  cures  among  185  cases  treated).  The 
treatment  is  recommended  particularly  in  such  cases  when  sur- 
gical treatment  is  for  some  reason  impossible  and  when  the 
affected  animals  are  still  in  good  physical  condition.  Affection 
of  the  tongue  or  larynx,  as  well  as  of  the  skin  and  subcutis,  is 
very  responsive  to  this  treatment,  while  actinomycosis  of  the 
bones  is  much  less  so. 

The  treatment  consists  in  the  internal  administration  of  potassium 
iodide,  young  cattle  receiving  2  to  4  gm.,  adnlt  cattle  5  to  10  gm.  daily 
in  their  drinking  water.  The  treatment  is  continued  from  2  to  4  weeks 
or  until  the  complete  disappearance  of  the  tumor  and  ulcers.  In 
case  symptoms   of  iodism    (nasal   and   conjunctival   catarrh,    cutaneous 


Treatment,   Prevention.  665 

eruption,  loss  of  hair,  omaciation)  appear,  the  daily  dose  must  be  de- 
creased or  the  treatment  must  be  suspended  for  5  or  6  days.  The 
effect  is  increased  by  external  application  of  tijicture  of  iodine  to  the 
tumor,  particularly  to  the  affected  tongue,  or  by  the  injection  of  this 
solution  into  the  tissues  of  the  tongue.  If  the  heart  action  is  affected 
it  is  recommended  that  sodium  iodide  be  administered  iustead  of  the 
I)otassium  iodide.  Prietsch  oliscrved  good  results  from  the  internal 
administration  of  iodovasogen  in  doses  of  10  gm.  of  a  W/,  solution 
administered  at  5-day  intervals,  -while  Blume  and  Dorn  recommended, 
in  addition,  the  injection  of  the  tumor  with  the  same  substance.  On 
the  other  hand  ]\Iitteldorf  obtained  very  favorable  results  even  in 
advanc(Ml  cases  from  the  direct  injection  into  the  tumor  of  iodipin 
(40  to  100  gm.)  and  the  administration  of  similar  doses  p/r  os.  Franz 
riH'onnnends  this  renuMly  for  both  external  treatment  (25  to  50  gm. 
of  a  25*^f  solution  injected  into  the  tumor  or  applied  to  its  surface) 
and  internally  15  gm.  per  day. 

Prevention.  In  regions  where  the  disease  is  enzootic  it  is 
recommended  that  hay  and  straw  from  low,  damp  soil  be 
excluded  from  feeding,  loung  cattle  should  not  be  permitted 
to  graze  on  low  or  damp  pastures.  In  a  number  of  instances 
it  has  been  found  that  green  feed  which  had  been  known  to  be 
dangerous  could  be  fed  with  impunity  after  being  scalded  or 
steamed.  The  dangerous  character  of  certain  pastures  and 
meadows  may,  however,  be  ameliorated  by  pro])er  cultivation 
and  drainage. 

Literature.  Bolliuger,  D.  Z.  f.  Tm.,  1S77.  IIT.  334.  —  Johne.  Ibid.,  1881. 
Y[.   141;    ISSS.  XIII.   140.   —  Ponfiek.  D.  Actiuonivkose  d.  Mensclien,  Berlin.   1882. 

—  Baug.  D.  Z.  f.  Till.,  1884,  X.  233'.  —  Thoniassen,  Echo.  vet.  beige,  1885.  XV. 
409,-  —  Bostroni,  Beitr.  z.  path.  Anat.,  1890.  IX.  1.  —  Easniussen.  D.  Z.  f.  Tm., 
1891.  XVII.  45.3;  1894.  XX.  299.  —  Salmon.  An.  Ind.,  1891  u.  1893.  —  Jensen 
Monh.,  1893.  IV.  166.  —  Imminger,  Monh.,  1899.  XT.  129.  —  Breuer,  Z.  f.  Flhyg., 
1901.  XL  103  —  Assman,  D.  t.  W.,  1904.  63.  —  Mitteldorf,  ibid.,  1904.  402.  — 
Lignieres  &  Spitz,  Bull.,  1905.  64.  —  Hollandt,  A.  f.  Tk.,.  1905.  XXXI.  417    (Lit.). 

—  Wright,  Public,  of  the  Massachusetts  Gen. -Hospital.  1905.  I.  1.  —  Nicolaus, 
Diss.  Bern,  1908   (Lit.).  —  Kowalewsky,  Hyg.  de  viande,  1909.  III.  204. 


Actinomycosis  of  Man.  This  rather  rare  disease  is  caused  by  the 
same  actinomyces  wliich  produce  the  disease  in  cattle.  The  localization 
of  the  morbid  processes  is  also  very  similar  to  that  observed  in  actinomy- 
cosis of  cattle.  The  morbid  changes  which  are  most  fre(|uently  observed 
in  the  gums,  in  the  lungs  and  the  maxillae,  consist  either  of  small,  firm 
tumors  or  more  frequently  of  larger  cold  abscesses  or  fistulous  ducts 
surrounded  by  a  very  tough  lardaceous  connective  tissue.  As  in  the 
case  of  animals,  infection  usually  occurs  through  the  medium  of  plant 
tissues  (awns  of  barley)  either  in  the  gums,  the  dental  alveoli  (especially 
in  the  presence  of  defective  teeth)  or  in  the  mucous  membrane  of  the 
mouth  or  larynx,  the  esophagus  or  intestine.  In  much  rarer  instances 
infection  may  take  place  from  the  skin.  Direct  transmission  of  the 
disease  from  cattle  to  man  has  not  been  established. 

Literature.     Koranyi,  Nothnagels  Spez.  Path.  u.  Ther.,  1897.  V.  Bd.  I.  T 


Actinobacillosis.      Under    this    name    Lignieres    &    Spitz    (1902) 
described  a  disease  of  cattle  which  occasionally  assumed  an  epizootic 


QQQ  Actinobacilloisis. 

character  in  Argentine,  sometimes  oO%  of  all  animals  in  a  herd  becom- 
ing affected  in  the  course  of  a  few  weeks.  As  a  rule,  however,  the 
disease  occurs  more  or  less  sporadically.  It  has  also  been  observed 
in  a  Rambouillet  ram  by  the  same  authors,  while  Nocard  and  Petit 
observed  it  in  France,  Bongert  in  Germany  and  Higgins  in  Canada 
among  cattle. 

The  clinical  symptoms  and  anatomical  changes  are  almost  precisely 
the  same  as  those  of  actinomycosis  bovis.  As  in  the  latter  disease  the 
most  frequent  lesions  consist  of  large,  firm  swellings  gradually  under- 
going softening  in  the  center,  occurring  in  the  skin  and  in  the  sub- 
cutaneous connective  tissue  of  the  pharyngeal  region ;  so  called  w^oody 
tongue  and  polypous  swellings  of  the  pharynx  constitute  the  most 
frequent  lesions.  The  jaw  bones,  the  udder  and  the  lungs  are  much 
more  rarely  affected.  On  the  other  hand,  however,  the  lymph  glands 
and  occasionally  some  of  the  salivary  glands  are  involved.  Simul- 
taneously with  the  development  of  the  local  changes  the  animals  suffer 
in  their  general  nutrition  and  when  tumors  are  present  in  the  pharynx 
or  in  the  pharyngeal  region,  the  disturbance  of  nutrition  and  respira- 
tion may  become  so  great  that  the  affected  animals  finally  succumb 
to  the  effects  of  inanition. 

In  the  purulently  softened  foci  of  the  tumors  are  found  granules 
varying  in  size  up  to  that  of  a  millet  seed,  readily  visible  to  the  unaided 
eye,  but  in  contrast  to  the  colonies  of  actinomyces  they  are  grayish- 
white  in  appearance.  Slightly  yellowish  and  occasionally  also  calcified 
granules  occur  exclusively  in  the  sarcoma-like  tumors  of  the  maxillae. 
Fresh  pus  examined  under  the  microscope  contains  clul)-like  structures 
which  are  branching  at  the  larger  end,  the  pointed  ends  converging  to 
form  radiating  colonies  which,  however,  contain  no  mycelium  centers. 
These  structures  are  easily  stained  with  acid  dyes  or  wdth  picro-carmine- 
glycerin.  On  the  other  hand  they  do  not  take  Gram's  stain  nor  can 
threads  of  mycelium  be  demonstrated  in  the  pus. 

Pus  triturated  in  a  mortar  and  inoculated  in  alkaline  food  media, 
when  kept  at  body  temperature  for  24  hours,  will  produce  small,  glisten- 
ing colonies  of  a  small  bacillus  hardly  exceeding  that  of  fowl  cholera 
in  size,  forming  long  chains  in  bouillon  and  not  staining  after  Gram. 
Cultures  on  agar  resemble  those  of  the  typhoid  bacillus.  This  bacillus 
acidifies  grape  sugar  agar  and  milk,  but  does  not  coagulate  the  latter. 
The  indol-reaction  is  not  pronounced.  Fluid  cultures  contain  toxins 
which,  when  injected  into  cattle,  produce  an  elevation  of  temperature 
of  from  1  to  2.5°  C.  persisting  for  several  hours,  trembling  and  loss 
of  appetite.  The  cultures  are  only  slightly  resistant  to  the  influence 
of  external  agencies.  Simple  drying  or  heating  to  52°  C,  destroys 
them  rapidly.  Grown  at  37°  C.  in  the  thermostat  they  are  gradually 
attenuated. 

Bacilli  injected  under  the  skin  of  cattle  collect  in  small  groups 
in  the  bodies  of  the  leucocytes  from  M^hich  they  subsequently  escape 
and  develop  into  characteristic  actino  colonies.  The  center  of  these 
colonies,  the  "germinative  zone"  consists  of  small  bacilli  which  are 
held  together  by  a  sticky  substance  while  the  outer  zone  consists  of 
club-shaped  projections  which  continue  to  grow  and  undergo  digitate 
branching   ("vegetative  zone"). 

Pathogenicity.  In  guinea  pigs  intraperitoneal  injection  of  bouillon 
cultures  produces  purulent  peritonitis  with  characteristic  colonies  in 
the  exudate,  while  subcutaneous  injection  is  followed  by  the  formation 


Stii'i.tdliiflH.scs.    Fiiicy    (.r    (';i*llc.  C^G7 

of  al)seessos  Avhicli  do  not  contain  those  strueturos.  Tn  liorscs.  assos 
and  cattle  intravenous  injection  is  followed  by  phlebitis  and  thi-ombus 
formation  while  subcutaneous  injection  of  these  aninuds  as  well  as 
of  sheep  is  followed  by  abscess  formation.  Tn  cattle  and  sheep  these 
a])scesses  contain  the  characteristic  colonies  while  in  horses  oidy  a  few 
bacilli  are  ])resent.  Tn  these  animals  as  well  as  in  do^s,  cats  and  swine 
intravenous  injections  are  followed  by  symptoms  of  intoxication,  other- 
wise, however,  cultures  are  only  sligrhtly  pathogenic  for  the  last  named 
species  of  animals.  They  are  non-pathogenic  for  rabbits,  white  rats 
and  mice. 

Although  feeding  experiments  have  not  given  positive  results  it 
seems  that  natural  infection  results  from  tlie  digestive  tract.  The 
l)acteria  are  i)ro])ably  aided  in  their  entrance  into  the  tissues  by  particles 
of  vegetation  to  wliich  they  adhere.  Tn  general,  the  contagiousness 
of  the  disease  is  only  very  slight  and  extensive  outbreaks  occur  only 
under  certain  favoral)le  conditions  as,  for  instance,  after  an  outljreak 
of  foot  ancT  mouth  disease. 

Todine  treatment  has  l)een  found  effective  in  many  eases  of  soft 
tumors.  Preventive  treatment  consists  of  the  destruction  of  badly 
infected  aninuils  and  isolation  of  the  milder  cases.  Recovery  from 
the  disease  does  not  produce  immunity  to  a  second  infection. 

Literature.  Ligniercs  &  Spitz,  Aptiiiobacillose.  Buenos  Aires,  1902;  Bull.. 
1902.  450.  —  Xocard,  Bull.,  1902.  69o.  —  Higgins,  ("anad.  Dept.  Agric.  Biol. 
Labor.  Bull.,  No.   1.  —  Petit,  Bull.,   1905.   268. 


5.     Streptotrichoses. 

{Atypical  Actinompkoses;  Pseudoactlnomy'kosis,  Actino- 

phytosis.) 

The  term  streptotrichoses  is  usually  applied  to  morbid 
processes  produced  by  fungi  that  resemlile  actinomyces,  in  so 
far  as  tliey  consist  of  thread-like  filaments  undergoing"  true 
brandling,  as  well  as  in  their  wavy  growth,  and  their  propaga- 
tion by  means  of  division  as  well  as  spore  formation,  but  wliicli 
differ  from  actinomyces  in  that  they  do  not  form  actiniform 
colonies. 

The  morbid  processes  belonging  to  this  group  are  generally 
characterized  by  chronic  suppuration. 

Literature,     s.  in  Petruschky.  Hb.  f.  p.  :sr.,  1903.  II.  832. 


(a)     Farcy  of  Cattle.    Lymphangioitis  Farciminosa  Bovis. 

{Farcin  du  hoeuf  [Frcuch'\.) 

This  is  a  chronic  infectious  disease  of  cattle  caused  by 
a  species  of  streptothrix  and  characterized  by  purulent  inflam- 
mation of  the  superficial  lymph  glands  and  hiiipli  vessels. 

History.  Lymphangioitis  farciminosa  bovis  was  first  described  by 
Sorillon   ('1829)   and  was  formerly  observed  frequently  in  France.     In 


668  Farcy  of  Cattle. 

more  recent  times,  however,  it  has  become  more  rare,  while  it  has  as 
yet  never  been  observed  in  other  parts  of  Europe.  On  the  other  hand 
it  is  a  common  and  malignant  disease  in  Guadeloupe  and  on  Moritz 
Island.  Its  etiology  was  cleared  up  by  Nocard,  while  Maillet  furnished 
an  accurate  description  of  the  clinical  symptoms.  It  is  evidently  the 
same  disease  that  Holmes  observed  in  oxen  in  Calcutta. 

Etiology.  The  cause  of  the  disease  is  a  streptothrix  (Str. 
farcinica),  the  branching  filaments  of  which  are  readily  stained 
by  Weigert's  method,  but  do  not  stain  according  to  Gram. 
They  thrive  in  artificial  media  in  the  presence  of  air  at  a  tem- 
perature between  30  and  40°  C.  On  agar  or  on  coagulated  blood 
serum,  yellowish  white  finely  granular  colonies  appear  which 
coalesce  and  form  a  membrane;  on  potatoes  the  colonies  are 
dry,  crumpled,  and  pale  yellow  in  color ;  in  bouillon  white  gran- 
ules appear  in  the  depths  of  the  medium,  and  membranes  resem- 
bling congealed  drops  of  fat  form  on  the  surface  of  the  fluid. 

Pathogenicity.  In  guinea  pigs  the  subcutaneous  injection 
of  a  pure  culture  is  followed  by  a  purulent  inflammation  of  the 
Ijanph  vessels  and  glands,  in  the  course  of  ^vhicli  the  purulent 
foci  become  ulcerous.  After  evacuation  of  the  purulent  con- 
tents the  animals  which  have  in  the  meantime  become  much 
emaciated,  gradually  recover.  Intraperitoneal  infection  is  fol- 
lowed by  the  development  of  numerous  tubercle-like  nodules  in 
the  peritoneum,  while  intravenous  infection  causes  similar 
changes  in  the  parenchymatous  organs.  Injection  of  pure 
cultures  into  the  circulation  of  cattle  or  sheep  produces  similar 
results,  while  infection  of  superficial  wounds  of  the  skin  pro- 
duces chronic  lymphangitis. 

Natural  infection  probably  takes  place  by  the  entrance  of 
secretions  containing  streptothrices  into  superficial  wounds  of 
healthy  animals. 

Symptoms.  The  morbid  changes  almost  invariably  de- 
velop on  the  extremities  and  especially  on  the  median  surface, 
where  firm,  painless  strands  and  nodes  are  to  be  noted  along 
the  course  of  the  superficial  veins.  Subsequently  these  nodes 
become  soft  and  fluctuating  and  when  incised  discharge  a  whit- 
ish, odorless  mass  resembling  soft  cheese;  local  healing  fol- 
lows within  5  or  6  days.  In  exceptional  cases  these  abscesses 
may  break  spontaneously,  but  as  a  rule  they  remain  intact, 
becoming  firm  and  hard  and  consisting  of  wdiite  or  grajdsh 
tough  lardaceous  connective  tissue.  The  regional  lymph  glands 
become  enlarged  and  form  firm,  painful  tumors. 

The  disease  progresses  for  12  to  18  months  without  neces- 
sarily disturbing  the  general  condition  of  the  animal  to  any 
serious  extent.  Affected  animals  do  not  even  get  lame  but  are 
exhausted  by  work.  In  the  later  stages,  however,  gradual 
emaciation  is  observed,  which  finally  terminates  in  extreme 
cachexia. 


Symptoms,  Treatment  and  Prevention.  669 

The  disease  may  be  eoiii'iised  with  tuberculosis  of  the  lymph 
glands,  although  a  microscopical  examination  will  readily  dif- 
ferentiate these  affections. 

According  to  Vryburg  a  special  form  of  l)Ovine  farcy  occurs  on 
the  Island  of  iSuiuatra;  this  begins  with  clu'onic  abscess  formation 
of  a  lymph  gland,  whereupon  the  i)rocess  spreads  to  the  neighboring 
lymph  glands  and  also  along  the  course  of  the  lymph  vessels,  producing 
abscesses  which  break,  discharge  a  thick,  creamy,  odorless,  rarely; 
viscous,  pus  and  become  transformed  into  torpid  ulcers.  Tlie  pre- 
scapular  and  inguinal  glands  as  well  as  the  lymphatic  vessels  of  the 
pectoral  and  abdominal  region  are  most  frecjuently  affected.  The 
disease  which  appears  occasionally  as  an  enzootic,  runs  its  course  in 
from  1  to  9  months.     About  90%  of  affected  animals  recover. 

The  pus  found  in  the  abscess  contains  an  immotile  aero-anaerobic. 
Gram  negative  bacillus  which  produces  indol  in  cultures.  It  is  said  that 
animals  may  be  protected  against  natural  infection  by  treatment  with 
attenuated  and  then  by  virulent  cultures  or  by  treatment  with  a  mixture 
of  cultures  and  imnunie  serum. 

Lienaux  described  a  disease  of  cattle  under  the  name  of 
Lymphangioitis  pseudofarcinosa  which  is  supposed  to  be  caused  by  the 
bacilhis  of  pseudotuberculosis   (see  p.  633). 

Treatment  and  Prevention.  Extirpation  of  the  tumors  and 
cauterization  of  the  surrounding  tissue,  if  resorted  to  before  the 
disease  becomes  advanced,  will  occasionally  check  the  local 
process,  but  even  in  these  favorable  instances  recurrences  are 
frequent. 

To  prevent  the  spread  of  the  plagTie  it  is  recommended  that 
all  diseased  animals  be  isolated,  their  morbid  products  de- 
stroyed and  all  contaminated  premises  and  utensils  thor- 
oughly disinfected. 

Literature.  Maillet,  Eec,  1829.  631.  —  Noeard,  A.  P.,  1888.  II,  i;93.  — 
Lienaux,  Ann.  vet.,  1905.  297.  —  Vryburg,  Eec,  1907.  171.  —  Holmes,  Trop.  Vet., 
1908.  III.  289. 

Other  Streptotrichoses  in  Ruminants  and  Horses.  According  to 
Luginger  cattle  are  subject  to  endocardites  as  a  result  of  hematogenic 
infection  with  a  form  of  streptothrix  which  is  said  to  constitute  a  specific 
species  (Str.  valvulas  destruens  bovis).  When  injected  into  the  blood 
stream  it  produces  purulent  pleuritis  as  well  as  pseudotuberculosis 
in  sheep. 

Berestneff  observed  a  delicately  branched  streptothrix  (coceo- 
bacillus  pseudoactinomycosis  polymorphus)  in  a  tumor  from  the  lip 
of  an  ox  which  he  designated  as  pseudoactinomycosis.  Bonvicini  isolated 
a  species  of  aerobic  streptothrix  from  a  similar  cutaneous  affection  from 
a  steer,  which  had  been  transmitted  to  several  cows.  Finally  Zschokke 
isolated  and  cultivated  a  fungus  from  a  goat's  tongue  which  Silber- 
schmidt  described  as  Str.  caprae. 

Zschokke  described  an  affection  under  the  name  of  actinophytosis 
which  manifested  itself  by  the  appearance  of  a  tumor  as  large  as  a 
child's  head  in  the  mucous  membrane  of  the  upper  lip  of  a  horse: 
in  another  instance  there  was  a  similar  tumor  as  large  as  a  man's  fist 


670  ■  Streptotrichosis  of  Dogs. 

oil  the  intermaxillary  bone.  The  small  soft  centers  contained  micro- 
organisms which  were  characterized  by  a  radial  structure  and  by 
giving  rise  to  destructive  changes  in  their  periphery.  Their  exact 
nature  was  not  determined.  Complete  recovery  followed  extirpation  of 
the  tumors. 

An  affection  of  a  horse,  described  by  Ciiille,  which  developed  with  symptoms 
of  a  distemper-lymphangitis  and  numerous  abscesses,  might  possibly  also  belong 
to  this  group.  The  pus  foci  opened  spontaneously,  one  after  the  other,  the  creamy 
pus  contained  in  part  small,  white,  transparent  granules  or  larger  yellowish  masses 
of  Gram  positive  intertwined  mycelia.  Artificial  cultivation  was  possible  only  in 
the  vacuum.  The  cultures  thus  obtained  produced  abscesses  in  horses  as  well  as 
in  guinea  pigs.  The  horse  referred  to  showed  symptoms  of  improvement  for  the 
time,  but  finally  died  with  symptoms  of  cachexia.  A  post-mortem  examination  was 
not  made.  A  similar  species  of  streptothrix  was  observed  by  Deau  in  a  hard  nodule 
at  the  commissure  of  the  mouth  of  a  horse. 

Carougeau  described  an  epizootic  disease  of  mules  and  horses  in ' 
Madagascar  under  the  name  of  sporotrichosis  which  is  characterized 
by  its  chronic  and  unfavorable  course  and  by  the  development  of  tumors 
in  the  most  varied  portions  of  the  body.  These  tumors  are  at  first 
firm,  but  subsequently  they  suppurate ;  they  do  not  involve  the  regional 
lymph  glands.  In  exceptional  cases  nodules  and  chancre-like  ulcers 
develop  on  the  nasal  mucous  membranes.  The  purulent  contents  of 
the  nodules  contain  Gram  positive  mycelia  with  club-shaped  ends, 
vacuoles  in  their  protoplasm  and  also  spore-like  Gram  positive  granules. 
The  parasite  (sporotrichum  equi)  is  easily  grown  on  artificial  media, 
propagating  by  means  of  exospores.  Horses  and  mules  have  been  sue 
cessfully  infected  with  sporulating  cultures.  Internal  treatment  wit>i 
potassium  iodide  has  been  found  very  effective. 

Literature.  Luginger,  Monh.,  1904,  XV.  289.  —  Berestneff,  Aktinomykose 
u.  ihre  Erreger.  Diss.  Moskau,  1897.  —  Silberschmidt,  A.  P.,  1889.  III.  841.  — 
Zsehokke,  Schw.  A.  1903,  XLIV.  303.  —  Cuille,  Eev.  vet.,  190.5.  816.  —  Dean, 
Transact,  of  the  Jenner  Institute,  1899.     11.  17.  —  Carougeau,  J.  vet.,  1909.  8. 


b)     Streptotrichosis  of  Dogs.    Streptothrichosis  canum. 


This  disease,  which  has  been  observed  only  occasionally,  is 
caused  by  a  specific  form  of  streptothrix.  It  is  characterized  by 
purulent  inflammation  of  the  serous  membranes  and  by  sub- 
cutaneous chronic  abscesses. 

History.  In  1888  Rabe  demonstrated  that  the  "granules"  found 
in  some  of  the  pleural  and  peritoneal  exudates  consisted  of  the  inter- 
woven mycelium  of  a  fungus  described  l)y  him  under  the  name  of 
Cladothrix  canis.  Subsequently  this  fungus  was  minutely  investigated 
by  Bahr  (1904). 

Etiology.  The  virus  of  the  disease  (Streptothrix  s.  actino- 
myces  canis)  produces  long,  branching  filaments  (Fig.  109), 
which  stain  by  the  Gram-Weigert  method  and  form  occasional 
club-shaped  terminals  in  the  course  of  their  growth. 


Etiology,  Pathogenicity.  671 

In  some  respects  they  are  similar  to  those  found  by  Wolf  &  Israel 
in  subcutaneous  abscesses  and  fistulae  as  well  as  in  exudates  of  serous 
cavities  in   man. 

Culture.  On  artificial  media  the  fungus  will  grow  only  at  body 
temperature,  at  first  only  anaerobieally,  but  after  repeated  transfers 
to  new  media  it  will  thrive  also  aei-ol)icaIly.  In  the  deei)er  layers  of 
the  agar  medium  white,  mulberry-like  colonies  appear  in  the  course 
of  3  or  4  days,  which  consist  of  long  branched  threads  with  club-shaped 
terminals,  or  of  short  rods  and  spore-like  structures,  easily  stained  after 
Gram  in  bouillon,  granules  as  large  as  pin  heads  develop  in  the  course 
of  4  to  6  days,  the  medium  renuiining  perfectly  clear.  Milk  is  not 
coagulated  alihough  its  reaction  becomes  distinctly  acid. 

Pathogenicity.  The  intraperi- 
toneal administration  of  pure  cultnres 
in  mice  produces  pus  foci  as  larg-e 
as  peas  on  the  peritoneum,  while  sub- 
cutaneous inoculation  of  rabbits  is' 
followed  by  the  development  of  nod- 
nles  approaching  the  size  of  hazel- 
nuts, consisting  of  a  fatty  or  cal- 
careous substance  surrounded  by 
fibrous  tissues.  Similar  treatment  of 
dogs  is  followed  in  the  course  of  a 
few^  davs  bv  the  development  of  firm      rig-  109-   ^treptoihrixcanis. 

nodules  which  subsequently  disappear    Plemae exudate,  Fuchsin  stain. 

or    become   converted   into   cold    ab- 
scesses, the  slimy,  reddish-gray  odorless  pus  of  which  contains 
streptothrix  mycelia.     Guinea  pigs,  calves  and  monkeys  resist 
experimental  infection. 

In  the  brain  of  a  dog  that  had  died  after  several  weeks  of  illness 
Trolldenier  found  numerous  light  grayish-white  foci  ranging  in  size 
to  that  of  a  pea,  some  of  which  contained  purulent  centers.  One  of 
the  bronchial  lymph  glands  Avas  greatly  enlarged  and  contained  a 
slightly  purulent  substance  in  its  interior.  IMycelia  similar  to  those 
described  could  be  demonstrated  in  the  cerebral  nodes  and  in  the  affected 
bronchial  lymph  gland.  These  mycelia  would  grow  on  artificial  media 
at  room  temperature  under  aerobic  conditions.  On  agar  the  colonies 
subsequently  developed  yellow  centers,  while  their  periphery  remained 
white  (actinomyces  bicolor).  These  cultures  were  pathogenic  for  mice, 
guinea  pigs,  rabl)its  and  dogs.  Joehim  described  the  same  fungus  in 
a  culture  obtained  from  a  dog  with  a  phlegmonous  condition  in  the 
cervical  region  and  numerous  nodules  in  the  internal  organs. 

Symptoms  and  Anatomical  Changes.  Tiie  disease  usually 
manifests  itself  by  the  appearance  of  a  peculiar  inflammation 
of  the  pleura  or  peritoneum,  in  the  course  of  which  purulent  or 
reddish-gray,  cloudy  exudate  accumulates  in  the  respective  body 
cavities.  Pronounced  symptoms  of  fever  are  absent.  "White 
granules  of  the  size  of  pin  heads  may  be  recognized  in  this 
exudate  by  the  unaided  eye,  while  the  pleura  is  covered  A\dth 
fibrous  masses;  the  lungs  occasionally  contain  firm,  gray  nod- 


672  Streptotrichosis  of  Dogs. 

ules  as  large  as  peas,  wliicli  may  be  soft  inside.  In  some  cases 
inflammation  of  the  serous  membranes  is  a  sequence  to  external 
local  affection ;  thus,  for  instance,  a  torpid,  phlegmonous  inflam- 
mation or  abscess  of  the  extremities,  in  the  subparotideal  region 
or  neck,  or  a  fistula  in  the  vaginal  wall  or  in  the  subperitoneal 
connective  tissue  of  the  pelvis.  These  abscesses  contain  a 
turbid,  gray  or  reddish-brown,  thick,  muco-purulent  substance, 
which  also  contains  the  granules  referred  to.  The  inflammatory 
process  wliicli  occasionally  develops  as  the  result  of  an  injury, 
e.  g.,  of  the  toes  (Eabe)  or  side  of  the  chest  (Eivolta)  gradually 
progresses,  attended  with  only  slight  pain,  and  without  produc- 
ing conspicuous  disturbance  of  function.  After  the  abscesses 
have  discharged  their  contents  and  healing  has  occurred,  new 
abscesses  will  occasionally  develop  in  other  regions  of  the  body, 
or  the  pus  in  the  old  abscesses  may  burrow  downward  along  the 
course  of  the  loose  connective  tissue.  Inflammation  of  the  lungs 
and  pleura  may  also  develop  very  gradually,  attended  with  only 
a  moderate  elevation  of  temperature,  until  finally  physical  exam- 
ination of  the  greatly  emaciated  animals  reveals  the  accumula- 
tion of  exudate  in  the  pleural  cavity  and  consequent  compres- 
sion of  the  lungs.  Inflammation  of  the  peritoneum  produces  a 
similar  effect,  the  exudate  distending  the  walls  of  the  abdomen 
to  a  greater  or  less  extent.  In  other  cases  the  presence  and 
exact  nature  of  the  exudate  may  be  definitely  determined  by 
aspirating  the  contents. 

At  post-mortem  examination  other  organs  also  (spleen, 
liver,  kidneys,  heart  muscle)  may  be  found  to  contain  firm  or 
softened  nodules.  Now  and  then  pus  accumulations  occur  in 
some  of  the  joints. 

Treatment.  In  some  cases  the  surgical  treatment  of 
primary  nodes  may  bring  about  a  complete  recovery  (Gohn). 
As  a  rule,  however,  new  nodules  will  develop  cubcutaneously  in 
other  regions  of  the  body,  and  the  emaciated  animals  finally  suc- 
cumb to  the  disease  (aspiration  of  the  pleural  or  peritoneal 
exudate  has  in  no  instance  proved  effective). 

Literature.  Eabe,  B,  t.  W.,  1888.  65.  —  Bahr,  Z.  f.  Tm.,  1904,  VIII.  47 
(Lit.).  —  TroUdenier,  ibid.,  1903.  VII.  81.  —  Jochim,  Diss.  Bern,  1909  (Lit.). 


6.    Botryomycosis. 

Botryomycosis  is  a  chronic  infectious  disease  of  horses 
which  may,  in  exceptional  instances,  occur  in  cattle.  It  usually 
results  in  the  formation  of  local  tumors  resembling  fibromata, 
and  occasionally  in  the  formation  of  metastases  in  the  internal 
organs.    It  is  caused  by  the  Botryomyces  equi. 

History.  Bollinger  was  the  first  to  observe  the  cause  of  the  disease 
in  the  nodules  of  a  horse's  tongue  (1869)  ;  subsequently  it  was  observed 


Botryomycosis. 


67n 


by  Rivolta  &  Micollone  (1879),  Johne  (1884)  and  hy  Ji!\ho  (1886) 
in  fistulae  of  the  spermatic  cord  of  horses,  as  well  as  in  tumors  of 
the  withers  and  pectoral  ref?ion.  Since  then  the  frequent  occurrence 
of  this  disease  has  been  confirmed  by  numerous  observations.  In  more 
recent  years  Kitt,  de  Jong,  Galli-Valerio  and  Parascandolo  &  Meis  made 
special  bacteriological  studies  of  this  organism. 

Etiology.  The  l)otrYoinyeos  eqiii,  Bollini?or  (Disoomyces 
eqni,  Kivolta;  Microeoeens  hotryogencs,  Rabe;  Micrococcus 
ascoformans,  Johne;  Botryocoecus,  Poneet  &  Dor)  appears  in 
the  diseased  tissues  in  the  form  of  mullierry-like  or  ij^rape-like 
clusters,  1,0  nnn.  in  diameter.  The  individual  elements  in  these 
clusters  are  surrounded  by  a  homogenous  gelatinous  capsule  of 
sharp  contour,  thus  forming  zoogloea  masses  (Fig.  110  and  111). 

Staining.  These  cocci  stain  readily  in  aqueous  aniline  dyes  as 
well  as  according  to  the  Gram-AVeigert  method.  The  gelatinous  capsule 
does  not  take  the  stain.  The  organisms  are  very  resistant  to  the  action 
of  alkalies  and  acids. 

Culture.  On  gelatin  the  broken  zooghea  give  rise  to  the  develop- 
ment of  colonies,  at  first  silver  gray  but  subsequently  grayish-yellow, 
with  a  metallic  luster,  Avhile  a  Avliite  streak  may  be  ol^served  to  develop 


^^y^^ 

■B^^ 


Fig.  110.  Botryomyces  egui.  Zoog- 
la?a  mass  from  a  soft  focus.  Xot  Stain- 
ed, Mag.  ca.  100  diam.  (accoi'ding  to 
Rabe). 


Fig.  111.  Boctryomyces  equi.  Section 
of  Zoogloea.  Stained  according  to 
Gram,  a  Ground  Substance ;  b  Cocci. 
Mag.  ca.  500  diam . 


along  the  needle  puncture  in  the  depths  of  the  medium,  gradually 
causing  the  gelatin  to  liquefy  along  its  course  when  the  colonies  sink 
to  the  bottom.  On  potatoes  a  pale  yellowish,  hoar-like  coating  is  formed. 
The  cultures  emit  a  peculiar  odor  recalling  that  of  strawberries.  The 
colonies  are  composed  of  micrococci  without,  however,  any  characteristic 
grouping  and  Avithout  hyaline  capsules. 

Pathogenicity.  Mice  are  not  susceptible  in  infection ;  infec- 
tion of  guinea  pigs  with  pure  cultures  produces  fatal  septicemia. 
Inoculation  of  sheep  and  goats  is  followed  by  an  inflammatory 
edema  occasionally  followed  by  necrosis  of  the  surrounding  area 
of  the  skin.     In  horses  inoculation  of  pure  cultures  produces 

Vol.  1—43 


674  Botryomycosis. 

also  an  inflammatory  edema  which  disappears  in  from  3  to  10 
days,  but  is  replaced  in  the  course  of  4  to  6  weeks  by  the  gradual 
development  of  lobulated  boils,  in  the  interior  of  the  soft  foci 
of  which  groups  of  cocci  with  hyaline  capsules  occur,  just  as 
after  natural  infection  (Rabe). 

According  to  Eabe  as  well  as  Poneet  &  Dor,  a  hyaline  capsule  which  envelopes 
the  individual  groups  of  cocci  is  the  product  of  a  reactive  inflammation  of  the 
surrounding  tissues,  while  according  to  Johne  it  is  a  product  of  the  cocci  them- 
selves. 

On  the  other  hand,  Ernst  looks  upon  the  capsules  as  a  degeneration  product 
resulting  from  the  mucoid  degeneration  of  the  cocci  in  the  periphery  of  the  groups 
under  the  influence  of  lytic  or  agglutinating  immune  bodies  which  cause  their 
destruction,  the  growing  central  mass  causing  the  peripheral  cocci  to  be  compressed 
into  a  scaly  or  striated  structure.  The  capsule  thus  formed  is  supposed  to  be  dis- 
tended and  ruptured  here  and  there  as  a  result  of  central  growth,  the  vegetating 
cocci  finding  their  way  through  these  openings  to  the  periphery  and  forming  new, 
smaller  encapsulated  structures.  The  repetition  of  these  processes  at  various  points 
results  in  the  formation  of  the  morula  like  structures. 

Very  frequently  it  is  possible  to  cultivate  organisms  from 
botryomyeomata  that  resemble  staphylococcus  pyogenes  aureus  in  every 
respect  and  for  this  reason  de  Jong  as  well  as  Galli-Valerio  regarded 
the  Botryomyces  as  identical  with,  or  at  least  as  a  variety  of  this 
Staphylococcus.  According  to  de  Jong  these  cocci,  when  retained  in 
primary  abscesses  as  a  result  of  incomplete  discharge  of  their  contents, 
suffer  a  check  in  their  vitality  which  results  in  the  formation  of  capsules 
and  the  characteristic  zoogloea  forms;  the  latter  thus  constitute  a 
permanent  irritant  in  the  tissues.  As  an  argument  against  the  identity 
of  the  forms  above  mentioned,  Parascandolo  cites  experiments  in  which 
blood  serum  obtained  from  rabbits  treated  with  staphylococci  failed 
to  agglutinate  botryomyces,  and  he  further  claims  that  reciprocal 
agglutination  on  the  part  of  these  two  parasites  could  not  be  demon- 
strated. It  has  also  never  been  possible  to  produce  typical  botryomyces 
with  cultures  of  staphylococcus  aureus. 

Kitt  and  Bodin  have  also  succeeded  in  obtaining  the  S.  aureus, 
Hell  the  S.  albus,  Mari  the  S.  aureus  as  well  as  the  S.  citreus  in  cultures 
from  botryomyeomata  and  these  authors  as  well  as  Sabazes  &  Laubie 
and  MacFadyean  are  also  inclined  to  look  upon  the  botryomyces  as 
a  variety  or  latent  form  of  the  cocci  referred  to,  viz.,  S.  aureus,  albus 
and  citreus.  On  the  other  hand  Poneet  &  Dor  as  "U'ell  as  Parascandolo 
regarded  this  organism  as  a  specific  variety  of  bacterium.  Letulle 
assumes  a  unique  position  claiming  that  the  individual  elements  of 
this  organism  are  identical  with  intestinal  amebae  which  have  enveloped 
leucocytic  nuclei. 

Natural  infection  usually  occurs  through  bruises  or  incised 
wounds  of  the  skin  (in  exceptional  instances  following  amputa- 
tion of  the  tail,  docking).  The  virus  is  usually  rubbed  into 
superficial  wounds  and  into  the  excretory  ducts  of  the  cutaneous 
glands  by  a  tight-fitting  harness.  When  the  tumor  thus  resulting 
breaks,  portions  of  the  discharged  viscous  secretions  adhere  to 
the  harness  and  are  thus  transmitted  to  other  animals  on  the 
first  opportunity  (Wester).  In  exceptional  cases  botryomyeo- 
mata may  also  occur  on  portions  of  the  body  that  do  not  come 
in  contact,  with  harness  (for  example,  in  the  udder,  under  the 


Natural  Infection.  (575 

abdomen).  In  such  cases  infection  evidently  occurs  through  the 
medium  of  ])l•('^•iously  existini^  wounds.  Infection  of  the  sper- 
matic cord  doubtlessly  occurs  in  this  manner,  the  contagion  prob- 
ably l)eing  transmitted  from  the  bedding,  and  finding  a  fertile 
soil  for  development  and  propagation  in  the  necrotic  end  of  the 
cord  and  in  tlie  retained  products  of  inflammation  (Chaussee). 
In  the  internal  organs  botryomycotic  changes  develop  as 
a  rule  as  metastases  resulting  from  sujierficial  botryomycomata 
on  some  other  part  of  the  body.  In  rare  cases,  however,  they 
may  constitute  primary  lesions.  Tlius,  in  a  case  described  by 
Bollinger,  the  lungs  and  the  bronchi  only  were  affected,  indicat- 
ing infection  through  the  respiratory  organs.  In  another  case 
(Rabe)  a  pelvic  tumor  communicated  witli  the  bladder  by  means 
of  a  fistulous  canal,  possil)Iy  caused  by  catheterization.  Finally 
the  possibility  that  botryomyces,  like  actinomyces,  may  gain 
entrance  into  the  tissues  from  the  lumen  of  the  intestine  and 
thence  pass  to  other  abdominal  organs,  does  not  seem  excluded. 

Pathogenicity.  The  botryomyces  constitute  a  tissue  irri- 
tant with  a  similar  action  to  that  of  the  actinomyces.  They 
cause  the  emigration  of  round  cells  which  subsequently  become 
transformed  into  epithelioid  and  giant  cells,  although  the  emi- 
gration of  leucocytes  is  more  rapid  in  infection  with  botryo- 
myces, consequently  the  formation  of  pus  is  earlier  evident. 
Connective  tissue  proliferation  also  occurs  in  the  region  sur- 
rounding the  pus  foci  and  leads  to  the  formation  of  firm,  fibroma- 
like tumors.  Finally  this  fungus  may  be  distributed  through  the 
hnnph  spaces,  in  exceptional  cases  also  through  the  blood  ves- 
sels, and  give  rise  to  metastases  in  remote  regions  of  the  body. 

Anatomical  Changes.  Botryomycomata  consist  of  tough, 
firm,  fibrous  connective  tissue,  grayish-white  or  pale  red  on  sec- 
tion and  lardaceous  in  appearance,  containing  yellowish-red  or 
brownish-yellow  gelatinous  foci  which  project  above  the  cut  sur- 
face and  in  which  whitish-gray  granules  are  embedded,  the 
latter  even  visible  to  the  naked  eye.  Very  large  tumors  may  now 
and  then  contain  large  cavities  or  fistulous  canals  filled  with  a 
muco-purulent  mass.  Their  tough  walls  are  lined  with  yellowish- 
red  soft  granulation  tissue. 

These  tumors  are  found,  as  a  rule,  in  the  subcutaneous  con- 
nective tissue  and  in  the  skin,  occasionally  also  in  the  muscles. 
In  addition  they  are  found  quite  frequently  in  the  end  of  the 
spermatic  cord  of  geldings,  in  which  cases  they  spread  through 
the  ing-uinal  canal  to  the  peritoneum  and  may  give  rise  to  sec- 
ondary tumor  formation  in  the  anterior  portions  of  the  abdom- 
inal cavity  (Schimmel). 

In  the  rare  cases  observed  in  the  lungs,  the  latter  organs 
may  contain  one  or  more  tumors  that  may  have  attained  the  size 
of  a  man's  head,  and  occasionally  very  numerous  smaller  tumors 
approaching  the  size  of  a  fist;  these  are  sharply  circumscribed 


676  Botryomycosis. 

but  firmly  adhere  to  the  pulmonary  tissue ;  they  are  firm,  tough, 
tumor-like  nodes,  sections  of  which  contain  the  soft  foci  above 
described,  or  they  may  be  homogenously  fibrous,  white  or  gray- 
ish-white in  color ;  the  milky  fluid  which  may  be  expressed  con- 
tains fine  granules.  The  surrounding  pulmonary  tissue  usually 
shows  inflammatory  changes.  Lesions  on  the  pleura  or  the  peri- 
cardium resemble  tuberculosis  of  the  serous  membranes,  with 
the  exception  that  the  nodules  are  softer  in  their  interior  and 
'* sandy"  (Piper). 

Similar  tumors  occur  now  and  then  in  other  internal  organs, 
usually  in  conjunction  with  involvement  of  the  spermatic  cord; 
thus  in  the  kidneys,  the  suprarenal  glands,  the  liver,  the  spleen, 
the  uterus,  the  maxillary  sinuses,  the  udder,  as  Avell  as  certain 
bones  (maxillae  and  ribs),  the  spongy  tissue  of  which  is  de- 
stroyed by  the  tumor  mass  and  the  external  lamella  here  and 
there  perforated.  The  regional  lymph  glands  may  be  affected, 
but  as  a  rule  they  remain  entirely  free. 

In  exceptional  cases  the  morbid  process  is  simultaneously 
observed  in  a  number  of  organs  in  a  generalized  form  (Rieck, 
Frohner,  Kofler,  Tiirnau). 

Symptoms.  Botryomycomata  usually  develop  very  grad- 
ually and  without  pronounced  acute  inflammatory  symptoms. 
They  may  occur  on  any  portion  of  the  skin  as  roundish  or  lob- 
ulated,  occasionally  pedunculated  fibroma-like  tumors  which  now 
and  then  attain  a  considerable  size  (collar  boils  and  shoe  boils 
belong  to  this  category)  wathout  affecting  the  movements  of  the 
animal  to  any  great  extent,  if  at  all  (Fig.  112).  In  some  cases, 
however,  the  tumor  becomes  more  diffuse,  causing  the  formation 
of  extensive,  very  firm  enlargements  almost  wood-like  in  con- 
sistency, or  of  shield-like  formations,  from  the  surface  of  which 
fistulous  canals  pass  into  the  deeper  tissues.  Innumerable  addi- 
tional nodules  may  develop  in  rapid  succession  in  the  tissue  of 
the  skin.  These  consist  of  lardaceous  connective  tissue  with  one 
or  more  purulent,  cheesy,  mortar-like  foci;  the  neighboring 
lymph  vessels  remain  intact,  although  the  regional  lymph  glands 
are  occasionally  enlarged,  firm  and  bosselated  and  contain  small 
soft  foci.  The  nodules  may  become  transformed  into  crater- 
shaped  ulcers  with  prominent  borders  and  discharge  a  tough, 
muco-purulent,  yellow  secretion. 

Another  frequent  form  of  the  disease  is  the  (improperly) 
so-called  fistula  of  the  spermatic  cord  which  in  most  instances 
is  a  result  of  infection  with  botryomyces  (Johne).  The  process 
develops  very  slowly  and  may  extend  over  a  period  of  4  years 
before  the  peritoneum  is  affected  (Plosz) ;  the  tumor  may  attain 
the  size  of  a  man's  head  and  extend  over  the  lower  portion  of 
the  abdomen. — In  affection  of  the  udder  (quite  common,  accord- 
ing to  Sand)  this  organ  becomes  enlarged  and  firm  nodes  are 
formed  in  its  tissues.  These  nodes  subsequently  break  and  dis- 
charge pus  through  fistulous  canals.  (In  a  case  described  by 
XJnterhossel  the  udder  of  a  mare  attained  the  size  of  that  of 
a  cow.)     In  exceptional  cases  the  disease  appears  also  on  the 


Symptoms. 


677 


external  iinieous  membranes;  thus  Frohner  observed  it  in  the 
form  of  a  soft  polypous  proliferation,  tlie  size  of  a  walnut,  near 
the  left  nostril.  Patrick  observed  the  same  in  the  form  of  a 
tumor  of  the  size  of  a  hen's  egg  on  the  upper  jaw,  while  Gutbrod 
described  a  case  in  which  numerous  small  nodules  occurred  on 
the  inner  surface  of  the  upper  eyelid,  causing  this  organ  to 
appear  much  swollen. 

Lienaux  saw  one  case  in  which  the  right  intermaxillary  gland 
attained  double  the  size  of  a  man's  fist,  while  about  20  nodes  the  size 
of  a  hazelnut  could  bo  observed  in  the  course  of  the  right  facial  crest. 

In  one  case  small  boils  with  muco-purulent,  yellowish-red  contents 
were  found  to  develop  after  the  operation  of  docking;  there  was  simul- 
taneous thickening  of  the  skin  and  complete  alopecia;  subse(|nently  the 
cutis  of  the  head  and  particularly  in  the  region  of  the  lips  became 
enormously  swollen,  numerous  fistulae  were  formed  and  there  was  slight 
CTilnrsrr'mr'Tit  of  tbo  intormaxinnrv   glnnds. 


^■^1 

^^^^^^^HH^^^^^^^^^^y^*^ 

p 

■L^  .''^'^^^^H 

^^^^^^^^^■^^^^^^^^^^^^^^^■B 

< 

^k     « 

1^ 

^ 

i 

s|| 

l^_^ 

ik  t 

fl 

1 

^^^^ta 

^_-^H 

^^ 

■fl 

Fig.  112.     Botryoniyci's  of  the  prepeetoral  Kegiou.      (Plosz. ) 

In  cattle  the  disease  is  much  less  frequent ;  Csokor  and  Im- 
melmann  observed  the  same  as  an  aifection  of  the  udder,  Reali 
in  the  form  of  tumors  of  the  subcutaneous  connective  tissue  of 
the  shoulder  and  croup,  Bollet  as  small  subcutaneous  nodes  of 
the  cervical  region,  extirpation  of  which  was  followed  after  two 
years  by  the  appearance  of  very  numerous  nodes  in  the  sub- 


678  Botryomyeosis. 

cutaneous  and  intermaxillary  connective  tissue  of  tlie  thorax 
and  of  the  abdominal  region. 

In  swine  Vilbrandt  observed  the  development  of  botryo- 
myces  in  the  spermatic  cord  within  six  weeks  after  castration, 
Petit  &  Cozette  the  same  within  three  months  after  this  opera- 
tion. The  grajdsh-yellow  pus  contained  granules  which  con- 
sisted of  coccus-zoogloea  but  formed  no  staphylococcus  groups. 

Diagnosis.  The  symptoms  of  botryomyeosis  are  similar  to 
those  of  actinomycosis,  and  the  two  conditions  may  be  differen- 
tiated with  certainty  by  means  of  microscopical  demonstration 
of  the  characteristic  morula-like  colonies.  As  a  rule  botryo- 
myeosis is  most  frequent  in  the  horse  and  actinomycosis  in 
the  ox. 

In  occasional  instances,  especially  when  diffuse  swellings 
exist,  glanders  or  farcy  may  be  suspected.  These  swellings, 
however,  are  considerably  firmer  in  botryomyeosis,  while  the 
peculiar  node-like  enlargements  of  the  lymphatic  vessels  are  not 
present  in  botryomyces.  The  neighboring  l>Tnph  glands  are 
rarely  involved,  and  ulcers  that  may  exist  show  a  tendency  to 
luxuriant  granulation.  Horses  affected  with  botryomyeosis  will 
not  react  to  mallein. 

Treatment.  The  treatment  for  superficial  botryomycomata 
is  purely  surgical  (extirpation).  Iodine  treatment  for  affection 
of  the  spermatic  cord  as  recommended  by  Thomassen  has  not 
been  effective  either  in  this  disease  (Frolmer,  Winter)  or  in 
affection  of  the  udder  (Vennerholm). 

Literature.  Bollinger,  V.  A.,  1870.  XLIX.  583;  1887.  XIIT.  176.  —  Johue, 
S.  B.,  1884.  40;  D.  Z.  f.  Tm.,  1885.  XII.  73;  1886.  XII.  204.  —  Eabe,  Ibid.,  1886. 
XII.  137.  —  tie  Jong,  Diss.  Giessen,  1899.  —  Kitt,  Cbl.  f.  B.,  1888.  III.  177; 
Monh.,  1890.  T.  71.  —  Jensen.  D.  Z.  f.  Tm.,  1892.  XVIII.  433.  —  Galli-Valerio, 
Cbl.  f.  B.,  1902.  XXVI.  508  (Lit.).  —  Glage,  Hb.  d.  p.  M.,  1903.  III.  795  (Lit.). 
—  Chanssee,  Eev.  gen.  1905.  V.  425.  —  Parascandolo  &  Meis,  O.  M.,  1805,  XXX J. 
433.  —  Ernst,  Cbl.  f.  Bakt.,  1907.  XLV.  121.  —  Letulle,  J.  de  phys.  et  path,  gen., 
1908.  X.  256 

7.    Glanders.    Malleus.    Farcy. 

{Malleus  humidus  et  farchninosus;  Rotzhranhheit,  Hautwurm 

[German];  Morve,  Farcin  [French'];  Morvo, 

Farcin 0  [Italian].) 

Glanders  is  a  contagious  and  usually  chronic  disease  of 
Solidungula.  It  is  characterized  by  the  development  of  nodules 
that  have  a  tendency  to  break  down  or  degenerate,  and  by  ulcers 
resulting  from  the  latter  process.  These  changes  occur  in  the 
tissues  of  the  mucous  membranes,  the  cutis  and  the  internal 
organs  and  are  the  direct  effect  of  the  Bacillus  mallei.  In  excep- 
tional cases  carnivora  become  affected.  Human  beings  are  sus- 
ceptible to  infection  by  the  virus. 

History.  Glanders  is  a  disease  that  has  been  knowTi  since  the 
remotest  times,  having  been  mentioned  by  Vegetius  400  years  before 


G  landers.  G70 

tlio  l)ii-th  ol"  Clirist  (tlie  namo,  malleus,  owes  its  origin  1o  Aristotle, 
being  deriveil  fi-om  the  Greek  word  Mi7^'s=/jar/  disease  or  rpichmic). 
Its  transinissibility  was  recognized  by  Apsyrtus  and  Vegetius  in  the 
fourth  century  and  in  the  seventeenth  and  eighteenth  centuries  it  was 
generally  recognized  as  an  infectious  disease.  In  1784  the  French 
government  enaeted  stringent  veterinary  sanitary  police  laws  for  the 
]>reven1ion  of  the  spread  of  the  disease.  At  that  time  Yiborg  (1707) 
maintained  that  glanders  and  farcy  (nasal  glanders  and  cutaneous 
glanders)  were  identical.  Hut  before  Yiborg 's  time  Abilgaard  had 
expressed  the  same  view  and  had  experimentally  demonstrated  by 
inoculation  the  infectious  nature  of  nasal  glanders.  Toward  the  middle 
of  the  last  century,  however,  the  Alfort  school,  on  the  basis  of  un- 
successful inoculation  experiments,  denied  the  infectiousness  of  glanders 
and  in  spite  of  the  fact  that  the  School  of  Lyons  took  a  firm  stand 
against  this  view,  this  new  doctrine  which  was  defended  even  by  such 
men  as  Renault  and  Bouley,  found  many  adherents.  Under  their 
influence  the  former  regulations  of  protection  and  extermination  were 
for  the  greater  part  suspended,  which  resulted  in  an  extraordinary 
dissemination  of  the  disease.  This  was  in  itself  a  convincing  argument 
against  the  correctness  of  the  new  conception  and  when  Rayer  (1887) 
and  Le  Blanc  (1838)  again  demonstrated  the  transmissibility  of  the 
disease  by  faultless  inoculation  experiments  the  former,  more  correct 
view,  gradually  gained  the  ascendency,  and  at  the  same  time  the  claims 
of  Dupuy  that  the  di-sease  was  the  same  as  tuberculosis,  those  of  Bouley. 
Ilering  and  Funke  that  it  was  merely  a  pyemia,  and  the  claims  of 
others  that  it  was  a  general  dyscrasia,  diphtheria,  etc.,  were  perma- 
nently abandoned. 

After  the  contagious  character  of  the  disease  had  been  generally 
acknowledged,  the  belief  still  persisted  that  the  disease  now  and  then 
developed  spontaneously,  or  as  the  result  of  a  degeneration  of  some 
other  morbid  process,  e.  g.,  distemper  or  strangles,  until  Gerlach  (1868) 
and  Bollinger  (1874)  demonstrated,  by  means  that  eliminated  the  last 
doubt,  that  glanders  resulted  from  the  mediate  or  immediate  contact 
exclusively  with  diseased  animals  or  their  pathologic  products. 

The  investigations  of  more  recent  times  have  demonstrated  the 
exact  nature  of  the  contagion.  After  Chauveau  had  shown  that  the 
removal  of  the  cellular  elements  from  glanderous  secretions  by  means 
of  filtration  destroyed  their  infectious  properties  and  thus  demon- 
strated that  the  infectious  principle  was  in  some  manner  fixed  to 
organized  elements,  a  number  of  authors  directed  their  search  for  the 
virus  to  the  microscopical  examination  of  the  secretions.  Thus  Babes 
(1881)  observed  in  the  pus  and  in  the  walls  of  an  ulcer  of  a  man 
atlPected  with  glanders,  small  rod-like  structures  with  thickened  ends. 
Rozsahegyi  observed  straight  or  slightly  bent,  homogeneous,  immotile, 
slender  rods  in  the  contents  of  a  pustule  of  a  diseased  man.  Bouchard. 
Charrin  &  Captain  (1882)  produced  bouillon  cultures  from  the  morbid 
products  of  diseased  persons  and  horses  which  produced  glanders  in 
guinea  pigs  and  asses  in  the  fifth  generation,  but  it  remained  for 
Loeffler,  with  the  cooperation  of  Schuetz  (1882)  to  isolate  and  grow 
pure  cultures  of  the  characteristic  rod-like  bacterium  which  he  demon- 
strated indisputably  by  means  of  exact  animal  experiments  (1886) 
to  be  the  etiological  factor  at  the  bottom  of  this  disease. 

Since  that  time  the  chief  object  of  researches  has  been  the  deter- 
mination of  the  exact  modes  of  infection  and  the  perfection  of  methods 
of  diagnosis.      For   the   latter   purpose,   aside   from   the   experimental 


680  Glanders. 

inoculation  of  laboratory  animals,  mallein  in  particular  had  attained 
considerable  importance.  Helman  in  St.  Petersburg  and  Kalning  in 
Dorpat  produced  this  in  1890  independently  of  each  other,  both 
recognizing  its  diagnostic  value.  In  more  recent  times  MacFadyean, 
Jensen,  Schuetz  &  Miessner,  Sehnuerer  and  others  added  the  agglutina- 
tion test  while  Schuetz  &  Schubert  as  well  as  Miessner  &  Trapp  enriched 
our  diagnostic  methods  by  the  complement  fixation  test. 

On  the  other  hand  the  view  concerning  the  exact  manner  in  which 
infection  actually  takes  place,  as  well  as  those  bearing  upon  the  patho- 
genesis of  the  disease  have  been  directed  into  more  correct  channels 
by  the  investigations  of  Nocard,  Schuetz,  Biegler  and  Hutyra. 

Occurrence.  Glanders  is  at  this  time  still  quite  prevalent 
among  Solidungiila.  In  former  times  the  disease  was  exten- 
sively prevalent  everywdiere,  independent  of  climatic  or  soil  con- 
ditions, and  was  the  cause  of  enormous  losses.  Thus,  for  ex- 
ample, 5.1%  of  all  horses  in  the  French  army  were  destroyed  on 
account  of  glanders  every  year  from  1835  to  1845.  In  the  Hun- 
garian Stud  Mezohegyes  about  20,000  horses  were  killed  on 
account  of  glanders  in  the  first  half  of  the  18th  century.  In 
recent  times,  however,  conditions  have  much  improved  in  those 
states  and  countries  in  which  proper  measures  for  protection  and 
extermination  are  rigidly  enforced. 

Since  the  introduction  of  mallein  as  a  diagnostic  agent  it 
has  been  found  that  the  disease  spreads  much  faster  in  large 
stables  than  was  formerly  suspected  when  only  manifest  or 
clinical  cases  of  the  disease  were  taken  into  consideration.  At 
the  same  time  the  fact  was  recognized  that  the  disease  fre- 
quently confines  itself  to  the  internal  organs,  in  which  form  it 
not  infrequently  terminates  in  recovery. 

Statistical  records,  especially  those  of  former  years,  usually  include 
manifest  clinical  cases  only. 

According  to  Krabbe's  compilations  for  1857  to  1873  the  number 
of  glandered  horses  per  100,000  was  as  follows :  Norway  6,  Denmark 
8.5,  Great  Britain  14,  Wlirttemberg  77,  Prussia  78,  Servia  95,  Belgium 
138,  France  1130,  Algiers  1548,  annually. 

In  Germany  a  considerable  decrease  in  the  number  of  cases  reported  haa 
been  noted  in  recent  years.  Thus,  for  instance,  while  in  1S90,  1,417  cases  occurred 
in  355  parishes  of  267  districts,  the  number  had  decreased  by  1908  to  418  cases 
in  141  parishes  of  96  districts. 

In  France  the  disease  was  formerly  widely  prevalent.  Since  1900,  however, 
the  number  of  cases  has  been  reduced  from  1,365  in  that  year  to  398  in  1908  (in 
the  Department  of  the  Seine  the  number  was  reduced  from  1512  in  1895  to  179  in 
1903.  In  1895  the  disease  was  so  prevalent  in  the  Compagnie  generale  des  voitures 
of  Paris  that  586  out  of  1,200  horses  had  to  be  destroyed  on  account  of  it,  and  in 
the  following  two  years  607  more  had  to  be  killed  (Blanc  &  Drouin;  see  also 
mallein  test). 

In  Great  Britain  the  number  of  cases  increased  from  1,385  in  1898  to  2,443  in 
1903,  in  addition  to  which  77  glandered  English  horses  were  reported  from  the 
abattoirs  of  Belgium.  In  1901  there  were  2,370  cases,  of  which  1,828  were  reported 
from  London,  67%  of  the  latter  coming  from  permanently  infected  stables  (Hunt- 
ing). In  1908  there  were  789  outbreaks  of  the  disease,  of  which  495  were  in 
London  and  198  in  the  Metropolitan  counties ;  2,433  horses  were  killed  on  account 
of  the  disease. 


Occurreiu'o,  Etiology.  ggj^ 

In  Austria  the  number  of  cases  ranged  from  400  to  550  from  1R91  to  1900. 
In  1896  there  were  647,  and  in  1898  there  were  1,043  cases  (among  these  were  519 
horses  slaiightoreil  for  food  in  Lower  Austria).  In  1908  the  weekly  average  of 
infected  parishes  ranged  from  7  to  41,  most  of  the  infected  parishes  being  in  the 
provinces  of  Ciaiicia,  Lower  Austria  and  tlie  Kingdom  of  Bohemia,  while  Upper 
Austria,  Tyrol  and  X'orarlberg  were  free  from  outbreaks. 

Eussia  is  at  present  badly  infesteil;  about  4%  of  all  horses  are  infected  with 
the  disease,  and  over  10,000  horses  are  oflicially  destroyed  every  year.  In  1900  the 
loss  in  the  Cherson  Government  reached  2,000,  in  Tauris  2,067,  in  St.  Petersburg 
alone  469,  in  Odessa  722  glandered  horses  (Samborski).  In  1908,  15,693  cases 
were  reported  in  7,S2S  parishes. 

In  Hungary  the  annual  number  of  cases  has  for  years  ranged  between  700 
and  950,  although  in  1895  the  number  reached  1,177,  and  in  1898,  1,683  cases.  In 
1908,  946  cases  were  reported  from  261  parishes,  mostly  based  upon  the  results  of 
mallein  tests.  The  largest  nund)er  of  cases  were  reported  from  the  southern  dis- 
tricts. 

The  following  official  figures  are  available  for  1908:  Belgium  18,  Netherlands 
26,  Italy  535,  Kouiuania  200,  Switzerlan<l  4  cases,  while  Denmark  reported  21 
infected  stables,  Bulgaria  132,  and  Norway  and  Sweden  are  free  from  disease. 

The  disease  is  i)revalent  also  in  Asia  (India,  Japan),  in  Africa  (Algiers, 
Egypt  and  South  Africa;  in  the  latter  country  oidy  since  recent  times),  as  well  as 
in  America  (United  States,  especially  in  the  northwestern  States).  Australia  has 
thus  far  remained  free  from  the  disease. 

Etiology.  Tlie  Bacillus  mallei  is 
a  straight,  or  slightly  bent,  slender, 
ininiotile,  non-spornlating  rod  with 
rounded  or  somewhat  pointed  ends; 
its  length  is  about  1/3  to  2/3  of  the 
diameter  of  a  red  corpuscle  (2-5  i^ 
long,  0.3-0.5  1^  in  diameter;  Fig.  13). 
In  tissues  the  bacilli  are  usually 
found  in  pairs  or  in  larger  sheaf-like 
"bundles,  while  in  artificial  cultures 
they  may  occasionally  form  filaments 
or  branched  threads.  (Marx  and  fro^^^'te^^^i"  ff'^^'cuinea"  p^"^ 
Conradi  therefore  classify  them  as  s'tT^ned^'vi''h  methyiennjlue !° 
Streptothrixes.) 

Staining.  The  bacilli  stain  slightly  with  aqueous  anilin  dres  more 
readily  iu  staining  solutions  containing  caustic  potash  or  carbolic  acid, 
often  imperfectly  or  irregularly  in  diseased  organs.  They  are  de- 
colorized by  Weigert's  or  Gram's  methods.  In  bacilli  from  cultures, 
stained  with  carbolfuchsin  or  methylene  l)lue,  we  may  observe  one  or 
two  more  intensely  stained  grannies  or  bodies  (usually  at  the  ends). 

Cultivation.  The  bacillus  of  glanders  is  an  obligate  parasite;  on 
artificial  media  it  thrives  only  at  temperatures  a])0ve  20°  C,  best  at 
body  temperature;  between  41.5°  and  43°  C.  its  growth  is  very  slow 
and  ceases  above  45°  C.  Neutral  or  slightly  acid,  as  well  as  glycerin 
media  are  best  adapted  for  its  growth.  The  cultures  have  a  peculiar 
smeary  or  slimy  consistency  and  thrive  only  in  the  presence  of  oxygen. 
On  potatoes  there  appear,  on  the  second  day,  small  honeydrop-like, 
transparent  colonies  that  subsequently  coalesce  into  a  fawn  or  chocolate- 
colored,  thick,  shiny,  ropy  mass,  while  the  culture  medium  in  the  ad- 
jacent area  becomes  blui.sh  or  greenish  in  color  (Fig.  114).  On  agar 
there  develop  gray,  transparent,  slimy,  ropy  colonies  with  smooth  out- 
lines, subseciuently  becoming  dark  gray  and  more  tenacious  in  con- 
sistency.    On  coagulated  blood  serum  pale  yellow,  transparent  colonies 


682 


Glanders. 


develop  that  subsequently  become  milky  white.  Bouillon  is  evenly 
clouded  but  at  a  later  stage  a  white,  ropy,  slimy  sediment  accumulates 
on  the  bottom  of  the  vessel.  Milk  cultures  remain  neutral  in  reaction 
but  cause  the  medium  to  coagulate  in  the  course  of  ten  to  twelve  daj's. 

Tenacity.  The  bacilli  of  gland- 
ers possess  only  slight  powers  of 
resistance  to  the  influence  of  external 
agencies.  In  damp  media  they  retain 
their  vitality  for  15  to  30  days;  in 
decomposing  substances  14  to  24  days 
(Cadeac  and  Malet)  ;  in  30%  glycerin 
they  retain  their  vitality  as  well  as 
their  virulence  for  12  days  (Galtier), 
while  drying  destroys  them  in  1  to  2 
weeks,  or  at  the  longest  in  three  months 
(Loeffler)  ;  sunlight  destroys  them  in 
24  hours  (Sirena  &  Alessi).  Heat  at 
55°  C.  destroys  them  in  10  minutes, 
at  80°  C.  in  5  minutes.  Carbolic  acid 
in  solutions  of  3  to  5%  destroys  them 
in  5  minutes,  1%  solutions  of  per- 
manganate of  potassium  in  5  minutes, 
1:5000  sol.  of  bichloride  of  mercury 
or  0.23%  chlorine  water  (chloride  of 
lime  water  containing  23%  chlorine) 
in  2  minutes  (Loeflfler),  3%  cresylic 
acid  or  lysol  solution  destroys  them 
rapidly  (Nocard),  also  5%  lime  water 
or  10  %  chloride  of  lime  (Jaeger)  and 
oil  of  turpentine  (Galtier).  Anti- 
formin  dissolves  them  in  a  few  min- 
utes. Cultures  are  destroyed  in  en- 
closures in  which  40  gm.  of  sulphur  is 
burned  for  every  culnc  meter  of  air 
space  (Thoinot).  Cold  does  not  affect 
them,  Wladmiroff  having  found  them 
alive  after  immersion  in  licjuefied  air 
for  80  minutes.  The  natural  secre- 
tions of  the  stomach  may  sometimes 
destroy  them  in  15  hours;  as  a  rule, 
however,  they  withstand  their  action 
without  loss  of  vitality  for  more  than 
40  hours  (Cadeac  &  Malet),  while 
they  are  destroyed  in  urine  in  40 
hours  or  less  (Nencioni).  Secretions 
or  tissues  containing  virus  los-e  their 
virulence  within  a  few  days  (Loeffler, 
Nowikoff). 

Pathogenicity.  Subcu- 
taneous inoculation  of  a  pure 
culture  or  administration  of 
the  same  to  the  nasal  mucous 
membrane  of  a  horse  or  ass 
results  in  a  general  febrile 
,  .  affection,    in    the    course    of 

which  smal  nodules  develop  at  the  point  of  inoculation  and 
subsequently  also  m  more  remote  regions  of  the  body.  These 
nodules  ulcerate  and  the  lymph  vessels  and  honph  glands  in  the 
neighboring  tissues  become  enlarged,  which  condition  is  fol- 
lowed by  rapid  emaciation  and  death.  Post-mortem  examina- 
tion reveals  similar  nodules  in  the  internal  organs,  especially 


Fig.  114:      Potato   Cultures   of    Bacillus 
mallei.  A  4  days,  B  8  days  of  age . 


Pathogenicity.  683 

in  the  lungs.    Subcutaneous  inoculation  also  is  followed  by  the 
development  of  symptoms  of  nasal  glanders. 

The  alimentary  administration  of  small  quantities  of  vir- 
ulent culture  of  glanders  bacilli  (0.01  to  0.02  gm.)  usually 
results  in  tlie  development  of  miliary  interstitial  nodules  of 
glanders  in  the  lungs,  especially  near  the  pleural  envelope,  sub- 
sequently these  may  develop  into  ])ronclio-])neumonic  foci  or  dif- 
fuse lesions  of  glanders  (Nocard,  MacFadyean  -  Riegler, 
llutyra).  In  some,  but  by  no  means  in  all  cases,  nodules  may 
also  develop  in  the  abdominal  organs,  especially  in  the  liver. 
The  mesenteric  and  the  intermaxillary  hanph  glands  may  also 
become  affected.  The  feeding  of  large  masses  of  virus  is  fol- 
lowed by  the  formation  of  glanderous  lesions  in  the  intestinal 
mucous  membrane,  in  the  lymphatics,  in  the  lungs  as  well  as  in 
other  organs  also  (Schuetz). 

Inhahition  of  an  atomized  bouillon  culture  produces  a  diffuse 
inflammatory  swelling,  attended  with  the  formation  of  nodules 
and  ulcers  in  the  lower  portion  of  the  nasal  cavities,  also  pneu- 
monic areas  in  the  lungs,  which  symptoms  are  soon  followed  by 
a  fatal  general  infection. 

According  to  Johne,  the  character  of  the  iiialleous  process  is  dependent  upon 
the  virulence  of  the  infectious  material;  highly  virulent  bacilli  producing  acute 
lesions  with  tendency  to  ulcerous  degeneration,  while  attenuated  bacilli  give  rise  to 
connective  tissue,  new  formations  (fibroid  glanderous  cicatrices^  proliferations)  as 
well  as  to  transparent  nodules  that  subsequently  become  fibrous. 

Among  other  animals  that  are  very  susceptible  to  infection 
with  glanders  may  be  mentioned  guinea  pigs,  cats  and  young 
dogs  (see  diagnosis),  as  well  as  species  of  arvicola  and  field  mice 
(Kitt) ;  mice  die  within  three  or  four  days  after  subcutaneous 
infection,  post-mortem  examination  revealing  small  pus  foci 
in  the  spleen,  liver  and  occasionally  also  in  the  lungs  (house 
mice  and  white  mice,  on  the  other  hand,  are  only  slightly  sus- 
ceptible, while  rats  are  immune).  Sheep  and  goats  may  occa- 
sionally be  infected  experiinentally  (Csokor,  Penchu),  also 
swine  (Cadeac  &  Malet,  Saccharow),  while  camels  are  very  sus- 
ceptible (Petrowsky)  and  cattle  practically  immune.  Fowls  also 
resist  experimental  infection. 

According  to  Sacharow,  Aruch  &  Petrini,  as  well  as  according  to  Galtier  & 
Nicolas,  subcutaneous  inoculation  of  virulent  glanders  bacilli  in  cattle  is  followed 
by  local  abscesses,  while  intravenous  administration  produces  respiratory  symp- 
tems  and  temporary  swelling  of  the  joints.  In  a  cow  that  had  repeatedly  been 
treated  with  dead  cultures,  Riegler  succeeded  in  producing  a  fatal  disease  by  the 
intravenous  injection  of  a  virulent  culture.  Nodules  and  ulcers  were  found  in  the 
lungs,  mucous  membranes  of  the  nose  and  pharynx  as  well  as  in  the  lymph  glands. 
On  the  other  hand,  Prettner  observed  transitory  illness  in  a  calf  following  intra- 
venous injection  of  26  gm.  of  a  culture  of  the  bacilli. 

The  virulence  of  the  bacilli  is  attenuated  by  passage  through  the  bodies  of 
Spermophilus  citillus  or  through  rabbits  (Gamaleia),  while  serial  inoculations  into 
the  central  nervous  system  of  susceptible  animals  (Tedeschi)  and  passage  through 
young  cats  (Foth)  increases  their  virulence.  According  to  Bulloch  ic  Twodt  virus 
cultivated   from  lesions  from  man  are  extremely  virulent. 


684  Glanders. 

Natural  infection  is  brought  about  through  the  medium  of 
the  secretions  of  diseased  animals.  In  diseased  horses,  except 
in  animals  with  acute  glanders,  in  which  case  the  entire  body  is 
infected,  the  virus  is  present  only  in  the  affected  organs  and 
their  secretions.  The  nasal  discharge  and  the  secretions  of  the 
cutaneous  ulcers  are  particularly  virulent,  while  the  saliva  is 
virulent  only  as  a  result  of  admixture  of  secretions  from  the 
lungs;  the  same  may  be  said  in  regard  to  the  feces,  although 
they  may  become  infected  from  intestinal  ulcers  also.  In 
affection  of  the  kidneys  the  urine  may  be  virulent.  Bacilli  that 
gain  access  to  the  outer  world  by  these  means,  though  they  are 
incapable  of  reproduction  under  ordinary  conditions  (obligate 
parasites)  may  retain  their  vitality  for  some  time,  especially  in 
damp,  dark  places,  where  they  are  protected  from  drying  out, 
and  may  then,  even  after  the  lapse  of  several  days,  gain  access 
to  the  bodies  of  susceptible  animals  in  a  virulent  condition. 

In  the  majority  of  cases  infection  of  horses  takes  place 
through  the  digestive  tract  by  the  ingestion  of  food  or  water 
contaminated  with  the  infected  nasal  secretions  of  a  diseased 
animal.  The  food  as  well  as  the  water  may  also  have  been  con- 
taminated by  infected  mucus  that  has  been  coughed  up  out  of 
the  lungs  or  by  the  secretions  of  cutaneous  ulcers,  the  feces  or 
the  urine.  Accordingly  infection  is  most  apt  to  occur  when 
healthy  horses  feed  out  of  the  same  manger  or  drink  from  the 
same  trough  to  which  glandered  horses  have  access.  Thus,  in 
a  large  stud  of  horses,  where  the  animals  are  not  tied  up,  but  are 
all  permitted  to  feed  and  drink  out  of  the  same  common  racks  or 
troughs,  a  single  glandered  horse  may  be  the  means  of  infecting 
a  large  number  within  a  very  short  time.  Under  ordinary  con- 
ditions, on  the  other  hand,  the  disease  usually  spreads  much 
more  gradually.  On  the  range  or  pasture  affected  animals  may 
contaminate  the  grass  with  their  nasal  secretions,  and  thus 
infect  healthy  horses. 

According  to  positive  results  of  feeding  experiments,  infec- 
tion may  also  take  place  through  the  intact  mucous  membranes ; 
the  presence  of  wounds  or  injuries  of  course  favors  the  process. 
Thus  Cadeac  &  Malet  found  that  horses  and  cats  are  very  easily 
infected  if  the  virus  is  rubbed  into  the  superficially  scarified 
mucous  membrane  of  the  mouth,  while  the  same  effect  is  produced 
in  asses  by  the  simultaneous  administration  of  fodder  contam- 
inated with  prickly  vegetation.  Catarrhal  conditions  of  the  in- 
testinal mucous  membrane  also  favor  infection. 

Infection  rarely  takes  place  through  the  uninjured  mucous 
membrane  of  the  respiratory  tract.  Aside  from  the  fact  that 
primary  nasal  glanders  is  very  rare,  the  observation  that  experi- 
mental infection  of  the  nasal  mucous  membrane  nearly  always 
produces  acute  glanders  argues  against  the  theory  that  natural 
infection  usually  takes  place  through  the  nasal  mucous  mem- 
branes ;  glanders  resulting  from  natural  infection  usually  runs 
a  chronic  course.    Primary  pulmonary  glanders  also  evidently 


Natural  Infection.  (335 

develops  only  in  exceptional  instances  as  a  result  of  inhalation 
of  the  infection ;  this  mode  of  infection  can  be  assumed  only 
when  the  morbid  process  manifests  itself  exclusively  in  broncho- 
pneumonic  foci.  An  infection  after  this  manner  can  in  fact 
occur  only  through  the  medium  of  fresh  particles  of  secretion 
that  are  forcibly  expelled  from  the  lungs  in  the  act  of  sneezing 
or  snorting;  dried  virus  loses  its  virulence  or  vitality  within  a 
very  short  time. 

The  air  iiorinallj  expired  by  glandered  horses  is  not  infectious.  This  is  at 
least  the  conclusion  reached  in  their  experiments  by  Eenault,  Cadeac  &  Malet. 
The  latter  investijjators  forced  healthy  horses  to  inspire  the  same  air  that  was 
expired  by  glandered  horses  hj  means  of  linen  tubes  passing  from  the  head  or  nos- 
trils of  one  animal  to  the  other,  but  in  no  instance  did  they  observe  the  transmis- 
sion of  the  disease  to  the  healthy  animals.  They  also  failed  to  produce  the  disease 
by  the  subcutaneous  injection  of  the  precipitate  of  moisture  from  the  expired  air 
of  glandered  horses.  On  the  other  hand  Nocard  failed  to  get  positive  results  in 
any  case  where  he  injected  virulent  cultures,  that  had  been  admixed  with  albumin- 
ous substances  and  dried  without  the  application  of  heat,  into  the  peritoneal  cavity 
of  guinea  pigs,  or  where  he  blew  the  dried  material  into  the  nostrils  of  asses. 
Similarly,  Hutyra  found  that  virulent  nasal  secretion,  dried  either  in  the  presence 
of  light  or  in  complete  darkness,  was  ineffective  in  producing  glanders  by  insuffla- 
tion in  horses.  Finally  Cadeac  &  Malet  report  positive  results  from  intratracheal 
injections  of  10  to  20  cc.  of  virulent  cultures  in  asses  in  only  50%  of  the  cases. 

The  disease  may  also  be  produced  experimentally  by  infection 
through  other  uninjured  mucous  membranes.  Thus  guinea  pigs  may 
be  infected  by  the  application  of  a  few  drops  of  culture  on  the  con- 
junctiva or  the  mucous  membrane  of  the  vagina  (Galtier).  Under 
natural  conditions  this  mode  of  infection  can  of  course  be  only  of  rare 
occurrence  (Riehter  observed  primary  glanders  of  the  conjunctiva  of 
the  horse  and  it  is  recorded  that  a  Russian  stallion  transmitted  the 
disease  to  a  number  of  mares  in  Prussia  by  coitus). 

A  severance  of  continuity  of  the  skin  or  at  least  of  its  horny 
epithelial  layers  is,  as  a  rule,  necessary  before  infection  can 
occur.  The  domestic  animals  are,  however,  well  protected 
against  this  possible  mode  of  infection,  since  infectious  secre- 
tions usually  adhere  to  the  hair  coat,  dry  up  and  become  harm- 
less. This  explains  why  primary  cutaneous  glanders  is  gen- 
erally of  rare  occurrence  as  compared  with  metastatic  affection 
of  this  organ.  As  a  rule  the  virus  is  nibbed  into  lesions  of  the 
skin  by  means  of  the  harness  or  combs  and  brushes  previously 
used  on  affected  horses,  or  infection  may  take  place  through 
larger  cutaneous  wounds,  or  through  bites  (Lothes). 

Babes  observed  the  development  of  the  disease  in  guinea  pigs  following  rub- 
bing of  virulent  cultures  into  the  previously  shaved  skin,  as  had  also  been  observed 
long  before  by  Viborg.  However,  when  Nocard  repeated  the  experiment  with  asses 
and  15  guinea  pigs  he  obtained  positive  results  in  only  three  of  the  guinea  pigs. 
Probably  the  infection  was  in  all  cases  brought  about  through  abrasions  in  the 
superficial  layers  of  the  skin,  but  nevertheless  the  possibility  that  the  bacilli  may 
pass  through  the  hair  follicles  of  the  intact  skin  and  from  these  into  the  neighbor- 
ing lymph  spaces,  can  not  be  excluded. 

The  disease  is  usually  introduced  into  uninfected  stables 
through  the  medium  of  affected  horses.    As  a  rule  the  horses 


686  Glanders. 

in  the  stalls  immediately  next  to  that  of  the  aifectecl  animal 
become  infected  first,  although  sometimes  more  remotely  located 
animals  are  attacked  while  the  intervening  ones  remain  appar- 
ently perfectly  healthy,  which,  however,  does  not  necessarily 
exclude  the  possibility  that  the  latter  were  not  also  infected. 
The  disease  may  merely  not  have  developed  as  yet  to  the  same 
degree  or  may  have  been  completely  arrested.  In  some  cases 
the  horse  that  was  the  means  of  introducing  the  disease  may 
remain  in  apparently  good  condition  for  months  and  at  the  same 
time  infect  other  horses  by  its  expectorated  lung  secretions  or 
its  infected  feces.  If  such  cases  are  not  recognized  in  time  they 
may  result  in  the  infection  of  the  greater  part  of  a  large  stable 
full  of  horses,  and  thus  give  the  disease  a  firm  foothold  for  years 
after. 

Diseased  horses  disseminate  the  virus  of  glanders  in  vari- 
ous ways.  Horses  belonging  to  ^express  drivers,  transportation 
companies  and  miners  and  those  handled  by  horse  traders  and 
gypsies,  in  particular,  play  a  very  important  role  in  the  dis- 
semination of  the  disease.  Livery  stables  and  country  inns 
often  constitute  permanent  centers  of  infection,  and  horses  that 
have  been  kept  in  such  places  over  night,  or  that  have  been 
merely  fed  there  or  watered  may  transport  the  contagion  to 
other  places.  Finally  it  is  possible  also  that  feed  or  hay  may 
be  the  means  of  transporting  the  infection  from  one  stable  to  the 
other,  although  infection  through  these  means  is  necessarily  a 
rare  occurrence  on  account  of  the  slight  degree  of  tenacity  pos- 
sessed by  the  virus. 

Of  all  Solidungula  the  ass  is  the  most  susceptible  to  glan- 
ders. This  animal  is  very  easily  infected  and  usually  develops 
the  acute  form  of  tlie  disease.  The  horse,  which  is  usually 
affected  with  the  chronic  form  of  the  disease,  is  less  susceptible 
and  may  recover  from  its  effects.  The  mule  seems  to  occupy 
an  intermediate  position  in  this  respect.  Among  animals  kept 
under  similar  conditions  and  exposed  in  the  same  manner  a  few 
may  be  hard  to  infect,  others  become  lightly  infected  and 
recover,  while  a  few  individuals  seem  to  be  immune.  Horses 
with  reduced  vitality  as  a  result  of  other  diseases  or  hard  work, 
or  animals  in  a  poor  state  of  nutrition,  are  more  frequently 
affected  than  others,  but  the  common  occurrence  of  glanders 
among  horses  of  this  character  is  in  a  great  measure  due  to  the 
fact  that  they  are  more  frequently  exposed  to  infection. 

Camels  are  easily  infected  by  coliabitatiou  with  glandered  horses.  Symptoms 
of  the  disease,  which  usually  point  to  affection  of  the  lungs,  the  nasal  mucous  mem- 
brane and  the  lymph  glands,  may  occasionally  appear  on  the  6th  day  after  exposure. 

The  hereditary  transmission  of  the  disease  is  possible  but  seems 
to  be  rare  in  horses  (Valentini  observed  one  instance  in  which  the 
fetus  in  a  mare  was  affected  in  the  9th  month  of  its  development), 
while  it  is  comparatively  frequently  observed  in  small  experiment 
animals.     This  is  probably  explained  by  the  fact  that  the  bacilli  are 


Pathogrenesis.  587 

rarely  found  in  llie  blood  of  diseased  horses  (as  a  rule  only  during 
a  l)rief  period  immediately  after  infection  or  in  the  acute  form  of 
the  disease)  while  in  some  ex]>eriment  animals,  especially  cats  and 
guin(>a  pigrs  this  is  much  more  fre(|uently  the  ease.  Bonome,  however, 
has  demonstrated  that  intrauterine  infection  may  occur  not  only  as 
a  result  of  hemorrhage  but  through  the  intact  placenta  as  well.  The 
extra-uterine  disease  of  the  horse  has  as  yet  never  been  demonstrated 
I>ositively  to  be  the  result  of  intrauterine  infection. 

Pathogenesis.  The  (liseovory  that  the  lesions  of  the  disease, 
in  clinically  healthy  appearin.i?  animals  that  have  been  killed 
on  account  of  positive  reaction  to  the  mallein  test,  are  found 
almost  exclusively  in  the  internal  or^-ans,  especially  the  lungs, 
but  also  the  liver  and  spleen  (sometimes  only  in  the  latter) 
Avhile  the  nasal  mncons  membranes  are  hardly  ever  affected 
nntil  the  morbid  processes  in  the  internal  organs  have  become 
quite  advanced,  point  to  the  conclusion  that  the  nostrils  are 
usually  secondarily  infected  or  are  attacked  simultaneously 
with  the  internal  organs.  After  Renault  (1851)  had  success- 
fully produced  infection  by  feeding  infected  nasal  secretions, 
Xocard  demonstrated  that  horses  conld  be  infected  Avith  food 
or  water  that  had  been  contaminated  with  only  slight  quantities 
of  infected  secretions  and  that  the  intestinal  mucous  membranes 
remained  intact  while  lesions  of  the  disease  in  the  form  of  small 
translucent  *'tul)ercles"  were  found  in  the  lungs,  liver  and 
spleen.  Following  this  the  disease  continued  in  its  usual  chronic 
character  and  gradually  spread  to  other  organs.  Nocard's 
'view  in  regard  to  the  intestinal  origin  of  glanders  has  been 
fully  confirmed  by  MacFadyean,  Riegler,  Bonome,  Hutyra  and 
others.  The  results  of  Schuetz's  experiments  are  also  in  har- 
mony "with  these  conclusions  in  so  far  as  they  showed  that 
the  feeding  of  large  masses  of  virus  resulted  within  a  short 
time  in  extensive  affection  of  the  lungs.  The  possibility  of  in- 
testinal infection  is  further  supported  by  those  post-mortem 
observations  in  which  lesions  of  glanders  are  noted  in  the 
posterior  sections  of  the  small  intestines  and  in  the  cecum; 
finally  also  by  the  observation  that  carnivora  in  zoological 
gardens  usually  become  infected  from  the  ingestion  of  the 
organs  of  glandered  horses. 

Xocard  fed  virulent  cultures  mixed  with  turnip  leaves,  or  bread, 
or  drinking  water  to  20  horses,  asses  and  mules  that  had  had  water 
Mithlield  from  them  for  some  time  and  then  gave  them  free  access  to 
all  the  water  they  would  take.  All  of  these  animals  reacted  to  mallein 
within  three  to  eight  days  and  in  all  of  them  small  hyaline  nodules 
or  large  cheesy  foci  developed  in  the  lungs;  in  some  animals  the  sub- 
maxillary lymph  glands,  the  epiglottis,  the  turbinated  bones  and  the 
nasal  septum  also  developed  glanderous  lesions  (some  of  them  in  8 
days).  Schuetz  administered  large  masses  of  cultures  enclosed  in 
gelatin  capsules  to  three  horses  this  was  followed  within  11  to  13  davs 
by  serious  affection  of  the  lymph  glands  and  of  the  lacteals  of  the 


688 


Glanders. 


mesentery  and  the  formation  of  soft  nodules  varying  in  size  from  a 
pea  to  that  of  a  hazelnut  in  the  liver  and  lungs.  In  one  of  the  horses 
there  were  two  nodules  in  the  lungs,  hyaline,  yellowish-red  in  appear- 
ance, the  size  of  hens'  eggs  and  one  as  large  as  a  man's  fist.  In  a 
horse  that  had  received  1/10  of  a  needle-loop  dose  of  culture  on  14 
consecutive  days,  the  lungs  contained  glanders  nodules  ranging  in  size 
from  pin  head  to  that  of  a  pea,  besides  similar  lesions  in  the  liver  and 
in  two  mesenteric  glands ;  after  feeding  smaller  masses  of  virus  small 
nodules  were  found  in  the  lungs.  Miessner  &  Trapp  report  similar 
results  obtained  from  feeding  cultures  en  masse  to  three  horses.  As 
a  matter  of  fact  Sadowski  had  some  time  ago  demonstrated  glanders 
nodules  in  the  lungs  as  a  result  of  feeding  infectious  nasal  secretions. 
Dedjulin,  who  administered  glanders  cultures  in  gelatin  capsules  to 
cats  per  os,  found  lesions  of  glanders  in  the  lungs  exclusively.  Mac- 
Fadyean  found  typical  lesions  of  glanders  in  the  lungs  of  all  horses 
that  had  been  fed  potato  cultures  of  glanders  bacilli  while  in  one  horse 
the  lungs  were  affected  exclusively.  Bonome  produced  nodules  in  the 
lungs  in  a  similar  manner.  Eiegler  observed,  after  intestinal  infec- 
tion of  three  horses,  nodules  in  the  lungs  and  affection  of  the  bronchial 
glands  in  every  case.  In  one  case  the  lesions  were  limited  exclusively 
to  these  organs  while  in  one  of  each  of  the  others  either  the  intestine, 
the  mesenteric  glands  or  the  liver  were  also  involved.  In  Hutyra's 
experiments  with  13  horses  that  had  been  fed  glanders  cultures  enclosed 
in  gelatin  or  keratin  capsules  in  doses  down  to  0.01  gm.,  providing 
the  animals  survived  only  ten  days,  this  author  observed  disseminated 
nodules  in  the  lungs,  but  in  those  cases  in  which  the  animals  were  not 
killed  until  the  end  of  the  third  week  after  infection,  there  were  large 
typical  nodes  of  glanders  of  broncho-pneumonic  foci. 

According  to  tlie  experiments  referred  to  there  can  be  no 
doubt  that  glanderous  infection  may  proceed  from  the  intestinal 

canal;  but  it  is  as  yet  an  open 
question  whether  the  affection 
of  the  lungs  is  to  be  looked  upon 
as  primary  or  secondary.  While 
Schuetz  defends  the  position 
that  affection  of  the  lungs  is 
always  a  sequel  to  primary  in- 
fection of  the  mesenteric  glands 
and  that  primary  pulmonary 
glanders  of  horses,  if  it  ever 
occurs  at  all,  is  one  of  the  rarest 
diseases  of  the  horse,  all 
other  authors  mentioned,  except 
Meissner  &  Trapp  regard  pul- 
mouari/  glanders  of  the  horse  as 
a  primary  morbid  process.  The 
correctness  of  this  latter  view 
is  supported  by  the  fact  that  in 
those  experiments  where  intes- 
tinal infection  by  means  of  small 
amounts  of  virus  was  successful,  the  occurrence  of  rather  ex- 
tensive lesions  of  the  lungs  is  not  attended  with  changes  of  the 


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Fig.  115.  Glanders.  Intestinal  in- 
fection with  0,0]  g.  potato  culture.  Post- 
mortem: miliary  nodules  in  the  lungs, 
acute  swelling  of  the  ]ymi)h  glands. 


Pathosrenesis, 


689 


lynipli  glands  or  of  other  aluloniinal  organs ;  tliere  may  bo,  at 
tlie  most,  slight  swelling  of  the  lymph  glands.  In  addition 
to  this,  Ilntyra  showed  that  an  alimentary  infection  was  always 
followed  immediately  by  a  distinct  febrile  reaction  (see  Fig. 
115),  that  the  bacilli  of  glanders  may  be  present  in  the  circulat- 
ing l)lood  on  the  4tli  day  after  intestinal  infection,  and  finally 
that  hematogenic 
miliary  nodnles  of 
glanders  (see  p. 
(590)  will  develo]) 
within  seven  days 
following  such  an 
infection. 

Since  the  inhal- 
ation of  virulent 
cultures  results  in 
infection  of  the 
lungs,  the  possibil- 
ity of  natural  infec- 
tion taking  place 
through  the  respira- 
tory organs  can  not 
be  denied.  As  a 
matter  of  fact,  how- 
ever, experiments  of 
this  kind  (inhala- 
tion of  bouillon  cul- 
tures reduced  to  a 
spray  immediately 
in  front  of  the  nos- 
trils of  a  horse)  re- 
sult in  the  forma- 
tion of  nodules  and 
ulcers  in  the  lower 
portions  of  the  nasal 
cavities  only,  while 
the  upper  regions 
remain  perfectlv  in- 
tact (Fig.  116)  "and 
the  lungs  mav  con-        .        ^  „    , 

in\ii  df  TYincf  icA  '^^"'  ^'^^-  ^^^andcrs  uodules  and  ulcers  on  the  lower 
lam,  at  mOSI,  ISO-  p^j-tjon  of  the  nasal  septum  16  days  after  inhalation  of  a 
lated  nodules.     This   bouillon  culture  of  glanders  bacilli— 36  hours'  growth. 

observation  sug- 
gests that  moist  air,  charged  with  bacilli,  loses  most  or  all  of 
them  as  a  result  of  the  whirling  air  currents  immediately  l)eliind 
the  alae  of  the  nostrils  and  that  at  most  only  a  few  bacilli  ever 
reach  the  deeper  portions  of  the  lungs  in  this  manner.  If  we 
consider  in  connection  with  this,  that  the  virus  of  glanders  is 
rapidly  destroyed  after  reaching  the  outer  world  and  that  con- 
sequently the  inspiration  of  dry  air  plays  no  role  in  the  process 


690  Glanders. 

of  infection  and,  further,  the  fact  that  normally  expired  air 
contains  no  glanders  bacilli  and  that  direct  transmission  of 
the  virus  from  animal  to  animal  through  the  act  of  coughing 
or  snorting  is  only  exceptional,  one  is  necessarily  forced  to 
the  conclusion  that  aerogenic  infection  plays  a  very  secondary 
role  in  the  development  of  glanders. 

As  a  rule  the  disease  is  a  result  of  the  ingestion  of  food 
or  water  contaminated  with  the  secretions  (glanders  bacilli) 
of  infected  horses.  The  bacilli  enter  the  lymph  vessels  of  the 
intestinal  walls  through  the  intact  mucous  membrane  and  then 
pass  into  the  mesenteric  lymph  vessels;  during  this  process, 
although  it  is  undoubtedly  a  rare  occurrence,  they  may  give 
rise  to  inflammatory  changes  in  the  follicles  of  the  intestinal 
mucous  membrane  as  well  as  in  the  mesenteric  glands.  Follow- 
ing the  course  of  the  h^npll  stream  they  enter  the  thoracic  duct 
and  are  discharged  into  the  blood  with  the  contents  of  the 
latter.  This  results  in  a  general  blood  infection,  attended  with 
febrile  elevation  of  body  temperature,  inflammatory  swelling 
of  the  h^npll  glands  (including  those  of  the  intermaxillary 
space),  and  of  the  nasal  mucous  membranes,  as  the  first  stage 
of  the  disease.  A  part  of  the  bacilli  which  circulate  in  the  blood 
are  deposited  in  the  capillaries  of  the  lungs,  the  organ  pre- 
eminently susceptible  to  infection,  while  others  may  lodge  in 
other  organs — thus,  also  in  the  nasal  mucous  membrane — and 
exert  their  pathogenic  action;  in  part,  however,  they  are  evi- 
dently destroyed  in  the  blood  and  in  the  lymph  glands.  How- 
ever, as  Lothes  had  already  noted  in  his  practical  observations, 
the  possibility  exists  that  the  virus  may  enter  the  hanphatics 
of  the  neck  and  thorax  directly  from  the  pharyngeal  region. 

After  lodging  in  the  small  lilood  and  lymph  vessels  the  bacilli  of  glanders 
give  rise  to  a  proliferation  of  the  surrounding  endothelial  eells  and  of  the  extra- 
vascular  connective  tissue  cells  which  results  in  the  formation  of  nodules  composed 
of  epithelioid  cells;  subsequently  white  blood  eells  pass  from  the  periphery  and 
lodge  between  the  cells  of  the  nodules,  as  a  result  of  which  the  latter  become 
softer  in  consistency  and  finally  degenerate  into  a  purulent  mass  which  contains,  in 
addition  to  well  preserved  pus  corpuscles,  large  masses  of  degenerated  cells  and 
cell-  and  tissue-detritus  (Baumgarten).  The  nodule  which  is  at  first  hyaline, 
assumes  a  white  or  yellowish-white  color,  while  the  surrounding  hyperemic  tissue 
which  is  infiltrated  with  small  round  cells  forms  a  red  area.  As  the  nodules  enlarge 
and  the  cellular  elements  rapidly  break  down  larger  foci  composed  of  detritus  and 
pus  cells  and  surrounded  by  a  red  area  are  formed.  If  the  nodule  developed  in  the 
mucous  membrane  or  the  skin,  the  resulting  superficial  necrosis  is  followed  by  grad- 
ually progressive  ulceration. 

When  only  a  few  bacilli  are  present  or  when  the  tissues  possess  unusual  resist- 
ance the  process  may  be  interrupted  in  its  initial  stage,  or  it  may  not  be  inter- 
rupted until  considerable  connective  tissue  has  accumulated  around  the  glanderous 
foci ;  following  either  condition  definite  recovery  may  result,  the  ulcers  cicatrizing, 
the  purulent  centers  becoming  dry,  and,  in  exceptional  cases,  calcifying. 

In  other  cases  the  bacilli  find  their  way  into  the  surrounding  tissues  through 
the  lymph  channels,  the  lymph  vessels  of  the  subcutis  forming  thick,  knotty  strands 
and  the  regional  lymphatic  glands  becoming  enlarged. 

If,  as  a  result  of  hematogenic  infection,  the  bacilli  have 
accumulated  in  large  masses  in  the  capillaries,  they  may  cause 
emboli  and  hemorrhages  and  edematous  infiltration  of  the  sur- 


Patliopniesis.  (391 

rouiuliiio;  tissues.  Tlioso  serous  inliltrations  oeoiir  parlienlarly 
in  the  lungs,  botli  in  the  perivascular  connective  tissue  and  in 
the  ])ronc'liial  Malls;  the  bacilli  may  then  pass  through  to  tiu^ 
surface  of  the  mucous  membrane  and  be  discharged  to  tlie 
exterior  with  the  catarrhal  secretions  (Nocard  cK:  Leclainehe). 
On  the  other  hand  they  are  aspirated  into  the  alveoli  with  the 
secretions  where  they  give  rise  to  catarrhal  processes  which 
are  followed  by  the  develo])m('iit  of  broncho-pneumonic  foci 
which,  as  a  result  of  the  glanderous  nature,  undergo  early 
central  softening. 

Aocortling  to  the  invest ijjations  of  Sehiietz  ^lamlers  nodules  develop  in  the 
luugs  as  miliary  fibrinous  inflammatory  foci,  in  which  the  chromatin  of  the  nuclei 
breaks  up  into  fine  granules  as  the  process  of  necrosis  advances  (Unna's  nucleus 
degeneration  or  clironiatotexis),  while  calcification  is  said  never  to  take  place  (f). 
iSimilarly,  Csokor,  in  harmony  with  the  views  of  other  authors  (Uoloff,  Eal)e),  is  of 
the  opinion  that  the  primary  glanders  nodule  is  the  result  of  swelling,  coalescence 
and  subsefjuent  fatty-granular  degeneration  of  the  alveolar  endothelium  following 
aerogenic  infection.  According  to  Xocard,  on  the  other  hand,  the  primary  pul- 
monary lesions  of  glanders  consist  in  the  develo[>nient  of  hyaline  tulicrcle-like 
nodules,  as  had  alreaily  been  observed  by  Loefller  and  Schuetz  in  the  lungs  of 
horses  that  had  lieen  infected  experimentally  by  subcutaneous  and  intranasal 
administration  of  cultures:  viz.,  fresh,  gray  nodules  varying  in  size  from  a  millet 
seed  to  that  of  a  hemp  seed  and  surrounded  by  a  red  area,  ^fore  recently  these 
nodules  have  been  regarded  as  of  j)articular  importance,  esjiecially  through  the 
experimental  investigations  of  Nocard,  who  frequently  demonstrated  them  to  be 
present  as  the  only  pathological  lesions  in  naturally  infected  horses  that  were  con- 
demned and  killed  upon  the  evidence  of  a  reaction  to  the  mallein  test,  and  in 
horses  that  had  been  infected  experimentally  by  the  alimentary  a<hninistration  of 
small  quantities  of  virus,  in  all  cases  the  glanderous  nature  of  the  nodules  having 
been  demonstrated  by  experimental  inoculation  of  laboratory  animals.  Coremans 
and  Priesz  express  similar  opinions  in  regard  to  the  nature  of  these  nodules,  having 
demonstrated  the  presence  of  glanders  bacilli  in  them  by  microscopical  examination 
as  well  as  by  culture.  On  the  other  hand  Schuetz  as  well  as  Olt  and  Angeloff 
deny  the  glanderous  nature  of  these  nodules.  According  to  their  views  they  are 
the  result  of  infection  with  embryonic  filaria  ("nodules  of  this  character  consist  for 
the  most  part  of  eosinojihile  cells  which  absolutely  do  not  occur  in  glanders  nod- 
ules) ;  in  addition  to  this  the  aforementioned  authors  maintain  that  the  encapsu- 
lated and  frequently  calcified  foci  are  also  due  to  the  presence  of  these  parasites. 
Kitt  and  Johne,  however,  have  succeeded  in  demonstrating  virulent  glanders  bacilli 
in  partially  calcified  foci,  and  it  seems,  therefore,  that  the  many  conflicting  observa- 
tions and  views  on  this  question  are  evidently  due  to  the  fact  that  different  investi- 
gators have  investigated  structures  of  a  different  nature. 

According  to  Hutyra's  histological  investigations  of  the  lungs  of  infected 
horses  and  guinea  pigs,  nodules  due  to  hematogenic  infection  are  caused  by  bacil- 
larr  emboli,  followed  by  the  formation  of  thrombi  and  the  development  of  an 
almost  sinuiltaneous  vasculitis  and  perivasculitis  in  the  peribronchial  and  inter- 
lobular connective  tissue  which  cause  the  formation  of  sharjdy  circumscribeil  groups 
of  round  cells  which  a]i])ear  macroscopically  as  glassy,  hyaline  nodules  (in  a  few 
instances  glanders  bacilli  could  be  demonstrated  within  these  nodules,  but  in  no 
instance  could  filaria  be  found).  As  the  cell  groups  enlarge,  the  inflammatory 
process  extends  to  the  neighboring  alveolar  walls,  which  may.  however,  be  involved 
from  the  beginning  as  a  result  of  the  lo<lgment  of  bacilli  in  the  interalveolar  cai)il- 
laries.  In  either  case  a  miliary  fibrinous  inflammation  is  the  result.  Finally  the 
nodules  which  develop  in  tho  walls  of  the  small  bronchioles  may  perforate  their 
lumen  and  discharge  their  contents  into  them,  producing  an  inflammation  of  their 
mucous  membranes,  which  is  followed  by  bronchopneumonic  processes.  The  coales- 
cence of  neighboring  pneumonic  foci  results  in  the  formation  of  larger  nodes,  and 
the  fusion  of  diffuse  inflammatory  areas  in  the  interlobular  septa  results  in  the 
formation  of  so-called  glanderous  growths.  In  both  instances  thrombus  formation 
in  the  bloodvessels  of  the  affected  area  goes  hand  in  hand  with  the  inflammatory 
process. 

In  regard  to  local  susceptibility,  the  various  organs  show 
consideral3le  diiTerence.    After  the  lungs,  the  mucous  membranes 


692  (llanders. 

of  tlie  respiratory  organs,  especially  of  tlie  nose,  are  most  pre- 
disposed to  infection.  The  latter  is  the  seat  of  the  glanderous 
lesions  so  frequently  observed  in  the  later  stages  of  the  disease 
and  which  are  probably  the  result  of  infectious  emboli  or,  though 
only  occasionally,  of  infection  with  bronchial  secretions  charged 
with  bacilli  (tlie  acute  exacerbations  of  the  morbid  process 
which  manifest  themselves  in  nasal  lesions  are  undoubtedly  due 
to  embolic  origin).  The  lymph  glands  are  also  very  susceptible 
to  affection  and  the  same  is  true  also  of  the  lymphatic  plexuses 
of  the  skin  and  the  subcutaneous  connective  tissue  (the  nodes 
found  in  these  localities  are  also  usually  of  embolic  origin), 
following  these  the  spleen,  the  liver,  testes,  bone  marrow  and 
periosteum  are  next  in  order  of  susceptibility,  although  lesions 
are  much  less  frequently  met  with  in  these  organs. 

The  susceptibility  or  resisting  power  of  the  various  tissues  is  also 
influenced  by  previously  existing  other  morbid  processes.  Thus  Cadeac 
&  Malet  succeeded  in  infecting  swine,  the  vitality  of  which  had  been 
reduced  by  other  causes  (tuberculosis,  prolapsus  of  the  rectum,  mammary 
abscess).  A  horse  that  had  just  recovered  from  an  attack  of  pneumonia 
but  in  which  a  pulmonary  adhesion  persisted,  was  fed  with  cultures 
of  glanders  by  the  authors ;  autopsy  showed  that  glanderous  lesions  were 
present  in  the  immediate  neighborhood  of  a  small  cavity  only,  and 
therefore  w^ere  confined  to  the  locus  minoris  resistentiae. 

When  large  masses  of  glanders  bacilli  gain  an  entrance  to 
the  circulation  and  thus  lodge  in  the  capillaries  of  a  number 
of  organs  at  the  same  time,  the  development  of  glanders  nodules 
will  be  observed  in  numerous  places,  but  al  vays  in  greatest 
abundance  in  the  nasal  mucous  membrane  and  the  skin.  The 
resulting  generalized  infection  is  then  manifested  in  appearance 
of  grave  acute  symptoms  which  however  are  probably  caused 
in  part  by  pyogenic  bacteria.  (According  to  Sewsejenko, 
streptococci  can  almost  always  be  demonstrated  in  the  blood 
in  the  course  of  acute  glanders.) 

The  bacilli  of  glanders  exert  their  pathogenic  action  by  means  of 
toxins.  These  are  formed  also  in  artificial  cultures,  probably  in  the 
form  of  endotoxins  as  a  result  of  dissolution  of  the  bacilli,  and  con- 
stitute the  active  ingredient  of  mallein.  Similar  toxins  evidently  also 
circulate  in  the  bodies  of  affected  animals  causing  cell  proliferation 
and  cell  emigration  in  the  neighborhood  of  the  bacilli.  The  degenera- 
tive processes  that  attack  the  cellular  elements  as  well  as  the  febrile 
reactions  following  infection  with  large  masses  of  virus  and  finally  the 
excessive  emaciation  and  great  exhaustion  w^hich  are  frequently  entirely 
out  of  proportion  with  the  extent  of  the  morbid  lesions  are  no  doubt  due 
to  these  toxins. 

Toxins  obtained  from  cultures  have  a  disease  producing  effect  in  rather  large 
doses  only;  in  small  experiment  animals  they  produce  spasms,  paralyses,  symptoms 
lof  congestion  and  occasionally  edema  at  the  point  of  injection  (Finger,  Babes). 
*Dead  bacilli  have  a  similar  effect.  Bromberg  succeeded,  in  his  experiments  with 
^cats,  in  producing  fatal  acute  affections  resembling  glanders  follovviug  the  injection 


Anatomical   Chaiifjos.  693 

of  deail  bacilli,  ■n-hilc  Cantacu7enc  and  Eiegler  observe.!  enlargement  of  the  spleen, 
nephritis  and  swelling  of  Peyer's  patches,  and  of  the  mesenteric  and  bronchial 
lymph  glands  in  guinea  pigs,  followijig  intrastoniachal  administration  of  dead 
bacilli  of  glanders. 

Anatomical  Changes.  In  those  cases  whoro  the  skin  and 
sn1)ontaneons  connootivo  tissne  are  affected,  tlie  skin  may  con- 
tain nodes  varyin.c:  in  size  from  a  lentil  to  that  of  a  pea,  of  firm 
consistency  and  with  soft  centers,  and  round  ulcers  with  rac^ged 
edges  tliat  have  developed  from  the  Latter,  while  on  the  other 
hand  (and  more  frequently)  considerably  larc^er  abscesses  and 
nodes  are  present  in  the  subcutaneous  connective  tissue.  Sub- 
sequently these  may  also  ulcerate  (see  s\miptoms).  The  sur- 
rounding tissue  is  gelatinously  infiltrated  or  lardaceous  and 
glistening  in  appearance,  firm  in  consistency  and  frequently 
contains  small  foci  composed  of  yellowish-gray  or  reddish 
viscous  pus.  The  hinph  vessels  between  the  nodes  and  ulcers 
are  enlarged  and  filled  with  a  thick,  yellowish-white  coagulated 
hnnph ;  tlie  regional  hnnph  glands  are  much  enlarged  and  firm 
and  their  interior  tough  connective  tissue  is  filled  ^^^th  small 
pus  foci. 

The  respiratory  organs  are  found  affected  almost  without 
exception  in  every' case,  sometimes  the  morbid  process  being 
limited  to  the  lungs  while  in  other  instances  the  upper  air 
passages  and  the  nasal  cavities  are  also  involved. 

In  the  lungs  the  initial  morbid  changes  are  represented 
either  bv  small  tubercle-like  nodules  or  by  large  lobar  pneu- 
monic areas.  The  nodules  consist  of  gray,  hyaline  or  grayish- 
white,  firm  structures  ranging  in  size  from  a  pin  head  to  that 
of  a  mustard  seed  imbedded  in  the  lung  tissue,  occasionally 
present  in  very  large  numbers  and  which  are  surrounded,  in  the 
later  stages  of  the  process,  by  a  hemorrhagic  area  (see  p.  691). 

The  catarrhal  pneumonic  form  of  pulmonary  glanders 
(broncho-pneumonia  malleosa)  appears  in  the  form  of  small 
atelectatic  foci  which  are  at  first  of  an  even  brownish-red 
color,  but  subsequently,  as  a  result  of  central  softening,  become 
transformed  into  a  yellowish  caseo-purulent  mass  and  sur- 
rounded bv  a  firm,  red,  inflammatory  halo  which,  like  its  im- 
mediate surrounding  area,  has  a  peculiar  yellowish  gelatinous 
sheen. 

In  some  of  the  more  advanced  cases  large  contiguous  areas 
of  the  lungs  have  become  transformed  into  sarcoma-like,  firm 
though  not  very  tough,  structures  (so  called  glanderous 
growths) .  Upon  section  the  surface  is  either  uniformly  gra>dsh- 
red  or  has  imbedded  in  its  structure  numerous  small  purulent 
or  cheesy  foci,  in  either  case  the  peculiar  gelatinous  character 
being  evident.  Glanderous  foci  of  still  greater  age  consist  of 
very  tough,  almost  cicatricial  connective  tissue  \yith  cheesy  or 
mortar-like  foci  imbedded  in  its  structure. 

More  extensive  or  more  acute  affections  of  the  lungs  are 
always   attended  with  an  acute   bronchitis  while   the   swollen 


694 


Glanders. 


and  bright  red  mucous  membrane  is  covered  with  a  purulent 
secretion,  occasionally  studded  with  small  nodules  and  ulcers, 
the  bronchial  walls  thickened  and  here  and  there  distended. 
In  affection  of  the  superficial  areas  of  the  lungs  the  ad- 
jacent visceral  layer  of  the  pleura 
is   indurated  while   wide   strands 
of  yellow  gelatinous  tissue  radiate 
between    the    pulmonary    lobules. 
In  very  rare  cases  serous  or  sero- 
fibrinous exudate  may  be  present 
in  one  or  both  pleural  cavities. 

.  The  lesions  of  glanders  of  the 
upxjer  air  passages  and  especially 
of  the  trachea,  the  larynx,  the  nose 
and  the  nasal  sinuses  are  essen- 
tially similar.  The  beginning  of 
the  morbid  process  is  manifested 
li}^  the  appearance  of  gray  or  yel- 
lowish, prominent  nodules  as  large 
as  millet  seeds  (rarely  larger)  and 
surrounded  by  a  tumefied  and 
brightly  reddened  area.  The  ul- 
cers resulting  from  the  breaking 
down  of  the  nodules  are  at  first 
round,  regular,  and  smoothly  bor- 
dered, but  subsequently,  as  a  re- 
sult of  progressive  tissue  destruc- 
tion, they  become  irregular  witli 
raised  borders,  ragged  edges,  pale 
yellow  lardaceous  base  covered 
with  pus  and  detritus  or,  even- 
tually, a  brown  scab.  Larger  ul- 
cers are  formed  Ijy  the  coalescence 
of  small  ones  and  these  are  usually 
surrounded  by  fresh  nodules  and 
ulcers  (Fig.  117).  On  the  other 
hand,  ulcers  that  have  "healed" 
are  replaced  by  irregular  star- 
shaped,  either  smooth  white  or 
prominent  reddish  or  white  callous 
cicatrices,  which  may,  in  some  rare 
cases,  extend  over  the  entire  sur- 
face of  one  side  of  the  nasal  sep- 
tum. In  addition  to  this  scar-like 
glanderous  growths  of  connective 
tissue  nature  may  form  without 
previous  ulcerative  processes. 


Fig.   117.   Glaiuk'ious  Ulcers  on  tlie 
Nasal  Septum . 


According  to  Johne,  glanderous  proliferations  which  may  subsequently  break 
down,  completely  or  partially,  are  products  of  attenuated  bacilli,  the  toxins  of 
which  are  no  longer  able  to  produce   coagulation  necrosis  of  the  proliferated   con- 


Anatomical  Clian,i>es.  695 

ijectivp  tissue.  That  from  such  connective  tissue  new  formations  can  actually 
develop  -without  the  previous  existence  of  lesions  has  been  confirmed  by  Ilahn  l)y 
the  demonstration  of  an  intact  mucous  epithelium  on  their  surface  and  by  Eabe, 
who  demonstrated  the  presence  of  the  normal  elastic  basement  mendjrane  of  the 
mucosa  on  the  surface  of  the  cicatrix. 

Ill  tlic  trachea  the  above-described  lesions  usually  occur 
on  the  ventral  wall,  in  the  larynx  usually  on  the  arytenoid 
cartilages,  the  lateral  ventricle  and  epiglottis.  In  grave  cases 
the  trachea  may  be  studded  with  its  entire  course  with  thickly 
strewn  nodules,  ulcers  and  cicatrices,  the  cartilages  may  even 
be  exposed  by  some  of  the  ulcers. 

In  the  nasal  cavity  only  a  few  nodules  or  ulcers  are  found, 
usually  in  the  upper  portions  and  on  one  side  only,  while  the 
lower  portion  of  the  mucous  meml)rane  suffers  no  changes  ex- 
cept catarrhal  injection  and  tumefaction.  In  cases  that  are 
less  recent  or  are  more  acute  in  character  the  mucous  mem- 
brane of  one  or  both  nasal  cavities  may  be  so  studded  with 
nodules  and  scars  that  it  is  almost  impossible  to  find  a  healthy 
area  of  tissue;  old  scars  from  former  attacks  may  also  be 
found  in  the  midst  of  acute  lesions.  In  rarer  instances  the 
ulceration  may  have  extended  to  the  cartilage  of  the  septum 
or  the  destructive  process  may  have  resulted  in  the  perfora- 
tion of  the  latter  and  formed  one  or  more  roundish  holes. 
Finally,  in  cases  that  are  equally  rare,  when  the  inflammatory 
process  has  extended  to  the  periosteum  of  the  neighboring 
bones  (maxillary,  nasal  and  muscles)  bosselated  enlargements 
and  exostoses  may  occur  on  their  surfaces. 

Disease  of  the  sinuses  is  usually  the  result  of  an  extension 
of  the  morbid  process  from  the  nasal  cavities.  The  antrum 
of  Highmore  on  the  side  of  the  affected  nasal  cavity  is  affected 
most  frequently,  the  frontal  sinus  coming  next.  Here  also  the 
disease  sometimes  leads  to  the  formation  of  nodes  and  ulcers, 
although  in  most  instances  the  surface  of  the  mucous  membrane 
is  smooth  while  its  substance  together  with  that  of  the  sub- 
mucous connective  tissue  forms  an  intensely  yellow  gelatinous 
layer  about  1-2  cm.  in  thickness,  the  corresponding  sinus  con- 
taining much  muco-pnrulent  secretion.  In  rare  cases  cicatrices 
are  found  here  also,  or  the  mucous  membrane  is  simply 
thickened,  tough  and  bosselated  on  the  surface.  Similar  morbid 
changes  are  occasionally  found  also  in  the  guttural  pouches  and 
the  Eustachian  tubes. 

The  mucous  membrane  of  the  digestive  tract  is  rarely 
found  affected.  In  exceptional  instances  lesions  are  met  with 
in  the  pharynx  but  only  when  the  nasal  cavities  are  likewise 
involved ;  here,  too,  the  lesions  consist  of  gelatinous  infiltration 
of  the  mucous  membrane  and  submucous  connective  tissue; 
occasionally  there  may  be  ulceration,  but  cicatrization  is  not 
the  rule.  Involvement  of  the  intestine  is  still  more  rarely 
observed.  In  several  horses  from  a  badly  infected  stable  the 
authors  found  the  solitary  follicles  and  Peyer's  patches  in  the 


696  Glanders. 

posterior  sections  of  the  ileum  excessively  tumefied,  while  the 
corresponding  visceral  peritoneum  was  raised  into  flat  bossela- 
tions  by  the  gelatinously  infiltrated  subserosa.  (Vecchia  ob- 
served glanderous  nodules  and  ulcers  of  the  mucous  membrane 
in  the  cecum  in  four  cases.) 

The  spleen  and  the  liver  quite  frequently  contain  small 
hyaline  nodules  or  yellowish-white  nodes  which  are  centrally 
softened  and  appear  lardaceous  upon  section.  More  frequently, 
however,  there  are  yellowish  pus  foci  or  mortar-like  masses 
surrounded  by  a  white,  tough  connective  tissue  capsule.  In 
much  rarer  instances  similar  nodes  are  found  in  the  kidneys. 
The  testes  are  more  frequently  affected.  These  lesions  are 
rare  also  in  the  brain  where  they  occur  as  gelatinous  hyaline 
or  more  or  less  purulent  foci.  Occasionally  the  muscles  of  the 
body  also  contain  glanderous  nodes,  in  a  few  cases  they  have 
been  observed  in  the  muscle  substance  of  the  heart. 

Among  the  bones,  the  ribs  are  most  frequently  the  seat  of 
morbid  changes  while  the  vertebrae  or  the  long  bones  are  rarely 
affected.  Sawed  sections  show  pale  yellowish,  roundish  or 
irregular  cavities  or  fistulous  canals  containing  a  viscous  sub- 
stance, the  bone  substance  in  the  immediate  surroundings  show- 
ing a  denser  structure.  Affection  of  the  ribs  may  be  attended 
with  an  ossifying  periostitis  as  a  result  of  which  the  diseased 
section  becomes  enlarged  to  a  remarkable  extent,  so  as  to  be 
easily  recognized  by  palpation;  the  adjacent  pleura  is  reddish- 
gray  and  contains  gelatinous  granulations. 

The  lymphatic  glands  in  the  neighborhood  of  affected 
organs  are  almost  always  involved;  thus  in  nasal  glanders  the 
maxillary  glands,  in  pulmonary  glanders  the  peribronchial 
glands,  in  cutaneous  glanders  or  farcy  of  the  extremities  the 
axillary  or  the  inguinal  glands,  as  the  case  may  be,  are  acutely 
tumefied  and  juicy  in  recent  cases,  while  in  chronic  cases  they 
are  firm  and  tough,  adherent  to  the  overlying  skin  or  surround- 
ing tissues,  and  "frequently  contain  small,  yellow  muco-caseous 
or  purulent  foci. 

In  horses  that  have  died  of  acute  glanders  we  find,  besides 
the  lesions  of  a  general  acute  infection  (tumefaction  of  the 
lymph  glands  and  the  spleen,  hemorrhages  of  the  serous  mem- 
branes) numerous  small  nodules  and  small  superficial  confluent 
ulcers  on  the  tumefied  and  reddened  mucous  membrane  of  the 
respiratory  tract,  and  usually  also  older  lesions  pf  glanders; 
the  lungs  contain  nodules,  catarrhal  pneumonic  foci  and  hemor- 
rhagic infarcts,  there  are  also  punctiform  hemorrhages  in  the 
visceral  pleura,  miliary  nodules  in  the  liver  and  spleen,  fibrino- 
purulent  inflammation  of  the  testes,  and  finally  numerous  nodes 
and  ulcers  in  the  subcutaneous  and  intermuscular  connective 
tissue. 

statistics   on   the   comparative   frequency   of   the   lesions   in  the   various   organs 
that  have  been  published  in  the  more  remote  past   (Eoell,  Haubner,  Bagge)   do  not 


Symptoms.  nqj 

correspond  to  actual  facts,  because  those  investifiators  an.l  authors  did  not  recoir- 
nize  the  initial  stages  of  the  disease  in  the  internal  organs.  But  in  snite  of  this 
the  inuneuse  frequency  of  pulmonary  glanders  lias  alwavs  been  recognized  the 
observations  nia.ie  in  this  respect  since  the  general  use  of"  niallein,  only  making  it 
more  evident,  while  disease  of  the  nose  and  skin  is  less  frequently  observed. 

Thus,  according  to  Koell,  of  17;i  glandere.l  horses  dissected  from  18G9  to  1878 
m  Vienna,  14;")  («4^J  )  were  affecte-l  with  pulmonarv  glanders;  of  21(5  glandered 
horses  dissected  at  the  veterinary  school  at  Berlin  only  10  faile<l  to  show  lesions 
of  pulmonary  affection,  in  four  cases  it  was  present  exclusively  in  the  lungs  and 
the  nose  was  free  in  :i2  instances.  On  the  other  hand,  among  27-4  horses  destroyed 
in  Budapest  in  ]S!Hi,  mostly  on  the  basis  of  mallein  reaction,  25(5  were  affecte<l 
with  pulmonary  glan-lers  exclusively,  .3  with  nasal  glanders  exclusively,  12  with 
both  pulmonary  an.l  nasal  glanders,  while  :^  of  the  latter  showed  cutaneous  lesions 
also.— According  to  Bagge's  Danish  statistics  there  were  1,33(5  cases  of  glanders 
and  167  of  cutaneous  glanders  or  farcy.— Noeard  oliserved  affection  of  the  lymph 
glands  of  the  cecum,  the  testes  and  the  right  kidney  in  one  case  in  which  all  other 
organs  were  free. 

Symptoms.  The  duration  of  incnbation  doponds  to  a  great 
extent  on  the  manner  and  on  the  intensity  of  the  infection. 
Following?  experimental  infection  from  the  skin  or  nasal  mncons 
membrane,  an  elevation  of  temperatnre  begins  as  earlv  as  the 
second  day  and  local  changes  may  be  observed  after  from  three 
to  five  days.  Tlie  alimentary  administration  of  small  quantities 
of  cultures  is  followed  in  three  or  four  days  bv  elevation  of 
temperature,  and  in  some  instances  swelling  of  the  submaxillary 
glands  and  serous  nasal  discharge  may  be  observed  on  the 
eighth  day.  After  natural  infection,  however,  several  weeks 
and  sometimes  months  may  elapse  before  evident  external 
sjTiiptoms  (except  elevation  of  temperature)  manifest  them- 
selves. (In  this  sense  Dieckerhoff  assumes  the  period  of  incu- 
bation to  be  at  least  two  weeks.) 

From  remote  times  it  has  been  customarv  to  distinguish 
pulmonary,  nasal  and  cutaneous  glanders.  For  practical  pur- 
poses this  classification  may  still  be  retained,  provided  it  is 
always  borne  in  mind  that  these  forms  merge  into  each  other 
and  that  any  or  all  of  them  may  be  present  at  the  same  time. 
However,  this  affection  usually  begins  in  the  lungs,  while  disease 
of  the  nose  as  well  as  of  the  skin  is  usually  secondary  in  nature. 

Pulmonary  glanders  usually  develops  verv  insidiously 
(latent  or  occult  glanders).  Months  may  elapse  before  a  horse 
that  is  affected  with  pulmonary  glanders  begins  to  show  the 
first  observable  symptoms  of  lung  trouble  and  these  may  be  so 
little  characteristic  that  they  will  for  a  long  time  excite  no 
suspicion  of  the  glanderous  nature  of  the  trouble ;  in  the  mean- 
time the  horse  in  question  may  have  been  the  medium  through 
which  many  others  have  boc(-)nie  infected.  In  some  cases  atten- 
tion is  attracted  to  the  animal's  condition  by  sudden  bleeding 
at  the  nose  as  the  first  SATuptoms  of  a  destructive  pulmonary 
process  (Greve)  or  the  animals  mav  discharge  bloody  mucus 
m  the  act  of  coughing  (Delamotte).  However,  the  first  SMup- 
toms  (which  in  fact  point  to  nothing  specific  except  a  chronic 
pulnionary  disease)  are  generally  manifested  in  a  ''run-down 
condition"   and  a  dull,   dry  asthenic  cough.     This   condition 


698  Glanders. 

which  simulates  heaves  may  persist  unchanged  for  a  long 
time  or  it  is  gradually  aggravated ;  percussion  of  the  thorax 
reveals  nothing  abnormal  and  auscultation  at  most  dry  or  moist 
rales.  In  rare  instances  the  percussion  sounds  may  be  some- 
what dulled  in  some  regions  or  even  quite  flat  as  a  result  of 
atelectatasis,  glanderous  infiltration  or  extensive  glanderous 
' '  growths ' '  in  certain  areas  of  the  lungs ;  upon  auscultation  the 
absence  of  the  normal  respiratory  sounds  is  noted  or  there 
may  be  distinct  vesicular  or  bronchial  respiration  admixed  with 
rales;  occasionally  there  may  be  bronchial  respiration  in  the 
area  in  question.  Eespiration  is  of  the  costo-abdominal  type 
and  more  or  less  labored.  At  the  trachea  large  moist  bubbling 
rales  may  then  usually  be  heard  while  abnormal  sensitiveness, 
painful  spasmodic  cough  or  excessive  inspiratory  dyspnea  as 
well  as  stertorous  or  snoring  respiration  point  to  an  affection 
of  the  larynx. 

In  some  cases  after  these  sjTiiptoms  have  existed  for  some 
time  and  while  the  animals  have  gradually  become  emaciated, 
more  characteristic  lesions  of  glanders  make  their  appearance 
either  on  the  nasal  mucous  membranes  or  on  the  skin  or  in 
both  regions;  previous  to  this  an  edematous  painless  swelling 
of  the  sheath  or  of  the  udder  and  of  the  extremities  may  be 
observed,  which  may  disappear  and  reappear  from  time  to 
time.  In  exceptional  cases  exclusive  affection  of  the  lungs  may 
be  attended  with  unilateral  enlargement  and  abscess  formation 
of  the  submaxillary  glands  (Eggeling). 

Nasal  glanders  begins  with  inconspicuous  symptoms  of 
nasal  catarrh.  The  mucous  membranes  are  moderately  red- 
dened and  there  is  a  slight  unilateral  or  bilateral  serous  nasal 
discharge  which  subsequently  becomes  more  mucous.  Later  on 
it  becomes  more  copious  and  purulent  or  may  consist  of  a 
mixture  of  a  greenish-yellow  serous  secretion  with  white  masses 
resembling  coagulated  egg  albumen;  sometimes  there  are 
streaks  of  blood.  The  secretion  adheres  to  the  alae  of  the 
nostrils  and  forms  dry  crusts  or  is  ejected  in  large  quantity 
by  coughing  or  snorting. 

In  the  meantime  the  catarrhal  injection  and  swelling  be- 
comes more  pronounced  and  the  veins  are  here  and  there  dis- 
tended. When  the  morbid  process  remains  confined  to  the 
upper  portions  of  the  nasal  cavities  this  condition  may  con- 
tinue for  weeks  or  even  months  without  material  change.  After 
a  certain  time,  however,  gray  or  yellowish  nodules  of  the  size 
of  hemp  seeds  or  lentils  make  their  appearance  in  the  lower 
third  of  the  cavities ;  these  soon  break  down  into  small  ulcers 
with  rather  smooth  and  sharply  defined  borders,  they  spread 
rapidly  however  and  assume  ragged  outlines,  raised  borders 
and  a  lardaceous  base.  Their  favorite  seat  is  at  the  lower 
end  of  the  turbinated  bones  and  the  opposite  surface  of  the 
septum.     They  may  finally  extend  to  the  edge  of  the  nostrils 


INSERT  FOLDOUT  HERE 


INSERT  FOLDOUT  HERE 


Knsal   Glanders,  (^99 

'vvliere  they  coalosoe  into  lari^e  irregular  ulcerous  surfaces  (see 
Fig-.  117  on  p.  69-4  and  Plate  IV).  Among  the  ulcers,  or  also 
in  their  absence,  the  regions  in  question  may  contain  hirge 
or  snuill  star-shaped,  bulging  or  flat,  reddish  or  white,  glisten- 
ing scars.  Isolated  ulcers  may  terminate  in  such  scars  where- 
upon the  nasal  discharge  subsides  temporarily  or  permanently. 
As  a  rule,  however,  exacerbations  occur  with  the  s^^uptoms 
just  described,  or  with  signs  of  some  other  localization.  In 
extensive  ulceration  of  the  nasal  mucous  membrane  the  alae 
of  the  nose  and  the  lip  may  become  swollen  and  the  skin  may  con- 
tain nodules  as  large  as  peas  and  which  subsequently  ulcerate. 
In  exceptional  instances  a  fluctuating  abscess  approaching  the 
size  of  a  walnut  may  develop  on  the  nasal  mucous  membrane  and 
occlude  the  nasal  opening  (Spassky). 

The  submaxillary  glands  are  always  enlarged  on  the  side 
of  the  affected  nasal  cavity.  At  first  the  tumor  is  somewhat 
painful  and  indefinitely  outlined,  but  subsequently  it  becomes 
painless,  firm  and  knotty.  (Fig.  118.)  In  the  beginning  the 
tumor  is  movable  but  soon  becomes  firmly  united  with  the  bone, 
the  overlying  skin  and  the  surrounding  tissues  owing  to  the 
extension  of  the  inflanunatory  process,  and  the  overlying  skin 
can  then  no  longer  be  raised  into  a  fold.  Occasionally,  and 
usually  simultaneously  with  the  appearance  of  fresh  nodular 
eruptions  on  the  mucous  membrane  of  the  nose,  acute  inflam- 
matory s}inptoms  manifest  themselves  in  the  tumor,  such  as 
increased  pain  and  swelling,  but  they  subside  again  within  a 
few  days.  In  rare  cases  a  point  in  the  periphery  of  the  tumor 
undergoes  softening,  the  overhang  skin  is  perforated  and  a 
small  quantity  of  viscous,  yellowish  muco-purulent  secretion 
is  discharged,  whereupon  the  borders  of  the  wound  contract 
and  gradually  heal  (Trasbot,  Chardin). 

Disease  of  the  nasal  cavity  is  frequently  also  attended  by 
a  catarrh  of  the  corresponding  conjunctiva.  Eichter  observed- 
a  case  in  which  the  cornea  showed  glanderous  changes,  the 
external  border  of  the  cornea  being  bluish-red  and  studded 
with  gray  or  gra^-ish-yellow  nodules  ranging  in  size  from  a 
millet  seed  to  that  of  a  pin  head;  in  the  course  of  1  to  2  days 
they  broke  down  and  formed  small  ulcers.  DeHaan  observed 
an  eye  affection  in  a  horse  that  resembled  periodical  ophthalmia, 
there  was  turbidity  of  the  cornea  and  a  tenacious  fluid  exudate 
in  the  anterior  chamber. 

In  cutaneous  glanders  nodes  and  ulcers  may  develop  in 
the  skin  or  in  the  subcutaneous  connective  tissue.  The  cutaneous 
nodes,  usually  as  large  as  peas  or  beans,  soon  break  open  and 
become  converted  into  ulcers  which  subsequently  either  heal 
or  extend  into  the  surrounding  tissue  by  the  breaking  down 
of  their  borders.  The  subcutaneous  nodes  usually  appear  on 
the  extremities,  on  the  sides  of  the  thorax  and  under  the 
abdoTuen ;  they  attain  the  size  of  a  walnut,  are  only  slightly,  if 
at  all  painful,  may  sometimes  be  fluctuating  or  surrounded  by 


700 


Glanders. 


glands 
nodes 
course 


Fresh 
in  the 
strands 


edematous  tissue.  Subsequently,  after  they  become  adherent 
to  the  skin,  a  small  round  opening  forms  and  discharges  a 
viscous,  yellowish-gray,  occasionally  reddish  pus.  By  progres- 
sion of  the  destructive  process  in  the  borders,  rather  deep 
crateriform  ulcers  form,  with  grayish-red,  easily  bleeding 
borders  that  show  torpid  granulations  and  similar  but  more 
lardaceous  bases  and  discolored,  purulent  secretion  (see  Plate 
V).  They  frequently  continue  to  progress  in  spite  of  careful 
treatment,  but  occasioiudly  local  healing  occurs,  often  with  scar 
fornLMtion.  "~ 

In  the  region  of  the 
nodes  and  ulcers  the  cen- 
tripetal hnnph  vessels  fin- 
ally become  enlarged  and 
are  then  palpable  through 
the  skin  as  slightly  pain- 
ful or  completely  insensi- 
tive tense  strands  which 
unite  the  nodes  with  tlie 
ulcers  and  with  the  neigh- 
boring enlarged  lymph 
(rosary), 
develop 
of  these 
and  subsequently  also  ul- 
cerate (Fig.  119). 

In  the  meantime  the 
edematous  infiltration  of 
the  surrounding  subcu- 
taneous connective  tissue 
progresses  and  spreads 
over  a  large  area  so  that 
finally  conspicuous, 
doughy,  painless  swellings  appear  on  the  lower  abdomen,  the 
thorax  or  on  one  or  more  of  the  extremities.  In  some  instances 
one  or  more  of  the  legs  become  enlarged  to  such  an  extent  that 
they  resemble  logs  that  are  sharply  set  off  at  the  hoofs 
(Elephantiasis  malleosa),  while  nodes  and  ulcers  may  occur 
here  and  there  in  the  tense  skin.  Enlargements  of  this  character 
interfere  seriously  with  the  movements  of  the  limbs,  and  some- 
times large  nodes,  but  especially  enlarged  lymph  glands,  may  be 
the  cause  of  locomotor  disturbances  by  exerting  pressure  on 
neighboring  nerve  trunks ;  as  a  rule,  however,  these  disturbances 
are  not  serious  on  account  of  the  painlessness  of  the  condition. 

Nocard  &  Leclainche  described  a  special  form  of  glanders  under 
the  name  of  lymphangioitis  reticularis  which  manifests  itself  in  diffuse 
swelling  affecting  in  the  course  of  a  few  hours  one  extremity  or  the 
lower  portion  of  the  body  and  is  attended  with  increased  heat  and  pain ; 
after  a  few  days  the  acute  symptoms  subside  somewhat  but  the  swelling 


Fig.    118.      Enlarged    Submaxillary 
Gland  in  Nasal  Glanders. 


Lymph 


Cxitaneous  Glanders. 


701 


persists  while  nodes  and  ulcers  sul)se4iiently  develop  in   llic  skin  and 
subcutaneous  connective  tissue. 

Glanders  of  the  bones  is  rare  and  when  observed  it  is 
usnally  in  the  form  of  spindle-slia]ied,  painless  enlarj^jements 
of  the  ribs.  deDoes  observed  the  disease  in  one  of  the  meta- 
tarsal bones,  a  painful  swelling  extending  from  the  hoof  to 
the  tarsus  having  appeared  after  the  operation  of  shoeing  and 
l)ecoming  hard  as  stone  in  the  course  of  a  month,  but  it  .subse- 
quently subsided  and  left  only  an  enlargement  the  size  of  a 


i'l. 


llJ.     Vutaut.-^... 


'/c/x   f I'arii/j,     2su^lt'-^  itii.l 


'>'")■" 


\  t-^. 


dollar.  Affection  of  the  joints  with  s37nptoms  of  moderate  pain 
and  diffuse  swelling  is  equally  rare. 

In  male  animals  a  glanderous  inflammation  of  the  testes, 
in  mares  a  similar  inflammation  of  the  udder  (Schmidt)  may 
])e  observed  in  connection  with  other  symptoms. 

In  the  line  of  general  s^nnptoms  disturbances  of  nutrition 
usually  make  themselves  manifest  before  the  disease  has  ad- 
vanced much;  even  in  the  latent  stage  of  the  affection.  In 
other  cases,  especially  in  pulmonary  glanders,  tlie  general  nutri- 


702 


Glanders. 


tioii  of  tlie  animals  may  be  re- 
markably good  for  a  long  time. 
These  distnrbances  manifest 
themselves  in  the  loss  of  the  nor- 
mal gloss  and  smoothness  of  the 
haircoat,  the  elasticity  of  the 
skin,  gradnal  emaciation  and  ex- 
cessive anemia  as  indicated  by 
the  decided  paleness  of  the  visi- 
ble mucous  membranes. 

The    body    temperature    is 
subject  to  constant  fluctuations. 
At   times  the  temperature  may 
rapidly  approach  or  exceed  39° 
to  40°   C,  but  it  returns  to  the 
normal  after  a  few  days  or  weeks, 
again  undergoing  a  rise  after  a 
few  days,  weeks,  or  months  (see 
Fig.  120).    These  fluctuations  are 
observed  much  more  frequently 
in  work  horses  than  in  animals 
that  are  permitted  to  rest  much. 
According     to     Eckert     the 
amount    of   fibrin    in    the    blood 
steadily    increases    toward    the 
termination  of  the  disease  while 
the    hemoglol)in    slightly    dimin- 
ishes, although  it  shows  no  fluc- 
tuations in  the  course  of  the  dis- 
ease.    MikrukoAV  observed  a  re- 
duction in  the  numljer  of  erythro- 
cytes and  an  increase  in  the  leuco- 
cytes, the  proportion  being  1:125 
near  the  termination  of  the  dis- 
ease.    The  red  cells   showed  no 
tendency  to  form  rolls,  they  were 
paler   than  normal,  greenish   in 
color    and    of    irregular    form. 
Burnett  &  Pearce  also  often  ob- 
served leucocytosis. 

In  very  sick  animals  heart 
weakness  may  develop,  resulting 
in  many  forms  of  venous  conges- 
tion (nasal  mucous  membrane) 
and  being  responsible,  in  part  at 
least,  for  the  edematous  swell- 
ings of  the  extremities,  the  abdo- 
men and  the  sheath, 


Acub'   CHauck'rs.  703 

Acute  glanders,  wliieli  usually  develops  I'rom  tlie  chronic 
form  in  horses,  but  frequently  appears  primarily  in  nmles  and 
asses  is  characterized  by  rapidly  aggravated  symptoms  of  a 
general  acute  infection.  Attended  with  sudden  elevation  of 
t(Mn])erature  and  other  fel)rile  symptoms  large  numbers  of 
fresh  glanders  nodes  and  their  consequent  ulcers  appear  in  the 
course  of  a  few  days,  on  any  portion  of  the  body,  but  particularly 
in  the  nose  and  uiKler  the  skin.  The  nasal  mucous  meml)rane 
tliroughout  its  extent,  nuiy,  in  tiie  course  of  2  to  3  days,  become 
thickly  studded  witli  nodules  and  ulcers;  coincident  with  this 
condition  is  a  profuse  and  often  bloody  nasal  discharge;  the 
resi)iration  becomes  wheezing  as  a  result  of  the  swollen  nasal 
mucous  menibi'anes  and  of  the  submucous  connective  tissue, 
while  the  submaxillary  glands  become  larger  and  sensitive. 

Simultaneously  with  the  appearance  of  these  conditions 
acute  edematous  swellings  with  nodes  or  farcy  buds  in  the  sur- 
rounding cutis  and  subcutaneous  tissue  make  their  appearance; 
the  nodes  soon  undergo  softening,  the  resulting  ulcers  become 
confluent,  producing  extensive  discolored,  ulcerating  surfaces. 
The  superficial  hanph  glands  undergo  acute  swelling  and,  in 
some  instances,  suppuration. 

In  the  meantime  the  animals,  in  a  constant  condition  of 
fever,  emaciate  rapidly,  respiration  becomes  labored,  and  pulse 
accelerated  and  small ;  finally  diarrhea  sets  in,  whereupon  death 
usually  follows  in  the  course  of  the  second  or  third  week  of 
the  acute  alfection. 

Course.  The  course  of  this  disease  may  be  extremely 
variable,  extending  over  a  few  weeks  or  over  several  years 
(Dieckerhoff  was  able  to  trace  the  course  of  one  case  back  for 
seven  years  while  Petrowsky  reports  a  case  of  six  years'  stand- 
ing). In  the  course  of  the  disease,  which  is  usually  chronic 
in  character,  acute  exacerbations  alternate  with  periods  of 
subsidence  or  of  apparent  complete  arrest  of  the  morbid 
process;  near  the  end,  however,  the  chronic  cases  usually  as- 
sume an  acute  character  and  terminate  with  the  sjTuptoms 
a])ove  described.  In  rare  cases  the  fatal  termination  is  the 
result  of  gradual  exhaustion  or  of  a  sudden  pulmonary  hemor- 
rhage. Tlie  temperature  elevations  that  are  occasionally  ob- 
served in  the  course  of  the  chronic  disease,  are  usually  due  to 
the  development  of  fresh  glanderous  foci,  particularly  in  the 
formation  of  glanderous  lesions  in  the  skin  and  subcutaneous 
connective  tissue. 

The  acute  exacerbations  may  occur  without  external  cause 
in  the  normal  course  of  the  disease,  or  they  may  appear  as  the 
result  of  an  intercurrent  acute  affection,  as  for  instance  an 
influenza-catarrh  of  the  upper  air  passages.  In  general  the 
disease  develops  more  rapidly  in  animals  in  a  poor  state  of 
nutrition  or  in  hard  worked  animals  in  which  it  assumes  an 
acute  character  at  an  earlier  stage  than  under  favorable  con- 


704  Glanders. 

ditions.  Auto-infection  of  animals  by  the  contamination  of 
their  food  and  drinking  water  with  their  nasal  and  pulmonary 
secretions  also  bears  a  certain  relationship  to  the  gradual  ag- 
gravation of  the  disease. 

In  a  certain  proportion  of  cases  the  disease  terminates  in 
recovery.  The  possibility  of  a  local  healing  of  the  ulcers  is 
proved  by  the  presence  of  the  characteristic  cicatrices  on  the 
nasal  mucous  membranes  and  on  the  skin,  as  well  as  by  the 
frequently  observed  dry,  cheesy  and,  in  some  instances,  partly 
calcified  foci  in  the  lungs  and  other  internal  organs  the  glander- 
ous nature  of  which  has  repeatedly  been  demonstrated. 

According  to  observations  made  in  the  warmer  southern 
countries,  for  instance,  in  Southern  Russia  (Noniewicz,  Semmer) 
the  course  of  the  disease  is  not  infrequently  benign  in  character, 
and  horses  that  have  already  presented  clinical  symptoms  of 
the  disease  may  occasionally  recover  (Semmer).  Finally  the 
possibility  of  recovery  from  the  disease  has  been  demonstrated 
by  observations  occasionally  made  in  connection  with  mallein 
tests,  according  to  which  horses  that  have  once  reacted  to  the 
test  cease  to  react  to  subsequent  applications  of  this  agent 
and  remain  free  frota  disease  thereafter,  while  post-mortem 
examination  reveals,  in  various  internal  organs,  encapsuled 
nodules  that  are  in  every  respect  similar  to  those  of  glanders. 
These  observations  point  directly  to  the  fact  that  even  in 
northern  countries  (Middle  Europe)  the  disease  not  infrequently 
results  in  recovery  in  its  initial  stages,  when  only  a  few  nodules 
have  as  yet  developed  in  the  internal  organs. 

In  the  stables  of  the  Compagnie  geiierale  des  Voitures  2,037  out  of  10,231 
horses  gavS  characteristic  reactions  to  the  mallein  test  in  1895 ;  of  these  687  sub- 
sequently developed  manifest  symptoms  of  glanders,  while  338  horses  ceased  to 
react  to  later  injections  of  mallein  A  part  of  the  non-reactors  were  subsequently 
killed  for  other  reasons,  and  in  all  of  them  Nocard  found  fibrous  or  calcareous 
lesions  in  the  internal  organs. 

The  possibility  of  recovery  from  the  disease  should,  how- 
ever, be  counted  upon  only  in  those  cases  that  present  no  clinical 
evidences  and  that  have  been  determined  by  the  mallein  reac- 
tion. On  the  other  hand,  all  cases  showing  clinical  signs  of 
infection  should,  for  practical  purposes  at  least,  be  considered 
as  incurable,  although  local  processes  may  heal  while  new 
lesions  develop  in  other  parts  of  the  body. 

Diagnosis.  Since  the  various  symptoms  do  not  present  a 
characteristic  clinical  picture  in  the  chronic  form  of  the  disease 
until  the  later  stages,  and  since  symptoms  that  are  characteris- 
tic in  themselves,  such  as  nodes  and  ulcers  in  the  nasal  mucous 
membrane,  do  not  occur  until  the  disease  is  quite  advanced,  the 
definite  diagnosis  of  glanders  upon  the  basis  of  clinical  symp- 
toms alone  is  frequently  a  difficult  matter 

In  stables  where  the  disease  has  already  been  recognized 


Diagnosis.  -r|- 

in  some  of  the  animals,  in  otiier  words,  in  stables  that  are  known 
to  be  inteetod,  mere  temporary  elevation  of  temperature  in 
otherwise  api)arently  healthy  animals  is  in  itself  suffieient 
evulence  upon  whieh  to  ])ase  suspicion,  especially  when  a  tem- 
porary nasal  discharcfe  and  slight  swelling  of  the  submaxillarv 
glands  has  been  noted  and  when  the  elevations  of  temperature 
recur.  ^ 

Any  nasal  discharge  of  some  duration,  especially  when  it 
IS  unilateral  and  possesses  the  characteristics  descrilied  above 
and  any  chronic  swelling  of  the  submaxillary  dands  should 
direct  suspicion  to  glanders.  These  symptoms  'are,  however 
not  characteristic  either  alone  or  collectively,  because  similar 
symptoms_  are  occasionally  observed  in  simple  nasal  catarrh 
and  especially  in  catarrh  of  the  antrum  of  Highmore  and  of 
the  giittural  pouches.  The  above-mentioned  symptoms  mav 
however,  be  present  for  a  long  time  without  apparent  change! 
especially  when  the  patients  are  kept  at  rest  and  otherwise 
under  favorable  conditions  of  feeding.  The  nasal  catarrh  and 
even  the  swollen  lymph  glands  may  then  subside  to  some  extent 
and  the  ulcers  undergo  healing  (cicatrization  in  the  nasal 
mucous  membrane!). 

The  absence  of  a  pronounced  acute  character  of  the  in- 
flammatory changes  and  the  torpid  character  of  the  ulcers  point 
to  the  glanderous  nature  of  skin  lesions  while  any  edematous 
swelling,  nodular  enlargement  or  ulceration  on  knv  part  of 
the  body  especially  the  ventral  surface  of  the  abdomen,  on 
the  sheath,  the  udder  and  the  extremities,  if  not  accountable 
tor  m  some  other  manner  must  be  regarded  with  suspicion 

1  he  recognition  of  pulmonary  glanders  is  attended  with 
the  greatest  difficulties.    For  months  s^Tiiptoms  of  chronic  luno- 
aftection  may  persist  without  any  specific  character  whatever' 
such  as  occasional  weak,  dull  cough,  rapid  exhaustion  durin^ 
work,  poor  condition,  rough  hair  coat,  now  and  then  moderatS 
fever,  etc.     iliese  are  the  s^Tiiptoms  of  heaves  in  general    and 
may  therefore  be  brought  on  by  other  causes,  since,  however 
they  may  have  a  glanderous  origin  as  well  it  is  alwavs  advisable' 
where  the  least  opportunity  for  exposure  has  existed,  to  look 
upon  such  an  animal  at  least  with  suspicion. 
^      The  difficulties  that  often  present  themselves  in  the  recogni- 
tion of  glanders  may  be  overcome  by  recourse  to  special  methods 
of  diagnosis. 

Extirpation  of  the  Submaxillary  Tumor.  The  operation  is  usually 
performed  easily  on  the  standing  animal  and  may  be  of  service  in  those 
cases  where  no  otlier  symptoms  exist  than  swelling  and  nasal  discharge 
In  case  the  tumor  is  glanderous,  small  cheesy  foci  surrounded  bv  a 
reddened  area  will  be  found  in  the  tough,  white,  fre<|uentlv  lardaceous 
connective  tissue.  (According  to  Bistroumow  immersion  in'5%  carbolic 
acid  solution  brings  out  the  foci  more  prominentlv  above  the  surface 
of  the  section.)  The  presence  of  these  lesions  makes  the  diacr„osis 
of   glanders  very   probable,   and   the   authors  have   confirmed   this   in 

Vol.  1—45 


706  Glanders. 

all  cases  by  post-mortem  examination.  The  foci  in  question  are  adapted 
equally  well  for  microscopical  examination  and  for  the  inoculation 
of  experiment  animals.  According  to  Rudenko  glanders  bacilli  may 
be  found  in  lymph  glands  as  early  as  two  days  after  endo-nasal  or 
percutaneous  infection,  while  no  other  changes,  except,  at  most,  slightly 
increased  juiciness  of  the  tissues,  are  visible  to  the  naked  eye. 

Microscopical  Examination.  The  practical  value  of  a  microscopical 
examination  is  limited  by  the  fact  that  the  bacilli  of  glanders  are  not 
readily  recognized  as  such  in  bacterial  mixtures.  Both  the  nasal  secre- 
tions as  well  as  the  secretions  of  ulcers  always  contain  a  mixed  bacterial 
flora  and  are  consequently  ill  adapted  for  a  microscopical  diagnosis. 
Freshly  incised  nodes  in  the  skin  or  subcutaneous  connective  tissue 
constitute  an  exception  to  this  however,  as  do  also  the  foci  in  the  sub- 
maxillary lymph  glands,  but  the  bacilli  are  present  in  these  in  such 
limited  numbers  that  their  discovery  is  not  always  an  easy  matter. 
However,  when  bacilli  that  resemble  those  of  glanders  in  their  mor- 
phological characteristics  and  stain  according  to  Gram's  method  are 
found  in  such  material,  the  diagnosis  of  glanders  is  justified. 

The  technic  of  the  examination  consists  in  the  staining  of  coverglass  prepara- 
tions with  aqneous  or  carbolized  anilin  staining  solutions.  Loefiier  's  method 
(Staining  fluid:  30  ce.  concentrated  alcoliolic  methylene  blue  solution  +  100  cc. 
of  a  1:10,000  caustic  potash  solution  or:  anilin  water,  gentian  violet  or  fuchsin 
and  similarly  diluted  caustic  potash  solution  or  ^A^  ammonia  aa,  followed  by 
treatment  with  acetic  acid)  as  well  as  the  method  of  Sahli  (Staining  solution:  i{.% 
methylene  blue  solution  and  1%  Borax  solution  aa)  are  in  no  way  superior  to  the 
ordinary  methods. 

Culture  Method.  This  may  occasionally  give  positive  results  when 
the  microscopical  examination  was  fruitless.  Sterile  boiled  potatoes  or 
coagulated  blood  serum  are  specially  adapted  for  this  purpose.  A 
small  quantity  of  the  contents  of  a  suspected  focus,  obtained  under 
aseptic  precautions,  is  carefully  spread  over  the  surface  of  the  medium 
by  means  of  a  platinum  needle.  If  kept  at  a  temperature  of  25°  to 
27°  C,  distinctly  visible  colonies  may  be  recognized  after  3  to  4  days 
by  their  viscous  nature  and,  on  the  potato  medium,  by  their  honey- 
yellow  color  which  subsequently  becomes  reddish-brown.  On  blood 
serum  they  have  a  honey-like  opacity  and  are  viscid  like  the  potato 
cultures  (on  potatoes  some  strains  of  coli  bacilli  form  similar  masses, 
though  are  less  distinctly  reddish-brown,  hut  more  yellowish-gray  and 
not  viscid).  If  the  material  is  applied  thinly  the  bacillus  may  some- 
times be  obtained  in  isolated  colonies  from  bacterial  mixtures. 

Portions  of  organs  with  suspected  glanderous  changes  are  best  preserved  in 
glycerin  and  sent  to  specially  equipped  laboratories  for  bacteriological  examina- 
tion. According  to  Galtier  tissues  that  are  infected  with  bacilli  and  immersed  in 
30%  glycerin  will  retain  their  virulence  for  at  least  ten  days,  and  frequently 
as  long  as  30  days. 

Diagnostic  Animal  Inoculations.  The  inoculation  of  experiment 
animals  with  suspected  morbid  products  may  frequently  give  very 
valuable  results,  although  they  are  decisive  only  when  they  furnish 
positive  evidence.  Such  results  are  best  obtained  by  the  inoculation 
of  material  from  the  interior  of  encapsulated  nodes  or  abscesses  or 
from  the  base  of  fresh  ulcers,  while  nasal  secretion  is  less  adapted  for 
this  purpose  because  it  usually  contains  admixtures  of  other  bacteria 


Dia.irnostir   Animal   Tiidculnlioiis.  707 

and  may  prodiu-i'  septicemia.  (^Aruch  &  Savaresc  obtained  positive 
results  from  the  inoeulation  of  aspirated  pulmonary  secretions).  A 
negative  result  from  sueh  an  inoeulation  tloes  not,  however,  justify 
the  exelusion  of  ^danders  because  virulent  bacilli  are  fre(|uently  absent 
in  true  glanderous  lesions  or  secretions,  and  because,  on  the  other  hand, 
foreign  bacteria,  e.  g.,  pus  cocci  may  ])revent  the  pathogenic  action 
of  the  glanders  bacilli  by  stimulating  pluigocytosis  (Panisset).  Aside 
from  the  solidungula  experiment  animals  best  adapted  for  this  pur- 
pose are,  above  all  others,  guinea  pigs,  after  Avhich  come  the  cat  and 
the  dog. 

Of  the  solidniifjula  the  ass  is  the  most  suitable  animal,  althoufrh  horses  and 
mwles  may  also  be  used.  The  application  of  glanderous  material  to  the  nasal 
mucous  meinlirane  or  its  subcutaneous  administration  is  usually  followeil  by  the 
development  of  acute  glanders  in  three  or  four  days  and  terminates  fatally  in 
about  10  to  14  days.  Jt  may  be  recognized  with  certainty  long  before  its  fatal 
termination  by  the"  characteristic  symptoms  (nasal  glanders  follows  also  the  sub- 
cutaneous administration  of  the  virus).  Unfortunately  the  expense  attending  the 
use  of  these  animals  for  experimental  or  diagnostic  purposes  makes  this  method 
impracticable. 

The  inoculation  of  guinea  pigs  with  glanderous  material  is  also  followed  by 
the  development  of  characteristic  lesions  of  disease.  Jf  the  material  was  ajiplied 
sul)cutaneously  (Trasbot,  LoeJller),  a  swelling  develops  at  the  ))oint  of  inoculation, 
followed  by  an  ulcer  with  thick  borders  ami  purulent  base  and  s\disequently  by  sup- 
puration of  the  regional  lymph  glands. — After  intraperitoneal  injection  (Strauss) 
in  males  the  testes  begin  to  swell  \n  from  2  to  4  days,  though  exce])tionally  not 
until  the  12th  day,  becoming  hot  ami  jiainful;  subsequently  they  ru])tnre  and  dis- 
charge pus  that  contains  large  nund:)ers  of  bacilli;  at  the  same  time  the  animals 
emaciate  and  usually  die  in  about  two  weeks  after  inoculation.  Tn  some  instances 
nasal  glanders  also  develops  (sneezing,  wheezing  respiration,  nasal  discharge)  and 
one  or  more  joints  or  extremities  may  become  swollen.  The  animals  may  be  killed 
upon  the  appearance  of  the  ulcers  or  of  the  swelling  of  the  testes  or  lymph  glands; 
at  post-mortem  examination  purulent  exudate  is  formed  between  the  tunics  of  the 
testes,  small  white  points  like  needle  pricks  or  somewhat  larger  may  be  found  in 
the  spleen,  liver,  testes,  lymph  glands,  etc.,  and  in  these  the  liacilli  of  g]an<lers  can 
usually  be  demonstrated  in  large  numbers,  either  microscopically  or  by  cultural 
means.  (Lienaux  observed  that  periorchitis  occasionally  did  not  develop  until  after 
the  12th  day,  while  Cadeac  «S:  Malet  observed  in  exceptional  cases  a  chronic  affec- 
tion following  intraperitoneal  injection  of  the  virus,  which  persisted  for  2  to  4 
months;  post-mortem  examination  revealed  dry,  cheesy  foci  in  the  internal  organs, 
and  the  nasal  mucous  memlirane  contained  deep  and  extensive  ulcers.  According  to 
these  authors,  inoculation  glanders  in  guinea  pigs  may,  in  exceptional  cases,  ter- 
minate in  recovery). 

The  subsequent  bacteriological  examination  of  the  exudate  of  the  testes  and 
of  the  metastatic  foci  of  the  internal  organs  must  not  be  neglected  for  the  reason 
that  orchitis  occurs  also  after  inoeulation  of  other  bacteria.  Nocard  demonstrated 
this  to  be  the  case  with  the  V)acillus  of  ulcerous  lymphangioitis  of  horses  (see 
p.  731),  Preisz  in  regard  to  the  bacillus  of  pseudotuberculosis  in  sheep  (see  p. 
633),  Kutcher  with  regard  to  a  bacillus  found  with  the  bacillus  of  glanders  in 
a  guinea  pig  that  had  been  inoculated  with  the  nasal  secretion  of  a  horse  (see 
p.  632)  ;  these  bacilli,  however,  in  contrast  to  glanders  bacilli  stain  according  to 
Gram.  Accor<ling  to  Baruchello  the  TuTc  Pyocyaneus  may  in  guinea  ]iigs  occasion- 
ally be  the  cause  of  periorchitis,  although  this  is  not  followed  by  ulceration  of 
the  swelling.  Nicolas  demonstrated  an  oval  bacillus  in  a  periorchitis  following 
intraperitoneal  injection  of  a  guinea  pig,  with  nasal  secretion  from  a  horse,  and 
observed  nodules  resendiling  those  of  glamlers  in  the  internal  organs.  Finally, 
Lignieres  produced  an  exudative  periorchitis  in  guinea  pigs  with  the  actino-bacillus 
Basset  obtained  the  same  result  with  a  small  Oram  negative  bacillus  obtained 
in  culture  from  a  rabbit  att'ecteil  with  pseudotidjerculosis,  (Jagnet  with  a  bac- 
terium obtainc'l  from  pus  foci  in  the  abdominal  organs  of  a  guinea  pig,  Pan- 
isset  &  Loiseau  with  the  bacillus  of  human  diphtheria,  and  Joly,  Basset  and 
Panisset  with  tubercle  bacilli. 

According  to  the  observations  of  Russian  experimentalists  (Lisicyn,  IMalzew, 
Sacharow,  etc.)  cats  are  specially  adapted  for  diagnostic  inoculations.  In  animals 
that  have  been  inoculated  siibcutaneously  the  temjierature  rises  to  40°-42..1''  C. 
beginning  with   the   2nd   or   3rd   day  ami   remains  at  this  height;    at   the   point   of 


708  Glanders. 

inoculation  a  circumscribed  swelling  develops,  and  4  to  7  days  thereafter  an  ulcei 
appears;  subsequently  to  this  similar  nodes  and  ulcers  appear  in  other  portions  of 
the  body,  and  finally  the  lesions  of  nasal  glanders  make  their  appearance.  Fol- 
lowing rapid  progressive  emaciation  the  animals  die,  with  few  exceptions,  on  the 
5th  to  the  12th  day  after  inoculation.  On  post-mortem  examination  the  lungs, 
spleen,  testes,  etc.,  are  found  to  contain  nodules;  bacilli  may  al^o  be  demonstrated 
in  the  blood.  (Young  cats  are  particularly  recommended  as  suitable  subjects  for 
inoculation.) 

Dogs,  especially  young  dogs,  are  also  adapted  for  experimental  inoculation 
(Puetz,  Galtier,  Gruenwald,  etc.).  After  the  application  (by  rubbing)  of  the  nasal 
discharge  of  a  glaudered  horse  to  the  scarified  skin  at  the  forehead,  ulceration  may 
be  observed  on  the  3rd  to  the  4th  day;  in  the  majority  of  cases  recovery  takes  place, 
although  in  some  instances  general  infection  may  result,  leading  to  the  formation 
of  miliary  nodules  in  the  lungs,  spleen,  etc. 

Finally  field  mice  and  a  certain  species  of  arvicola  may  be  used  for  diagnostic 
inoculations  (Kitt),  but  only  in  cases  where  the  inoculating  material  is  known, 
beforehand,  to  be  free  from  foreign  admixtures.  > 

Technic  of  Inoculation.  The  most  expedient^  method  of  inoculating  horses 
and  asses  is  to  insert  the  suspected  material  or  secretion  into  the  nat-al  mucous 
membrane  by  means  of  an  inoculating  needle  or  applying  it  directly  to  a  portion 
of  the  mucous  membrane  that  has  previously  been  prepared  by  rubbing  with  a 
piece  of  coarse  linen.  Inoculation  of  the  skin  is  less  reliable  because  the  resulting 
nodule  not  infrequently  heals  before  definite  results  are  obtained.  The  subcutaneous 
injection  of  a  larger  mass  of  secretion  mixed  with  water  is  more  apt  to  produce 
results. 

If  pure  material  is  at  our  disposal,  guinea  pigs  are  best  infected  by  intra- 
peritoneal injection,  otherwise  (in  the  use  of  nasal  secretion  or  material  from  a  con- 
taminated ulcer)  the  subcutaneous  or  intramuscular  method  is  better.  Under  the 
first  named  conditions  a  small  quantity  of  the  suspected  material  is  thoroughly 
ground  up  in  a  mortar  with  distilled  water,  filtered  through  a  sterile  piece  of  linen 
and  then  injecte<l  with  a  hypodermic  syringe  into  the  abdominal  cavity;  in  sub- 
cutaneous inoculation  the  hair  is  clipped  from  a  small  area  on  one  side  of  the 
abdomen,  an  incision  is  made  through  the  skin  and  a  small  pocket  formed  with  the 
end  of  the  scalpel  handle,  whereupon  a  small  particle  of  the  susjiected  tissue  (as 
large  as  a  lentil)  is  inserted  and  the  skin  firmly  pressed  into  place;  the  intra- 
muscular inoculation  consists  in  the  injection  of  an  emulsion,  prepared  as  above 
described,  into  the  muscles  of  the  thigh  (according  to  Aruch  &  Savarese  lesions 
are  produced  more  rapidly  V)y  this  method  than  by  subcutaneous  infection),  if  at 
all  possible  several  animals  should  be  inoculated,  and  preferably  males. 

Cats  receive  subcutaneous  injections  of  the  emulsion,  while  dogs  may  be  infected 
by  insertion  of  a  ^eton  saturated  with  the  suspected  material  into  the  subcutis  of 
the  back  of  the  neck  (Puetz,  Galtier),  or  the  skin  of  the  forehead  may  be  scarified 
by  means  of  superficial  incisions  and  the  material  applied  directly  (Nocard).  A 
more  practical  method  consists  in  the  injection  of  the  suspected  material,  after  dilu- 
tion with  sterilize<l  water,  into  a  joint,  a  serous  cavity  or  under  the  skin   (Balitzky). 

Allergic  Mallein  Reactions.  Infection  with  glanders  pro- 
duces a  peculiar  allergic  condition  of  the  animal  body  very 
similar  to  that  observed  in  tuberculosis  (see  p.  574).  This 
condition  manifests  itself  by  an  increased  susceptibility  to  the 
toxins  of  the  disease-producing  organism.  This  hyper-sensitive- 
ness is  made  use  of  for  diagnostic  purposes  by  administering 
the  toxin  of  the  bacillus  of  glanders  to  the  suspected  animals 
in  question,  and  the  resulting  positive  or  negative  reaction  is 
looked  upon  as  an  index  of  the  presence  or  absence  of  infec- 
tion, as  the  case  may  be. 

Mallein  constitutes  the  antigen  or  inoculating  material. 
It  is  prepared  from  the  cultures  of  glanders  bacilli  and  is  in- 
jected into  the  subcutaneous  connective  tissue  or  applied  to 
the  conjunctiva. 


Subcutaneous  Mallein  Test.  7OO 

Preparation  of  Mallein.  ^Fallein  contains  the  toxic  sulistanco,  on.lo-  an«l  exo- 
toxin, of  tiio  ylamliTS  liacillus  cultivated  in  a  liquid  glycerine  nie<liuni.  Jt  was  first 
prepared  by  llelinan  and  J-Calning  by  extraction  of  potato  cultures.  I*reusse  as  well 
as  I'reisz  prepared  the  material  as  follows:  Potato  cultures  that  have  been  ]ierniitt(>d 
to  grow  for  t^everal  months  are  immert'ed  in  a  mixture  of  equal  i)arts  of  water  and 
glycerine  ami  kept  for  several  days  in  an  incubator  at  '.\~i°  to  37°  C. ;  the  li(|uid  is 
then  sterilised  l)y  means  of  steam  and  filtereil  thro\igh  ]iorcelain  (in  order  to  insure 
greater  uniformity  of  the  product;  I'reisz  adds  l)i('hloride  of  mercury).  Koux  culti- 
vates highly  virulent  glan<lers  bacilli  in  glycerine-iieiiton-bouillon ;  at  the  end  of 
4  weeks  tho  culture  is  sterilized,  filtered  and  evai)oratc<l  to  ,'0  its  original 
volume  (a  similar  method  is  recommended  by  I^ang,  also  by  Johne;  the  latter, 
however,  does  not  evaporate  the  filtrate,  but  adds  nine  volumes  of  a  2%  solution  of 
carbolic  acid).  In  Kussia,  also,  mallein  is  used  in  its  dilute  form  in  1.0  cc.  doses. 
It  is  i)repared  by  Kresling  by  cultivating  a  specially  toxic  strain  of  bacilli  in  ~>'/f 
glycerine  bouillon  for  a  perioil  of  S  months.  Foth  evajiorates  the  original  bouillon 
culture  to  ^g  its  volume,  then  treats  tho  same  with  absolute  alcohol,  and  in  this 
way  obtains  a  white  preci]>itate  which  subsetpiently  becomes  yellow;  when  dry  this 
leaves  a  spongy  mass,  which  is  readily  pidveri7eil  (dry  mallein).  Schweinitz  & 
Kilborne  ])roduce  a  ])ulverizeil  form  of  mallein  by  a  similar  metliod,  while  A.  Bales 
prepares  his  ''Morvin,"  which  is  used  almost  ex(dusively  in  Koumania,  by  culti 
vating  the  bacilli  on  boiiil!on-i)Otato  medium;  5-7  weeks  later  this  mass  is  washed 
on  a  Witt  filter  until  the  addition  of  alcohol  to  the  filtrate  no  longer  produces  a 
])recii)itate.  Finally  Schniirer  attempted  to  proiluce  an  effective  niallein  by  dis- 
solving glanders  bacilli  in  2%  antiformin  solution,  evaporating  to  ^^  of  its 
volume  and  obtaining  therefrom  an  alcohol  precipitate.  This  ])reparation,  though 
it  possessed  properties  similar  to  those  of  mallein,  was  only  1/ l.l  of  the  strength 
of  Eoux's  crude  mallein. 

Crude  niallein  is  a  dark  brown,  syrupy  fluid  possessing  a  ]>eculiar  odor  and 
having  a  neutral  or  slightly  acid  reaction,  if  kept  in  a  cool  place  and  protected 
from  sunlight  it  retains  its  activity  for  months.  When  injecteil  in  large  doses 
(20  to  50  cc.)  into  the  blood  of  healthy  horses  it  may  jiroduce  death,  preceded  by 
symptoms  of  increased  heart  activity,  respiratory  difficulties  and  ])rofuse  sweat;  the 
subcutaneous  injection  of  doses  of  1.0  to  2.0  gm.  into  healthy  horses  produces  no 
morbid  symptoms;  on  the  other  hand  in  horses  affected  with  glanders  even  smaller 
doses  will  produce  a  characteristic  reaction.  Experimentally  infected  guinea  pigs 
react  both  locally  and  generally  to  injections  of  0.2  to  0.5  gm.,  while  the  injection 
of  2.0  gm.  into  healthy  guinea  pigs  produces  only  temporary  elevation  of  tempera- 
ture  (Pearson). 

The  effectiveness  of  mallein  varies  according  to  the  virulence  of  the  strain  of 
bacilli  use<l  as  well  as  to  the  method  according  to  which  it  has  been  prepared.  At 
present  we  have  no  reliable  methods  of  standardizing  this  material,  aside  from  its 
practical  application  in  testing  glandered  horses. 

1.  Subcutaneous  Mallein  Test  (Tliormic  Eeaction).  Fol- 
lowino-  the  siibcntaiioons  injection  of  a  suital)le,  comparatively 
small  (lose  of  mallein  glandered  horses  show  a  rise  of  body 
temperature  which  usually  begins  in  the  fourth  to  eighth  hour 
after  injection  and  rapidly  increases  for  from  8  to  14  hours,  in 
exceptional  cases  not  until  the  sixteenth  or  thirtieth  hour,  until 
it  reaches  its  maximum  ;  after  this  the  temperature  gradually 
returns  to  the  normal,  but  frequently  a  second  less  pronounced 
elevation  may  be  observed  (Fig.  121).  In  the  course  of  the 
thermic  reaction  other  febrile  sym])toms  may  also  frequently 
be  observed  (organic  reaction);  thus  increased  heai't  action 
and  respiration,  which,  however,  are  not  always  synchronous 
with  the  change  of  temperature,  muscular  tremors,  which,  when 
they  occur  at  all,  usually  appear  between  the  sixth  and  eighth 
hour  after  injection;  that  is,  in  the  beginning-  of  the  febrile 
attack;  finally  there  may  be  depression,  dullness  and  loss  of 
appetite,  as  well  as  a  more  or  less  extensive  inflammatory 
edematous  swelling  at  point  of  injection  (Fig.  122).     (In  the 


710 


Glanders. 


case  of  glanders  of  the  cornea  before  referred  to  [see  p.  699] 
Ricliter  observed  hyperemia  of  the  corresponding  region  of 
the  cornea  after  subcutaneous  injection  of  the  mallein.  The 
number  of  visible  nodules  on  the  cornea  became  very  numerous. 
On  the  other  hand  Walter  observed  conspicuous  redness  of 
the  cutaneous  ulcers  during  a  reaction).  In  some  cases  the 
temperature  remains  permanently  elevated  after  the  appear- 
ance of  the  reaction  and  the  disease,  which,  up  to  this  time, 
has  been  chronic,  takes  an  acute  course,  the  general  s^anptoms 
increase  in  intensity  and  the  animal  succumbs  in  the  course 
of  a  few  weeks.  Healthy  animals  do  not  react  to  mallein;  and 
in  horses  with  other  diseases  a  reaction,  though  occasionally  ob- 
served, is  of  very  exceptional  occurrence  (possibly  in  some  cases 
of  alveolar  emphysema  of  the  lungs?). 


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Fig.  121.     7'i/pical  Tlnriniv  Mallein  Reaction. 

In  interpreting  the  results  of  the  mallein  reaction  the  fol- 
lowing principles  should  be  observed: 

A  mallein  reaction  is  positive  (typical)  if  the  temperature 
after  injection  exceeds  the  preinjection  temperature  by  2°  C.  or 
more  and  rises  above  40°,  providing  the  preinjection  tempera- 
ture did  not  indicate  fever.  The  reaction  is  positive,  also,  if 
the  increase  in  temperature  is  only  1.5  to  1.9°  C.  or  exceeds 
29.5  to  39.9'  C,  providing  it  is  attended  with  a  pronounced 
organic  reaction. 

The  reaction  is  indefinite  or  doubtful  if  the  rise  in  tempera- 
ture equals  1.0  to  1.9°  C.  and  no  organic  reaction  occurs. 

The  reaction  is  atypical  if  the  rise  in  temperature,  no  matter 
how  excessive  this  may  be,  is  very  rapid  and  subsides  with  equal 


Sulic-iitaiiemis  Mallein   Test. 


711 


suddenness,  that  is,  if  the  febrile  condition  is  of  short  duration 
only,  four  to  six  hours  at  the  most. 

The  reaction  is  negative  if  the  rise  of  temperature  does 
not  exceed  1.0°,  or  39.0    C. 

A  positive  (typical)  reaction  justifies  the  conclusion  that 
the  horse  in  question  is  affected  \vith  glanders;  on  the  other 
hand  a  doubtful  reaction  as  well  as  an  atypical  reaction,  justifies 
a  suspicion  only,  in  which  case  a  final  decision  depends  upon 
a  repetition  of  tiie  test  in  about  four  weeks;  finally  the  absence 
of  a  reaction  in  a  horse  in  good  condition  and  not  of  great  age, 
justifies  the  exclusion  of  tlie  disease. 


Fi<^.  122.  Organic  Mallein  Reaction.  Edoinatous  Swollinjf  at  tlie  Point  of  In- 
jection and  the  Afferent  Lymph  Vessels  Following  Subc  itaneous  Injection  of 
jNIallein. 


In  regard  to  the  interpretation  of  mallein  reactions  the  views 
are  still  quite  at  variance.  AVlien  mallein  was  first  introduced  into 
practice  a  reaction  of  1.0°  C.  was  considered  as  positive  ( Johne,  Dieeker- 
hoff  &  Lothes).  Sul)sequent  experiences  have,  however,  shown  that 
higher  and  longer  continued  temperatures  only  may  be  regarded  as 
such.  Nocard  regarded  every  horse  which  showed  an  organic  reaction 
and  an  extensive  painful  swelling  at  the  point  of  inoculation  and 
showing  a  typical  rise  of  1.5°  C.  of  temperature  or  exceeding  40°  C. 
as  affected  with  glanders,  while  an  elevation  of  only  1.0  to  1.4°  simply 


712  Glanders, 

pointed  to  suspicion.  According  to  Schindelka  a  positive  reaction 
consisted  of  an  elevation  of  temperature  of  2.0°  wliile  an  elevation  of 
1.5°  to  1.9°  simply  indicated  suspicion,  an  elevation  of  less  than  1.5° 
being  regarded  as  of  negative  importance.  Thomassen  and  MacFadyean 
also  considered  an  elevation  of  2°  as  a  positive  reaction,  but  regarded 
an  elevation  of  1.0  to  1.4°  as  pointing  to  probable  or  possible  infection. 
Babes  and  Furtuna  defined  the  term  "specific  reaction"  as  a  rapid 
increase  of  temperature  of  at  least  2°  C.  occurring  within  the  sixth 
to  eighth  hour  after  injection  and  exceeding  40°  C.  followed  on  the 
next  day  by  a  second  rise  above  the  preinjection  temperature,  with 
simultaneous  local  and  general  organic  reaction  (great  typical  reaction)  ; 
such  a  reaction  only  justified  the  diagnosis  of  glanders  while  a  similar 
elevation  of  temperature  not  exceeding  40°,  but  also  with  simultaneous 
organic  reaction  (small  typical  reaction),  as  well  as  pronounced  eleva- 
tions of  temperature  of  short  duration  (great  atypical  reaction)  indi- 
cated suspicion  only;  a  similar  but  slight  elevation  of  temperature 
(small  atypical  reaction)  had  no  significance.  According  to  Peter, 
Preusse  and  Foth  an  elevation  of  temperature  of  1.5°  is  to  be  regarded 
as  positive.  These  authors,  with  the  exception  of  Foth,  lay  special 
stress  upon  the  importance  of  the  organic  reaction  in  the  interpretation 
of  the  results  of  the  mallein  test. 

In  poorly  nourished  overworked  as  well  as  in  old  glandered  animals 
a  reaction  may  fail  to  take  place  or  it  may  occur  at  an  unusually  late 
period;  thus  in  a  case  observed  by  the  authors  the  elevation  of  tem- 
perature did  not  begin  until  the  twenty-first  hour  after  injection,  being 
typical  however  in  other  respects  (Fig.  123). 

Horses  affected  with  other  diseases  do  not  give  typical  reactions 
to  mallein.  Thus  Hutyra  &  Preisz  failed  to  observe  reactions  in  dis- 
temper, sarcomatosis,  phlegmonous  conditions,  pectoral  influenza, 
morbus  maculosus  and  botryomycosis,  while  Schindelka  failed  to  ob- 
serve reactions  in  distemper,  nasal  catarrh,  as  well  as  in  emphyemia  of 
the  antrum  of  Highmore. 

The  diagnostic  value  of  a  mallein  reaction  has  been  con- 
firmed by  the  practical  experience  of  the  last  two  decades. 
The  varying  results  obtained  during  the  first  few  years  after 
the  introduction  of  mallein  into  general  use  were  due  to  the 
fact  that  the  interpretation  of  the  temperature  reactions  were 
based  on  different  principles  (an  elevation  of  1.0°  C.  was  looked 
upon  as  a  positive  reaction  while  the  animal's  state  of  nutrition 
as  well  as  advanced  age  did  not  receive  due  consideration,  etc.) 
and  the  fact  that  the  primary  lesions  of  glanders  Avere  at  that 
time  not  as  thoroughly  understood.  The  lack  of  uniformity 
in  the  mallein  preparations  was  also  at  fault.  At  the  present 
time,  however,  it  has  been  firmly  established  that  mallein  is 
an  extremely  delicate  and  reliable  agent  for  the  diagnosis  of 
latent  glanders.  But  in  order  to  apply  this  agent  properly  and 
successfully  in  the  extermination  of  glanders  it  is  necessary 
that  the  test  be  made  intelligently  and  systematically,  further 
that  the  results  of  observations  during  the  period  of  reaction 
be  carefully  interpreted  and  that  all  clinical  sjinptoms  receive 
proper  consideration.  In  this  respect  as  well  as  in  the  general 
technic  of  the  test  the  instructions  given  under  the  head  of 


Subcutaneous  Mallein  Test. 


713 


tnberonlin  testing  are  equally  applicable  to  the  mallein  test 
(see  p.  577).  There  seems  to  l)e  a  difference,  however,  in  regard 
to  the  innnunizing  elTects  of  repeated  injections  of  these  two 
dias^nostic  a,i;ents  in  that  horses  will  nsnally  react  typically  to 
repeated  injections  of  mallein  made  at  short  intervals.  '  In 
some  cases  the  reaction  becomes  even  more  pronounced  (thus 
Galtier  observed  11  positive  reactions  in  a  glandered  horse  in 
the  course  of  a  month). 


Fig.  123.     Late  Thermal  Mallein  Reaction. 

Reports  on  the  use  of  mallein  on  a  large  scale  have  with  few  ex- 
ceptions been  favorable  in  that  post-mortem  examinations  as  a  rule 
contirmed  the  diagnosis  of  the  disease.  Thus  according  to  Preusse's 
compilations  of  reports  recorded  in  the  hterature  up  to  1897,  positive 
reactions  were  confirmed  by  post-mortem  examination  in  94.7%,  negative 
in  95.7%  of  all  cases  (Foth  estimates  the  value  of  the  reactions  at 
86%  and  94 7o  respectively,  Rudovesky  at  87%  and  96%o). 

According  to  the  eonipilationa  of  Hutyra  &  Pieisz,  post-mortem  examinations 
were  held  on  85  out  of  410  horses  tested  with  mallein  in  Hungary  up  to  1893; 
of  these  14  gave  a  reaction  of  less  than  1.5°,  and  G  of  them  were  "found  affected 
with  glanders;  12  gave  a  reaction  of  1.5  to  2.0°,  and  all  of  them  were  found 
affected;  59  gave  a  reaction  of  2.0°  or  more,  and  58  of  them  were  found  affected 
with  glanders;  in  one  the  post-mortem  findings  were  negative,  but  this  one  gave 
an  atypical  reaction.  In  those  cases  where  the  temperature  elevation  was  more 
than  1.5°  and  exceeded  39.5°,  all  horses  without  exception  were  found  affected. 

Kitt  (1901)  basing  his  observations  on  reports  from  the  Kingdom  of  Bavaria 
since  1892  showed  that  mallein  always  produces  a  ]>rompt  reaction  in  glandere<l 
horses,  and  that  reactions  failed  to  appear  in  more  than  120  other  diseases  (nasal 
catarrh,  disease  of  the  maxillary  sinus,  heaves,  etc.).  According  to  Feist  72  out  of 
73  reacting  horses  in  Alsace-Lorraine  were  found  affected  with  glanders,  while  on 
the  other  hand  not  one  out  of  287  non-reactors  were  found  affected.  Schindelka  of 
Vienna  maintains  that,  aside  from  glanders,  only  pulmonary  emphysema  will  pro- 
duce an  occasional  reaction  to  mallein,  basing  his  statement  on  the  results  of  503 
tests  and  148  post-mortem  examinations.  Jensen,  of  Denmark,  collected  data  cover- 
ing 184  cases;  in  177  cases  the  post-mortem  findings  confirmed  the  diagnosis  as 
based  upon  the  text,  in  six  cases  the  results  were  doubtful,  and  in  one  case  the 
result  was  of  an  op|)osite  character.  Nocard  (1897)  on  the  basis  of  several  thou- 
sand tests  conducted  by  him  in  France,  concluded  that  a  positive  mallein  reaction 
justified  the  diagnosis  of  glanders.  A  negative  reaction  on  the  other  hand  justified 
the  diagnosis  of  an  absence  of  glanders,  irrespective  of  the  presence  of  any  clinical 
symptoms   that   simulate   this   disease.     Upon   this   basis   he   succeeded  in    diflferen- 


714  Glanders. 

tiating  several  diseases  from  glanders  which  had  formerly  been  confused  with  that 
affection.  Thomasseu  in  the  Netherlands,  MacFadyean  and  Wright  in  England, 
Wirtz  in  Holland,  Heyne,  Dieckerhoff  &  Lothes,  Johne,  Edelmann,  Piel  and  Schlegel 
in  Grermany,  Kowalewski  in  Eussia,  Babes  and  Fortuna  in  Koumania,  Schweinitz  & 
Kilborne  in  America,  Hoogkamer  &  de  Haan  in  Lower  India,  and  Schniirer  in 
Austria  have  all  expressed  themselves  definitely  in  favor  of  the  diagnostic  value 
of  niallein. 

The  opposite  view  has  been  championed  by  Schiitz,  who  in  1884  conducted 
54  autopsies  on  horses,  of  which  15  reacted  to  the  extent  of  1.5°  to  2.5°  C,  while 
7  gave  a  reaction  of  1.0°  C.  to  1.4°  C.  (the  temperature  curve  and  the  highest 
post  injection  temperature  were  not  reported).  In  the  high  reactions,  as  well 
as  in  a  portion  of  the  others,  post-mortem  examination  revealed  only  hartl  nodules, 
aside  from  other  immaterial  changes,  and  in  one  case  cheesy  masses,  while  in  several 
others  there  were  gray  maculae  (?),  and  in  one  yellow  foci  in  the  peribronchial 
lymph  glands.  In  another  instance,  among  4  horses  which  reacted  out  of  a  total 
number  of  6,  post-mortem  examination  in  three  showed  calcified  foci  in  the  lungs, 
the  liver  and  the  peribronchial  lymph  glands  (!)  In  one  case  there  was  induration 
of  the  pulmonary  tissue  with  muco-purulent  foci.  In  1898,  42  horses  were  tested 
with  Preusse  "s  malleiu;  9  of  these  gave  a  reaction  of  1.5°  G.  or  more  (in  two  this 
was  followed  by  a  temperature  exceeding  40.0°,  in  three  only  to  39.5°).  In  these 
horse  glanders  could  not  be  demonstrated,  while  three  horses  that  were  affected 
with  chronic  glanders  gave  no  reactions  (the  temj^eratures  were  recorded  only  up 
to  the  14th  hour.  On  the  other  hand  the  post-mortem  diagnosis  was  confirmed  by 
microscopical  examination).  In  addition  to  the  above,  Olt,  Eobeis,  Poetschke, 
Schoeneck  and  others  have  expressed  themselves  against  the  diagnostic  value  of 
mallein  in  practically  all  cases,  basing  their  views  on  limited  observation.  (In  Olt 's 
experiments  it  is  reported  that  nine  glanderous  horses  did  not  react,  while  three 
healthy  horses  gave  positive  reactions.) 

In  Hungary  (1S97  to  1901)  570  horses  were  killed  on  account  of  the  disease 
or  suspicion  of  it  and  positive  reaction  to  the  mallein  test;  of  these  536,  i.  e.,  94%, 
were  found  affected  with  glanders  at  post-mortem  examination  conducted  under 
unfavorable  conditions.  In  1902  to  1908,  1,385  horses  were  officially  destroyed  on  the 
strength  of  positive  reactions  to  the  mallein  test  and  suspicion  of  disease,  1609 
were  destroyed  on  the  ground  of  positive  reaction  to  the  test  and  suspicion  of 
infection  or  exposure;  in  the  first  group  1,313,  i.  e.,  94.8%,  in  the  second  1,447,  i.  e., 
89.9%  showed  anatomical  lesions  of  glanders  at  post-mortem  examination. 

Technic  of  the  Subcutaneous  Mallein  Test.  The  mallein  is  prepared  in  a 
manner  similar  to  that  followed  in  the  preparation  of  tuberculin  (see  page  582). 
Since  the  normal  temperature  of  horses  does  not  exceed  38°  C,  it  is  reconmiended 
that  the  test  be  applied  in  such  cases  only  where  the  body  temperature  does  not 
exceed  38.5°  at  the  time.  Fluid  crude  mallein  should  be  diluted  before  injection 
(in  case  this  has  not  been  done  by  the  manufacturer)  with  9  parts  of  a  i/>%  solu- 
tion of  carbolic  acid. 

The  diagnostic  dose  of  Preusse 's  mallein  or  of  Preisz  's  potato  mallein  is  0.50 
gm.,  that  of  Eoux's  condensed  bouillon  0.25  gm.,  that  of  Johne 's  uncondensed 
(10  X  diluted)  mallein  5.0  gm.,  that  of  Foth's  dry  mallein.  0.10  gm.,  that  of 
Eussian  mallein  and  Babes'  morvin  1.0  gm.  for  each  injection. 

In  positive  reactions  the  temperature  usually  reaches  its  maxinuim  at  the 
12th  to  the  15th  hour  after  injection ;  in  view  of  the  possibility  of  a  late  reaction 
(see  page  712)  temperature  readings  should  be  made  up  to  or  beyond  the  21st 
hour.  Tatray  observed  in  395  cases  of  typical  reactions  (his  observations,  how- 
ever, extending  only  to  the  21st  hour)  that  the  maximum  temperature  occurred  in 
two  instances  in  the  sixth  hour;  in  74  instances  in  the  ninth  hour;  in  174  in  the 
12th;  114  in  the  15th;  23  in  the  18th,  and  in  8  instances  in  the  21st  hour  after  the 
injection.  According  to  Calinescu,  the  intravenous  injection  of  the  mallein  (0.02 
gm.  morvin)   results  in  a  reaction  in  the  5th  hour. 

Although  glanderous  horses  will,  as  a  rule,  react  to  repeated  injections  of 
mallein,  it  is  recommended  in  cases  where  doubtful  results  have  been  obtained  (in 
order  to  evade  every  criticism)  not  to  repeat  the  test  until  the  expiration  of  4 
weeks.     In  an  emergency  the  test  might  be  repeated  after  15  days. 

2.  Ophthalmic  Mallein  Test  (Oplitlialmoreaction,  conjunc- 
tival reaction).  Following  observations  on  the  action  of  tuber- 
culin on  the  conjunctiva  and  the  skin  of  tuberculous  persons 
and  cattle  (see  p.  583)  similar  experiments  were  made  on 
glanderous  and  healthy  horses  with  mallein.  The  results  of 
the  latter  experiments,  however,  can  not  as  yet  be  judged  prop- 


INSERT  FOLDOUT  HERE 


Ophthalmic  Malleiii   Test. 


715 


erly  on  account  of  the  comparatively  siiiall  imiiil)or  of  liorses 
tested  and  the  lack  of  sufficient  post-mortem  control  work. 

After  the  administration  of  a  small  quantity  of  dilut(» 
mallein  into  the  conjunctival  sac  the  oi)lit]ialmie  reaction  ap- 
pears in  the  form  of  a  conjunctivitis,  swellini!:  of  the  eyelids, 
intense  redness  of  the  conjunctiva  tarsi  et  bulbi  and  a  purulent 
secretion  (see  Plate  VI).  Accordin.<r  to  observations  thus  far 
recorded  a  pronounced  reaction  with  purulent  exudate  seems 
to  point  to  tlie  existence  of  the  disease,  while  a  nei^ative  or 
doubtful  reaction  has  only  a  circumstantial  value  since  it  is 
known  that  actually  infected  horses  may  sometimes  react  only 
slicfhtly  or  not  at  all.  (It  seems  that  these  tests  not  infre- 
quently give  negative  results  in  the  first  stages  of  the  disease.) 

The  ophthalmic  test  was  first  applied   suceessfiillv  by  rhoroiiiansky ;    1;"   glan- 
dere<l   horses   tliat   were   treated   with   Ci.l    gm.    of   Kussiaii'  mallein    reacting   liy   the 
api)earanee  of  a  severe  conjunctivitis,  while  37  healthy  horses  gave  a  negative  "reac- 
tion  to    this,   as   well 
as     to     the     subcuta- 
neous  test   which   was 
subsequently    applied. 
Wladimiroff  reports  a 
similar     result     ob- 
tained   in    12   affected 
an<l      20      apparently 
healthy     horses;     this 
author,    however,    ob- 
tained   positive    oph- 
thalnioreactions     also 
in     hordes     that     had 
ceased    to    react   typi- 
cally    to     the     usual 
subcirtaneous      test, 
consequently     he     did 
not    consider    a    posi- 
tive   reaction    to    the 
ophthalmic      test      as 
necessarily    indicating 
the    presence    of    dis- 
ease.   (An  observation 
made      by      M  a  r  t  e  1 
agrees  with  this  view ; 
this    author    obtained 
a     typical     cutaneoup 
reaction    on    his    arm 
14  years  after  he  had 
been      infected      with 
glanders).      Schniirer 
expresses     himself 
very   favorably  in   re- 
gard  to  the  value   of 
the     ophthalmic     test, 
having    obtained    only 
one  negative  result  in 
47  glanderous  horses; 
while  the  test  on  o.33   suspected  horses  and  on   16  horses  affected  with  some  other 
disease   agreed   with   the    results    of   the   cutaneous   and    subcutaneous    tests    in    the 
negative   character  of  all  of  them. 

The  observations  of  Vallee  in  three  cases,  of  Dietrich  in  13,  of  Putzey  & 
Stiennon  in  7,  of  Martel  in  7,  and  of  Klinimer  &  Kiessig  in  9  glandered  horses 
were  less  satisfactory.  These  authors  obtained  distinct  reactions  in  onlv  about 
one-half  of  their  tests,  whiih  were  made  with  10  to  20Vc  mallein  solution. 

Technic  of  the  Ophthalmic  Test.  Since  the  most  satisfactory  results  have 
thus  far  been  obtained  from  tiie  use  of  concentrated  mallein,  it  is  recommended  that 


Fig.124.  Cutaneous  Reaction  i»  Glanders.  Lvniph  Vessels 
Enlarged  as  Result  of  Inllammation  Radiatiny  from 
Scarified  Area. 


716  Glanders. 

this  material  Le  applied  to  the  inner  angle  of  the  conjunctival  sac  by  means  of 
a  pipette  or  camel 's-hair  brush.  Before  making  the  application  the  operator 
should  satisfy  himself  that  the  eye  contains  no  foreign  bodies,  and  that  no  symp- 
toms of  conjunctivitis  or  periodical  ophthalmia  exist. 

The  reaction  begins  from  the  4th  to  the  6th  hour  after  the  application,  and 
may  continue  for  24  to  26  hours,  or  even  longer,  the  accumulation  of  pus  below 
the  inner  canthus  of  the  eye  as  well  as  inflammatory  hyperemia  and  swelling  of  the 
conjunctiva  are  readily  recognized  (the  purulent  exudate  may  drop  off  from  time 
to  time,  or  it  may  be  removed  intentionally  by  an  attendant,  so  that  the  positive 
character  of  the  reaction  may  not  be  observed  at  the  time!).  If,  in  case  of  sonie 
other  diseaj^;e  or  on  account  of  suspected  infection,  the  result  of  the  reaction  is 
negative  or  doubtful,  the  test  may  be  repeated  on  the  following  day,  in  which  case 
the  reaction  is  in  some  hordes  decidedly  more  pronounced.  In  exceptional  cases  the 
reaction  appears  also  in  the  untreated  eye,  and  in  very  rare  instances  there  is  noted 
also  a  simultaneous  slight  elevation  of  temperature.  Previous  suljcutaneous  injec- 
tion of  niallein  may  partly  or  wholly  prevent  the  local  reaction,  for  which  reason 
this  test  should  be  applied  after,  but  not  before,  the  ophthalmic  test. 

3.  Cutaneous  Mallein  Tests  (Dermoreaction,  intradermal 
reaction).  These  reactions  manifest  themselves  by  local  symp- 
toms very  similar  to  those  observed  in  tuberculosis  (see  p.  583, 
and  Fig.  124).  However,  the  small  number  of  observations  witli 
regard  to  these  tests  which  have  thus  far  been  reported  con- 
stitute a  very  unsatisfactory  basis  upon  which  to  form  an 
opinion  in  regard  to  the  value  of  these  tests. 

According  to  Vallee,  the  cutaneous  test  is  unreliable  because  the  thin  and 
sensitive  skin  of  healthy  horses  may  react  with  ecjual  facility  and  becaui^e  the 
difference  between  reactions  in  healthy  and  infected  horses  is  merely  a  matter  of 
degree ;  Martel  and  Putzey  &  Stiennon  also  expressed  themselves  unfavorably,  but 
Schniirer  considers  the  test  as  of  diagnostic  value.  But  even  the  last  nameil  author 
admits  that  it  is  probably  less  accurate  than  the  ophthalmic  test.  According  to 
his  observations  the  intradermal  test  is  more  satisfactory,  the  latter  possibly  being 
of  value  also  in  standardiJ-ing  the  mallein,  since  the  edematous  swellings  develop- 
ing at  the  point  of  inoculation  are  usually  in  direct  proportion  to  the  amount  of 
mallein  injected. 

Technic  of  the  Cutaneous  Mallein  Test.  The  skin  is  carefully  washed  and 
then  scarified  until  slight  bleeding  occurs,  whereupon  concentrated  mallein  is 
applied  to  the  field  of  operation.  Schniirer  recommends  washing  an  area  10  cm.  by 
5  cm.  at  the  side  of  the  neck  and  then  slightly  scarifying  three  areas,  thus  #  #  #  . 
The  first  and  third  areas  are  treated  with  mallein,  the  middle  one  serving  as 
a  control  for  the  traumatic  reaction. 

The  reaction  begins  at  about  the  6th  hour  and  increases  in  extent  during  the 
following  24  hours,  whereupon  it  gradually  disappears  with  the  subsidence  of  the 
inflamed  area.  The  degree  of  the  reaction  is  determined  by  the  extent  of  the 
swelling  (15-50  X  20-55  mm.)  and  the  degree  of  its  thickness  (1-2  cm.).  Applica- 
tion of  the  mallein  to  the  scarified  skin  by  rubbing  with  a  rough  cloth  does  not 
give  so  satisfactory  results. 

Serum  Diagnosis.  Under  the  influence  of  the  toxin  of  the 
bacillus  of  glanders,  as  antigen,  other  antigen  bodies  besides 
immune  substances  are  formed  as  products  of  reaction  in  the 
infected  animal  body.  These  may  be  demonstrated  by  suitable 
methods  as  agglutinins,  precipitins  and  complement-fixing  sub- 
stances. Since  these  reaction  bodies  possess  an  affinity  for  their 
own  antigen  only  (glanders  toxin)  and  consequently  are  strictly 
specific  in  their  nature,  their  presence  in  the  blood  of  an  animal 
justifies  the  conclusion  that  the  animal  in  question  is  infected 
with  glanders. 

This  constitutes  the  basis  of  a  number  of  diagnostic  methods 
all  of  which  are  conducted  with  the  blood  sernm  of  tlie  animal 
to  be  tested  and  the  use  of  cultures  of  the  bacilli  of  glanders 


CdHipk'dicnf    Fixation    Method.  yiy 

or  of  tlieir  extracts.  None  of  tliese  motliods  are  infallihle 
lliey  may,  liowever,  be  supplemented  so  tliat  doiil)tfnl  residts 
given  ])y  one  are  rectified  by  a  positive  result  ol)taine(l  from 
another  method,  thus  tlie  simultaneons  application  of  several 
methods  vrill  reduce  the  errors  to  a  very  small  percentage. 

Sinco  th.>  i.u'tlio.ls  of  siTuin  .lia^nosis  aiv  all  lalioratorv  niethofls,  it  is  neces- 
sary tor  tl.o  prac-titioiuM-  to  son.l  suspo.-tod  material,  properfy  preserve.!,  to  a  suit- 
able lalioratorv  lor  exanimatio.i.  For  tliis  ],urposc  iroiii  'M)  to  5U  ccm.of  hloo.l  arc 
.Irawn  troMi  tjie  jii-ular  vein  (te.-hni..  as  in  or.liiiary  phlebotoniv)  into  a  steriliycd 
test  tnl:e  Attor  supplym-  tl.o  tube  with  a  cork  to  i.revent  intV.-tion,  it  is  kept  in 
a  cool  place  tor  a  tew  hours  to  permit  separation  of  the  serum  from  the  clot 
whereuj.on  It  may  be  sent  to  the  laboratory  for  examination.  As  a  rule,  results  may 
be  reporte<l  within  one  or  two  days.  "^ 

Since  the  results  obtaine.1  in  serum  diagnosis  may  be  inlluenced  bv  previous 
subcutaneous  malloinization.  horses  from  which  blood  is  obtaine,!  for  this  pun.osc 
must  not  be  teste.)  with  mallein  until  after  the  withdrawal  of  the  serum. 

1.  Complement  Fixation  Method.  The  method  of  Bordet 
&  Gengou,  maugui-ated  in  1901,  and  adapted  bv  AVasserman  & 
Bruck  for  the  ])ractical  diagnosis  of  sv])hilis  in  particular,  is 
based  upon  tlie  demonstration  of  antibodies  in  the  blood  serum 
These  antibodies,  with  the  aid  of  their  antigen,  have  the  power 
ot  hxmg  the  complements  of  fresh  serum  and  thus  divert  them 
from  hemolytic  systems.  This  method  which  was  worked  out 
by  Schutz  &  Schubert  for  the  diagnosis  of  glanders  has  alreadv 
given  results  of  such  an  exact  nature  that  it  mav  be  looked  upon, 
at  this  time,  as  the  best  sero-diagnostic  method  for  the  de- 
termination of  this  disease. 

-  If  an   experiment   animal    is   repeatedly    treated   with   red   blood 
corpuscles  from  another  species,  the  serum  of  the  former  develops  the 
property  of  dissolving*  the  red  blood  corpuscles  of  the  latter  witliiii 
a  short  time,  even  in  very  dilute  solution.     By  heating  for  80  minutes 
at  ;)6°  to  58°  C.  this  property  is  destroyed.     However,  if  fresh  serum 
from  any  animal,  not  previously  treated  as  al)ove  described,  is  added 
to  a  mixture  of  serum  thus  incubated  (inactivated)  plus  red  corpuscles 
a   solution  of  the   erythrocytes    (hemolysis)    again   takes  place      This 
]>lienomenon  therefore  occurs  as  the  result  of  the  action  of  two  sul)- 
stances:      (1)    A  thermostahile  suhstance  Avhich  is   found  only   in   the 
serum  of  an  animal  previously  treated  with  the  hlood  corpuscles  from 
another  species,  and  which  develops  as  a  reaction  product    or  antibody 
for  red  blood  corpuscles,  i.  e.,  as  an  antigen.     (2)   A  thermolabile  sub- 
stance which  is  present  in  the  fresh  serum  of  anv  animal  and  which 
IS  designated  as  complement  or  alexin.     According  to  Ehrlich's  theory 
this  process  may  he  explained  by  supposing  that  an  antibody  possesses 
two   affinities   or  haptophore  groups    (see  p.   447)     (hence   the   name- 
hemolytic  amboceptor  or  mediating  body)  ;  one  of  these  combines  with     " 
the  red  blood  corpuscles  as  antigen,  the  other  with  the  complement 
The  complement  can   not   combine   directly  Avith   the  antigen     but   if 
anchored  to  it  by  means  of  the  amboceptor  it  M-ill   act  as  a'  sort  of 
digestive  or  proteolytic  ferment  and  dissolve  the  red  blood  corpuscles 
(According  to  Bordet 's  theory  the   red   corpuscles  are  sensitized  for 
the  alexin  by  the  antibody  in  a  manner  similar  to  the  action  of  mordants 
m  the  dyeing  of  cloth,  for  which  reason  he  designates  the  antibody  as 

♦XOTE:— strictly  speakinK  therp  is  no  corapletP  solution  of  the  red  blood  rorpuscles  but 
only  Bn  action  of  the  hemolysin  on  their  stroma   which  permits  the  escape  of  the   hemoKrobin 


718  Glanders 

sKbsfancc  scHsihiUsa trice  or  fixate iir).     Red  })lootl  eorpuscles+hemolytic 
aniboceptor-)-compleinent  form  a  hemolytic  system ! 

The  hemolytic  amboceptor  is  strictly  specific,  consequently  it  will 
combine  by  means  of  its  cytophile  group  with  its  own  antibody  only 
(red  blood  corpuscles).  On  the  other  hand,  the  complement,  which 
is  present  in  all  fresh  serum,  is  not  specific,  hence  it  may  be  fixed  by 
various  amboceptors  in  suitable  complementophile  groups.  Thus  the 
complement  will  fix  specific  immune  bodies  that  develop  in  the  tissues 
of  infected  animals  under  the  action  of  bacteria ;  these  immune 
amboceptors  attract  the  complement  to  the  bacteria  in  question  or  to 
the  dissolved  elements  of  their  substance.  Hence,  if  we  add  fresh 
serum  which  contains  the  complement  in  suitable  quantity,  to  a  mixture 
of  a  suspension  of  bacteria  or  a  bacterial  extract-|-immune  serum,  the 
complement  will  unite  with  the  amboceptor  of  the  immune  serum  so 
that  the  free  complement  disappears  from  the  fluids.  Now,  if  we  sub- 
seciuently  add  to  this  fluid  a  mixture  of  hemolytic  amboceptor+red 
blood  corpuscles  hemolysis  ivill  not  result,  because  the  necessary  com- 
plement has  already  been  fixed  by  the  immune  amboceptors  and  the 
free  complement  no  longer  exists.  In  this  case,  therefore,  a  fixation 
of  the  complement  by  means  of  an  immune  amboceptor  has  occurred : 
in  other  words  the  complement  has  been  diverted  from  the  hemolytic 
system.  On  the  other  hand  if  immune  amboceptors  were  not 
present  in  the  first  mixture,  the  complement  remains  free  and  can 
therefore  exert  its  corpuscle-dissolving  properties  on  the  subsequently 
formed  hemolj'tic  system.  These  two  cases  may  be  expressed  graphically 
as  follows : 

1.  Baeteria-(-Immuiie-Serum+Coinplement-|-Hemolytic    Amboceptor-1-Red    Blood    Corpuscles 
(Antigen)    (Immune  Amboceptor) 

■■~^""^'~~"^"~'^^^"  =:  No  Hemolysis    (Complement  Fixation) 

2.  Bacteria4-Normal    Serum-[-Cnmplement-|-Heiii(ilytic    Aiaboceptor-|-r>ed   Blood   Corpuscles 
(Antigen)   (No   Immune       ^^■^■"■■■■"■■i^"M«™^^-^»^^^^^^^^^^^^^^^^^""«"^^^^ 

Amboceptor)  =  Hemolysis    (No  Complement  Fixation) 

Consequently  if  hemolysis  fails  to  occur,  i.  e.,  if  the  complement 
is  fixed,  we  may  conclude  that  the  fluid  contains  an  immune  amboceptor ; 
since,  however,  the  latter  can  fix  complement  only  wdth  the  aid  of 
its  antigen  and  since  the  antigen  (bacterial  suspension  or  extract) 
is  known,  the  further  conclusion  is  justified  that  the  fluid  contains 
an  immune  amboceptor  whicli  eorresponels  with  this  eintigen  and  thus 
originates  from  an  animal  which  is  infected  with  the  bacteria  in  ques- 
tion. For  example,  if  glanders  bacilli  were  used  as  antigen  the  com- 
plement fixation  whic^h  followed  indicates  that  the  serum  possessing 
the  fixing  property  originated  from  a  glanderous  horse.  Under  opposite 
conditions,  for  instance,  if  hemolysis  is  not  prevented,  the  conclusion 
is  justified  that  the  horse  which  furnished  the  serum  is  not  affected 
with  glanders. 

According  to  the  observations  of  Schiitz  S:  Schubert, 
Miessner  &  Trapp,  the  authors  and  others,  the  complement 
fixation  method  for  the  diagnosis  of  glanders  has  already  proved 
itself  very  valuable.  Its  advantage  consists  in  that  the  relative 
amount  of  immune  amboceptor  in  the  serum  to  be  tested  can 
be  determined  quantitatively  and  that  the  result  of  the  test  is 
very  evident.  If,  for  instance,  carefully  and  progressively 
graduated  quantities  of  serum  are  used  with  suitable  amounts 
of  hemolytic  amboceptor  and  complement  it  is  possible  to  de- 


INSERT  FOLDOUT  HERE 


Compleuieiit    Fixation   Method.  73^9 

termine  _  the  smallest  quantity  of  serum  that  ^vill  prevent 
hemolysis.  The  result  is  shown  by  the  contrast  between  the 
clear  serum  following-  complement*  fixation  and  the  distinctly 
red  serum  containino-  the  hemoi>-lo])in  in  solution.  Altliough 
errors  may  occur  in  this  method  of  diagnosis  in  those  exce^p- 
tional  instances  in  which  the  serum  of  horses  affected  with 
chronic  glanders  Avill  not  fix  the  complement  and  in  the  still 
rarer  cases  in  which  an  apparent  specific  fixation  occurs  in 
healthy  horses,  these  errors  are  consideral)ly  less  frequent  than 
those  obtained  by  other  sero-diagnostic  methods. 

AcoorWins  to  the  official  refjiilations  of  Prussia,  -ivhich  prescribe  that  the  serum 
of  horses  Aviiicii  will  lix  conipleinoiit  in  iiiaxiiiiuiii  (luuiitities  of  0.1  c.ciii.  in  the  pre- 
scribed method  of  procedure  (see  below)  are  rcfrarded  as  atYecte<l'  with  glanders. 
Basing  their  work  upon  this  standard,  the  results  of  tests  made  by  Miessner  & 
Trapp  in  the  examination  of  549  healthy  horses  showed  that  the  serum  of  only  7 
{1.277c)  showed  a  complement  fixation  power  equal  to  0.1-0.01,  while  on  the  other 
hand  the  sera  of  69  glandered  hors-es  showed  a  fixing  power  of  0.2  in  two  cases  and 
a  fixing  power  exceeding  0.2  in  five  cases.  In  one  experimentally  infected 
horse  the  fixing  power,  as  well  as  the  agglutination,  began  to  decline  on  the  sixth 
day,  but  in  horses  infected  naturally  with  glanders  the  fixing  power  was  retained 
for  a  longer  time;  previous  malleinization  also  tended  to  increase  the  fixing  power 
temporarily.  Haan,  de  Bliek,  an<l  Yalenti,  as  well  as  Klimmer  &  Kiessig  also 
report  favorably  on  the  results  obtained  by  this  method,  while  Keyser  found  this 
method  applicable  to  cadavers  also.  Sera  of  horses  affected  with  other  diseases 
gave  no  positive  reaction. 

Technic  of  the  Complement  Fixation  Method.  This  consists  essentially  in 
mixing  suitable  amounts  of  glaiiders-baciilus-antigen  and  fresh  guinea  pig  serum 
containing  complement  with  the  inactivated  serum  to  be  tested  and  then 
incubating  for  one  hour,  in  order  to  hasten  fixation.  To  this  mixture 
are  then  added  the  inactivated  hemolytic  serum  and  the  corresponding 
red  blood  corpuscles.  This  two-fold  mixture,  after  again  being  incubated  for 
two  hours,  is  ready  for  the  determination  of  results.  If  complement  fixation  has 
been  complete  all  of  the  red  blood  corpuscles  will  have  settled  to  the  bottom  of 
the  test  tube,  while  the  supernatant  slightly  yellow  fluid  is  perfectly  clear.  On  the 
other  hand,  if  hemolysis  was  complete  all  blood  corpuscles  will  have  been  dissolved 
so  that  the  supernatant  fluid,  which  is  clear  also  in  this  case,  is  of  an  even  red' 
or  port  wine  color.  Transition  stages  in  which  only  a  part  of  the  red  blood  cor- 
puscles are  dissolved,  may  be  observed  between  these  two  extremes,  in  which  case 
the  fluid  is  only  slightly  reddened,  or  reddened  only  in  the  lower  part  of  the  test 
tube,  while  a  certain  number  of  intact  blood  corpuscles,  forming  a  correspondingly 
smaller  mound,  will  have  collected  on  the  bottom  of  the  vessel.  For  the  sake  of 
convenience  the  different  degrees  of  hemolysis  are  referred  to  as  0,  trace  incom- 
plete, nearly  complete,  and  complete.  ' 

This  method  was  first  applied  practically  to  the  diagnosis  of  glanders  bv 
Schiitz  &  Schubert,  but  subsequently  perfected  by  Miessner  &  Trapp.  According  to 
these  investisrators  the  test  is  conducted  with  the'  following  reagents: 

(a)  The  antigen  usually  consists  of  a  normal  saline  solution  of  sterilized 
shake-extract,  or  of  a  suspension  of  dead  glanders  bacilli;  antiformin  extracts  or 
mallein  are  less  suitable  for  this  purpose,  although  in  some  cases  the  authors 
obtained  more  pronounced  results  with  these  than  with  the  first  named  antigens. 

(b)  A  series  of  successively  decreasing  amounts  of  the  serum  to  be  tested 
which  must  be  inactivated  by  incubating  for  30  minutes  at  56°  to  60°   C.  ' 

(c)  Fresh  guinea  pig  serum,  containing  complement  in  the  smallest  amount 
(usually  0.03-0.04  c.  cm.),  m  which  it  will  produce  complete  hemolysis  in  a  hemolvtie 
system.  "^ 

(d)  Hemolytic  inactivated  rabbit  serum  (from  rabbits  previously  treated 
with  sheep  blood  corpuscles),  in  double  the  amount  required  to  produce  hemolysis. 

(e)  Sheep  blood  corpuscles,  5%  suspension  in  physiological  salt  solution. 
Eeagents  of  which  only  small  quantities  are  needed  should  be  standardized  by 

the  addition  of  normal  salt  solution,  so  that  equal  volumes  of  each  reagent  enter 
into  the  mixture.  By  providing  suitable  control  tubes  we  are  enabled  to  determine 
that  neither  the  antigen  nor  the  serum  un<ler  test  have  alone  been  the  cause  of  the 
complement  fixation,  and  also  that  the  hemolytic  system  was  properly  formed.  The 
successive  steps  in  this  test  are  illustrated  graphically  in  the  tables  on  page  720. 


720 


Glanders. 


Antigen 

Anti- 
body 
(in  1,0) 

Comple- 
ment 

Hemo- 
lysin 

Blood 

Phys. 

Salt 
Solu- 
tion 

Hemolysis 

after 

1 

2 

16 

Hours 

Tnact. 

Fresh 

Inact. 

Defi- 

Bacillus 

serum 

guinea 

rabbit 

brin. 

emulsion 

of 

pig  serum 

sheep 

sheep 

0,85  % 

1:500 

suspected 
horse 

1:25 

serum 
1:700 

blood 
1:20 

1,0 

0,1 

1,0 

1,0 

1,0 

0 

0 

0 

03 

1,0 

0,1 

1,0 

1,0 

1,0 



0 

0 

0 

K 

1,0 

0,05 

1,0 

1,0 

1,0 

— 

0 

0 

0 

tu 

1,0 

0,02 

1,0 

1,0 

1,0 

— 

0 

0 

0 

S 

1,0 

0,01 

1,0 

1,0 

1,0 

— 

0 

+ 

+ 

O 

Bacillus 

extract 

1:500 

1,0 

0,2 

1,0 

1,0 

1,0 

0 

0 

0 

1,0 

0,1 

1,0 

1,0 

1,0 



0 

0 

0 

1,0 

0,05 

1,0 

1,0 

1,0 



0 

0 

0 

1,0 

0,02 

1,0 

1,0 

1,0 



0 

+ 

+ 

1,0 

0,01 

1,0 

1,0 

1,0 

— 

0 

+ 

+ 

-4^ 

Bacillus 

Inact. 

emulsion 

normal 

73 

1:500 

horse 

Ph. 

serum 

> 

1,0 

0,2 

1,0 

1,0 

1,0 



+  + 

+++ 

++++ 

eg 

1,0 

0,1 

1,0 

1,0 

1,0 

— 

+  + 

+++ 

++++ 

bD 

1,0 

0,05 

1,0 

1,0 

1,0 

— 

+  + 

+++ 

++++ 

1^ 

1,0 

0,02 

1,0 

1,0 

1,0 

— 

+  +  + 

+++ 

++++ 

1,0 

0,01 

1,0 

1,0 

1,0 

— 

+  +  + 

+++ 

++++ 

Inact.  se- 

rum of 
susp. 
horse 

— 

0,1 

1,0 

1,0 

1,0 

1,0 

+  +  + 

++++ 

++++ 

— 

0,1 

— 

1,0 

1,0 

2,0 

0 

0 

0 

normal 

horse 

serum 

CO 

— 

0,1 

1,0 

1,0 

1,0 

1,0 

+++ 

++++ 

++++ 

^H 

— 

0,1 

— 

1,0 

1,0 

2,0 

0 

0 

0 

"S 

Bacillus 

o 

Q 

emulsion 

1,0 

— 

1,0 

1,0 

1,0 

1,0 

+++ 

+++ 

++++ 

1,0 

— 

— 

1,0 

1,0 

2,0 

0 

0 

0 

Bacillus 

extract 

1,0 

— 

1,0 

1,0 

1,0 

1,0 

+++ 

+++ 

++++ 

1,0 

— 

1,0 

1,0 

2,0 

0 

0 

0 

— 

— 

1,0 

1,0 

1,0 

2,0 

+++ 

++++ 

++++ 

— 

— 

1,0 

1,0 

3,0 

0 

0 

0 

— 

— 

1,0 

1,0 

3,0 

0 

0 

0 

~ 

— 

1,0 

4,0 

0 

0 

0 

Examination   by   Complement   fixation   of   serum   of   glanderous   horse    (fever   curve — see 
702;   Exam.  Jan.   17). 
Hemolysis:    0  =  no   hemolysis,   -f  =  trace,   -{-4=  incomplete,    -1-+4-  =  almost   complete, 
+++-!-=  complete. 


Agglutiiiatiun    Test.  721 

2.  Agglutination  Test.  Tliis  is  hased  ii])on  the  fact  tliat 
blood  soniiu  Avliicli  contains  a<;\i;liitinatiiii;'  snl)staiiccs  will  cause 
the  cliiin])iiig-  of  ^-landers  bacilli  in  suspensions  of  potato  or 
a^Ji'ar  cultures,  -wliereupou  these  clumps  are  precipitated  to  the 
bottom  of  the  supernatant  clear  fluid. 

The  ai>;i>-lulinatin^-  action  of  blood  serum  was  first  observed 
by  Dedjulin  in  human  beiugs  affected  with  g'landers,  by  Mac- 
Fadyean  in  horses  affected  with  this  disease.  Subsequent  in- 
vestiu'ations,  especially  those  of  Schiitz  and  his  co-workers, 
showed  that  tlu^  serum  of  healthy  horses  may  also  contain 
(normal)  ai>;i>lutinins  in  rather  large  quantities,  but  that,  never- 
theless, the  reaction  is  specific  in  the  sense  that  agglutination 
is  brought  about  by  the  serum  of  infected  horses  in  considerably 
greater  dilutions  than  is  the  case  with  serum  of  liealthy  horses. 
The  following  general  rule  has  beeji  found  ((uite  ai)plicable  and 
reliable,  viz.,  agglutination,  if  appearing  in  dilutions  of  1:400 
or  less,  with  few  exceptions,  indicates  freedom  from  infection ; 
on  the  other  hand  dilutions  of  1  :1000  or  more,  also  with  few 
exceptions,  indicates  the  presence  of  infection,  while  agglutina- 
tion in  dilutions  of  1  :2000  or  more  indicates  recent  infection. 
However,  in  infected  stables  we  usually  find  a  rather  con- 
siderable number  of  horses  the  sei'um  of  which  will  produce 
the  agglutinating  phenomenon  in  dilutions  of  1  :500-800;  a  titer 
of  this  kind  has  no  diagnostic  value  in  either  direction.  This 
fact  which  presents  a  considerable  disadvantage  to  the  practical 
application  of  this  method  of  diagnosis  is  compensated  for  in 
a  certain  number  of  cases  by  the  discovery  that  the  agglutina- 
tion titer  of  glanderous  horses  nndergoes  very  considerable 
fluctuation  from  month  to  month,  thus  it  may  be  very  high 
(2000-4000  or  more)  a  few  days  after  infection  and  then  grad- 
ually drop,  while  exacerbations  of  the  morbid  process  may  again 
cause  a  pronounced  upward  tendency. 

The  practical  value  of  the  agglutination  test  is  considerably 
reduced  by  the  necessitj^,  in  a  considerable  number  of  sus- 
pected horses,  of  repeated  serum  tests  at  intervals  of  several 
weeks.  Since  healthy  horses  also  occasionally  show  physio- 
logical fluctuations  in  agglutinating  power  of  no  inconsiderable 
degree,  and  since  on  the  other  hand  these  fluctuations  can  no 
longer  be  recognized  in  horses  with  chronic  glanders,  the  prac- 
tical value  of  this  test  must  not  be  ranked  too  high  and  by  no 
means  above  that  of  the  subcutaneous  mallein  test.  Never- 
theless by  giving  due  consideration  to  the  possible  negative  re- 
sults, careful  attention  to  technic,  and  especially  supplementa- 
tion of  other  methods,  particularly  the  complement  fixation 
method,  this  test  constitutes  a  valuable  addition  to  our  diag- 
nostic methods  (see  p.  717),  and  may  be  of  much  value  in 
doubtful  cases.    In  recent  infections  it  is  quite  reliable  in  itself. 

The  agglutination  test  was  first  reeommendetl  for  practical   nso  by  Bourses  & 
Mery,    Pokschischewsky,    Arpad,    Rabieaux    and    particularly    by    Jensen.     The    last 
named  author  ranks  it  above  the  mallein  test  because  post-mortem  examinations  were 
Vol.  1—46 


722  Glanders. 

negative  in  horses  wliich  gave  positive  or  doubtful  reactions  to  mallein,  but  the 
blood  serum  of  which  did  not  distinctly  agglutinate  glanders  bacilli.  Subsequent 
experiments  showed  that  sera  which  agglutinated  the  typhoid  bacillus,  the  Bacillus 
suipestifer,  or  the  colibacillus,  would  not  affect  the  bacillus  of  glanders. 

In  the  experiments  of  Sehiitz  &  Meissner  the  agglutination  titer  of  the  sera 
of  1,911  horses  which  were  free  from  glanders  was  1:100-400  in  1,602  horses 
(83.8%),  1:500-800  in  299  horses  (15.7%)  and  1:1000  in  10  horses  (0.5%o)  ;  on 
the  other  hand,  among  298  glanderous  horses  the  titer  was  1:400  in  6  (2.0%), 
1:500-800  in  10.3  horses  and  1:1000  in  only  189  horses  (63.4%,).  If  we  regard  titers 
of  1:400  as  decisively  negative  and  1:1000  or  more  as  decisively  positive  evidence 
of  infection,  the  erroVs  in  diagnosis  m  these  cases  were  only  0.77%.  However,  in 
18.2%  of  all  cases  and  in  34.6%,  of  the  infected  horses  that  gave  agglutination  titers 
of  1:500-800  the  diagnosis  had  to  be  held  in  abeyance. 

Sehniirer  places  a  similar  value  on  the  results  of  the  agglutination  test, 
although  according  to  his  opinion  the  average  amount  of  normal  agglutinins  fluc- 
tuates between  400  and  600.  However  this  investigator,  whose  observations  extend 
over  300  cases,  recommends  this  method  strongly  for  practical  use,  as  do  also 
Benome,  Wladimiroflf,  Fedorowsky,  Langer,  Moore,  Taylor  &  Giltner,  Berns  & 
Way,  etc.,  while  Foulerton,  Preusse,  Stanciu  and  Eiemer  express  themselves  less 
favorably.  The  last  named  author  observed  agglutination  powers  of  1:500,  1:700 
and  1:1000  in  glanderous  horses,  while  the  titers  in  six  healthy  horses  were  1:800 
(in  four  cases),  1:2000  and  1:4000,  respectively.  In  pleuro-pneumonia  (Miessner) 
as  well  as  in  distemper  (Sustmann)  the  serum  seems  sometimes  to  possess  greater 
agglutinating  power,  it  has  also  in  the  course  of  a  long  period  of  observation  been 
found  to  be  more  uniform,  while  other  diseases  do  not  influence  the  agglutination 
titer   (Langer). 

After  an  experimental  infection,  the  agglutinating  power  may  rise  to  1:2000 
or  more  in  2  days  (Bonome,  Hutyra;  according  to  Sustmann  in  3  days;  according 
to  Sehiitz  &  Miessner  in  6  days)  remaining  at  this  point  about  4  weeks,  whereupon 
it  gradually  returns  to  the  normal. 

Subcutaneous  malleinization  raises  the  agglutination  titer  in  healthy  as  well 
as  in  infected  horses.  Pekschischewsky  saw  the  titer  double  in  the  course  of  a  mal- 
lein reaction,  and  according  to  Pfeiler  it  sometimes  reaches  4,000  in  these  cases, 
while  Meissner  as  well  as  Fedorowsky,  Kleine  and  Bonome  observed  only  a  mod- 
erate but  long  continued  increase  of  titer.  Sehiitz  &  Miessner  failed  to  observe 
any  change  in  three  horses.  Arpad  observed  the  titer  increase  in  two  days  from  300 
to  1,600  in  healthy  horses,  but  it  dropped  again  to  800  in  7  days,  while  according 
to  Miessner  the  increase  does  not  begin  until  the  5th  or  7th  day,  reaching  its  max- 
imum in  14  days  and  not  beginning  to  gradually  return  to  the  normal  until  after 
4-6  days.    According  to  Sustmann  the  elevation  continued  for  more  than  3  months. 

Practical  observations  of  Nevermann  include  statistics  on  3,466  horses  which 
were  tested  in  the  course  of  two  years  in  several  hundred  Prussian  stables  or  studs. 
According  to  these  statistics  the  temporary  diagnosis  based  upon  the  agglutination 
test  was  confirmed  by  post-mortem  examination  in  79.2%  of  the  negative  results 
(titer  300-400)  and  in  79.5%  of  the  positive  results  (titer  1,000  or  more,  with 
fluctuations).  Of  18.2%  of  the  horses  destroyed  on  the  ground  of  suspicion  (giving 
titers  of  500-800)  lesions  of  the  disease  were  present  in  46.6%.  In  more  than 
one-half  of  the  stables  the  test  for  some  of  the  animals  had  to  be  repeated  from 
3  to  6  times. 

Technic  of  the  Agglutination  Method.  The  test  fluid  is  prepared  with 
a  sus]3ension  of  agar  or  potato  culture  of  2  to  5  days'  growth  prepared  from  a 
suitable  strain  of  glanders  bacilli  and  diluted  with  physiological  salt  solution. 
After  killing  the  bacilli  by  heating  at  60°  C.  the  test  fluid  is  standardized 
by  adding  the  necessary  amount  of  normal  salt  solution.  For  each  2.0 
cc.  of  this  fluid  in  test  tubes  the  serum  to  be  tested  is  added  in  success- 
ively decreasing  amounts  (from  1:300  to  1:4000)  whereupon  the  tubes  are 
incubated  for  36  hours.  By  keeping  the  fluid  in  the  thermostat  for  one-half  hour 
and  suDsequently  centrifuging  for  5  to  15  minutes  (the  time  being  determined  by 
the  number  of  revolutions),  the  result  may  be  obtained  within  one  to  two  hours, 
positive  reactions  are  indicated  by  the  accumulation  of  agglutinated  bacilli  on  the 
bottom  of  the  tubes  in  the  form  of  a  circular  film  with  serrated  border,  while  the 
supernatant  fluid  has  become  perfectly  clear.  On  the  other  hand  a  negative  reaction 
is  indicated  by  the  cloudiness  of  the  fluid,  while  the  precipitated  but  not  aggluti- 
nated bacilli  have  accumulated  on  the  bottom  of  the  test  tube  in  the  form  of  a  flat 
<lisc  with  a  smooth  outline. 

King  &  Houghton  have  worked  out  a  method  by  means  of  which  the  test  can 
easily  he  made  in  actual  practice.  Carefully  measured  amounts  of  properly  prepared 
test  fluid  are  placed  in  graduated  test  tubes  whereupon  square  pieces  of  filter  paper 


Precipitin   Keaction.  70*'> 

of  varying  l.ut  .iofmito  size,  that  have  been  saturated  with  seiiiin,  are  ..jace-l  in  the 
tluKl.  In  this  manner  varying  dilutions  of  serum  are  pro.luced  in  the  test  fluid 
which  IS  then  im-ubated  for  24  to  48  hours  or  allowed  to  stand  near  a  warm  stove' 
The  afjjjlutination  titers  may  then  be  determined  bv  eoniparin-r  the  results  in  the 
tubes   with    a   properly   tabulated   guide.  •  i         >-  us         me 

3.  Precipitin  Reaction.  In  this  ])lu'ii()iiicii()ii  tlie  serum  of 
an  immunized  animal  ])ro(luees  a  line  flaky  precipitate  in  the 
culture  filtrate  of  the  organism  used  in  iminunization.  It  was 
first  observed  ])y  Kraus,  subsequently  by  AVladimiroff,  who 
noted  that  it  occurred  also  in  filtrates  of  glanders  cultures 
after  the  addition  of  serum  from  o-landerous  horses.  The 
latter 's  observation  was  confirmed  by  Pfeiler,  Miessner  and 
^riiller,  altJiouuh  the  investi^-ations  of  the  latter  showed  that 
the  sera  of  healthy  horses  also  produced  precipitates  (normal 
precipitins)  but  in  a  less  degree,  thus  causing  more  or  less 
confusion  in  diagnosis.  On  the  other  hand  thev'obtained  better 
results  when  they  used  bacillary  extracts  or  mallein  solutions 
instead  of  culture  filtrates  and  instead  of  mixing  these  with 
the  serum  gently  pouring  them  on  the  surface  of  the  same  (con- 
tact or  ring  test).  By  this  latter  method  a  distinct  grav  band 
of  precipitate  which  may  be  regarded  as  quite  specific,  will 
form  within  a  few  minutes  at  the  line  of  contact  of  the  two 
fluids. ^  According  to  observations  thus  far  recorded  this  method 
is  giving  satisfactory  results  in  most  instances  while  the  fact 
that  precipitins  can  be  demonstrated  also  in  chronic  cases  of 
disease  presents  an  additional  advantage. 

Pfeiler,  who  uses  extract  of  glanders  bacilli  prepared  with  carbol-sodium- 
chlonde  solution  or  carbolized  horse  eerum  as  a  precipitinogenic  fluid,  tested  452 
blood  samples  obtained  from  306  horses  suspected  of  the  disease  or  exposure  thereto. 
He  compared  his  results  with  those  obtained  by  the  agglutination  and  complement 
fixation  tests  and  found  that  they  confirmed  each  other,  particularly  in  recent  cases 
of  infection.  In  experimentally  infected  horses  the  precipitins  could  be  demon- 
strated within  4  or  5  days  after  infection.  Similarlv  favorable  results  were  obtained 
nnV/  ^^^^"^'^  ^"  ^^  glanderous  horses  by  the  use  of  extract  of  glanders  bacilli  and 
10%  mallein  solution  made  with  Foth's  drv  mallein.  In  very  old  cases  onlv  were 
the  results  from  this  method  less  satisfactory.  Finallv,  r^fiiller  was  able  to"  deter- 
mine the  specificity  of  the  reaction  in  his  guinea  pig  experiments. 

Other  Diagnostic  Methods.  In  former  times  the  following  were  frequently 
resorted  to:  The  inoculation  of  a  suspected  horse  with  its  own  secretions,  a  healthv 
portion  of  the  bo.ly  being  selected  to  reproduce  the  characteristic,  glanderous 
lesions;  trephination  of  the  antrum  of  Highmore,  in  order  to  permit  direct  ins])ec- 
tion  of  its  mucous  membrane;  the  artificial  production  of  a  fever  or  of  the  acute 
form  of  the  disease  by  subjecting  the  suspected  animal  to  hard  work  or  bv  the 
subcutaneous  injection  of  oil  of  turpentine  (Cagnv)  or  bv  the  injection  of  strepto- 
coccus cultures  (Jewsejenko).  In  any  of  these  niethods  only  a  positive  result  had 
any  value,  and  all  of  them  have  long  been  superseded  bv  modern  methods  of 
diagnosis. 

_  In  more  recent  times  Baldoni  and  Dieckerhoff  recommended  the  intravenous 

injection  of  Crede's  colloidal  silver,  which  produces  a  febrile  reaction  in  glander- 
ous horses  and  consequently  might  be  of  service  in  the  diagnosis  of  doubtful  cases. 
Eoder,  Passau  and  Blome  have  also  ol>served  this  action,  although  Poetschke  and 
subsequently  also  Roder  observed  that  a  similar  reaction  occurred  occasionally  in 
the  course  of  other  internal  and  external  diseases  and  even  in  healthv  horses. 

Carro7o  recommen.ls  Ehrlich's  dio7oreaction  (red  coloration"  of  the  urine 
after  the  a.ldition  of  hydrochloric  sulphanilic  acid,  potassium  iodide  and  ammonia), 
this  reaction  being  much  more  i>ronounced  in  the  urine  of  glanderous  horses  than  in 


724  Glanders. 

that   of  horses   affected  with   other   infectious   diseases.      The   value   of  this   method 
has  not  as  yet  been  confirmed  by  others. 

Fursenko  tested  the  blood  of  2.5  horses  for  opsonins  and  obtained  2.3  positive 
and  two  doubtful  reactions.  The  results  were  better  than  those  obtained  with 
mallein  or  with  the  agglutination  test. 

Differential  Diagnosis.  From  a  differential  diagnostic 
point  of  view  the  following  diseases  sliould  be  considered  in 
connection  with  nasal  glanders ;  chronic  nasal  catarrh  may 
arouse  suspicion  of  glanders  when  the  nasal  discharge  persists 
for  a  long  time  and  there  is  enlargement  of  the  submaxillary 
glands ;  in  this  disease,  however,  the  nasal  discharge  is  always 
bilateral,  the  tumefied  lobules  of  the  submaxillary  gland  may 
be  distinctly  palpated,  the  nasal  mucous  membrane  usually  con- 
tains no  nodules,  catarrhal  ulcers,  which  may  be  present,  never 
exceed  the  size  of  lentils,  are  circular  and  regular  in  outline, 
have  sharp  borders  and  smooth,  lu'ight  red  bases,  while  proper 
treatment  results  in  recovery.  Although  occlusion  of  the 
afferent  ducts  of  the  mucous  glands  in  the  course  of  simple 
catarrh  may  cause  the  formation  of  nodules  as  large  as  lentils, 
these  persist  for  a  long  time  without  ulcerative  degeneration. — 
Croupous  inflammation  of  the  nasal  mucous  membrane  is  at- 
tended by  acute  symptoms,  the  nasal  mucous  membrane  is  much 
tumefied,  highly  reddened  and  appears  to  be  covered  with  ex- 
tensive membranous  masses,  the  ])riglit  red  mucous  membrane 
beneath  bleeding  at  the  slightest  touch ;  the  submaxillary  glands 
which  are  usually  swollen  show  increased  heat  and  pain. — 
Ehinitis  chronica  proliferans,  and  so  called  rhinoscleroma  are 
confined  to  the  lower  portions  of  the  nasal  cavity;  in  these 
conditions  cicatricial  induration  of  the  mucous  membrane  as 
well  as  catarrhal  ulcers  may  be  present,  while  the  mucous  mem- 
brane above  as  well  as  that  of  the  turbinated  bones  is  normal. 
The  submaxillary  glands  do  not  show  the  characteristic  firm 
enlargement. — Ulcers  and  scars  of  traumatic  origin  are  usually 
found  near  the  nasal  fossa  on  the  septum;  the  ulcers  have  a 
red  actively  granulating  base,  the  scars  usually  being  elongated, 
or  angular,  flat,  rarely  bulging  in  character ;  the  lymph  glands 
show  nothing  abnormal. — Cauterization  of  the  nasal  mucous 
membrane  with  lime  may  produce  extensive  ulceration  but  the 
submaxillary  glands  are  not  involved. 

Petropawlowski  called  attention  to  the  fact  that  mineral-  and 
coal-dust  may  produce  an  ulcerous  inflammation  of  the  nasal  mucous 
membrane  and  Jewensko  observed  a  severe  inflammation  of  the  nasal 
mucous  membrane  in  the  horses  of  a  regiment  of  dragoons  in  Ismail, 
after  feeding  with  dusty  fodder,  as  a  result  of  Avhich  200  horses  were 
destroyed  on  account  of  suspected  glanders ! 

Very  obstinate  catarrhal  conditions  may  also  be  produced  by 
pentastoma  and  by  gastruslarvae.  In  old  horses  chondromalasia  may 
he  confused  with  glanders.  In  this  disease  the  nasal  septum  may 
contain  ulcers  with  pronounced  ragged  borders  and  nodules  of  various 
sizes  while  the  cartilage  contains  cavities  filled  with  a  glassy,  mucous 
mass   (Petropawlowski). 


Dirterwitial    Diagnosis.  725 

In  some  districts  iiijuric's  ol"  the  nasal  mucous  membrane  and 
from  them  cicatrices  whicli  have  l)een  caused  by  (juacks  in  an  effort 
of  treatment,  are  very  fre<iuent  occurrences.  Cicatrization  may  also 
occur  after  fractures  of  the  nasal  bones. 

Chronic  oatarrli  of  the  nasal  sinuses  often  gives  rise  to  - 
suspicion  of  glanders,  the  nasal  discharge  in  this  disease  fre- 
(liiently  being  unilateral  and  otherwise  very  much  like  that  in 
glanders  while  the  submaxillary  lyini)h  glands  are  usually  also 
eidarged.  However,  the  sensitive  condition  of  the  infraorbital 
nerve,  the  temporary,  profuse  nasal  discharge,  the  fluctuating 
results  obtained  in  percussion  of  the  sinus,  the  soft  and  lobulated 
structure  of,  and  the  absence  of  adhesion  in,  the  submaxillary 
glands  as  well  as  the  absence  of  nodules  and  ulcers  on  the  nasal 
mucous  membrane,  are  usually  sufficient  to  enable  one  to  recog- 
nize the  nature  of  the  ai¥ection.  In  addition  to  this  the  results 
of  trephination  which  would  be  therapeutically  indicated  in  this 
case  would  (Iccide  the  character  of  the  affection,  as  would  also 
the  determination  of  any  special  cause  of  the  trouble  (tooth 
caries,  bone  necrosis,  neoplasms,  etc.).  In  chronic  catarrh  of 
the  guttural  pouches  also  there  may  be  unilateral  nasal  dis- 
charge, the  origin  of  this,  however,  is  at  once  indicated  by 
the  tumefaction  in  the  sul)i)arotideal  region. — Distemper  or 
strangles  might  be  confused  with  glanders  but  only  in  affections 
of  a  subacute  character  in  which  the  intermaxillary  abscess 
appears  late  in  the  development  of  the  disease  or  fails  to 
make  its  appearance,  or  in  cases  where  the  lymph  vessels  of 
the  surrounding  region  become  enlarged,  and  finally  also  when 
metastatic  abscesses  appear  in  remote  regions  of  the  body;  but 
even  in  this  case  the  morbid  changes  present  a  more  acute 
character  than  those  of  glanders.  There  are  no  nodules  on 
the  mucous  membrane  while  the  interior  of  the  swellings  or 
abscesses  contain  only  streptococci  (ulceration  of  the  mucous 
membrane  does  not  necessarily  exclude  distemper  since  this 
may  also  be  brought  about  by  the  streptococcus  of  strangles 
[Rabe].  See  p.  .']73). — Stonuititis  pustulosa  contagiosa  may 
excite  suspicion  of  glanders  when  the  lips  and  nasal  alae  become 
swollen  and  nodules  and  ulcers  are  present  on  the  nasal  mucous 
membrane;  aside,  however,  from  the  acute  and  favoi'able 
course  of  the  process  the  existence  of  similar  changes  on  the 
oral  mucous  membrane  in  itself  would  exclude  glanders. — 
Finally  ulceration  of  the  nasal  mucous  membrane  occurs  also 
in  the  course  of  tuberculosis  (see  p.  550)  as  well  as  in  epizootic 
]}ini)hangioitis  (see  p.  737).  In  these  cases  chronic  enlarge- 
ment of  the  submaxillary  glands  may  also  be  present  (this, 
however,  may  also  occur  in  actinomycosis),  consequently  a 
microscopical  examination  of  the  extirpated  tumors  or  tissue 
portions  alone  would  be  confirmatory. 

The  following  conditions  may  be  confused  with  cutaneous 
glanders :     Septic  lymphangioitis,  which,   however,   is   aecom- 


726  Glanders. 

panied  by  eontiimoiis  fever,  extreme  pain,  a  conspicuous  dis- 
turbance of  function,  in  addition  to  which  the  al^scesses  after 
perforation  heal  readily  by  active  granulation.— Botryomycosis, 
in  those  cases  where  subcutaneous  tumors  undergo  suppura- 
tion attended  with  edematous  infiltration  of  the  surrounding 
tissue;  in  these  cases  there  is  also  active  granulation  and  the 
efferent  lymph  vessels  are  not  involved. — In  ulcerous  lympli- 
angioitis  the  cutaneous  ulcers  are  very  similar  to  those  of 
glanders,  but  the  regional  lymph  glands  are  not  enlarged,  a 
short  bacillus  which  takes  Gram's  stain  is  present  in  the 
ulcerous  secretions,  Avhile  in  epizootic  lymphangioitis  the  pres- 
ence of  coccus-like  structures  which  do  not  readil}^  stain  con- 
firms the  diagnosis;  furthermore,  no  reactions  follow  the  injec- 
tion of  mallein  in  this  disease. — Urticaria  is  characterized  by 
its  sudden  appearance  and  the  equally  sudden  subsidence  of 
the  cutaneous  swellings. — Contagious  acne  is  characterized  by 
pustule  formation  and  the  rapid,  complete  healing  of  the  small 
fleers. — In  morbus  maculosus  we  have  extensive  swellings  with 
al)rupt  contour.  Cutaneous  nodes  caused  by  nematodes  are 
characterized  by  their  permanence  and  their  hemorrhagic 
character. 

Chronic  inflammatory  affections  of  the  lungs  in  general  and 
pursiness  resulting  therefrom  have  so  much  in  common  witli 
pulmonary  glanders  in  their  general  symptoms,  that  their 
presence  can  never  be  definitely  excluded  in  suspicious  cases. 
Since  these  conditions  are  frequently  attended  by  poor  general 
nutrition  the  mallein  test  (and  in  protracted  cases  serodiag- 
nostic  methods  as  well)  may  not  enable  us  to  arrive  at  a 
definite  diagnosis.  It  is,  therefore,  necessary  that  animals  thus 
affected  be  kept  under  careful  observation  for  some  time  so 
that  any  characteristic  symptoms  of  glanders  may  be  discovered 
at  once.  In  this  respect  torpid  edematous  swellings,  bloody 
bronchial  secretions  as  well  as  cachectic  symptoms  in  general 
demand  consideration. 

As  far  as  the  patliologico-anatomieal  diagnosis  is  coneerned  the  followiiig 
morbid  processes  are  of  particular  importance :  Perilironchitis  nodosa  multiplex 
(,  Dieckerhotf )  s.  Nodosis  pulmonum ;  this  is  characterised  by  uniformly  gray,  firm, 
frecjuently  calcified  noilules  ranging  in  size  from  a  poppy  seed  to  tlmt  of  a  lentil, 
the  surrounding  pulmonary  tissue  showing  no  evidence  of  reactive  infiammation ; 
the  peribronchial  lymph  glands  also  are  intact  in  this  affection. — Peribronchitis 
diffusa  and  Pneumonia  interstitialis  chronica:  the  walls  of  the  bronchial  tubes  are 
uniformly  thickened,  the  inter-alveolar  connective  tissue  is  uniformly  indurated  in 
large  surrounding  areas;  nodules  are  present  and  there  is  no  gelatinous  infiltration 
of  the  tissue  nor  enlargement  of  the  lymph  glands. — In  pneumonia  catarrhalis  of 
young  horses  the  hepatized  pulmonary  areas  are  uniforndy  red  or  grayish-red  and 
without  soft  centers,  although  there  is  acute  swelling  of  the  peribronchial  lymph 
glands  they  contain  no  caseous  foci. — In  tuberculosis  we  find  as  a  rule  in  addition 
to  gray  hyaline,  fresh  nodules  as  large  as  poppy  seeds,  large  sarcoma-like  nodes 
as  well  as  broncho-i^neumonic  foci,  while  the  thoracic  lymph  glands  are  cai^eated. — 
Nodules  caused  by  animal  parasites  (nematodes  or  their  embryonic  forma  and 
echinococei)  are  very  similar  to  glanders  nodules,  but  all  of  them,  even  the  smallest, 
are  enclosed  by  a  delicate  capsule,  in  addition  to  which  their  peripheral  layer  is 
frequently  hyaline,  while  calcium  salts  have  been  deposited  in  their  centers;  the 
capsule  surrounding  even  the  larger  nodes  is  much  more  delicate  than  those  enclos- 


Treatment.  727 

ing  the  cheesy  nodules  of  glanders;  the  diagnosis  can,  however,  only  be  confirmed 
definitely  by  microscopical  examination  (numerous  eosinophile  cells  in  parasitic 
nodules!). — In  botryomycosis  and  in  imeumouomycosis  the  morbid  changes  are  gen- 
erally more  chronic  in  character,  ■while  the  presence  of  botryomyces  or  mycelia  and 
other  fungi  is  readily  determined  by  the  microscope. — Metastatic  pus  foci  are  fre- 
quently very  much  like  end)olic  nodules  of  glanders  in  their  general  apjiearance, 
especially  those  of  acute  glanders,  but  the  absence  of  more  advanced  glanderous 
changes  in  the  lungs,  as  well  as  in  other  internal  organs,  is  against  their  glanderous 
nature  (pus  bacteria  nuiy  also  be  present  in  broken-down  glanderous  foci!).  Metas- 
tases of  new  formations  (sarcomata,  carcinomata)  may  be  recognized,  aside  from 
their  characteristic  niacroscopical  ainiearaiu-e  on  section,  by  the  presence  of  primary 
tumors  or  by  histological  examination. 

Finally,  suspicion  of  glanders  may  be  aroused  in  those 
instances  in  which  new  formations  (rhinoscleromata,  sarcomata, 
carcinomata,  librous  polyps,  etc.)  occur  on  the  nasal  mucous 
membrane  or  when  metastases  of  malignant  tumors,  particu- 
larly melanomata,  give  rise  to  chronic  enlargement  of  the  lymph 
glands  in  different  regions  of  the  body  (Bissonge  and  Foilor 
observed  the  sul)maxillary  glands  thus  affected).  In  these  cases 
an  exact  diagnosis  is  possible  only  by  careful  consideration 
of  the  anamnesis  or  by  means  of  a  histological  examination 
of  portions  of  the  tumors.  Observations  of  the  past  have  shown 
tliat  the  mallein  test  gives  negative  results  in  these  cases. 

Treatment.  Since,  according  to  generally  accepted  princi- 
ples of  sanitary  police  control  evidently  glanderous  horses  must 
be  destroyed  at  once,  successful  treatment  of  this  disease  is 
of  no  practical  consequence.  But  this  is  true  irrespective  of 
this  fact  since  all  the  many  attempts  to  cure  the  disease  that 
have  been  made  in  the  past  have  proved  failures.  The  internal 
administration  of  the  most  varied  medicinal  agents  has  been 
found  just  as  ineffective  as  the  more  recently  recommended 
intratracheal  injections  of  Lugol's  solution  (Delamotte, 
Trinchera),  even  in  human  medicine  favorable  results  have 
lieen  obtained  only  now  and  then  by  the  repeated  cutaneous 
application  of  gray  mercurial  ointment. 

The  appearance  of  local  reactions  following  the  injection 
of  mallein  has  given  rise  to  the  belief  that  repeated  injections 
of  this  kind  would  have  a  healing  influence  on  the  glanderous 
process.  Although  the  healing  of  ulcers  and  even  definite  re- 
covery from  the  disease  has  been  observed  noAv  and  then  to 
follow  such  treatment  (Johne,  Helman,  Semmer,  Pilavios, 
Choromansky,  Sitschew)  the  possibility  of  spontaneous  recovery 
in  these  cases  could  not  be  definitely  excluded;  even  if  we 
admitted  the  possilnlity,  this  mode  of  treatment  would  hardly 
be  of  i)ractical  value. 

Immunization.  Recovery  from  this  disease  does  not  protect  against 
suhsecjuent  infection,  at  least  not  as  far  as  experimental  observations 
on  dogs  treated  with  virulent  material  are  concerned  (Charrin,  Galtier). 
Experiments  made  with  repeated  mallein  injections  (MacFadyean, 
Sehindelka)    also  gave  no  satisfactory  results. 

After  Sadowsky  had  succeeded  by  the  administration  of  cultures 
killed  at  62°   C,  in  increasing  the  resisting  power  of  a  colt  to  such 


728  Glanders. 

an  extent  that  the  inoculation  of  virulent  cultures  produced  no  harmful 
effect,  Levy,  Blumenthal  &  Marxer  obtained  happy  results  in  horses 
hy  the  subcutaneous  administration  of  600  mg.  or  two  successive  in- 
jections of  300  mg.  of  bacilli  that  had  been  killed  in  80%  glycerin  or 
in  10  7o  urea  solution.  Subsequently  they  prepared  an  immunizing 
powder  from  cultures  treated  in  the  manner  mentioned  and  which 
they  named  "farase."  This  is  applied  in  doses  of  0.4  g.  followed  in 
three  weeks  by  0.8  g.  injected  subcutaneously.  This  substance  w^hich 
keeps  well  even  at  high  temperatures  is  said  to  be  absolutely  harmless, 
treatment  therewith  not  seriously  affecting  the  general  condition  of 
the  animal  and  producing  an  immunity  of  at  least  one  year's  duration. 

According  to  Malzew,  cattle  serum  in  doses  of  250  to  420  cc.  injected  sub- 
cutaneously protects  horses  against  the  action  of  virulent  cultures  of  glanders. 
Noeard,  Aruch  &  Petrini,  as  well  as  Prettner,  found  that  even  the  serum  of  cattle 
which  had  been  injected  repeatedly  with  virulent  cultures  was  ineffective,  and 
Galtier  &  Nicolas  observed  that  treatment  with  serum  of  this  kind  after  experi- 
mental inoculation  would  at  most  prolong  the  course  of  the  disease. 

Veterinary  Sanitary  Police.  The  live  stock  sanitary  laws 
of  all  civilized  countries  include  glanders  among-  those  diseases 
which  must  be  ofificially  reported,  and  provide  also  for  regula- 
tions requiring  the  immediate  destruction  of  diseased  and  the 
quarantine  of  suspected  and  exposed  animals,  including  thor- 
ough disinfection  of  infected  premises.  Public  traffic  with 
horses  is  subjected  to  careful  supervision  for  the  purpose  of 
the  prompt  detection  of  new  outbreaks.  The  strict  enforce- 
ment of  these  regailations,  especially  in  those  localities  where 
adequate  compensation  is  provided  for  condemned  animals,  has 
resulted  in  a  marked  decrease  in  this  disease,  which  is  strictly 
contagions  in  its  nature. 

In  recent  years  the  systematic  application  of  mallein  tests 
and  of  serodiagnostic  methods  has  added  much  to  the  success 
in  the  control  and  eradication  of  glanders ;  while  formerly  the 
presence  of  doubtful  symptoms  or  the  absence  of  pronounced 
lesions  merely  pointed  to  suspicion  of  disease  and  consequently 
involved  the  necessity  of  a  long  period  of  observation  while 
the  animal  was  held  in  quarantine,  modern  methods  of  diag- 
nosis make  it  possible  to  decide  the  nature  of  the  malady  at 
once,  or  within  a  very  short  time,  and  thus  make  possible  the 
immediate  isolation  (or  destruction)  of  dangerous  individuals. 
These  methods  also  enable  us  to  remove  at  once  such  horses 
from  infected  stables  as  are  healthy  in  general  appearance, 
but  yet  may  have  been  the  cause  of  the  dissemination  of  the 
disease.  By  isolation  and  further  observation  of  such  animals 
the  healthy  horses  are  protected  against  possible  infection. 
This  makes  it  possible,  also,  to  dispense  with  many  quarantine 
regulations  that  were  formerly  necessary.  The  advantages 
thus  afforded  to  the  owner  of  horses  and  to  horse  traffic  in 
general  is  evident. 

The  application  of  the  mallein  tests  and  of  serodiagnostic  methods 
is  recommended  in  all  cases  where  individual  horses  show  symptoms 


Veterinary  Police.  729 

pointing  to  possible  infection  witii  glanders,  or  in  such  cases  wliere 
the  remaining  horses  in  the  stable  are  under  suspicion  of  exposure. 
While  differences  of  opinion  still  exist  in  regard  to  tlie  value  of  allergic 
reactions  and  serum  tests,  nevertheless  observations  thus  far  recorded 
show  that  the  exaet  and  intelligent  ai)i)li('alioii  of  these  methods  produce 
very  favorable  results  and  that  the  supplemental  use  of  several  of  these 
methods  enables  us  to  reduce  errors  to  a  minimum.  While  the  newer 
methods  and  particularly  the  serum  tests  make  the  duties  of  the  prac- 
ticing veterinarian  less  burdensome,  clinical  examinations  nevertheless 
are  still  of  great  importance  and  quite  indispensable,  especially  for 
the  reason  that  these  tests  will  occasionally  give  negative  results  in 
very  chronic  and  extensive  (and  consequently  the  most  dangerous) 
cases. 

Since  1010  the  coniplemeiit  fixation  method  and  the  agglutination  test  Iiave 
been  useil  in  Prn^sia  exclusively  as  official  tests.  All  animals  with  a  fixation  titer 
of  0.2  or  less,  or  -with  agglutination  power  of  over  1.000  must  lie  destroyed;  all 
horses  with  a  fixation  titer  above  0.2  or  an  agglutination  jiower  below  1,000  are 
regarded  as  free  from  suspicion,  provided  that  the  examination  is  made  at  least 
two  weeks  after  the  animal  in  question  has  l;een  removed  from  exposure.  From 
1900-7  to  1907-S,  6-lS  animals  were  destroyed  on  evidence  furnished  by  the  aggluti- 
nation test;  of  these  39.5  (60. 9o^)  were  found  aflFecte<l  with  glanders."  The  success 
of  the  method  consisted  in  the  fact  that  after  completion  of  the  blood  test  (which, 
however,  had  to  be  repeated  in  a  number  of  cases)  not  a  single  glanderous  animal 
was  found  in  any  of  the  stables  investigated. — In  Hungary  all  animals  which  give 
t}^iical,  at}-]iical  or  doubtful  reactions  to  the  subcutaneous  mallein  test  and  show 
clinical  symptoms  of  disease,  are  destroyed  at  once.  Horses  that  react  to  the  test, 
but  are  otherwise  in  apparent  health,  must  be  isolated  from  other  solidungula,  but 
may  with  the  consent  of  the  proper  authority  be  use<l  under  certain  restrictions ; 
thus  for  farm  work,  etc.,  contact  with  other  horses  must  be  avoided.  These  animals 
must  be  examined  every  two  weeks  by  a  veterinarian,  and  in  the  event  that  any 
Busjncious  symptoms  of  glanders  make  their  appearance,  the  animal  must  be 
•destroyed  at  once.  Those  animals  which  have  reacted  to  the  mallein  test  but  appear 
otherwise  in  perfect  health  may  be  used  by  their  owners  without  restrictions,  except 
that  none  of  these  animals  that  have  been  in  immediate  contact  with  diseased 
horses  may  be  sold  outside  of  a  parish  before  the  expiration  of  60  days  nor  vrithout 
a  second  examination  by  a  veterinarian.  Exposed  animals  which  have  reacted  to 
the  test  are  retested  after  30  days;  those  animals  that  do  not  react  at  the  second 
test  and  otherwise  appear  in  perfect  health  are  released  from  the  restrictions,  while 
the  reactors  are  treated  as  above  indicated  (destroyed  or  continued  in  quarantine 
and  again  tested  as  the  authority  in  charge  may  designate  for  each  case). 

Under  these  regulations  (1902-1908)  l,.3So  suspected  glanderous  horses  and 
1,609  horses  exposed  to  glanders  (a  total  of  2,994  actually  glanderous  horses,  all  of 
which  were  affected  with  glanders  in  the  first  stage  of  the  disease)  gave  positive 
reactions  to  the  mallein  test  and  were  quarantined  (60.1%  of  all  glamlerous  horses 
destroyed  during  this  period).  A  similar  method  was  followed  in  the  extermina- 
tion of  glanders  in  the  Compagnie  generale  des  Yoitures  of  Paris  without  serious 
interruption  of  the  business  of  the  company;  while  the  disease  was  verv  prevalent 
in  the  stables  of  this  company  in  189.5  and"  1896  (see  page  680),  only  101,  40  and 
8.5  horses,  respectively,  had  to  be  destroyed  on  account  of  disease  in  1897,  1898 
and  1899.     In  1903  only  18  reacting  horses  were  found  in  all  of  the  stables. 

During  the  time  intervening  1)etween  the  mallein  tests  and  that 
of  procuring  the  blood  for  serum  tests  the  body  temperature  of  those 
horses  suspected  of  infection  or  disease  should  be  recorded  systematically 
twice  daily.  An  elevation  of  temperature  continuing  for  several  days 
points  to  recent  infection  unless  it  can  be  ascribed  to  some  other  cause 
(see  pp.  690  and  697),  or  to  the  continuance  and  the  probable  pro- 
gression of  already  existing  lesions. 

Literature.  Loffler  &  Schiitz,  D.  m.  W.,  1882.  Xr.  .52;  1883.  Nr.  14.  — 
LofHer,  Arb.  d.  G.A.,  1886.  I.  141.  —  .Tohne  I).  Z.  f.  Tni.,  1886.  XVi.  .".21.  — 
C'adeac  &  Malet,  Rev.  vet.,   1886.  406;    1888.  581;   Bull.,  1894.  555.  —  Schiitz.   A.  f. 


730  Glanders. 

Tk.  1889,  XX.  425;  1895.  XXI.  382;  1898,  XXIA^  1;  1908,  XXXIV.  74.  —  Olt, 
A.  F.  Tk.,  1895,  XXI.  352.  —  Foth,  Z.  f.  Yk.,  1892.  169;  D.  Z.  f.  Tm.,  1894. 
XIX.  437.  —  Bass,  D.  Z.  f.  Tm.,  1893,  XIX,  217  (Historical).  —  Nocard,  Bull., 
1893,  116;  1894,  89.  225.  367;  1896,  196;  1897,  781;  1901,  387;  Eec,  1897,  675; 
1898.  296.  —  Senimer,  D.  Z.  f.  Tm.,  1894,  XX.  59.  —  Hutyra  &  Preisz,  D.  Z.  f. 
Tm.,  1894,  XX.  369.  —  Olt,  A.  f.  Tk.,  1895,  XXI.  352.  —  MaeFadyeaii,  J.  of 
eomp.  Path,  1896,  IX.  322;  1901,  XIV.  265;  1904,  XVII.  295.  —  Wladimiroff,  Eec, 
1897,  618;  Hb.,  d.  p.  M.,  1903,  II.  707  and  1904.  III.  1020  (Lit.);  B.  t.  W., 
1908.  50.  —  Jensen,  B.  t.  W.,  1901,  621.  —  Babes,  Moyens  a  comb  la  Morve, 
Bucharest  1903.  — Bonome,  Patogenesi,  etc.,  della  Morva  chiusa,  Padova  1905.  — 
Eiegler,  Kongr.  Budapest  1905,  II.  338.  ■ — •  Schlegel,  D.  Eotzbekiimpfung  usw., 
Stuttgart  1905.  —  Sehniirer,  Cbl.  f.  Bakt.,  1905,  XXXIX,  180;  Z.  f.  Infkr.,  1908. 
IV.  216;  D.  t,  "W.  1910.  65  (Lit.  ou  Allergy).  —  Feodorowsky,  A.  f.  Tk.,  1905, 
XXXL  505.  —  Schiitz  &  Miessner,  1905.  XXXI.  353.  —  Hutyra,  Z.  f.  Tm.,  1907. 
XI.  1.  —  Levy,  Blumenthal  &  Marxer,  Z.  f.  Infkrkh.,  1907.  III.  294  (Lit.  on  Im- 
munization). —  Sustmann,  Diss.  Ziirich  1908  (Lit.  on  Aggl).  —  Schulz,  A.  f.  Tk., 
1908.  XXXV.  198  (Lit.  on  Aggl.).  —  Schiitz  &  Schubert,  ibid.,  p.  44.  —  Pfeiler, 
ibid.,  p.  323  (Lit.  on  Prezip.).  —  Miessner  &  Trapp,  ibid.,  p.  85  (Lit.  ou  Patho- 
genese);   Cbl.  f.  B.,  1909.  LIL   115   (Lit.   on  Fixation). 


Glanders  in  Carnivora.  After  the  ingestion  of  the  meat  and  the 
organs  of  glanderous  horses  carnivora  may  also  become  infected  with 
glanders.  In  zoological  gardens  actual  enzootics  are  occasionally  ob- 
served among  the  animals  of  the  cat  species  from  this  cause,  while 
animals  of  the  dog  kind  are  much  more  rarely  the  victims  of  these 
conditions. 

In  such  cases  the  disease  usually  takes  an  acute  course.  As  a  rule 
the  first  symptoms  consist  of  an  excessive  inflammation  of  the  con- 
junctivae and  of  the  mucous  membranes  of  the  air  passages,  the  eyes 
and  nose  discharging  at  first  purulent  but  later  a  greenish-gray  or 
bloody  secretion.  Following  this  the  respiration  becomes  very  labored 
as  a  result  of  excessive  swelling  of  the  respiratory  mucous  membranes. 
These  symptoms  become  rapidly  aggravated,  the  tissues  of  the  head 
become  swollen,  particularly  in  the  nasal  region,  while  metastatic 
nodules,  which  soon  perforate  the  skin  and  form  ulcers,  make  their 
appearance  in  the  subcutaneous  tissue  of  various  regions  of  the  body. 
Finally  diarrhea  sets  in,  whereupon  the  animal  succumbs  in  the  course 
of  the  first  or  second  week  after  the  appearance  of  the  first  symptoms. 

Glanders  in  Sheep  and  Goats.  Although  sheep  are  susceptible  to 
experimental  infection  with  glanders  they  are  not  known  to  become 
infected  from  natural  sources.  The  destructive  disease  described  by 
Audum  in  Livland  under  the  name  of  glanders,  causing  the  death  of 
60  Merino  sheep  and  the  slaughter  of  200  exposed  animals,  is  evidently 
not  the  morbid  process  under  discussion,  experimental  infection  of  dogs 
as  well  as  of  guinea  pigs  having  been  unsuccessful.  (Hemorrhagic 
septicemia  was  formerly  described  repeatedly  as  glanders  of  sheep ; 
see  p.  118.) 

Ercolani,  Karsten-Harms,  Koch  and  Trasbot  observed  glanders 
in  goats  in  stables  where  glanderous  horses  had  been  kept  for  a  long 
time.  Of  morbid  symptoms  were  observed  particularly  profuse  purulent 
nasal  discharge  and  in  one  instance  abscess  of  the  udder. 

Literature.  Ercolani,  II.  med.  vet.,  1891.  —  Harms,  H.,  Jhb.,  1874.  88.  — 
Trasbot,  Ann.  d'Alf.,  1876.  521.  —  Audum,  Unters.  lib.  d.  Schafrotz,  Diss.,  Dor- 
pat,    1888. 


GlaiiMors  in    Man.  731 

Glanders  in  Man.  In  nuiii  <rl;in(lcfs  scoins  to  occur  most  fre<inently 
wlit'ii  till'  virus  tijiius  an  ciiti-aiicc  dii-cctly  into  the  lyinpli  s])a('('S  or 
into  the  subcutaneous  and  submucous  connective  tissue  from  lesions 
in  the  skin  or  mucous  nuMubrane,  or  Avhen  it  enters  the  blood  stream 
directly.  Aside  from  positive  observations  alonj?  this  line  this  view 
is  supported  by  the  fact  that  persons  who  are  frequently  exposed  to 
dangrer  of  infection  (stable  attendants)  are  comparatively  rarely 
affected  Avitli  the  disease.  Nevertheless  the  possibility  of  an  iutestiiud 
infection  must  be  admitted. 

The  course  of  the  disease  uiay  be  acute  or  chronic.  Tn  acute 
cases  a  snuill  nodule  or  ulcer  develo])s  at  the  point  of  infection,  the 
surrounding  connective  tissue  is  edematous  and  the  afferent  vessels 
and  the  regional  lymph  glands  are  swollen.  Subse(|uently  small  nodules 
and  bluish-red  pustules  appear  on  other  parts  of  the  body  where  they 
are  in  a  short  time  transformed  into  ulcers;  fre(|uently  there  may 
be  purulent  inflammation  of  the  articulations  and  of  the  corpus 
cavernosum  of  the  penis.  In  the  course  of  these  changes  there  is  febrile 
elevation  of  temperature  with  occasional  attacks  of  chills,  and  the 
patient  complains  of  severe  muscular  and  articular  pains.  Tn  some 
instances  there  is  also  an  ulcerative  inflammation  of  the  nasal  mucous 
membrane  attended  at  first  by  a  thin  discharge  M'hich  subsequently 
becomes  purulent,  reddish  and  viscid.  The  appearance  of  cough,  hoarse- 
ness, difficult  respiration  and  deglutition  indicate  affection  of  the 
larynx  and  lungs.  These  symptoms  are  attended  with,  or  followed  by, 
gradual  exhaustion  of  the  patient  and  finally  terminate  in  death  in  the 
course  of  2  to  6  weeks. 

Tn  some  cases  (intestinal  infection?)  the  morbid  picture  is  very 
similar  to  that  of  typhoid  fever;  the  persistence  of  the  fever  beyond 
the  third  week  as  well  as  the  subsequent  appearance  of  cutaneous 
pustules  alone  make  the  final  definite  diagnosis  possible. 

The  chronic  form  develops  insidiou.sly ;  ivhile  febrile  elevations 
of  temperature  continue,  nodules  and  small  ulcers  appear  on  various 
parts  of  the  body;  these  may  heal  and  the  patients  may  be  apparently 
\vell  for  months  or  even  years ;  later,  however,  fresh  nodules  appear 
and  symptoms  of  lymphangioitis  and  phlebitis  set  in  and  the  process 
finally  becomes  acute,  or  the  disease  may  run  a  chronic  course  through- 
out (in  Bollinger's  cases  the  disease  continued  for  11  years),  although 
this  form  of  the  disease  is  said  to  end  under  propc^r  treatment  not  in- 
frequently (50%)  in  recovery  (superficial  application  of  gray  mercurial 
ointment). 

Literature.  Bollinger,  Zienissen's  Handbuch,  1S74.  ^99  (Lit.).  —  Konnivi, 
Nothnagel's  Handbuch,  1900.  V.  Bd.  IT.  —  Strube,  A.  f.  Klin.  Chir.  LXI.  (Lit.). 


8.     Ulcerative  Inflammation  of  the  Lymphatics  of  the  Horse. 

Lymphangioitis  ulcerosa  equorum. 

Ulcerative  lynipliaiigioitis  is  a  cliroiiic,  conta,nioiis  disease 
of  horses  in  the  course  of  wdiicli,  usually  Avithont  involving" 
the  reo'ional  lynipli  n'lands,  there  is  developed  a  pro.U'ressive 
inflammation  of  the  subcutaneous  lymph  vessels  with  a  tendency 
to  ulceration. 


732  Ulcerative  Lympliangioitis. 

History.  This  disease  was  first  described  by  Nocard  (1892  and 
1896)  as  a  specific  morbid  process,  this  author  having  demonstrated  the 
disease  (in  59  horses  suspected  of  having-  glanders)  to  be  etiologically 
different  from  glanders.  Following  the  latter  author  Mollereau  and 
Vallee  reported  the  disease  from  France,  Darmagnac  from  Algeria, 
while  Schwartzkopf  observed  similar  diseases  in  the  Philippine  Islands. 
The  identity  of  the  disease,  in  the  latter  instance,  has  however  not 
as  yet  been  definitely  determined  owing  to  the  absence  of  bacteriological 
evidence. 

Etiology.  The  cause  of  the  disease  is  identical  in  all  of 
its  characteristics  Avitli  the  l)acillus  of  pseudotuberculosis  of 
Preisz  and  Nocard  (see  p.  626). 

Pathogenicity.  Subcutaneous  injection  of  tlie  pure  culture 
in  a  horse  or  ass  is  followed  l)y  local  suppuration ;  the  abscess 
thus  formed  will  break  in  the  course  of  6  to  10  days,  whereupon 
the  contents  are  discharged  and  healing  follow^s  w^ith  the  for- 
mation of  a  scar  (Nocard  observed  in  one  case  only  the  develop- 
ment of  progressive  inflammation  of  the  hnnphatics  follow^ing 
such  inoculation).  Intravenous  injection  produces  at  the  most 
a  temporary  febrile  condition. 

Injection  of  pure  cultures  or  of  pus  obtained  from  nodes 
or  ulcers  into  the  abdominal  cavity  of  a  guinea  pig  is  followed 
by  inflammation  of  the  tunica  albuginea  of  the  testes  wdiich 
is  usually  quite  pronounced  at  the  end  of  the  od  to  the  5tli 
day  and  in  the  course  of  wdiich  abundant  purulent,  fibrinous 
exudate  collects  betw^een  the  tunics  of  these  organs.  Occa- 
sionally death  results  by  the  end  of  the  first  week,  post-mortem 
examination  revealing  an  exudative  peritonitis  in  addition  to 
periorchitis.  Highly  virulent  cultures  may  cause  death  in  from 
24  to  48  hours  without  involving  the  testes. 

Natural  infection  apparently  takes  place  from  wounds  or 
other  solutions  of  continuity  in  the  skin,  and  the  fact  that  the 
disease  usually  develops  on  the  limbs  seems  to  point  to  the 
fetlocks  as  the  ports  of  entrance  of  the  infection,  or  the  process 
may  be  induced  by  the  kick  of  a  horse.  However,  the  disease 
does  not  usually  spread  direct  from  animal  to  animal,  but  the 
bacilli  probably  gain  access  into  the  hanph  spaces  and  the 
cutis  directly  from  the  soil. 

Symptoms.  Attended  wdth  diffuse  swelling  of  the  extremi- 
ties of  the  limbs,  isolated,  firm,  sharply  circumscribed,  sensitive 
nodes  appear  on  one  or  both  hind  legs;  later  these  nodes  rup- 
ture and  become  transformed  into  irregular  ulcers  with  bulging 
but  not  thickened  borders  wdiich  at  first  discharge  a  creamy,  but 
subsequently  a  thinner,  viscid  purulent  secretion.  These  ulcers 
are  not  progressive  in  character  and  yield  readily  to  antiseptic 
treatment.  This  is,  however,  soon  follow^ed  by  the  appearance 
of  fresh  nodes  in  the  neighborhood  or  in  more  remote  regions 


Symptoms,    l)iaj>iio.sis.  733 

of  tlic  body,  wliich  also  become  transformed  into  nleers,  wliile 
the  connecting  lynipli  vessels  form  thick  strands  in  the  course 
of  which  new  nodules  and  ulcers  develop.  In  this  manner  the 
disease  may  coiitimie  for  months,  duriiii>-  which  tijne  it  may 
spread  from  the  i)usterior  to  the  anterior  lim))s,  the  trunk,  tlie 
neck,  and  even  the  facial  portion  of  the  head,  and  may  finally 
terminate  in  the  death  of  the  animal.  In  some  cases  the  disease 
may  continue  for  years.  In  one  case  the  nodes  and  ulcers 
ap])eared  only  durini'-  the  cold  season  while  the  affected  horse 
seemed  perfectly  healthy  during  the  summer. 

The  lymph  glands  in  the  region  of  the  ulcerous  processes 
may  occasionally  undergo  moderate  swelling,  but  as  a  rule, 
there  is  no  induration,  while  suppuration  never  occurs. 

An  unusual  course  of  the  disease  is  noted  by  Darinagnac  inasmuch 
as  the  ulcerous  process  spread  in  spite  of  proper  treatment  from  the 
inner  surface  of  the  thigh  to  the  scrotum,  and  caused  an  extensive 
swelling  of  the  entire  lower  portion  of  the  alxloinen,  fresh  nodes 
rapidly  reappearing  throughout  its  extent,  some  of  them  leading  to  the 
formation  of  indolent  fistulae.  The  constant  loss  of  tissue  secretions 
finally  caused  the  death  of  the  horse,  and  i)ost-i.nortem  examination 
revealed  innumeral)le  pus  foci  scattered  throughout  the  firm  lardaceous 
connective  tissue  of  the  swelling.  In  addition  to  this  there  was  also 
simple  hj'pertrophy  of  the  inguinal  and  su])lumbar  lymph  glands. 

Cocu  observed  in  a  mare  of  advanced  age  a  large  paranephritic 
abscess,  from  the  interior  of  which  a  fistulous  canal  communicated 
with  the  outer  world  in  the  lumbar  region.  The  right  kidney,  which 
was  surrounded  by  pus,  contained  in  its  otherwise  normal  parenchyma 
numerous  abscesses  ranging  in  size  up  to  that  of  a  pigeon 's  egg.  Nocard 
demonstrated  the  above  named  bacillus  in  the  pus. — The  authors  ob- 
served a  similar  paranephritic  abscess  as  large  as  a  man's  head  at 
the  post-mortem  examination  of  an  ass,  they  could  also  demonstrate  the 
bacillus  referred  to  in  a  purulent  secretion  of  an  otherwise  l)enign 
wound  of  the  fetlock  of  a  horse  which  healed  perfectly. 

Diagnosis.  The  disease  resembles  cutaneous  glanders  in 
many  respects.  The  difTerences  are  that  the  sinall  ulcers  which 
develop  from  the  nodes  in  ulcerous  h^nphangioitis  heal  rapidly, 
the  lymph  glands  are  hardly  involved  in  the  process,  the  nasal 
mucous  membrane  remains  intact  and  the  mallein  test  gives  no 
positive  reaction.  In  the  pus  of  the  nodes  and  in  the  secretion 
of  the  ulcers  short  (iram  positive  bacilli  can  be  demonstrated, 
which  do  not  thrive  on  naturally  acid  potatoes.  Finally,  intra- 
peritoneal infection  of  guinea  pigs  is  followed  more  rapidly  by 
periorchitis  than  is  the  case  in  infection  with  glanderous 
nuiterial,  the  bacilli  in  question  are  found  in  great  masses  in 
the  purulent  fibrinous  exudate,  while  pus  foci  are  found  in  the 
parenchymatous  organs. 

Epizootic  Ij'niphangioitis  is  in  general  a  more  malignant 
disease  while  the  hnnph  glands  also  usually  suppurate  and  the 
pus  contains  large  globular  schyzomycetes  wdiich  do  not  stain 
readily. — Contagious  acne  is  probably  closely  related  etiologic- 


734  Epizootic  Lvmphangioitis. 

ally  to  tlie  disease  under  discussion.  It  usually  develops  on 
portions  of  the  body  which  come  in  contact  with  the  saddle  and 
harness. 

Treatment.  Application  of  antiseptic  fluid  to  the  ulcers 
usually  brings  about  speedy  recovery;  if  the  abscesses  persist 
the  nodes  may  be  incised  and  treated  with  strong  antiseptics. 
In  exceptional  cases,  however,  even  heroic  treatment  does  not 
check  the  progress  of  the  disease. 

In  view  of  the  similarity  of  the  organisms  at  the  bottom 
of  this  disease  and  Loffler's  diphtheria  bacillus,  Vallee  tried 
treatment  with  diphtheria  antitoxin.  Subcutaneous  injection 
of  the  serum  (40-50  cc.  at  four  day  intervals)  as  well  as  the 
local  application  of  pulverized  serum  was  followed  by  remark- 
ably rapid  liealing  of  the  ulcers  and  the  checking  of  the  morbid 
processes. 

Literature.  Noeard,  BnlL,  1893.  IKi;  A.  P.,  1S96.  X.  609.  —  Cocii,  Bull., 
1899.  232.  —  Schwarzkopf,  Amer.  vet.  Eev.,  1902.  XV I.  111.  —  Dassonville,  Bull., 
1907.  576.  —  Darmagnac,  Eev.  gen.,  1904.  III.  303.  —  A^allee,  Bull.,  1907,  181. 


Lymphangioitis  Pseudofarcinosa.  Lienanx  o1)served  a  very  chronic 
affection  of  cattle  in  Belgium  which  manifested  itself  in  the  appearance 
of  large  painless  nodes  on  the  legs,  approaching  the  size  of  a  fist  and 
communicating  with  each  other  by  means  of  greatly  enlarged  lymph 
vessels;  the  interior  of  these  nodes  contain  pus  foci  which,  however, 
do  not  break  spontaneously ;  as  a  rule  they  become  indurated.  The 
regional  lymph  glands  become  swollen  and  develop  into  firm  nodes 
with  purulent  centers.  This  disease  which  otherwise  resembles  glanders 
(see  p.  668)  is  etiologically  related  to  pustulous  dermatitis,  described 
by  Lienaux.  Treatment  consists  in  early  evacuation  of  the  abscesses 
and  surgical  treatment  of  the  tumors  (Ann.  1905,  LIV,  297;  see  also 
p.  670). 


9.    Epizootic  Lymphangitis.     Epizootic  Inflammation  of  the 
Lymphatics.    Lymphangioitis  Epizootica. 

{African  Glanders;  Japanese  Glanders  or  Farcy;  Saccharomy- 

cosis;  Lyfnphangite  episooticjue,  Farcin  de  riviere,  Farcin 

d'Afrique,  Farcin  cryptococcique   [French]; 

Linfangite  farcinoide,  Farc'mo  cripto 

cocchico  [Italian].) 

Epizootic  lymphangitis  is  a  chronic,  contagious  disease 
of  Solidungula  caused  by  a  yeast  fungus,  Cryptococcus  farcimi- 
nosus;  in  exceptional  instances  cattle  also  are  attacked.  The 
disease  is  characterized  by  purulent  inflammation  of  the  sub- 
cutaneous lymphatic  vessels  and  of  the  regional  lymph  glands. 

History.  The  disease  was  first  described  by  Italian  and  French 
veterinarians.     Its  cause  was  described  bv  Rivolta    (1873),   while  its 


Oc-(iiiit'nt'(\    Etioli)';v.  735 

etiology  ami  syinplomatology  were  studied  and  elucidated  by  Rivolta 
&  iMieellone,  Nocard,  Tokishige,  IMarcone,  Tartakowsky,  Sanfelice, 
Pricolo.  ete. 

Occurrence.  Tho  disease  was  formerlj-  observed  only  in 
soutlieni  Kmopc,  particularly  on  the  shores  of  the  Mediter- 
ranean, ([uite  t'i'e(iuently  in  Italy  and  in  France.  Recent  re])()rts, 
however,  mention  its  occurrence  in  more  northern  localities 
(Finland  and  northern  Russia,  England).  It  seems  also  to  l)e 
widely  ])rcvalent  in  Asia  and  Africa. 

The  disease  was  observed  by  Lindcjuist  in  Finland,  by  Tartakowsky,  Dedjulin 
and  Awryinsky  in  the  governmental  districts  of  Olonotz  and  Novgorod  in  Kussia, 
by  Tokishige  in  .lajian  (rather  common),  by  Pearson  in  Pennsylvania,  Fischer  in 
Ohio,  by  Does  i:  liaan  in  Lower  India  and  by  Nockolds  in  the  I'hilippine  Islands, 
where  it  appears  as  a  very  freqnent  disease  with  unfavorable  course,  on  account 
*  of  which  large  numbers  of  horses  have  in  recent  times  been  destroyed  under  suspi- 
cion of  glanders. 

In  1902  it  was  transported  with  shipments  of  horses  from  India  to  South 
Africa  and  from  there  with  English  troops  that  returned  from  the  Transvaal  war, 
to  England  in  wliich  latter  country  it  gained  wide  prevalence  in  several  garrisons 
and  was  subsequently  disseminated  by  discarded  army  horses  to  private  stables. 
This  plague  became  so  prevalent  that  the  English  government  formulated  special 
regulations  for  its  control,  the  success  of  which  is  evident  from  the  report  that 
only  two  eases  of  the  disease  were  observed  in  190(i.  —  In  1901  a  number  of 
cases  were  observeil  in  a  German-Russian  border  villages  in  the  government  district 
of  Gumbinnen. 

Etiology.  The  Crj^^tococeus  fareiminosus  Rivolta  (Sac- 
cliaromyces  fareiminosus  Tokislii,^e)  forms  comparatively  large, 
,  3  to  4  /^  long',  2.4-3.6  -"  "wide,  doubly  contoured,  somewhat  oval 
bodies  usually  either  somewhat  pointed  at  the  ends  or  pro- 
vided with  bud-like  protuberances.  These  organisms  multiply 
by  budding  and  in  this  respect  resemble  saccharomyces,  al- 
though they  are  smaller  and  do  not  cause  saccharine  fermenta- 
tion. They  are  not  readily  stained  by  the  usual  methods,  even 
carbol-fuchsin  staining  the  contents  only  slightly  wdiile  the  cell 
membrane  remains  unstained. 

Culture.  Artificial  cultures  are  difficult  to  obtain  and  growth  on 
artificial  media  is  slow.  Thus  on  nutrient  agar  grayish-white^  granules 
appear  only  after  al)out  30  days.  su})se(iuently  they  enlarge  to  form 
prominent  colonies  drawn  into  folds  resembling  the  convolutions  of 
the  intestines.  On  gelatin  bouillon  yellowish-white  sandy  granules 
appear  in  the  course  of  56  days,  on  potatoes  light  brown  masses  appear 
in  a  somewhat  shorter  period  while  in  pepton  bouillon  white  flakes 
develop  in  the  course  of  17  da.vs.  Under  the  microscope  the  colonies 
are  seen  to  consist  of  hyphae,  spherical  fungi  and  granules  resembling 
spores  ( Tokishige) . 

According  to  Bridre  &  Negre  the  fact  that  immune  bodies  are  present  in  the 
serum  of  affected  horses  which  fit  into  complement  fixation  systems  with  ordinary 
yeast  cells  points  to  the  blastomycetic  nature  of  these  parasites. 

In  contrast  to  the  above  view  Ducloux,  whose  observations  were  subsequently 
confirmed  by  Thiroux  &  Teppaz,  is  of  the  opinion  that  the  cause  of  the  disease 
is   a    protozoon    (Leucocytoioon    piroplasmoidcs).      These    investigators   found    round 


736  Epizootic  Lymphangitis. 

or  pear-shaped  structures  in  the  pus  of  nodes  and  ulcers.  Some  of  these  structures 
were  enclosed  by  mono-  and  polynuclear  leucocytes,  in  the  cell  substance  of  which 
karyosomes  could  be  demonstrated  with  eosin-methylene  blue,  and  which  suggested 
the  appearance  of  Heliosoma  tropicum,  the  cause  of  Oriental  boil  plague.  Thiroux 
&  Teppaz  failed  in  their  attempts  to  cultivate  the  parasite,  nor  could  they  repro- 
duce the  disease  liy  inoculation  of  the  pus  from  the  nodes.  According  to  their 
view,  the  leucocytozoons  may  be  transported  to  the  internal  organs  by  means  of 
leucocytes  and  there  set  up  their  morbid  process. 

Pathogenicity.  After  the  adniiiiistration  of  pus  taken  from 
the  nodes  or  ulcers  into  cutaneous  wounds  of  sohdungula,  in- 
flammation and  swelling-  of  the  lymphatics  may  occur  in  rare 
cases  in  the  course  of  20  to  60  days.  Along  the  course  of  the 
lymphatic  vessels  nodes  develop  which  later  form  ulcers  (Tixier, 
Chauvrat,  Delamotte,  Peuch),  In  rabbits  experimental  infec- 
tion produces  local  abscesses  only,  while  in  guinea  pigs  swelling 
of  the  lips  and  the  popliteal  glands  usually  results.  Other 
experiment  animals  are  immune. 

Natural  infection  probably  occurs  from  superficial  wounds 
by  immediate  contact  with  infected  objects  (harness,  litter, 
bandages,  instruments,  etc.),  or  from  contact  of  diseased  ani- 
mals with  healthy  ones.  (Thiroux  &  Teppaz  are  of  the  opinion 
that  infection  is  spread  through  the  medium  of  insects).  The 
ass  is  most  susceptible,  the  horse  and  the  mule  less  so  while, 
according  to  Tokishige's  observations,  cattle  are  also  sus- 
ceptible. 

Anatomical  Changes.  In  the  affected  regions  the  skin  and 
subcutaneous  connective  tissue  become  thickened  (up  to  5  or 
6  cm.)  and  firm;  cross  sections  have  a  lardaceous  appearance 
and  contain  pus  foci  of  various  sizes,  while  the  distended 
lymphatics  are  filled  with  coagulated  serum  and  pus,  the  walls 
of  these  vessels  being  intensely  reddened  and  having  a  finely 
granulated  appearance.  The  regional  lymph  glands  are  swollen 
and  frequently  contain  small  pus  foci  or  cicatrices  wdiich  have 
resulted  from  their  presence.  In  the  diseased  joints  we  find 
large  masses  of  serous  or  sero-purulent  exudate  and  the  synovial 
membranes  are  covered  w^itli  villous  proliferations;  adjacent 
tendons  are  much  enlarged  showing  serous  infiltration  and 
containing  large  pus  cavities,  in  the  internal  organs  (lungs, 
testes,  intestinal  wall)  metastatic  pus  foci  are  found  only  in 
exceptional  cases.  The  nasal  mucous  membrane  is  occasionally 
swollen  near  the  nostrils  and  contains  on  its  surface  sharply 
circumscribed,  flat,  yellowish  elevations  as  well  as  deep  ulcers. 

Symptoms.  Inflammation  of  the  l^anph  vessels  begins  most 
frequently  on  the  limbs,  especially  the  anterior  ones,  but  is 
observed  also  on  the  scrotum  or  the  udder,  somewhat  rarely 
on  the  abdomen  and  neck  where  they  usually  develop  from  a 
wound  or  a  fresh  scar.  Such  wounds  refuse  to  heal  and  grad- 
ually form  ulcers  with  red  luxuriant  granulations,  or  the  re- 


Syiiii>t(in)s.  737 

snitinp:  cicatrice  is  transfonued  into  a  firm  painless  node  wliicli 
may  attain  the  size  of  a  pigeon's  egg,  breaking  spontaneously 
and  discharging  a  thick,  yellowish,  grnel-like  pus. 

The  local  process  is  followed  by  swelling  of  the  regional 
hnipli  vessels  which  form  prominent,  wavy  and  branching 
painful  strands  in  the  course  of  which  develop  firm  tumors  up 
to  the  size  of  a  fist,  sul)sequently  these  ])ecome  elastic  and 
finally  fhictuating  and  contain  the  above  described  thick,  yellow 
pus.  The  nodes  also  break  and  discharge  their  contents,  wliere- 
upon  they  are  transformed  into  fistulous  ulcers  witli  indolent, 
easily  bleeding  granulating  borders.  The  ulcers  frequently 
produce  excessive  granulations  which  lead  to  the  formation  of 
ugly  ulcerous  surfaces. 

The  regional  lymph  glands  swell  and  form  firm,  tuberous 
or  nodular  timiors  wliicli  do  not  adhere  to  the  surrounding 
tissue;  they  also  suppurate,  wdiereupon  the  abscesses  break 
spontaneously  and  gradually  heal  with  scar  formation.  In 
some  cases  an  excessive  but  uniform  swelling  of  the  ends  of 
the  extremities  or  the  region  of  the  joints  may  develop  followed 
by  ulceration  of  the  overlying  skin. 

In  other  instances  there  may  be  in  various  regions  of  the 
body  spontaneous  development  of  flat  elevations  as  large  as 
a  copper  cent  or  of  nodes  approaching  the  size  of  a  walnut, 
which  break  and,  after  discharging  their  muco-purulent  con- 
tents, are  transformed  into  flat  ulcers  which  heal  without  scar 
formation.  In  rarer  instances  numberless  minute  furuncula 
appear  whicli  partly  communicate  with  each  other  by  means  of 
strands  with  serous  contents  which  later  dry  and  form  scabs. 

In  exceptional  cases  yellowish  flat  elevations  or  white 
nodules  as  large  as  lentils  occur  on  the  nasal  mucous  mem- 
brane. Some  of  the  nodules  may  have  become  transformed 
into  ulcers  with  projecting  labiate  granulating  borders 
(Pricolo).  The  intervening  mucous  tissue  is  hardly  swollen 
to  an  observable  degree,  though  it  is  usually  cyanotic;  simul- 
taneously with  the  appearance  of  these  lesions  the  submaxillary 
glands  become  enlarged  and  occasionally  suppurate.  On  the 
other  hand  nasal  discharge  is  rarely  o])served.  In  a  case  de- 
scril)ed  by  Marcone  the  nasal  mucous  membrane  was  covered 
with  numberless  nodules  and  ulcers,  while  the  turbinated  Ijones 
were  covered  with  pedunculated  growths  which  had  resulted  in 
the  partial  destruction  of  the  dental  alveoli.  The  nasal  alae 
were  much  enlarged,  firm  and  studded  with  small  pus  foci 
covered  with  scabs,  in  addition  to  which  a  thick  strand  was 
observed  to  cross  from  the  left  nasal  ala  toward  the  facial 
crest.  Cominotti  observed  a  similar  case  except  that  the  sub- 
maxillary gland  was  enlarged  to  the  size  of  a  small  apple, 
only  slightly  sensitive,  bosselated  on  its  surface  and  not  ad- 
herent to  the  surrounding  tissue.  Finally  the  conjunctiva  and 
especially  the  meml)rana  nictitans  have  in  rarer  cases  l)een 
observed    to    be   affected    with    nodule    formation    and    ulcers 

Vol.  1^47 


738  Epizootic  Lymphangitis. 

(Carparini,  Awryinsky),  while  deDoes  observed  in  one  instance 
glanderoiis-like  enlargement  of  the  testis,  with  numerous  soft 
centers  in  its  tissue  (the  weight  of  the  testis  was  1.5  kg.). 

In  cattle  Tokishige  observed  firm  painless  nodes  as  large  as  walnuts 
scattered  through  the  subcutis  in  various  regions  of  the  body ;  these 
remained  distinctly  isolated,  showed  a  slow  growth  and  did  not  result 
in  abscess  formation  nor  in  ulceration   (see  also  p.  670). 

The  course  is  very  protracted;  the  morbid  process  may 
under  favorable  conditions  continue  for  from  4  to  6  wrecks; 
under  opposite  conditions  it  may  persist  for  six  months;  even 
after  apparently  complete  recovery  the  symptoms  of  the  disease 
may  reappear  after  a  certain  time.  The  general  nutrition 
usually  remains  good,  although  in  malignant  cases  the  animal 
may  become  emaciated.  In  the  meantime  exacerbation  may 
appear  with  acute  symptoms,  elevation  of  temperature  to 
40.6°  C,  rapid  enlargement  of  the  limbs,  the  lips  and  the  nasal 
mucous  membrane,  eruption  of  small  vesicles,  etc.  (Awryinsky). 
In  a  portion  of  the  cases  the  disease  progresses  without  in- 
terruption until  the  patient  finally  becomes  exhausted,  and  the 
disease  occasionally  terminates  with  s}Tnptoms  of  hectic  fever. 

The  mortality  is  about  7  to  10%  (Tokishige,  Pallin),  al- 
though in  tropical  countries  it  is  considerably  higher. 

Diagnosis.  The  differential  diagnosis  of  this  disease  from 
glanders  may  occasionally  be  quite  difficult.  In  recent  and 
well  marked  cases,  however,  the  flat  and  actively  granulating 
ulcerous  surfaces  as  well  as  the  creamy  pus  in  contrast  with 
the  crateriform  ulcers  of  glanders  and  their  viscid  secretions, 
are  sufficient  diagnostic  characteristics.  In  chronic  cases,  how- 
ever, the  ulcers  of  epizootic  lymphangioitis  may  have  a  similar 
appearance.  In  such  cases  microscopical  examination  will  re- 
veal the  nature  of  the  affection,  in  epizootic  lymphangioitis 
the  bright  parasites,  partly  enclosed  in  pus  cells,  are  readily 
observed  without  staining  under  a  magnifying  power  of  400-500. 
In  addition  to  this,  inoculation  of  rabbits  or  guinea  pigs  with 
pus  produces  only  local  suppuration,  while  the  mallein  test 
gives  a  negative  reaction.  The  good  physical  condition 
of  the  animal  in  the  presence  of  ulcerating  skin  disease  speaks 
against  the  existence  of  cutaneous  glanders. 

Ulcerous  lymphangioitis  takes  a  more  benign  course  and 
the  pus  from  glanderous  lesions  contains  small  bacilli  which 
stain  according  to  Gram's  method  and  when  injected  intraperi- 
toneally  produce  orchitis  in  guinea  pigs. 

Treatment.  This  consists,  especially  in  the  beginning  of  the 
affection  and  wherever  possible,  in  the  extirpation  of  the  nodes 
and  lymph  strands  and  the  neighboring  lymph  glands.  The 
prompt  incision  of  abscesses  and  careful  antiseptic  treatment 
of  pus  cavities  and  ulcers  is  of  course  always  indicated.  Thiroux 


Treatment.  739 

&  Teppaz  had  favorable  results  in  the  treatment  of  mild  cases 
with  atoxvl,  although  this  gave  no  results  in  severe  forms  of 

the  disease.  . 

Prophvlaxis  consists  in  the  isolation  of  the  diseased  ani- 
mals, desti-uction  of  morbid  products  and  disinfection  of  stables 
with  strong  disinfectants. 

Literature.  Kivolta  &  MicoUono,  Oioni,  die  Anat.,  Fis.  et  Patol.,  1883. 
143  _  Nocard,  Bull.,  1S97.  367.  —  Tokishige,  Cb.  f.  Bakt.,  1806.  XIX.  105.  — 
Baruchello,  Siil.  fare,  eriptoe.,  Torino  1808.  —  MacFadyean,  J.  of  eomp.  Path., 
1903  XVI.  379.  —  Martin,  J.  of  eomp.  Path.,  1005.  XVIII.  81.  —  Sullivan,  \et. 
Eec,  1905.  Nr.  870.  —  Sanfelice,  Z.  f.  Hyo;.,  1006.  LTV.  299.  —  Mrowka,  Z.  f._\  k^, 
1906  XVIII.  261  —  Marcone,  Kev  gen.,  1907.  IX.  249.  —  Pricolo,  ibid.,  l->0(.  X. 
457.  _  Ducloux,  Soc.  biol.,  1908.  LXIV.  593.  —  Thiroux  &  Teppaz,  A.  P.,  1000. 
XXIII.  420. 


MaUgnant  Hyphomycosis  of  Horses.  Leeches  (TTypliomykosis 
destruens  e(iui.)  In  ludia  as  well  as  on  the  Sunda  Islands  a  disease 
occurs  among  horses  Miiieh  is  known  by  the  name  "bursattee' 
(bnrus=rain).  and  Avhich  has  been  described  in  particular  by  F.  Smith 
and  Stell,  and  more  recently  also  by  dellaan  and  Iloogkamer.  Ac- 
cording to  Lyford  and  Bitting  this  same  disease  occurs  quite  fre(|uently 
in  North  America  among  horses  and  mules  where  it  is  known  as 
"leeches"  while  in  Europe  only  a  single  case  has  lieen  observed  by 
Drouin  &  Renon  in  Alfort. 

The  morbid  symptoms  consist  in  the  appearance  of  very  firm 
nodules  under  the  skin  of  the  lips,  the  nasal  alae,  the  eyelids,  the  neck, 
the  bodv  and  the  limbs,  finally  also  in  the  mucous  membrane  of  the 
gums  and  the  nasal  cavities ;  these  gradually  enlarge  and  later  become 
transformed  into  ulcers.  The  ulcers  have  uneven,  ragged,  easily  bleed- 
ing granulating  borders  which  communicate  with  deep,  sinuous,  fistulous 
canals  which  occasionally  extend  to  or  into  the  bones  (perforation  of 
the  hard  palate  has  also  been  ol)served).  Within  the  ulcers  and 
fistulous  canals  as  well  as  in  the  interior  of  the  nodes  are  found  grayish- 
yellow,  occasionally  also  calcified  masses  and  cores  Avhich  may  approach 
the  size  of  an  egg  and  have  a  bosselated  surface,  these  are  firmly 
attached  to  the  surrounding  tissue  by  means  of  their  ramifications.  The 
lips,  nasal  alae  and  eyelids  may  be  extensively  swollen,  while  the  mouth 
and  nose  discharge  k  bloody  mucous  mass.  The  affected  regions  of 
the  body  seem  to  cause  excessive  itching.  Tn  severe  cases,  which  how- 
ever do  not  involve  the  regional  lymph  glands,  the  nutrition  of  the 
patients  suffers  seriously. 

The  grayish-yellow  cores  above  mentioned  contain  1)ninching 
myeelia  and  free  spores  of  a  mold  fungus  imbedded  in  hyaline  con- 
nective tissue  bundles  and  leucocytes;  according  to  dellaan  these  form 
a  delicate  sod  on  nutrient  agar  while  in  acid  liouillon  they  form  groups 
of  delicate  balls.  Experimental  inoculations  have  failed  to  give  positive 
results. 

The  treatment  consists  in  an  early  extirpation  or  cauterization  of 
the  affected  portions  of  the  cutis;  dcDoes  observed  healing  of  tlie  lesions 
in  the  mucous  membranes  after  internal  iodine  treatment  (10-30  gra. 
potassium  iodide  daily)  while  dellaan  &  Iloogkamer  found  this  treat- 
ment ineffective. 

Literature.  Drouin  &  Renon,  Soc.  biol.,  1896.  425.  —  De  Haan  &  Hoog- 
kamer,  A.  f.  Tk.,  1003.  XXIX.  305. 


740  Infectious   Abortion. 


10.  Infectious  Abortion.    Abortus  Enzooticus. 

{Abortus    infectiosus;    Seucheuhaftes    Verwerfeii     [German]; 

Avortement  epizootique  [French];  Ahorto 

enzootics  [Italian].) 

Under  the  term  'infectious  abortion"  are  included  those 
cases  which  occur  in  otherwise  healthy  mothers,  as  a  result 
of  external  infection  producing  inflammatory  lesions  of  the 
uterine  mucous  membrane  and  of  the  fetal  membrane.  It 
usually  occurs  in  an  enzootic  form. 

History.  As  long  since  as  the  beginning  of  the  last  century  this 
disease  was  considered  as  contagions  in  several  mountainous  regions 
of  England  (Lawrence,  Skellet),  and  since  then  other  authors  (Ziindel, 
St.  Cyr)  have  maintained  that  an  infection  was  the  causative  agent 
in  spite  of  the  opposite  view  held  by  others  (Hurtrel  d'Arboval,  Hering, 
Stockfleth).  The  correctness  of  this  view  was  however  only  established 
by  Franek  (1876),  and  later  by  Lehnert  (1878)  and  Brauer  (1880), 
by  producing  abortion  artificially  through  the  introduction  of  vaginal 
discharge  and  fetal  membranes  into  the  vaginas  of  healthy  cows.  Later 
Nocard  (1885)  called  particular  attention  to  the  importance  of  the 
inflammatory  changes  in  the  fetal  membranes.  Bang  (1896)  with  the 
cooperation  of  Stribolt,  discovered  the  cause  of  infectious  abortion 
of  cattle,  which  was  later  also  investigated  extensively  by  Preisz  (1902), 
while  on  the  other  hand  Ostertag  (1901)  connected  a  streptococcus 
with  the  cause  of  infectious  abortion  of  mares. 

Occurrence.  Infectious  abortion  occurs  most  frequently  in 
cattle  breeding  establishments,  more  seldom  in  studs  and  in 
the  breeding  of  sheep  and  swine.  The  stal)le-fed,  finer  bred 
animals  are  especially  affected,  but  the  infection  may  become 
widely  spread  in  range  animals  (Kocourek,  Keleti).  The  intro- 
duction of  the  disease  into  large  cattle  herds  causes  heavj"  losses, 
because  of  the  fact  that  a  number  of  unviable  calves  perish, 
and  because  of  the  decrease  of  the  milk  production,  moreover 
the  cows  conceive  only  with  difficulty  after  abortion  or  not 
at  all. 

Infectious  abortion  is  widely  spread  in  all  sections  in  which  intensive  stock 
farming  is  in  vogue.  In  Central  Europe  (Belgium,  Denmark,  Germany,  France, 
Austria,  Switzerland,  Hungary)  and  in  England  it  appears  frequently,  especially 
in  cows,  while  in  North  America  it  appears  that  mares  are  especially  affected. — 
In  England  Mascall  called  attention  to  the  disease  as  early  as  1567,  and  during 
the  last  century  it  gained  such  a  foothold  in  the  dairies  that  in  certain  localities 
50-60%  of  the  cows  slunk  their  calves  (McFadyean  &  Stockman  recently  could 
show  the  disease  in  36  shires)  ;  besides  the  disease  appears  frequently  in  horse 
breeding  and  sheep  raising  establishments    (Penberthy). 

Etiology.  In  cattle  abortion  is  caused  by  a  small,  short 
and  comparatively  thick  bacillus  (Corynebacterium  abortus  in- 
fectiosi)   which  is  non-motile,    forms   no   spores;   in  artificial 


Etiology,    Pathogenicity.  74]^ 

eultiiros    Olio    end    is    freqiioiitly   club-shaped,   and   sometimes 
brnnehes  {Fig.  125). 

Staining.  The  hacillus  stains  easily  but  not  uniformly  with  aciueous 
as  well  as  with  earbolized  aniline  dyes,  giving  the  appearance  of  seg- 
ments separated  by  clear  spaces;  the  Gram  and  Gram-Weigert  methods 
give  negative  results. 

Cultivation.  The  bacillus  of  abortion 
grows  especially  well  in  a  pure  oxygen  at- 
mosphere, or  in  air  with  low  oxygen  con- 
tents, while  in  the  total  absence  of  oxygen 
it  grows  only  with  ditificulty,  and  in  ordi- 
nary atmosphere  only  after  it  has  gradually 
become  accustomed  to  such  environment. 
Cultures  made  according  to  these  conilitions 
give  particularly  good  results  in  or  upon 
gelatin-agar,  a  combination  of  agar,  gelatin 
and  blood  serum,  as  well  as  in  glucose-agar. 
L'pon  the  surface  of  such  media,  kept  at 
body  temperature  there  appears  very  fine,  Fijr.  125.     Conjnebncterium 

flat,  conical,  evenly  rounded,  on  transmitted  abortus  infeetiosi.  Two-day- 
light, bluish  transparent  colonies  which  even  old  aj^ar  cultures ;  carbol  fuchsia, 
if  thinly  seeded  reach  at  most  the  size  of  a 

pin  head.  When  the  material  to  be  examined  is  mixed  with  the  media 
there  develop,  at  a  fixed  distance  from  the  surface  and  downward, 
numerous  similar  colonies  closely  placed  (Fig.  126).  Coagulated  calf 
serum  becomes  li(iuelied  in  the  vicinity  of  the  colonies.  In  peptone 
bouillon  and  in  li(iuid  blood  serum,  few  small  white  granules  form. 
MJlk  becomes  coagulated.  Potato  cultures  show  a  marked  resemblance 
to  a  culture  of  the  bacterium  mallei  (McFadyean  &  Stockman). 

Tenacity.  In  cultures  the  bacillus  dies  within  two  weeks  (Nowak  found, 
however,  that  agar  cultures  were  even  after  two  years  still  capable  of  development. 
A  temperature  of  55°  C.  will  destroy  the  organism  in  3  minutes.  It  is  destroyed 
by  0.05%  corrosive  sublimate  solution  in  15  seconds,  by  V/r  carbolic  acid'  in 
1  minute,  by  2%  acetic  acid  in  two  minutes,  by  1%  acetic  acid  in  20  minutes 
(Preisz).  On  the  other  han.l  it  may  retain  its  virulence  for  many  months  in 
uterine  secretions  if  preserved  sterile,  also  if  uncontaminated  inside  of  the  womb 
and  in  the  dead  foetus   (Bang). 

Pathogenicity.  In  Bang's  investigations  the  injection  of 
pure  cultures  into  the  vagina  of  pregnant  cows  and  ewes  pro- 
duced in  8  to  10  weeks  either  abortion  or  premature  birth; 
in  these  cases  large  numbers  of  bacilli  were  present  in  the 
vaginal  discharge,  in  the  exudate  on  the  surface  of  the  coty- 
ledons and  the  chorion.  Injections  of  8  and  18  cc.  of  culture 
respectively  into  the  circulation  of  pregnant  ewes  produced 
fever  lasting  several  days,  wliereupon  these  animals  gave  birtli 
after  7  and  12  days  to  small  lambs.  Bang's  experiments,  the 
results  of  which  were  subsequently  confirmed  by  McFadyean 
&  Stockman,  demonstrated  that  the  feeding  of  culture's  or 
exudate  to  cow'S,  ewes  and  goats  results  in  abortion  after  1 
to  2  months,  with  the  cliaracteristic  changes  in  the  fetal  mem- 
branes and  cotyledons.    Finally  it  was  also  possible  to  produce 


742 


Infectious  Abortion. 


premature  birth  in  a  mare  28  clays  after  tlie  injection  into  the 
vagina  of  25  cc.  of  culture  and  the  chorion  exudate  contained 
numerous  bacilli.  (Nowak  caused  abortion  in  guinea  pigs  and 
rabbits  by  subcutaneous,  intravenous,  or  intraperitoneal  injec- 
tions of  pure  cultures.) 

The  bacilli  are  always  found  in  large  numbers  in  the 
exudate  of  the  fetal  membranes  and  of  the  cotyledons,  either 
free  in  the  serous  exudate  or  enclosed  in  cells, 
besides  these  locations  the  organisms  may  also 
be  demonstrated  in  the  intestinal  contents,  in  the 
blood,  as  well  as  in  other  organs  of  the  aborted 
fetus. 

In  no  case  of  infectious  abortion  of  mares 
did  Ostertag  find  the  Bang  bacillus  in  the  fetal 
membranes,  but  in  its  stead  he  found  short  Gram- 
negative  streptococci  in  the  heart  blood,  pleural 
fluid,  and  in  the  stomach  contents  of  the  still- 
born foals,  as  well  as  in  the  sub-chorial  edema. 
They  grow  on  serum  agar  in  the  form  of  fine 
deposits,  which  are  hardly  visible  to  the  naked 
eye,  in  stab  agar  as  a  frail  thread  reaching 
from  the  surface  to  the  bottom  of  the  tube, 
while  in  serum  bouillon  after  two  days'  growth 
there  appears  a  uniform  turbidity  which  after 
two  more  days  sinks  to  the  bottom.  In  seven 
cases  the  streptococci  were  obtained  in  pure 
culture  from  the  bodies  of  the  fetuses,  in  the 
other  cases  the  streptococci  were  found  in  com- 
mon with  other  bacteria  on  the  surface  of  the 
chorion ;  in  the  chorion  some  were  present  in  the 
epithelial  cells. 

One  mare  aborted  twenty  days  after  the  in- 
travenous injection  of  the  culture,  another  one 
Fig.  126.     Agar  gjyg  jji^th  after  a  vaginal  injection  at  the  normal 
ciiiuTof °ibo^?ionr    time  to  a  very  weak  foal ;  in  the  heart  blood  of 
(After  Preisz.)      the  fctus  from  the  first  mare  the  streptococci 
could  be  demonstrated,  and  they  were  also  pres- 
ent in  the  reddish-gray,  thick  deposits  of  the  uterus  of  a  mare 
killed  immediately  after  having  aborted. 

Aside  from  the  use  of  pure  cultures  the  artificial  produc- 
tion of  abortion  was  repeatedly  made  possible  in  pregnant 
animals  by  the  transference  into  their  genital  tracts  of  vaginal 
discharge  and  portions  of  fetal  membrane  from  aborting  animals 
of  the  same  species,  and  this  is  not  only  true  with  reference 
to  cows  (Brauer,  Lehnert,  Trinchera),  but  also  in  mares 
(Ostertag,  Guillerey) ;  on  the  other  hand  the  introduction  of 
shreds  of  fetal  membranes  from  mares  into  10  cows  and  two 
goats  failed  to  cause  abortion  (Ostertag). 

According  to  Lignieres  the  bacillus  of  tuberculosis  zooglique  may  also  cause 
abortion  indirectly,  when  it  enters  the  alimentary  tract  with  food.     By  the  eliniina- 


Natiual  liifectiun.  743 

tion  of  toxins  it  favors  the  penetration  of  other  V)aeteria  present  in  the  intestines 
and  other  tubular  oryans  or  body  cavities,  into  the  blood  circulation  and  other 
organs,  thereby  indirectly  producing  abortion.  He  produced  abortion  successfully 
in  j^umea  pigs,  rabbits  and  cows  by  feeiling  pure  cultures. — Al  ortion  can  evidently 
be  occasioned  by  various  infectious  causes,  since  it  is  quite  frequently  observed  in 
the  course  of  acute  infectious  diseases,  but  such  cases  should  be  interpreted  dif- 
ferently than  as  the  independent  disease  of  infectious  abortion. 

Natural  infection  may  take  place  from  the  external  genitals, 
most  frequently  it  is  transmitted  (lurini»'  copulation  by  males, 
Avlio  have  ])reviously  covered  infected  females.  On  the  other 
hand  the  straw  and  floors  of  stables  become  contaminated  with 
the  va,<>inal  discharge  durino-  and  after  abortion,  by  the  amniotic 
fluid  and  the  fetal  membranes,  which  contain  enormous  nnmbers 
of  bacilli,  whence  the  contagion  may  likewise  penetrate  the 
genital  organs;  at  the  same  time  the  infection  may  be  intro- 
duced by  various  objects,  such  as  sponges  and  other  utensils 
and  also  by  attendants. 

The  possibility  of  an  intestinal  infection  in  cows,  goats 
and  sheep,  by  the  ingestion  of  food  and  drinking  water  con- 
taminated with  anmiotic  fluid  and  afterl)irth,  was  proven  be- 
yond a  doubt  by  the  successful  experiments  of  Bang;  and  this 
mode  of  infection  should  be  considered  as  the  natural  infection 
more  often  than  has  heretofore  been  the  case.  Especially  does 
it  play  an  important  part  in  cases  where  the  malady  spreads 
rapidly  on  a  farm. 

In  cattle  establishments  free  from  the  infection  the  virus  is 
usually  introduced  by  an  already  infected  female,  who  during 
abortion  infects  the  stable,  and  during  copulation  infects  the 
male.  The  infection  then  spreads  on  this  particular  farm  with 
every  favorable  opportunity,  since  the  first  cases  of  abortion 
or  premature  births  are  given  little  attention,  as  they  are  fol- 
lowed by  new  cases  only  after  a  considerable  period,  and  con- 
sequently the  necessary  measures  to  eradicate  the  disease  are 
omitted.  The  introduction  of  the  disease  can  also  be  accom- 
plished by  means  of  animals  that  suffer  from  a  chronic  uterine 
catarrh  subsequent  to  abortion,  and  also  rarely  by  animals  that 
in  s]^ite  of  their  being  infected,  carry  the  fetus  the  full  terra. 
More  seldom  is  the  disease  introduced  by  males  that  have  re- 
cently been  covering  animals  on  infected  premises,  and  likewise 
also  by  new-born  animals  from  such  farms. 

The  infection  spreads  as  a  rule  only  among  animals  of 
the  same  species,  at  times  however  animals  of  other  species 
are  attacked.  As  a  matter  of  fact  the  Bang  bacillus  is  not 
only  capable  of  producing  abortion  in  cattle,  but  also  in  horses, 
goats  and  sheep  (Garcia  &  Izcara  found  during  an  epizootic 
abortfon  among  sheep,  a  bacillus  in  the  exudate  which  mor- 
phologically corresponded  with  Bang's  organism) ;  on  the  other 
hand  Ostertag's  streptococcus  has  to  the  present  date  been 
found  exclusivelv  in  mares. 


744  Infectious  Abortion. 

Pathogenesis.  The  contagion  which  reaches  the  vagina 
through  copulation  passes  into  the  uterus,  where  it  multiplies 
on  the  surface  of  the  mucous  membrane,  and  later  also  on  the 
fetal  membranes.  The  bacteria  that  reach  the  vagina  during 
pregnancv  are  evidently  capable  of  passing  the  mucous  plug 
of  the  neck  of  the  uteru's,  whereupon  they  multiply  between  the 
fetal  and  mucous  membranes.  The  bacilli  may  also  reach  the 
mucous  membrane  of  the  uterus  from  the  intestinal  canal  by 
means  of  the  blood  stream,  either  before  or  after  conception; 
since  it  appears  that  this  organ  is  an  exceedingly  favorable 
medium  for  their  propagation. 

The  infective  material  produces  an  inflammation,  as  a  re- 
sult of  which  a  fibro-purulent  exudate  forms  l)etween  tlie 
mucous  membrane  and  the  chorion,  which  loosens  the  contact 
of  the  layers  of  tissues,  and  finally  causes  a  partial  detachment 
of  the  fetal  membranes.  The  inflammatory  process  extends  in 
the  meanwhile  also  to  the  layers  of  connective  tissue  between 
the  chorion  and  allantois,  as  well  as  to  the  navel  cord,  on  ac- 
count of  which  they  acquire  a  gelatinous  appearance,  on  the 
other  hand  the  bacteria  may  also  pass  into  the  body  of  the 
fetus  either  through  the  circulation,  or  by  means  of  the  amniotic 

fluid. 

In  consequence  of  the  loosening  and  detachment  of  the 
fetal  membranes  abortion  may  occur  in  various  stages  of 
gestation;  at  times,  however,  the  uterine  catarrh  does  not 
cause  expulsion,  but  only  the  death  of  the  fetus,  in  which  case 
there  is  formed  a  gradually  accumulating  exudate  around  the 
fetal  membranes,  enclosing  a  shrunken  mummified  fetus.  Later 
this  exudate  becomes  inspissated,  assuming  a  tenacious  gela- 
tinous consistency  and  in  this  the  abortion  bacillus  may  remain 
viable  even  for  nine  months  after  the  death  of  the  fetus  (Bang). 
The  fact  that  the  bacilli  remain  alive  for  so^  long  a  time  in 
the  uterus  explains  the  etiological  connection  in  the  abortions 
that  occur  in  an  advanced  stage  of  pregnancy  as  a  result  of 
infections  occurring  during  or  even  several  weeks  before  copula- 
tion. It  also  explains  the  cases  of  abortion  in  females  that 
have  previously  aborted  but  were  not  exposed  to  any  new 
infection  in  the  meantime. 

Repeated  abortion  reduces  the  otherwise  very  great  sus- 
ceptibility to  new  infections.  Cows  abort  quite  frequently  a 
second  time,  but  a  third  abortion  is  exceptional.  The  reduced 
susceptibility  of  the  animal,  and  possibly  the  decreased  viru- 
lence of  the  virus  is  also  evidenced  by  practical  experience 
upon  certain  farms  where  abortion  occurs  in  progressively  later 
stages  of  gestation,  and  finally  by  the  fact  that  the  respective 
animals,  if  they  conceive  at  all,  carry  their  pregnancy  to  term 
in  spite  of  the  infected  surroundings  (Sand). 

Symptoms.  Cows  are  most  likely  to  abort  in  tlie  fifth  or 
sixth  month  of  pregnancy,  mares  in  the  fourth  to  eighth  month, 


Symptoms.  745 

sheep  in  the  fourth  month,  and  swine  in  the  eightli  to  twelfth 
week;  at  times  the  abortion  takes  place  in  an  earlier  or  later 
period  of  pregnancy. 

Animals  wliicli  are  ])ro<i;iiant  for  the  first  time,  as  a  rule  abort  at  an  earlier 
period  of  prestation  tlian  ilo  older  ones  or  those  whi(di  have  previously  aborted. 
The  Danish  veterinarians  olisei\e<l  tiiat  abortion  wouhl  most  often  occur  in  cattle 
duriuju  the  fifth  or  sixth  month,  but  in  the  be^nnninfj  of  an  outl)reak,  cases  also 
occurred  in  the  third  or  fourth  mouth.  Jn  mares  Konye  saw  it  occur  in  one-third 
of  the  cases  in  six  months,  in  one-fifth  in  7-8  months,  Guillerey  as  a  rule  in  4-7 
months;  Poijakow,  on  the  other  hand,  reports  most  of  the  cases  as  occurring 
from  the  ninth  to  eleventh  month  of  gestation.  According  to  the  experiments  of 
Berger  sows  abort  in  the  tenth  to  twelfth  week  of  pregnancy;  according  to  those 
of  Fritsche  in  eight  to  twelve  weeks. 

The  abortion  is  nsually  preceded  by  a  catarrh  of  the  genital 
passages.  With  the  moderate  swelling  of  the  lips  of  tlie  vulva 
the  vaginal  mucous  memlu'ane  becomes  reddened  and  reddish 
nodules,  like  millet  seeds  in  size  (swollen  follicles)  appear  on 
its  surface.  At  the  same  time  there  appears  from  the  vagina 
a  mucous  or  nnico-purulent,  exceptionally  bloody,  and  always 
odorless  discharge  which  in  cows  is  reddish-g-ray  or  yellowish, 
in  mares  and  sows  whitish-g^ray  in  color.  The  milk  production 
becomes  simultaneously  diminished,  the  milk  having  a  colostruin- 
like  appearance  and  coagailating  on  boiling. 

Two  to  three  days  after  the  appearance  of  the  first 
catarrhal  sjTiiptoms  the  abortion  usually  takes  place  with  mod- 
erate pains  and  with  mild  general  manifestations.  Should  the 
al)ortion  occur  in  an  early  period  of  gestation  the  fetal  mem- 
.branes  are  expelled  together  with  the  fetus.  On  the  other  hand 
in  abortions  taking  place  at  a  later  stage  of  gestation  the  after- 
birth is  passed  off  subsequently  to  the  fetus,  and  it  is  not  a 
rare  occurrence  to  have  it  retained  for  some  time.  Following 
the  abortion  a  continuous  vaginal  discharge  is  always  observed 
for  one  or  two  weeks.  The  secretion  which  is  then  dirty  brown 
or  reddish-brown,  odorless,  or  somewhat  fetid,  may  accumulate 
in  the  uterus,  and  from  time  to  time  be  discharged  under 
straining.  Gradually  the  discharge  becomes  diminished,  and 
finally  it  disappears  entirely,  still  in  spite  of  their  otherwise 
healthy  appearance  the  animals  either  do  not  conceive,  or  if 
they  abort  at  an  earlier  or  later  stage  of  gestation,  and  in 
rare  cases  this  may  be  repeated  more  than  once.  Abortion 
reappears  as  a  rule  in  cases  when  copulation  occurs  shortly 
after  the  first  abortion,  or  when  the  vaginal  discharge  was  still 
present,  whereas  in  cases  where  copulation  occurs  several 
months  after  the  abortion  normal  births  are  more  likely  to 
follow. 

Fetuses  aborted  at  early  periods  of  gestation  are  usually 
dead,  those  however  that  are  expelled  at  a  later  period  are 
not  seldom  born  alive.  Prematurely  born  calves  often  emit 
a  loud  prolonged  bellowing,  which  reminds  one  of  the  howling 
of  a  rabid  dog.  Nocard  attributes  tbis  to  a  diseased  condition 
of  the  medulla.     Poorly  developed  fetuses  mostly  die  within 


746  Infectious  Abortion. 

one  or  two  days,  with  manifestations  of  intestinal  catarrh. 
The  afterbirth  shows  a  subchorial  edema  and  a  marked  injec- 
tion of  the  chorion,  and  a  muco-purulent  exudate  exists  between 
the  tufts  of  the  cotyledons. 

Poljakow  frequently  found  a  rarifying  ostitis  in  the  beginning 
and  towards  the  end  of  an  outbreak  in  mares,  whereas  at  the  height 
of  the  outbreak  he  found  manifestations  of  septicemia,  such  as  a  de- 
generation of  the  parenchymatous  organs,  hemorrhages  m  the  serous 
membranes,  and  dark  liquid  blood. 

Guillerey  observed  in  the  course  of  an  outbreak  in  which  87  out 
of  97  pregnant  mares  aborted,  the  development  of  sequels,  such  as 
febrile  nephritis  lasting  from  6  to  8  days  (of  15  such  mares  one  died  as 
the  result  of  it),  arthritis  (especially  in  the  hock),  tendonitis,  acute 
laminitis,  hemoglobinuria,  inflammation  of  the  Vena  saphena,  finally 
pneumonia.  Desoubry  saw  in  mares  after  abortion  a  rise  of  tempera- 
ture up  to  40°  C,  and  with  a  marked  depression  of  the  sensorium 
catarrhal  symptoms  of  the  genital  passages,  which  in  exceptional  cases 
increased  to  an  inflammation  of  the  uterus. 

Bulls  that  have  covered  affected  cows,  exceptionally  show  a  diseased 
condition  of  the  genital  organs.  Thus  Reindl  found  nodules  on  the 
penis  of  a  bull  similar  to  those  observed  in  cows  shortly  before  abor- 
tion ;  Nohr  also  observed  acute  inflammatory  manifestations  on  the 
penis  in  several  bulls  after  the  infectious  coitus. 

Diagnosis.  The  infections  character  of  abortion  is  indi- 
cated by  the  prodromal  symptoms  which  appear  2  to  3  days 
before  the  expulsion  of  the  fetus.  These  are  manifested  in 
a  swelling  of  the  vulva,  vaginal  discharge,  as  an  indication 
of  an  existing  catarrh  of  the  genital  passages.  In  other  forms 
of  abortion,  excepting  in  infections  vaginal  catarrh,  the  abortion 
occurs  without  such  prodromal  symptoms,  or  there  may  pre- 
viously be  observed  disturbances  of  digestion  and  symptoms 
of  general  illness  as  in  general  infectious  diseases  or  in  poison- 
ing. The  infectious  nature  of  abortion  is  further  indicated 
by  an  existing  vaginal  discharge  which  continues  subsequently 
for  a  long  time,  and  by  a  large  amount  of  fibrinous  purulent 
exudate  on  the  fetal  membrane.  Later  sufficient  ground  is 
afforded  in  this  respect  by  the  rapidly  following  cases  of  abor- 
tion, when  the  diagnosis  is  further  confirmed  by  the  exclusion 
of  other  causes. 

In  young  cows,  sometimes  also  in  mares,  swelling  of  the  vulva,  a 
slight  amount  of  mucous  discharge,  as  well  as  debility  and  diminished 
appetite  appear  sometimes  toward  the  end  of  the  fifth  month  of  preg- 
nancy, hut  these  symptoms  disappear  after  3  to  4  days,  and  then  the 
pregnancy  and  parturition  follow  in  a  normal  manner   (Cagny). 

In  abortion  of  cows  a  microscopical  examination  of  the  vaginal 
discharge  is  very  advisable;  in  this  the  fine,  unevenly  stained  bacilli 
of  abortion  are  found  either  exclusively  or  in  predominating  majority, 
but  always  in  great  numbers  (the  dried  cover-glass  preparations  stain 
most  readily  with  carbol-fuchsin ;  see  Fig.  127). 


Sero-Diaimosis  ami    Allrrt;ic    Reaction. 


■47 


Sero-Diagnosis  and  Allergic  Reaction.  Recent  investiga- 
tions permit  the  assninption  tliat  it  will  be  possible  to  deter- 
mine infection  with  the  bacilhis  of 
abortion  l)y  bacteriological  methods 
long  before  and  after  the  abortion.  If 
these  resnlts  are  contirmed  the  com- 
l)atting  of  the  disease  will  appear  con- 
siderably more  effective,  as  it  will  be 
])ossil)le  to  prevent  the  introdnction  of 
the  virns  by  apparently  healthy  ani- 
mals. 

1.     Agglutination  Test.     Experimeuts  iu  this 

ilirec'tion   hy    MacFadycau    &    Stoekiiiaii    show   that 

iiiltuies    grown    in    serum-free    media    are    agglu- 

tiiiateil  by  normal  serum  as  a  rule  in  a  proportion 

¥i".  127.     Vaqlnal  diseJiarsc    "*  "^^  higher  than  1:25,  wliereas  serum  of  infected 

with  "bacilli  of  abortion  :  carbol    'O^^'^'   'j^'*  ■^vhic-h  have   not  yet  aborted,   shows   f re- 

fuchsin.  quently   an   agglutination   value   of    1:100    or   over. 

These  results,  however,  were  not  sufficiently  uniform 
for  utilization  in  practice.  Better  results  were  obtained  by  Holth  with  serum  bouillon 
cultures,  or  suspensions  of  such  eentrifugalized  cultures,  as  ^7  out  of  39  samples 
of  serum  from  cows  which  had  previously  aborted  gave  au  agglutination  value 
of  over  100,  mostly  over  500,  while  seven  specimens  from  healthy  heifers  and 
cows  failed  to  give  an  agglutination,  even  in  dilutions  of  1:50.  Grinsted  also 
found  that  in  infected  cows  the  agglutination  value,  even  several  weeks  before 
abortion,  rises  to  1:300  and  over,  and  after  abortion  it  rises  to  1:2000-4000,  while 
in  healthy  animals  it  does  not  exceed  1:300. 

2.  Complement  Fixation.  MacFadyeau  &  Stockman  obtained,  although 
not  in  all  cases,  distinct  complement  fixation  (see  p.  718)  with  sera  from  cows 
which  had  already  aborted,  and  a  still  more  distinct  reaction  with  sera  of  infected, 
.still  pregnant  cows,  while  Holth  showed  that  the  complement  fixation  test  corre- 
sjiomls  with  the  results  of  the  agglutination  test. 

3.  Allergic  Reaction.  ^lacFadyean  &  Stockman's  experiments  with  the 
preparation  named  ' '  Aliortin ' '  which  they  prepared  from  4-fi  weeks '  old  glycerin 
sugar  bouillon  cultures  of  the  bacillus  of  abortion,  in  the  sanie  manner  in  which 
tuberculin  is  obtained,  showed  that  infected,  as  well  as  cows  which  had  already 
aborted  respond  after  several  hours,  with  few  exceptions,  to  an  intravenous  or 
subcutaneous  administration  of  the  preparation  (5-10  cc),  with  a  rise  of  tem- 
perature to  40.5-41°   C,  and  some  also  with  organic  symptoms. 

Course.  Infectious  abortion  often  persists  for  years  in 
infected  premises  when  proper  measures  for  its  suppression 
are  not  taken.  After  the  first  case  of  abortion  new  cases 
appear  as  a  rule  only  after  several  weeks,  then  however  they 
follow  each  other  in  more  rapid  succession,  and  finally  normal 
birtlis  occur  only  exceptionally.  After  a  time  however  the 
cases  of  abortion  again  become  more  rare,  as  animals  which 
have  already  aborted  once  or  twice  again  give  birth  at  the 
normal  termination  of  pregnancy,  and  only  the  newly  intro- 
duced young  cows  or  newly  purchased  animals  from  healthy 
herds  abort,  until  finally  the  disease  dies  out  of  its  own  accord 
after  several  vears. 


Prevention  and  Treatment.  For  suppressing  the  disease 
after  it  has  appeared  in  a  herd,  first  of  all  the  change  of  the 
remaining  apparent-ly  healthy  female  animals  which  have  never 


748  Infectious  Abortion. 

aborted,  to  a  place  free  from  the  infection  is  indicated.  If 
this  cannot  be  accompHshed  under  existing  conditions  it  is  at 
least  advisable  to  keep  the  already  infected  and  the  suspected 
animals  in  another  stable,  or  at  least  in  an  isolated  part  of  the 
same  stable,  and  to  supply  special  attendants  for  them.  Sub- 
sequently it  is  necessary  after  removing  the  remnants  of  food 
and  straw  in  these  parts,  to  disinfect  the  entire  infected  stable 
tlioroughly  and  repeatedly,  the  floor  and  walls  as  well  as  the 
stable  utensils,  in  addition  to  which  the  external  sexual  organs 
of  the  pregnant  animals  should  be  washed  daily  with  a  non- 
irritating  antiseptic  fluid,  and  their  vaginas  should  also  be 
irrigated.  In  the  meantime  these  animals  should  be  subjected 
to  careful  observation,  and  those  in  which  prodromal  sjniiptoms 
of  abortion  are  noticed  should  be  isolated  immediately  and  their 
stalls  disinfected.  At  the  same  time  it  must  be  taken  into 
consideration  that  the  vaginal  discharge  has  possibly  already 
contaminated  the  litter  and  food. 

The  expelled  fetus  together  with  the  fetal  membranes  and 
the  afterbirth  should  be  burned,  or  at  least  scalded  and  then 
buried  deeply.  If  remains  of  the  fetal  membrane  were  retained 
in  the  uterus  it  should  be  attempted  to  remove  them  soon,  if 
possible  in  the  course  of  two  or  three  days. 

Males  which  have  covered  affected  females,  or  in  which 
there  is  a  suspicion  in  this  direction,  should  be  subjected  to 
treatment  by  cutting  the  hair  short  at  the  opening  of  the  sheath, 
the  prepuce  sack  should  be  washed  with  a  %-l%  lysol  solution, 
■14=-%%  septoform,  or  1%  soda  solution,  and  following  each 
covering  the  washing  should  be  repeated  with  pure  lukewarm 
water  or  with  one  of  the  fluids  mentioned.  In  sheep  and  swine 
herds  where  this  is  accompanied  with  difficulties  it  is  advisable 
to  suspend  breeding  for  a  certain  time. 

The  treatment  of  animals  which  have  aborted  consists  in 
irrigation  of  the  vagina  and  uterus  with  lukewarm  antiseptic 
fluids,  by  means  of  an  irrigator,  the  soft  rubber  tube  of  Avhich 
should  be  introduced  deeply  into  the  uterine  cavity.  For  dis- 
infecting fluids,  which  are  also  satisfactory  for  washing  the 
surrounding  parts  of  the  vulva,  freshly  prepared  corrosion 
sublimate  in  rain  water  (1:8000-10,000,  concentrated  solutions 
cause  severe  straining!),  1-2%  creolin  or  lysol  solution,  1:1000 
permanganate  of  potassium  solution,  etc.,  may  be  used,  of  which 
large  animals  receive  3-4  liters,  small  animals  0.5  liters  each. 
This  treatment  should  be  continued  at  first  1  to  2  times  daily, 
later  every  2  or  3  days,  until  the  discharge  has  ceased  for 
several  days  (usually  for  two  weeks).  After  the  conclusion 
of  this  procedure  it  is  advisable  to  keep  the  animals  separated 
for  several  weeks,  and  to  breed  them  again,  not  earlier  than 
two  months  after  the  abortion. 

Brauer  recommends  as  prophylactic  measures,  subcuta- 
neous injections  of  2%  carbolic  acid,  in  the  fifth  to  seventh 
months  of  pregnancy  (10  cc.  weekly).    He,  as  well  as  Schrader, 


Picvt'iition    and   Tivatiiieiit.  749 

Tafin  and  others,  observed  a  gradual  reduction,  and  linally  a 
coin])lete  disa])pearance  of  the  disease  from  sucli  treatment. 
llaul)ohl,  SchlaK,  \'()llratli  and  otliers,  however,  found  this 
treatment  incnVctivc,  and  even  in  the  favorable  cases  the  dis- 
appearance of  the  disease  was  probably  tlie  result  of  a  disin- 
fection which  was  carried  out  sinndtaneously.  _  The  same 
probably  wouUl  a])ply  also  to  the  internal  administration  of 
carl)oliz'ed  water  (l-l'Vii  liters  of  a  1%  carbolic  acid  solution 
once  daily  [Nuesch]),  as  well  as  the  weekly  prophylactic  irri- 
gations of  the  vagina  of  pregnant  cows  with  14  liter  of  a 
2I0-370  solution,  with  which  Horlyck  and  Dolmer  have  recently 
obtained  very  good  results. 

In  order  to  prevent  the  introduction  of  tlie  disease  from 
outside,  newly  purchased  pregnant  animals  should  be  observed 
carefully,  and  should  be  kept  isolated  until  calving;  further 
animals*  with  symptoms  of  a  uterine  or  vaginal  catarrh 
(leucorrhea!)  should  not  be  bred  at  least  until  completely  re- 
covered. The  association  with  persons  who  are  employed  in 
infected  premises  sliould  also  be  limited  as  far  as  possible. 
In  male  animals  which  have  served  on  other  premises,  it  is 
advisable  to  disinfect  the  prepuce  and  the  penis  before  the 
act  of  covering.  Furthermore,  each  case  of  abortion  should 
be  treated  as  if  it  were  an  infectious  form  of  the  disease,  and 
particularly  does  this  appear  to  be  necessary  in  those  cases 
where  the  abortion  occurs  under  the  above-described  manifesta- 
tions even  in  a  herd  which  has  been  known  to  be  free  of  the 
■affection. 

Females  which  have  aborted  one  or  more  times  should  be 
disposed  of  only  if  they  fail  to  conceive  after  a  subsequent 
covering,  provided  that  they  have  received  suitable  treatment. 
By  keeping  pregnant  animals  the  disease  will  be  brought  to  a 
standstill  more  quickly  than  if  new  susceptible  material  is  con- 
tinually added  in  their  place   (Bang). 

If  the  described  method  is  carried  out  accurately  it  almost  in- 
variably succeeds  in  suppressing:  the  disease.  In  already  infected 
animals  abortion  cannot  be  prevented,  but  the  infection  of  healthy 
animals  can  be  prevented.  Authoritative  measures  which  would  pre- 
vent animals  from  infected  herds  being  taken  to  markets,  animal  ex- 
hibitions and  public  pastures,  would  considerably  aid  in  the  prevention 
of  the  dissemination  of  the  virus  (such  measures  exist  at  present  in 
Norway). 

Immunization.  Bang's  most  recent  investigations  indicate  the 
possibility  of  immunization  of  cattle,  sheep  and  goats  against  the  in- 
fection. He  found  that  several  animals  which  repeatedly  received  in- 
travenously living  cultures  (10  cc.  each  time)  at  least  two  months 
before  conception,  carried  the  fetus  to  normal  time  in  spite  of  the  fact 
that  during  their  pregnancy  they  were  infected  per  os  with  cultures 
or  exudates.  As  however  the  intravenous  injection  sometimes  disturbed 
the  general  health  greatly,  experiments  were  later  undertaken  on  sheep 
and  goats  with  subcutaneous  injections  of  cultures   (5  to  7  times,  a 


750  Infectious  Abortion. 

total  of  50-70  cc),  the  results  of  which  also  proved  satisfactory.  Of 
five  cattle  which,  a  long  time  before  breeding,  were  injected  subcu- 
taneously  in  eleven  doses  with  100  cc.  of  cultures  of  bacilli  killed  by 
Tuluol,  and  which  during  pregnancy  w^ere  fed  with  cultures  and 
exudates,  two  animals  gave  normal  births.  Of  four  cattle  which  re- 
ceived living  cultures  subcutaneously  in  increasing  doses,  from  4-40  cc, 
a  total  of  140  cc,  one  gave  birth  at  the  normal  time,  while  one  aborted 
shortly  after  the  feeding  of  the  infectious  material,  and  two  aborted 
later.  Based  on  the  results  of  encouraging  laboratory  experiments 
MacFadyean  &  Stockman  recommend  imnnniization  with  150  cc.  of 
virulent' culture  6  to  8  wrecks  before  breeding. 

Literature.  Xoeard,  Eec,  18S6.  669.  —  Briiner,  D.  Z.  f .  Jm.,  1888.  XIV.  95 ; 
1895.  XXI.  455.  —  Sand,  ibid.,  1895.  XXI.  195  (Lit.).  —  Berger,  D.  t.  W.,  95. 
117.  —  Bang,  Z.  f.  Jm.  1897.  I.  241;  A.  f.  Jk.,  1897.  XXXIII.  312.  —  Guillerey, 
A.  F.  Jk.,  1903.  XXIX.  37  (Lit.).  —  Ostertag,  Mouh.,  1901,  XII.  386;  HI.  d.  p. 
M.,  1903.  III.  287.  —  Preisz,  Cbl.  f.  Bakt.,  1903.  XXXIII.  190.  —  Schottler, 
A.  f.  Jk.,  1904.  XX.  329.  —  Penberthy,  J  of  comp.  Path.,  1904.  VII.  362.  — 
MacFadyean  &  Stockman,  V.  J.,  1909.  459.  —  Holtli,  B.  t.  W.,  1909.  686. 
—  Nowak,  A.  P.,  1908.  XXII.  541. 


11.    Infectious  Vaginal  Catarrh  of  Cattle.    Colpitis  Granulosa 

Infectiosa  Bovum. 

{Vaginitis  infectiosa  granular  is  s.  follicular  is,  Vaginitis  verru- 
cosa; Ansteckender  Scheidenkatarrh  der  Binder  [German]  ; 
Vaginite  granuleuse,  infectieuse  on  contagieuse  [French^.) 

Infectious  vaginitis  is  a  clironic  infectious  disease  of  cattle, 
which  is  principally  characterized  by  peculiar  nodule  forma- 
tions on  the  catarrhal,  swollen  vaginal  mucous  membranes.  A 
Gram  negative  streptococcus  is  at  present  considered  to  be  its 
cause. 

History.  The  disease  was  recognized  generally  only  tow-ards  the 
end  of  the  last  century.  After  Isepponi  (1887)  and  Ehrhardt  (1896) 
had  observed  its  occurrence  in  Switzerland  it  was  described  in  the 
years  of  1894-1904  by  German  authors  (Trommsdorf,  R.  Frohner, 
Martens,  Ellinger,  Georges,  Hecker,  Ostertag,  Raebiger  and  others), 
further  by  Jensen  in  Denmark,  by  De  Bruin  in  the  Netherlands,  by 
Gratz,  Keleti,  Ladanyi  and  others  in  Hungary,  and  by  Saccani  and 
Tosi  in  Italy.  The  cause  of  the  disease  has  been  described  by  Ostertag 
and  Hecker,  while  knowledge  concerning  the  mode  of  infection  and 
symptomology  was  especially  furthered  by  the  inquiries  of  the 
"Association  of  Swiss  Veterinarians"  in  1902,  and  by  the  compilation 
of  their  results  by  Hess. 

Occurrence.  The  disease  appears  to  be  quite  widely  spread 
on  the  European  continent,  and  most  of  the  cows  in  the  in- 
fected herds  usually  become  affected.  As  some  of  the  affected 
animals  are  impregnated  with  difficulty,  abort  easily,  and  sub- 
sequently remain  sterile,  the  disease  causes  considerable  loss 
in  cattle  breeding,  which  in  severe  cases  is  also  increased  by  a 
reduction  in  their  nutrition  and  milk  production. 


OecunTiite,    Etiology,    Pat  liogen  icily.  751 

The  disease  is  widely  distributed  in  middle  and  northern  Germany,  and  is 
.itill  spreadinjr.  lu  eastern  Prussia  alone  about  H0,000  cows  api)ear  to  be  atJ'ected 
(Midler),  JH>-J)8',;  of  the  cows  bein^r  usually  affected  in  the  infected  herds 
(Kaebiger),  and  in  the  corporation  herds  also  the  frequency  reaches  90%.  The 
disease  existed  in  1901  in  Thiiringia  to  such  an  extent  that  not  a  single  township, 
indeed  in  many  places  not  even  a  single  stable,  was  spared  (Pr.  V.-B.).  The 
disease  was  reported  in  lOdlJ  from  almost  every  government  district,  and  about 
90%  of  30,000  cattle  of  the  East  Prussian-Netherlands  Society  were  affected. 

The  general  inquiry  in  Switzerland  showed  a  very  considerable  distribution 
of  the  disease,  as  among  4,'.V2'2  cattle  examined  in  344  stables,  G0%  were  found 
to  be  infected.  Jn  the  western  part  of  Austria  one  half  of  the  entire  nundjer  of 
cattle  are  supposed  to  lie  affected  (Keichl).  In  Hungary  it  is  also  widely  s])read. 
According  to  the  investigation  of  Ladanyi  at  the  stockyards  of  Hudapot,  43.8% 
out  of  5,013  cattle  showed  symptoms  of  the  disease;  of  the  improved  liree<ls  58.9%, 
and  of  the  range  cattle  43%  j)roved  to  le  aff'ecte<l,  while  all  of  the  buffalo  cows 
were  found  to  be  healthy.  According  to  the  origin  of  the  animals  the  morbidity 
in  cows  from  Hungary  was  50.7%,  from  Servia  43.8%,  from  Bosnia  57. 8'/^,  from 
Croatia  52.3%,  besides  which  the  disease  has  also  been  diagnosed  in  calves. 

Etiology,  The  organism  considered  as  the  cause  of  tlie 
disease  is  a  streptococcus  chain  consisting  of  6-9  cocci,  tlie  in- 
dividnal  cocci  being  enclosed  in  a  fine  capsule. 

Staining.  The  cocci  are  easily  stained  by  a(iueous  auilin  dyes 
while  the  capsule  remains  unstained ;  by  Gram 's  method  even  the  cocci 
remain  unstained. 

Cultivation.  The  streptococci  grow  on  the  ordinary  alkaline  media 
in  the  presence  of  oxygen,  at  body  or  room  temperature ;  luxuriant 
cultures  grow  especially  on  agar  containing  glycerin  or  urine.  Gelatin 
and  coagulated  blood  serum  are  not  liquefied ;  in  bouillon  a  difil'use 
turbidity  develops;  milk  is  not  coagulated.  Neither  gas  nor  iudol 
-form  in  the  cultures. 

Tenacity.  The  streptococci  are  killed  in  cultures  in  one  minute  by  corrosive 
sublimate  1:5000,  silver  nitrate  %%,  lactic  acid  2%,  lysol  or  creolin  solution  2^4% 
(Ostertag\  One  per  cent  tannin  solution  appears  to  destroy  them  after  20  hours, 
while  a  11A%  solution  of  bacillol  has  a  rapidly  destructive  action  (De  Bruin). 
From  fibrinous  purulent  discharge  of  the  vaginal  mucous  membrane,  dried  on 
small  wooden  sticks,  the  streptococci  may  be  grown  on  artificial  media  even  after 
3^L>   years    (Heckelmann), 

Pathogenicity.  Pure  culture  or  vaginal  discharge  intro- 
duced into  the  vagina  of  healthy  female  cattle  produces  in 
from  2  to  3  days  a  purulent  vaginal  catarrh,  in  the  course  of 
which  the  discharge  at  first  (according  to  Thoms  as  early  as 
from  16  hours  on)  contains  exclusively  streptococci,  later  also 
staphylococci  and  colon  bacilli.  A  transmission  to  other  animals 
is  not  successful  (only  DeBruin  reports  that  he  succeeded  in 
transmitting  it  to  horses,  sheep,  goats  and  hogs). 

Following  the  investigations  of  Prowazek  &  Halberstadter  on  trachoma  of 
man,  Blahn  found  that  the  epithelial  cells  on  the  point  of  the  follicular  nodules 
contain  very  small  bodies  resembling  the  trachoma  bodies,  which  sometimes  were 
numerous,  again  few,  and  were  enclosed  in  cells  or  free  in  great  clumps.  He  con- 
siders these  bodies,  which  sometimes  have  a  sickle  shape,  and  are  invariably  present 
only  on  one  side  of  the  nucleus,  as  evolution  forms  of  a  protoroon  as  yet  unknown, 
belonging  to  Prowazek  's  Chlamydo7oa.  According  to  his  view  the  disease  repre- 
sents a  specific  affection  of  the  epithelia,  with  degeneration  of  the  adenoid  layer 
of  the  mucous  membranes,  probably  as  a  result  of  an  obstruction  of  the  glandular 


752  Infectious  Vaginitis. 

canals,  and  subsequently  appearing  follicular  formations.  This  conception  requires 
confirmation,  as  does  also  that  regarding  the  etiological  importance  of  the  trachoma 
bodies   (Pomayer  already  reports  that  he  never  observed  the  bodies  in  question). 

The  natural  infection  results  as  a  rule  during  the  act  of 
coitus;  more  rarely,  but  also  easily  by  contact  of  healthy  cows 
with  affected  animals,  or  by  straw  contaminated  with  vaginal 
discharge,  ichor,  or  stable  utensils,  further  by  the  contaminated 
hands  of  the  attendants  during  the  examination  of  the  genital 
organs,  as  well  as  by  instruments  which  are  used  in  the  treat- 
ment of  affected  animals. 

Bulls  may  transmit  the  disease  more  readily,  as  some- 
times they  themselves  may  be  affected,  and  besides  the  infec- 
tion may  retain  its  virulence  for  a  long  time  in  the  pelvic  por- 
tion of  the  urethra,  from  the  flexura  sigmoidea  to  the  neck  of 
the  bladder  (Hess).  As  a  matter  of  fact  bulls  infected  by 
diseased  cows  may  within  a  short  time  cause  the  appearance 
of  the  disease  at  different  places,  by  disseminating  the  infection 
during  service  of  cows  led  to  them  from  other  villages,  and 
the  infection  then  extends  rapidly  in  the  herds.  Young  cattle 
are  espiecially  susceptible  to  the  infection,  and  the  disease  has 
been  observed  in  calves  only  two  weeks  old.  Young  strong 
cows,  and  in  general  animals  with  tender,  sensitive  vaginal 
mucous  membranes  are  more  easily,  more  quickly,  more  severely 
and  more  typically  affected  than  older  animals  with  tougher,  less 
sensitive  mucous  membranes.  Accordingly  the  disease  is  ob- 
served only  very  exceptionally  in  cows  over  ten  years  of  age, 
and  animals  with  a  chronic  affection  of  the  vaginal  mucous 
membrane  (prolapse  of  the  vagina,  nymphomania),  are  es- 
pecially very  resistant  (Hess). 

Female  animals  are  generally  more  susceptible  than  males. 
The  nutrition,  the  method  of  feeding,  and  the  character  of  the 
utilization  of  the  animals  has  no  influence,  likewise  the  period 
of  the  year,  or  the  weather  (the  frequency  of  the  disease  in 
the  spring  and  summer  is  the  result  of  the  breeding  period  Avhicli 
usually  occurs  at  this  time). 

Pathogenesis.  With  the  entrance  of  the  streptococci  into 
the  mucous  membrane  of  the  vagina,  they  produce  on  one  hand 
a  chronic  catarrh,  and  on  the  other  a  sw^elling  of  the  h^nph 
follicles.  They  may  be  demonstrated  in  the  mucous  membrane 
between  the  epithelial  cells,  and  also  in  the  papillary  body.  As 
the  nodules  characteristic  of  the  disease  occur  also  m  the 
OS,  and  on  the  mucous  membrane  of  the  uterus,  and  streptococci 
were  demonstrated  not  only  in  the  secretion  of  the  uterus,  but 
also  in  the  contents  of  the  degenerated  cystic  ovaries  (Heckel- 
mann,  Raebiger),  sometimes  changes  result  which  later  render 
conception  difficult,  or  altogether  impossible. 

According  to  Pomayer  the  inflammatory  process  always  begins  at  the  folds 
running  backwards  and  forwards  from  the  clitoris,  as  well  as  in  the  prepuce  of 
the  clitoris,  and  extends  only  later  to  the  lateral  and  superior  walls  of  the  vestibule 


INSERT  FOLDOUT  HERE 


INSERT  FOLDOUT  HERE 


Patliogenesis,  Synipluiiis.  753 

of  tho  vafjiiia.  By  prosKuro  on  thf  anterior  wall  of  the  clitoris  a  drop  of  yellow- 
ish, thick,  oilorless  inncus  may  V)e  squeezed  out  from  the  follicular  cavity,  which 
contains  diplococci  in  pure  cultures.  The  sj)ecilic  changes  never  attack  the  cervix 
or  the  uterine  mucous  niendirane,  and  that  alVecteil  animals  frecpiently  fail  to 
conceive  may  be  e.\j)laiiied  thus  that  during;  copulation  the  i>ressure  of  the  penis  on 
the  hypersensitive  nerve  endiufjs  of  the  inllamed  clitoris,  and  the  vulva,  causes 
liy  reilex  action  the  os  to  be  drawn  up\var<ls  and  to  close.  ^Mostly,  however,  steril- 
ity, as  well  as  abortion,  is  caused  by  a  coexistin<r  uterine  catarrh  (fiuor  albus), 
which  exists  indejiendentiy  of  the  specific  alVection  of  the  vaf^ina. 

Accordiuff  to  the  histological  examinations  of  Thoms,  the  nodules  of  the 
mucous  meml)rane,  especially  in  the  surroundinjj  jtarts  of  the  clitoris,  represent 
■princii)ally  club-shai)e<l,  thickened  papillae  of  the  already  normally  strongly  devel- 
oped papillary  body,  while  in  other  parts  the  nodules  develop  from  one  or  more 
follicdes,  which  cause  a  profusion  of  the  surface  of  the  mucous  memin-ane.  After 
recovery  from  the  vaginal  catarrh  the  follicles  gradually  retrogress,  but  they  persist 
in  ]>art.  although  in  somev.-hat  less  definite  form.  Therefore  recovery  from  the  dis- 
ease is  not  necessarily  connected  with  the  entire  disappearance  of  the  nodules. 

Symptoms.  The  incubation  ])eriod  of  infectious  vaginitis  is, 
after  artilicial  infections,  accordinii'  to  ()stertai>',  '2  to  .'>  days, 
according  to  Hess  20  to  72  hours,  after  coitus  usually  3  to  5  days, 
sometimes,  however,  only  24  hours  (Raebiger). 

The  disease  commences  with  a  moderate  swelling  of  the 
vulva,  and  diffuse  s])otted,  or  streaked  reddening,  further  swell- 
ing, formation  of  folds  and  increased  sensitiveness  of  the  vaginal 
mucous  membrane,  when  a  muco-purulent  secretion  collects  on 
the  surface.  In  from  1  to  2  days  millet  seed  to  half  of  a  hemp 
seed  sized,  more  rarely  even  somewhat  larger,  smooth  nodules 
at  first  dark  red  and  easily  bleeding,  appear  on  the  mucous 
membrane  of  the  vestibule  of  the  vagina,  especially  on  the 
clitoris  and  on  the  folds  of  its  prepuce,  as  well  as  in  the  im- 
mediate surroundings.  They  appear  especially  sharply  promi- 
nent by  side  illumination,  forming  dense  clumps  in  the  vicinity 
of  the  clitoris,  on  the  lateral  walls  of  the  vestibule  of  the  vagina, 
however,  they  are  arranged  in  sagittal  rows  (Plate  VIII),  and 
by  stroking  the  mucous  membrane  with  the  fingers  they  are 
easily  palpable.  The  tissue  of  the  mucous  membrane  lying  be- 
tween the  nodules  shows  a  diffuse  or  pad-like  swelling  and  a 
reddish-yellow  discoloration  as  a  result  of  edematous  infiltra- 
tion. 

According  to  Hess  the  first  changes  on  the  vaginal  mucous  membrane  consist 
in  slightly  elevated,  red  points,  which  change  inside  of  24-72  hours  to  millet-seed 
sized,  pale  gray,  transparent  vesicles.  With  a  severe  increase  of  the  inflammatory 
manifestations  "they  burst  after  an  additional  24  hours,  forming  very  small,  regular, 
superficial,  rapidly  coalescing  minute  ulcerations.  ^feanwhile  the  mucous  mem- 
brane is  covered  with  a  tenacious,  muco-purulent  discharge,  and  only  after  its 
disappearance  do  the  highly  reddened  nodules  become  prominent  on  the  mucosa, 
which  in  part  is  still  bare  of  epithelia.  The  nodules  therefore  are  not  to  be  viewed 
as  primary,  but  as  the  terminal  stage  of  the  process.  The  vesicular  state,  how- 
ever, may  pass  unnoticed  on  account  of  its  sliort  duration;  on  the  other  hand,  the 
described  stages  may  be  altogether  absent,  and  the  affection  manifest  itself  only  in 
a  diffuse  catarrhal,  or  catarrhal  purulent  inflammation.  On  account  of  the  develop- 
ment of  the  process  from  primary  vesicles  and  the  protracted  course,  the  author 
considers,  in  agreement  with  several  Swiss  veterinarians,  that  the  disease  is  a  severe 
form  of  vesicular  exanthema.  Nielsen  is  also  inclined  to  accept  the  view  that  the 
vesicular  eruption  represents  only  an  acute  form  of  follicular  vaginitis,  as  he  suc- 
ceeded in  producing  an  acute  vesicle  formation  with  the  mucous  from  cows  with 
chronic  nodular  vaginitis.  .Tiiterbock,  however,  failed  to  observe  in  4,000  cases, 
vesicles  on  the  vaginal  mucous  membrane  in  a  single  instance. 

Vol.  1— 46. 


754  Infectious  Vaginitis. 

Simultaneously  with  tlie  development  of  the  nodules,  a 
vaginal  discharge  appears  in  the  majority  of  cases,  which  is 
at  first  very  scanty,  later  somewhat  more  profuse,  glassy, 
tenacious,  and  sometimes  more  muco-purulent  in  character.  It 
is  odorless,  alkaline  or  neutral  in  reaction.  The  discharge  soils 
the  parts  surrounding  the  vulva,  where  it  dries  to  brown  crusts ; 
exceptionally  a  profuse  secretion  forms,  which  passes  in  long 
strings  from  the  vagina. 

The  general  health  of  the  patient  is  usually  undisturbed, 
and  the  body  temperature  is  not  elevated.  The  catarrh  of 
the  vaginal  mucous  membrane  however  causes  frequent  micturi- 
tion, and  sometimes  also  straining  for  action  of  the  bowels. 
At  the  same  time  frequent  shifting  of  the  feet,  swinging  the 
tail,  occasionally  also  standing  with  legs  widely  spread,  a  stiff 
gait,  rubbing,  kicking  against  the  abdomen,  and  arching  of 
the  back  is  observed.  Only  in  rare,  severe  cases  are  appetite 
and  rumination  absent,  or  is  the  milk  secretion  suppressed. 

This  clinical  picture  remains  almost  unchanged  from  3  to 
4  weeks,  whereupon  the  process  gradually  passes  into  a  chronic 
stage,  which  is  manifested  by  the  nodules  becoming  pale,  a  dis- 
appearance of  the  discharge  and  of  all  acute,  inflammatory 
symptoms,  the  mucous  membrane  appearing  of  a  light  yellowish 
shade.  The  nodules  are  then  glassy  transparent  or  yellowish- 
gray,  and  no  longer  surrounded  hj  a  reddened  zone.  The 
process  may  remain  in  this  form  for  weeks  and  months,  until 
finally  recovery  ensues. 

Heckelmann  describes  as  a  rare  finding  in  the  first  eight  days 
numerous  yellowish-gray-white  spots  on  the  raucous  membrane,  which 
represent  either  erosions  covered  with  broken-down  epithelia  or  grayish- 
yellow  membranes  adhering  strongly  to  the  mucous  membrane,  while 
dark  red  nodules  appeared  later.  Probably  similar  findings  caused 
Ladanyi  to  distinguish  a  special  eroding  form  of  the  disease,  which, 
according  to  his  observation  is  manifested  so  that  on  the  swollen 
yellowish  mucous  membrane,  poppy  seed  to  lentil-sized,  always  yellowish- 
white,  sharply  circumscribed  spots  appear,  which  are  not  elevated  over 
the  surrounding  parts,  and  which  degenerate  from  the  center,  whereby 
the  mucous  membrane  obtains  a  peculiar,  reticulated  appearance,  until 
finally,  in  from  10  to  14  days,  the  superficial  loss  of  substance  heals 
without  formation  of  nodules. 

Regarding  the  influence  of  vaginal  catarrh  on  pregnancy 
and  subsequent  conception,  the  views  of  the  practical  veteri- 
narians vary  widely.  As  nodules  were  found  in  some  cases 
on  the  mucous  membrane  of  the  uterus,  apparently  the  result 
of  an  extension  of  the  inflammatory  process  from  the  vaginal 
mucous  membrane,  and  possibly  also  by  aspiration  of  the  in- 
fected semen  during  copulation,  an  unfavorable  influence  on 
the  development  of  the  fetus  cannot  be  disregarded.  In  har- 
mony with  this  many  observers  report  on  relatively  frequent 
cases  of  abortion  in  affected  cows,  and  still  more  frequent  are 


Syiiiptoiiis.  755 

tliG  observations  in  \vliicli  oestrum  appears  repeatedly  in  the 
animals,,  and  conception  only  after  repeated  copulations,  or 
not  at  all.  On  the  other  hand  there  are  also  numerous  ol)serva- 
tions  at  hand  aceordiuii-  to  which  the  disease  lias  no  uut'avoral)le 
inlluence  on  either  conception,  or  on  the  full  development  of 
the  fetus. 

These  contradictor}  results  of  ohservatioiis  ai'c  i)rol)ahly 
due  to  the  variations  in  the  character  of  the  disease.  ()n  the 
other  hand  the  ])ossibility  is  not  excluded  that  coucei)tion  is 
prevented  by  a  non-specific  uterine  catarrh,  an«l  the  abortion 
to  Avhich  Baui*-  has  already  called  attention,  is  not  ])rouglit  oii 
})y  the  va«:initis,  but  by  "infectious  abortion."  Both  forms  of 
the  disease  may  be  confounded  with  each  other,  as  in  infectious 
abortion,  the  follicles  of  the  vaginal  mucous  membrane  may 
also  be  swollen,  besides  the  animals  affected  with  infectious 
vaginitis  may  very  likely  be  affected  also  with  the  virus  of 
the  above-mentioned  affection.  As  a  matter  of  fact  the  ob- 
servations in  which  most,  or  the  total  num])er  of  cows,  or  two- 
thirds,  and  even  80%  of  the  animals  failed  to  conceive,  as  a 
result  of  the  affection,  can  be  hardly  credited,  in  view  of  the 
nature  of  the  somewhat  mild  local  disease  process.  The  same 
may  be  applied  also  to  the  supposed  connection  of  vaginal 
catarrh  ^vith  the  severe  purulent,  or  septic  inflammation  of 
the  uterine  mucous  membranes,  as  well  as  with  affections  of 
the  ovaries.  In  consideration  of  the  uncertainty  of  this,  accu- 
rate and  especially  bacteriologic  examinations  would  be  very 
-desirable. 

According  to  Heckelmann  "s  expeiieiice,  out  of  448  affected  cows  fioCf  con- 
ceived with  certainty,  147r  piobal)ly,  while  2\%  failed  to  become  pregnant  ajjain. 
3n  the  district  of  Olpe  in  1902  only  48  out  of  29fi  affected  cows  gave  birth  to 
living,  well  developed  calves.  According  to  Eaebiger  sometimes  68%  of  the 
affected  animals  abort,  while  Ellinger  claims  50-707c  of  normal  births.  Swiss 
veterinarians  also  report  on  frequent  sterility  (30-o0%,  and  even  more)  in  affected 
animals.  Nuesch  claims  infectious  vaginitis  as  the  cause  of  non-conception  in  SU^J, 
Fasciati  in  60-70%;  some  veterinarians,  however,  have  failed  to  observesuch  result-^ 
in  their  practice,  and  according  to  Rusterholz  conception  fails  only  in  a  certain 
form  of  the  disease. 

Bail  results  in  these  directions  have  been  observed  in  Hungary  only  in  recent 
times.  Keleti  established  that  in  20  herds,  17  out  of  503  affected  cows  remained 
sterile,  and  7  aborted,  while  in  the  same  locality  out  of  489  healthy  cattle  b"! 
remained  sterile  and  8  aborted.  The  percentage  was  therefore  in  both  groups  quite 
uniform  (4.8  and  4.7%).  Likewise  there  was  no  difference  in  primiparae.  wheflier 
affected  or  not.  Kovarzik  failed  also  to  observe  bad  results,  and  Landler  noted 
the  conception  of  all  affected  animals  in  a  herd  of  240,  all  of  which  gave  birth 
normally.  Recently,  however,  he  has  not  infrequently  observed  abortion  and  still 
more  frequently  sterility. 

In  regard  to  the  publications  on  the  economic  losses  from  infectious  vaginitis, 
Angstein  states  that  the  almost  uniform  sterility  or  abortion  of  the  animals  is  by 
no  means  as  extensive  in  practice  as  might  be  inferred  from  published  reports; 
as  a  matter  of  fact,  the  disease  appears  very  frequently  in  herds  without  the 
owners  having  the  slightest  idea  of  its  existence,  as  they  fail  to  observe  any  detri- 
mental results. 

Bulls  which  have  covered  affected  cows  become  affected 
rarely  and  then  usually  but  mildly.  Tn  such  cases  they  show 
dullness    and    froquout' micturition,   which   is    sometimes   asso- 


y56  Infectious    Vaginitis. 

ciated  .with  pain ;  the  penis  is  liigiily  reddened  and  painful,  ex- 
ceptionally nodules  develop  on  its  surface  and  on  the  inner 
lining  of  the  sheath  a  muco-purulent  discharge  being  emitted 
from  the  opening  of  the  sheath.  Bleeding  is  sometimes  ob- 
served during  the  act  of  covering.  Swiss  veterinarians  further 
report  nodules  and  vesicles  on  the  mucous  membrane  of  the 
penis,  ulcerations  on  the  orifice  of  the  sheath,  painful  swelling 
of  the  scrotum,  and  even  necrosis  of  the  testicles,  while  Jiiter- 
bock  regularly  found  on  slaughtered  bulls  pronounced  follicular 
formations  on  the  mucous  membrane  of  the  penis. 

Course  and  Prognosis.  The  course  is  mostly  very  pro- 
tracted. Although  sometimes  the  acute  inflammatory  symp- 
toms, and  with  them  the  vaginal  discharge  subside  inside  of 
two  weeks,  in  the  great  majority  of  cases  they  last  from  2  to 
3  months,  and  even  longer.  With  the  retrogression  of  the 
swelling  of  the  mucous  membrane  the  nodules  become  paler, 
yellowish,  or  grayish-transparent,  whereupon  they  disappear 
entirely,  or  persist  in  this  form  for  months.  Their  healing- 
appears  to  be  favored  by  pregnancy,  but  in  such  cases  there 
is  probably  only  an  apparent  disappearance  of  the  nodules, 
as  a  result  of  the  physiological  swelling  of  the  vaginal  miicous 
membrane,  as  in  some  cases  they  become  again  more  prominent 
after  parturition  (Hess). 

The  prognosis  depends,  aside  from  the  character  of  the 
disease,  first  of  all  on  the  inaugurated  treatment  as  well  as 
on  the  existing  hygienic  conditions.  In  early  and  energetic 
treatment  it  is  as  a  rule  favorable,  as  under  these  conditions 
recovery  of  fresh  cases  ensues  mostly  in  2  to  4  weeks,  chronic 
cases  however  are  usually  characterized  by  a  marked  stubborn- 
ness. Further  the  possibility  of  quite  frequent  recurrences  must 
also  be  considered,  which  may  result  either  after  mechanical 
irritation  (repeated  copulation)  or  as  a  result  of  re-infection. 

Diagnosis.  For  the  cases  running  a  normal  acute  course, 
aside  from  the  epizootic  character  of  the  disease,  the  develop- 
ment of  small  nodules  in  association  with  inflammatory  symp- 
toms of  the  mucous  membrane  of  the  vagina,  and  especially 
of  the  vestibule  is  characteristic,  as  well  as  the  fact  that  the 
nodules  do  not  change  into  vesicles  or  pustules,  and  that  they 
do  not  break  and  form  ulcers.  In  the  exclusive  presence  of 
nodules  the  diagnosis  should  be  made  with  care,  as  the  hmiph 
follicles  may  also  swell  in  infectious  abortion,  and  from  other 
inflammatory  causes,  as  well  as  from  simple  traumatic  irrita- 
tion of  the  mucous  membrane  (Attinger,  Jiiterbock),  (some 
authors  even  doubt  their  pathological  nature).  The  diagnosis 
is  especially  difficult  in  pregnant  cows,  as  nodules  possibly 
present  on  the  swollen  mucous  membrane  in  these  cases  are 
not,  or  only  indistinctly  visible,  and  appear  only  10  to  15  days 
after  parturition  (Jiiterbock). 


Diagnosis,    Treatment.  757 

Tlio  vesicular  exantlienia  with  Avliieh  the  disease  is  fre- 
quently coufouiuled,  is  associated  with  febrile  symptoiiis,  in 
which  on  the  vaginal  mucous  membrane  lentil  to  pea-sized 
vesicles,  and  only  a  small  number  of  hard  nodules  develop 
within  3  to  4  days,  which  however  ehan,i;e  into  vesicles,  and 
later  into  ulcerations.  Besides  in  this  disease  complete  recovery 
follows  in  2,  more  rarely  in  from  3  to  4  weeks.  In  infectious 
abortion  the  nodules  which  are  sometimes  observed  on  the 
vaginal  mucous  membrane  api)ear  only  several  days  after  the 
expulsion  of  the  fetus,  and  disappear  shortly  after.  :More- 
over  the  usuallv  profuse  vaginal  discharge  contains  the  bacillus 
of  abortion  in  great  numbers.  Of  course  animals  may  be  affected 
with  both  diseases  simultaneously.  Profuse  and  especially 
fetid  vaginal  discharge  in  general  indicates  a  complication  with 
one  or  another  inflainmatory  affection  of  the  genital  organs. 

According  to  Schneider  a  vaginitis  may  develop  in  weakly 
or  poorlv  developed  cows  after  copulation  by  mechanical  means, 
which  is  manifested  by  a  marked  reddening  and  frequently 
follicular  swelling  of  the  mucous  membrane,  as  well  as  a  muco- 
purulent discharge,  in  severe  cases  also  in  erosions  and  ulcera- 
tions. 

Treatment.     One  of  the  most  important  requirements  for 

satisfactorv   results   consists   in   cleanliness,   disinfection,   and 

most    painstaking    care    of    the    stables,    also    in    the    careful 

supervision  of  copulation,  in  order  not  to  hinder  the  healing 

-process  bv  reinfection  and  fresh  additional  inflammation. 

The  most  varied  antiseptic  and  astringent  remedies  are 
recommended  for  treatment  in  various  forms  of  application. 
The  results  however  depend  not  so  much  on  the  selection  of 
the  remedies,  as  on  the  care  and  the  accuracy  of  their  applica- 
tion, as  well  as  on  the  persistence  of  the  treatment.  In  general 
it  is  recommended  to  repeat  it  in  short  (daily),  later  in  longer 
(2  to  3  davs)  intervals,  and  to  continue  at  least  until  the  com- 
plete cessation  of  the  discharge,  if  possible,  even  until  the 
disappearance  of  the  nodules,  therefore  on  an  average  for  5 
to  6  weeks. 

For  local  treatment,  which  may  be  supported  effectively 
by  cleaning-  and  washing  the  external  genital  parts  with  luke- 
warm soda  solution  or  with  1-2%  lysol  or  creolin  solution, 
irrigation  of  the  vagina  with  mildly  acting  disinfecting  solutions 
is  indicated,  especially  in  acute  cases,  as  in  such  treatment 
the  remedies  come  in  contact  with  all  parts  of  the  mucous 
membrane.  In  less  acute  and  more  protracted  cases,  tampons, 
painting,  powdering,  liniments,  salves  and  suppositories  come 
into  consideration,  all  of  which  exert  an  intensive  healing  action 
at  the  point  of  application  and  in  their  immediate  surroundings. 
Considering  their  easy  application,  as  well  as  the  fact  that  in 
this  the  remedy  remains  for  a  longer  time  in  contact  with  the 
affected  parts  of  the  mucous  membrane,  these  methods  of  treat- 


758  Infections  Yasiinitis. 

ment  are  especially  advised  in  cases  in  which  the  daily  applica- 
tion of  irrigations  meets  with  insurmonntable  obstacles,  or 
in  which  the  affection  is  found  to  be  confined  to  the  vestibule 
of  the  vagina. 

The  most  varied  disinfectants  and  astringents,  further  also 
cauterizing  remedies  have  been  recommended  for  treatment, 
thus  especially  for  irrigation  lysol  and  creolin  (0.5-2%),  bacillol 
(1.5-3%),  potassium  permanganate  (1%),  nitrate  of  silver 
(0.5%),  lactic  acid  (2%),  boracic  acid  (3%),  liquor  cresolis 
compositus  (l%),alum  (1%),  formaldehyde  (1.5-1%),  protargol 
and  ichthyol  (0.5-2%;  expensive),  ichthargan  (1:1000,  expen- 
sive), and  others.  All  may  be  used  in  similar  concentrations, 
also  for  saturation  of  tampons  for  introduction  into  the  vagina. 
For  painting,  iodide  of  glycerin  (1:1),  tincture  of  iodine  with 
alcohol  (1:2),  further  Lugol's  solution  may  be  employed. 
Bacillol,  ichthyol,  chinosol,  formaldehydum  saponatum  (septo- 
form),  and  recently  the  hydrargyrum  sozojodolicum  (marketed 
as  Bissulin,  in  the  form  of  cra^^ons),  all  in  10%  concentration, 
are  most  frequently  utilized  as  ointments.  If  they  are  to  be 
applied  in  the  form  of  suppositories,  or  so  called  vaginal  balls, 
they  are  prepared  with  tallow,  wax  or  cocoa-butter.  Of  dusting 
powders  are  recommended,  four  parts  of  sulphate  of  zinc  or 
alum,  and  one  part  of  boracic  acid;  bacillol  w^ith  boracic  acid 
(1:30);  boracic  acid  with  flour  or  powdered  oak-bark,  aa  and 
others.  Finally  for  superficial  cauterization  of  the  nodules  1  % 
nitric  acid,  or  3%  nitrate  of  silver  solution  may  be  used. 

Technique  of  Treatment.  The  local  treatment  is  inaugurated  by  washing  the 
vagina  with  a  1%  luke-warni  soda  solution,  in  order  to  remove  the  secretion  collected 
therein.  If  severe  symptoms  of  irritation  exist,  it  is  advisable  to  cover  the  vesti- 
bule of  the  vagina,  on  the  first  day,  with  an  ointment  containing  tincture  of  opium. 

The  irrigations  are  executed  with  the  aid  of  a  rather  stift  rubber  tube  of  an 
irrigator,  or  with  a  bulb  syringe  having  a  dull  nozzle,  a  considerable  quantity  of 
fluid  is  to  be  introduced,  in  order  that  it  may  penetrate  up  to  the  uterine  os^  and 
into  all  folds  of  the  mucous  membrane.  Following  this,  a  wad  of  cotton  saturated 
with  the  same  solution,  and  with  a  long  string  attached,  may  be  introduced  as 
deeply  as  possible  into  the  vagina,  where  it  remains  until  the  following  day,  if  not 
expelled  before  that  time,  when  it  may  be  removed  by  drawing  it  out  by  the 
protruding  string. 

For  the  application  of  ointments  Eaebiger's  ointment  syringe,  constructed 
especially  for  this  purpose  is  adapted,  which  makes  possible  the  introduction  of  the 
remedies  into  the  depths  of  the  vagina  and  also  the  accurate  measuring  of  doses. 
Besides  a  rolled  rag  may  be  covered  with  the  salve,  and  placed  in  the  vagina  at 
such  a  depth  that  the  front  part  touches  the  os  uteri  (Eusterholz) ;  finally  the 
salve  may  be  also  used  in  gelatin  capsules. 

Vaginal  balls  or  bougies,  such  as  are  at  the  present  marketed  by  many  con- 
cerns and  in  varying  compositions,  are,  after  previous  superficial  warming  in  warm 
water  or  over  a  flame,  introduced  with  the  fingers  or  with  a  spoon  forceps  deeply 
into  the  vagina  and  allowed  to  remain. 

Male  animals  also  require  a  treatment  for  which  it  is  advisable  to  remove 
the  brush  of  hair  at  the  opening  of  the  sheath  with  scissors,  whereupon  the  sur- 
rounding parts  are  washed  with  luke-warm  soap  water,  and  finally  the  sheath  is 
irrigated  with  a  non-irritating  disinfecting  solution,  or  the  extended  penis  during 
a  copulation  trial  is  covered  with  the  salve. 

To  promote  conception  it  is  advisable  to  irrigate  the  vagina  before  copulation 
with  a  luke-warm  2%  solution  of  sodium  bicarbonate. 


Treatment,     Prevention.  759 

Prevention.  For  ])iovontin^'  tlio  spread  of  tlie  disease  it 
is  advisal)I('  to  se<;rci;ate  the  Iicaltliy  aniinals  from  the  affected 
ones,  to  disinfect  repeatedly  and  tliorouglily  the  infected  stables, 
and  especially  the  stalls,  as  well  as  the  draining  gutters,  and 
if  possilde  to  prevent  the  affected  cows  and  bulls  front  copula- 
tion during  the  duration  of  the  disease.  This  measure  can  be 
carried  out  in  practice  only  at  consideral)le  expense  on  account 
of  the  resulting  falling  off  in  the  number  of  calves.  In  bulls 
wliicli  are  exposed  to  the  danger  of  infection  the  brush  of  hair 
at  the  opening  of  the  sheath  should  be  cut  short,  and  the  sheath 
should  be  irrigated  after  every  copulation  with  a  mild  disin- 
fecting solution.  Finally,  in  order  to  prevent  the  introduction 
of  the  disease,  newly  bought  female  animals  shoidd  be  care- 
fully examitied  for  the  presence  of  the  disease. 

Literature.  Isopjjoni,  Sehw.  A.,  188;s.  XXIX.  1.  —  Ehrhar.lt,  il.i.l.,  1896. 
XXXVIII.  SO.  —  Ilecker,  B.  t.  W.,  1900.  445.  —  Ostertag,  Monh.,  1901.  XII.  ',:',:',. 
—  Raehig-er,  D.  t.  W.,  1901.  454.  —  Zschokke,  D.  Uiit'ruchtbarkeit  d.  Kiiules,  iisw. 
Ziirieh,  1900;  Sehw.  A.,  1904.  XLVT.  281.  —  De  Bruin,  D.  t.  W.,  1905.  :«)2.  — 
Attinger,  B.  t.  W.,  1905.  845.  —  Hess,  Bericht  iib.  d.  von  d.  Gepellsch.  sehweiz. 
Tior:ir7te  veranst.  I'ntersiiehung  betr.  d.  Knotchcnseuche.  Bern  1905.  —  Kelcti, 
Ailatorvosi  Lapok.  1905.  409;  190fi.  229.  —  Ladanvi,  ibid.,  1900.  97.  —  Thorns, 
Monh.,  1906.  XX'II.  193  (Ut.).  Casper,  T.  Z..  1907.'  393.  —  Jiiterbock,  Z.  f.  Tni., 
1909.   XIII.  354   (Lit.).   Poniayer,  B.  t.   W.,   1910.   173. 


Group  VI. 
INFECTIOUS  DISEASES  PRODUCED  BY  PROTOZOA. 

1.     Piroplasmoses. 

{Bahesioses,  Malaria  of  Animals.) 

To  the  group  of  piroplasmoses  belong  those  diseases  which 
sometimes  show  an  acute,  at  other  times  a  chronic  course  and 
are  caused  by  a  unicellular  protozoa,  the  so  called  piroplasma 
(pirosoma,  babesia).  The  parasites  are  inoculated  into  the 
body  fluids  of  mammals  by  ticks,  and  in  penetrating  the  red 
blood  corpuscles  they  produce  their  destruction,  causing  anemia, 
and  frequently  also  hemoglobinuria,  as  well  as  icterus  to  de- 
velop in  the  animals. 

General  Morphology  and  Biology  of  the  Causative  Factors. 
Piroplasmas  are  unpigmented,  roundish,  pear,  ring  or  rod- 
shaped  protozoa  with  a  nucleus  which  probably  encloses  a 
l)lepharoplast    (centrosom),    and    are    closely    related    to    the 


Fig.  128.  Piroplasma  higeminum :  Typical  ring  and  pear  shapes.  The  upper 
row  stained  with  alkaline  methylene  bine,  the  lower  after  Ronianowsky.  (After 
Kossel  &  Weber). 

hemosporidia.  In  the  inside  of  the  red  blood  corpuscles,  where 
they  are  usually  found,  they  are  frequently  present  in  pairs, 
in  which  the  pear  shapes  meet  each  other  with  their  pointed 
ends.    In  the  fresh  condition  they  show  ameboid  movements. 

Their  reproduction  has,  up  to  the  present  time,  not  been 
accurately  investigated.  In  the  blood  of  the  host  it  results 
probal)ly  by  the  way  of  direct  fission,  or  schizogony,  in  which 

760 


CieiR-ral   Morpliulogy  and   Biology.  7ol 

the  division  of  the  phisiiin  Ixxly  is  preceded  hy  fi  division  of 
tilt'  iiiR'k'us.  I^esidos,  accord iii.i;'  to  tiic  more  recent  iiivcsti^^a- 
tions  changes  in  generation  appears  to  occur  in  tlie  body  of 
the  ticks,  as  is  indicated  hy  the  fact  that  certain  species  of 
l)iroplasnia  are  transmitted  to  niannnals  only  ))y  certain  ticks, 
and  only  hy  })ro,i;('nies  of  the  ticks  which  have  suck(Ml  tlic  in- 
fected blood.  The  nature  and  mode  of  this  i)ropagation  how- 
ever is  not  yet  suflficiently  clear,  as  the  investig-ations  along' 
this  line  with  various  piroplasma  gave  variable  results  (fur- 
ther infonnation  is  given  under  the  various  forms  of  the  dis- 
ease). 

Staining-.  In  cover  glass  dry  prcparalions  fixed  in  the  air  or  in 
aleohol,  the  )>iroplasnias  stain  uniformly  with  methylene  blue  or  other 
aijueous  anilin  dyes,  wliile  the  ])reparations  wliieii  are  stained  with 
one  of  the  nuelear  staining  methods  l)y  Komanoswky-Ziemann,  Laveran 
or  Giemsa,  disclose  one  or  more  chromatin  granules  in  the  l)lue  staini'd 
plasma. 

Cultivation.  Attempts  at  cultivation  in  various  ways,  mostly  in 
bouillon,  have  given  only  partially  positive  results,  however,  they  were 
successful  in  keeping  the  parasites  alive  for  a  time  outside  of  the 
animal  body,  and  in  demonstrating  in  them  morphological  changes, 
Avhich  arc  considered  by  some  ol)servers  to  be  stages  of  development 
(see  p.  766). 

The  differentiation  of  various  species  of  piroplasma  de- 
pends partly  on  the  characteristic  form  and  size,  and  first  of 
all  on  the  fact  that  the  individual  species  are  strongly  bound 
to  certain  mammals,  so  that  they  cannot  even  artificially  he 
transmitted  to  other  species. 

Pathogenicity  and  Natural  Infection.  AVith  few  exceptions 
(coast  fever,  tropical  piroplasmosis),  tlie  piroplasma  may  he 
transmitted  artificially  with  the  blood  of  an  affected  animal 
containing  the  parasite,  liy  subcutaneous  or  intravenous  inocula- 
tion, whereupon  after  an  incubation  period  of  several  days, 
or  even  several  weeks  they  appear  in  the  circulating  Idood, 
and  some  species  will  produce  the  symptoms  of  their  respective 
disease. 

Under  natural  conditions  all  piro])]asnui  are  transmitted 
from  affected  to  healthy  aninuds  l)y  ticks,  and  not  only  in  a 
purely  mechanical  way,  but  also  in  that  not  the  tick  which  sucked 
the  manmialian  blood  containing  the  pirojdasmas  transndts  the 
disease,  but  its  innnediate  or  more  renu)te  offs|)ring.  This  is 
possibly  because  the  piroplasnui  undergo  in  the  ticks  in  the 
meantime  certain  stages  of  development.  Some  piroplasma, 
as  those  of  Texas  fever,  the  piroplasma  of  dogs  and  of  sheep, 
jjass  from  the  female  ticks  which  suck  the  blood  of  affected 
animals,  through  the  eggs  to  the  larvae,  and  likewise  also  to 
the  later  forms,  whereby  tlie  })arasites  are  inoculate<l  into  the 


yg2  I^ir()i)lasnuises. 

body  of  the  mammals  either  by  the  hirvae  nymphs  (Texas 
fever),  or  by  the  sexually  ripe  ticks  (piroplasmosis  of  sheep 
and  dogs).  Other  piroplasma  do  not  pass  through  the  eggs, 
but  are  transmitted  only  by  the  nymphs,  which  have  sucked 
the  infected  blood  as  larvae,'  or  by  matured  ticks,  which  sucked 
it  as  nymphs  (tropical  piroplasmosis,  piroplasmosis  of  horses). 
AVith  a  few  exceptions,  a  species  of  ticks  transmits  only 
a  certain  species  of  piroplasma,  while  one  certain  piroplasma 
may  be  transmitted  in  different  localities  by  different  kinds  of 
ticks. 

The  ticks  are  arthropodes,  which  as  Txodinae  and  Argasidae  form 
the  family  of  Ixodidae.  As  transmitters  of  the  piroplasmat  the  Ixodinae 
come  exclusively  into  consideration,  while  ticks  of  the  genus  Argas 
transmit  the  infection  in  spirochetoses. 

The  Ixodinae  are  obligatory  parasites  and  exist  on  l)lood  which 
they  suck  from  mammals  by  pricking  the  skin  with  the  proboscis,  more 
correctly  with  the  hypostome.  The  females  impregnated  on  the  hosts 
fall  to  the  ground,  where  they  lay  eggs  on  blades  of  grass.  The  hatched 
larvae  look  for  a  host  in  order  to  suck  blood ;  in  some  species  they 
then  develop  on  the  same  animal  up  to  the  nymph  stage  or  also  to 
sexual  maturity,  while  in  others  the  larvae  as  well  as  the  nymphs,  or  the 
nymphs  alone,  leave  the  host,  in  order  to  develop  into  the  next  stage. 
According  to  the  imture  of  the  development  the  Ixodidae  may  be 
combined  into  the  following  groups    (Meuleman)  : 

1.  Species  which  pass  through  their  develoinuent  on  the  same  host;  here 
belong  the  species  of  the  Boophihis  (Margarojnis,  Ehii»icephalus,  bhie  ticks),  namely 
B.  annulatus,  B.  decoloratiis,  B.  australis  and  B.  argentinus  (according  to  Neumann 
only  varieties  of  one  species)  ;  all  are  transmitters  of  Texas  fever,  the  B.  deeolor- 
atus  transmits  also  tropical  piroplasmosis. 

2.  Species  which  leave  the  host  as  nymphs;  here  belong  Ehipicojdialus 
evertsi  (red  tick:  transmitter  of  East  African  coast  fever,  and  the  piroplasmosis 
of  horses),  Eh.  bursa  (transmitter  of  piroplasmosis  of  sheep),  and  Hyalomnia 
aegyptium   (transmitter  of  Texas  fever?). 

3.  Species  which  leave  host  as  larvae  and  as  nypmhs ;  here  belong  Ixodes 
ricinus  s.  reduvius  (transmitter  of  piroplasmosis  of  cattle  in  Europe,  probably  also 
of  piroplasmosis  of  dogs),  Ehipicephalus  appendiculatus  (brown  tick).  Eh.  nitens, 
Eh.  sinius  (dotted  black  tick),  and  Eh.  capensis  (transmitter  of  coast  fever).  Eh. 
sanguineus  and  Haemaphysalis  leachi   (transmitter  of  piroplasmosis  of  dogs). 

Pathogenesis.  Some  piroplasma,  as  for  instance,  the 
ordinary  piroplasma  of  cattle  (Texas  fever),  of  dogs,  and  of 
sheep,  exert  their  pathogenic  action  by  penetrating  the  red 
blood  corpuscles  and  causing  their  destruction.  According  to 
the  intensity  of  the  affection  a  larger  or  smaller  number  of 
red  cells  is  destroyed,  as  a  result  of  which  a  more  or  less  pro- 
nounced anemia  develops,  and  simultaneously  the  hemoglobin 
of  the  attacked  cells  is  eliminated  into  the  blood  plasma.  If 
only  a  small  number  of  erythrocytes  is  destroyed,  only  a  hemo- 
globinemia  results,  the  eliminated  hemoglobin  is  then  changed 
in  the  liver  into  bilirubin,  and  eliminated  as  such,  while  in 
a  greater  destruction  of  blood  corpuscles  a  part  of  the  hemo- 
globin is  passed  with  the  urine,  and  icterus  sets  in  at  the  same 


Patlioiieuesis. 


7G3 


time.  Tlio  debris  of  tlie  cells  at  the  same  time  cause  emboli 
in  the  various  organs,  especially  in  the  kidneys,  as  a  result 
of  which  hemorrhages  develop,  and  parenchymatous  indannua- 
tion  is  produced  in  the  kidneys  (Smith,  Betegh),  manifested  in 
the  presence  of  albumen  in  the  urine,  which  exceeds  the  hemo- 
globin in  quantity.  The  rapid  dimiimtion  of  the  number  of 
red  blood  corpuscles,  and  the  disturbance  in  nutrition  which 
is  always  present,  lead  finally  to  death  from  exhaustion  in  a 
large  proportion  of  the  cases. 

Accordiii};  to  tho  investigations  of  Banatt  &  Yorko,  tlio  haoniOKloliinnria 
develops  in  piroplasniosis  of  doj^^s  as  a  diioct  losiilt  of  tho  liacmoj^lohinoniia  only 
when  tiie  blood  plasma  contains  as  nnu-h  honiofjlobiu  in  solution  as  0~)%  reil 
blood  corpuscles  in  proportion  to  the  total  volume  of  the  plasma.  At  the  same 
time  the  red  coloration  of  the  urine  is  jjronounced  only  in  a  marked  and  rapid 
destruction  of  erythrocytes,  while  in  chronic  eases  it  is  usually  not  observed,  as 
in  these  the  destruction  reaches  a  greater  proportion,  but  develops  only  gradually. 

Contrary  to  the  al)Ove  piroplasmosis,  hemoglobinuria  is 
not  observed  in  East  African  coast  fever,  or  in  tropical  piro- 
plasmosis, and  only  exceptionally  in  piroplasmosis  of  horses, 
although  a  great  proportion  of  the  erythrocytes  contain  the 
parasites.  These  affections  are  manifested  in  the  acute  cases 
l3y  more  or  less  ])ronounced  symptoms  of  a  general  blood  in- 
fection, and  the  anemia  appears  only 
in  the  more  chronic  cases.  The 
cause  of  the  difference  in  the  patho- 
genic action  is  at  the  present  un- 
known. 

Animals  which  have  recovered 
from  an  acute  attack  continue  to 
harbor  the  respective  piroplasma  in 
the  red  blood  corpuscles,  even  for 
years,  in  spite  of  the  apparent  re- 
covery and  satisfactory  nutrition,  al- 
though only  in  small  numbers;  they 
may  also  be  present  in  animals 
which,  probal)ly  on  account  of  their 
high  resistance,  have  never  shown 
manifest  s^inptoms  of  the  disease. 
Such  animals  are  constant  virus  carriers,  and  may  be  the  cause 
of  the  infection  of  ticks,  thereby  aiding  the  spread  of  the  dis- 
ease among  susceptible  animals.  At  the  same  time  they  them- 
selves are  usually  immune  against  later  infection  with  the  same 
piroplasma  (cattle  which  have  recovered  from  coast  fever  are 
incapable  of  transmitting  the  infection). 

Anaplasma  Marginale,  In  America  and  Africa,  in  localities  in 
which  the  piroplasmoses  are  prevalent,  the  blood  of  animals,  especially 
of  cattle,  which  pass  through  the  disease,  contains  erytlii-oeytes  with 
very  small,  round  or  oval,  marginal  bodies  (Fig.  129),  staining  with 
the  chromatin,  the  nature  and  importance  of  which  is  still  in  doubt. 
Smith   &   Kilborne   described   them   as  peripheral,    coccus-like    bodies. 


Fig.  129.  Anaplasma  mar- 
ginale.  Chromatin  staining. 
(After  Theik-r). 


yg4  Piroplasniosis  of  Cattle. 

Theiler  as  marginal  points.  These  authors,  as  well  as  Knuth,  Spring- 
feldt  and  Sprenll  are  inclined  to  consider  them  as  special  blood  para- 
sites, while  Dschunkowsky  &  Luhs  consider  them  as  piroplasma  spores 
and  are  of  the  opinion  that  they  produce  the  chronic  form  of  tropical 
piroplasmosis.  Theiler  named  them  recently  anaplasma  marginale, 
as  they  consist  only  of  chromatin  substance,  and  he  proved  that  after 
inoculation  with  blood  which  contained  such  bodies,  they  appeared  in 
the  blood  of  the  inoculated  animals,  sometimes  also  causing  severe  febrile 
affections.  According  to  his  most  recent  experience  he  considers  these 
parasites  as  the  cause  of  the  so-called  gall  sickness  which  is  prevalent 
in  Africa  (see  p.  783). 

Literature  on  piroplasmas  and  piroplasmosis  in  general:  Liihe,  Hb.  d.  Trop- 
enkrkh.,  1906.  III.  193.  —  Hennig,  ibid.,  page  744. " —  Schilling,  Hb.  d.  p.  M., 
Erganzb.,  1906.  75.  —  Panisset,  Eev.  gen.,  1906.  VII.  113.  —  Kaestner,  D.  tier- 
pathog.  Protozoen,  Berlin,  1906;  Ergeb.  d.  allg.  Path.,  1907.  XI  1.  496  (all  with  lit- 
erature). —  Eiekniann,  Tierz.  n.  Tierkrkh  in.  D.  Siidwestafrika.  Berlin  1908.  — 
Doflein,  Protozoenkimde.  1909.  653.  —  Knnth,  Z.  f.  Infkr.,  1910.  VII.  141  (more 
recent  literature).  —  Theiler,  Bull.  Soc.  Path,  exot.,  1910.  III.  135. 


(a)     Piroplasmosis  of  Cattle.    Piroplasmosis  Boum. 

{Texas    fever,   Redwater,   Blachivater,    Tick    fever,    Southern 

cattle  fever,  Haemoglohinnria  s.  Babesiosis  honm,,  Haemo- 

fflobinaemia  enzootica,  Malaria  hoicm;  Piroplasmose 

der  Binder  [German];  Piroplasmose  du  hoeiif 

Mai  de  brou,  Mai  de  bois  [French]; 

Ematinuria,  Piscia  saugue  [Italian]; 

Tristesza  [Spanish].) 

This  febrile  infectious  disease,  which  is  usually  observed 
in  enzootic  extension  and  in  the  course  of  which  hemoglobin 
appears  in  the  urine  as  a  result  of  the  breaking*  down  of  red 
blood  corpuscles,  is  caused  by  the  piroplasma  bigeminum,  which 
is  in  various  localities  inoculated  into  the  bodies  of  cattle  by 
various  kinds  of  ticks. 

History.  The  disease  was  first  studied  bacteriologically  in  Roumania 
by  Babes  (1888),  who  considered  as  its  cause  a  bacterium  w^hich  usually 
was  present  in  the  red  blood  corpuscles  (Haematococcus  bovis)  ;  he  has 
also  proved  that  the  disease  may  be  transmitted  with  the  blood  and 
kidney  substance  from  affected  cattle  to  healthy  animals.  Shortly 
after  him  (1889),  Th.  Smith,  later  in  association  with  Kilborne,  estab- 
lished for  the  Texas  fever  which  is  prevalent  in  North  America,  the 
fact  that  the  parasite  represents  a  hemosporidium,  and  that  the  disease, 
as  already  claimed  by  Reverleyin  1881,  is  spread  by  a  tick,  the  Boophilus 
bovis,  in  such  a  manner  that  the  tick  inoculates  blood  containing  the 
parasites  from  affected  animals  into  the  bodies  of  healthy  cattle. 

The  publications  which  have  followed  each  other  rapidly  since  that 
time,  have  established  the  occurrence  of  a  disease  w^hich  is  identical  with 
Texas  fever,  or  at  least  very  closely  related  to  it,  in  many  different  locali- 
ties. Thus  Krogius  &  Hellen  established  it  in  Finland,  Krageriid  in  Nor- 
way, Celli  &  Santori  in  Italy,  Nicolle  &  Adil-Bey  in  Turkey,  Jackschath 
and  Zieman  in  Germany,  Lignieres  in  France,  Gasille  and  de  Jong  in 


History.  Occurrence,  Etiologj'.  765 

Ilollaiul,  lliityra  in  Iluiigai'v,  Xocard,  later  Stockman  in  England, 
Bettencourt  in  Portugal;  further  Koch  in  East  Africa,  Theiler  and 
Ilutcheon  in  South  Africa,  Stockman  in  India,  Sanarelli  and  Ligniercs 
in  South  America,  finally  Pound  and  Tidswell  in  Australia. 

Kossel  &  ^Vel)er  (18!)9)  showed  further  for  Finland,  and  later  in 
association  with  Schiitz  &  ]\Iiessn(>r  (liiU:})  for  Germany,  that  the  infec- 
tion in  Europe  is  transmitted  by  the  Ixodes  reduvius.  These  same 
authors,  as  well  as  Smith  &  Kilhorne,  and  also  Lignieres  before  them, 
have  suggested  a  satisfactory  method  of  immunization  for  tlie  practice. 

Occurrence.  The  disease  occurs  usually  in  the  form  of  an 
enzootic  in  the  sprini;-  and  in  the  sinnnier  in  certain  localities, 
especially  in  marshy  and  forest  pastures,  whereas  in  the  cold 
periods,  "and  during  stable  feeding  it  occurs  only  exceptionally. 
The  so-called  forest  disease  (hemoglobinuria),  which  was  for- 
merly attril)uted  to  the  ingestion  of  various  plants,  especially 
to  tliose  containing  turpentine,  and  which  was  accepted  as  an 
intoxication  caused  by  resinous  substances  (turpentine),  is 
identical  with  the  disease  is  question. 

According  to  general  experience  older  cattle  become  usually 
affected,  and  the  disease  sometimes  causes  very  decided  losses 
among  the  improperly  wintered  cattle  of  poor  owners. 

The  disease  causes  great  losses  in  Germany,  especially  in  those  localities  in 
the  northern  part,  where,  as  a  rule,  all  animals  are  pastured,  and  among  these 
in  unfavoral)le  years  an  emphatic  decimation  of  the  animals  may  result.  It  occurs 
especially  frequently  in  Prussia  and  Ohlenburg,  then  in  Bavaria,  Wiirtemberg, 
Baden,  Hessen,  Mecklenburg,  Braunschweig  and  in  the  imperial  domains,  but  it  is 
also  observed  as  a  permanent  disease  of  spring  and  summer  in  other  localities  in 
marshy  and   moorland  pastures. 

in  Eoumania  it  occurs  most  ilestructively  in  the  inundated  territories  of  the 
Danube  Delta,  where  the  disease  in  some  years  causes  a  loss  of  30,000  to  50,000 
cattle. 

In  Hungary  tlie  "forest  disease"  prevails,  especially  in  the  mountainous 
regions  of  northern  Hungary  and  Transylvania  and  occurs  there  in  some  localities 
almost  every  spring;   it  has  also  been  observed  in  the  southern  part  of  the  country. 

Texas'  fever  has  for  a  long  time  been  known  in  America  around  the  sea-girt 
portions  of  Mexico;  in  the  middle  of  the  last  century  the  disease  was  introduced 
to  the  Ignited  States  with  herds  driven  from  Texas,  and  while  it  sliowcd  in  its 
original  home  a  very  mild  course,  in  the  North  it  caused  enormous  losses  among 
the  native  cattle,  the  money  value  of  which  has  been  estimated  in  some  years  as 
$2,nnO,ono.  in  the  northern  part  of  South  America  it  also  causes  periodically 
great  losses,  especially  among  imported  cattle.  It  also  occurs  as  a  dangerous 
disease  in  India  (Schein  observed  it  there  also  among  buffaloes),  in  Central  and 
South  Africa,  further  in  Australia,  where  it  was  introduced  by  American  cattle. 

Etiology.  The  cause  of  the  disease,  the  Piroplasma  bigemi- 
num  (Babesia  bovis,  Pirosoma  bigem.,  Apiosoma  bigem., 
Ixidio])lasma  bigom.),  occurs  in  the  blood  of  febrile  cattle, 
mostly  inside  of  red  blood  corpuscles,  more  rarely  on  their 
surface,  or  free  in  the  blood  plasma.  The  parasites  are  found 
either  singly  as  roundish  bodies  of  1-2  f^  diameter  which  in  a 
fresh  state  sliow  ameboid  movements,  or  in  pairs  in  which 
case  the  somewhat  larger,  non-motile,  and  pear-shaped  para- 
sites (piruni  =  pear)  frequently  hang  together  ^vith  their 
elongated  ends  in  a  straight  line,  or  at  an  angle  (Fig.  128  on 
p.   760   and   Fig.    130).     Smaller   diplococcus-like,   as   well    as 


766 


Piroplasmosis  of  Cattle. 


rod  and  lancet  forms  are  found  rarely,  and  the  presence  of 
more  than  two  parasites  in  one  blood  corpuscle  is  also  infre- 
quent. 

The  cultivation  and  propagation  on  artificial  media  has  not  yet 
been  successful  with  a  certainty. 

According  to  Lignieres  and  Miyajima  they  are  supposed  to  multiply  in  blood- 
bouillon  for  a  time,  and  here,  according  to  the  observations  of  the  Japanese  investi- 
gator, forms  containing  ilagellae  similar  to  the  trypanosomes  are  supposed  to 
appear  after  3-4  days;  the  propagation  reaches  its  height  on  the  10th  to  14th  day; 
on  the  4.5th  day,  hovrever,  the  culture  died  (it  is  possible  that  they  represented 
mixed  infections). 

According  to  Smith  &  Kilborne,  as  well  as  Laveran  &  Nicolle,  their 
propagation  results  by  fission,  or  schizogony,  while  according  to  Theiler's 
former  view,  which  was  also  accepted  by  Koch,  the  parasites  assume,  in 
certain  stages  of  development,  rod-  and  ring-shapes,  and  then  appear 
similar  to  the  causative  factor  of  African  horse  fever  (Fig.  131).  Such 
forms  are  usually  found  in  the  blood  of  cattle  that  are  immune  against 
Texas  fever,  and  they  also  appear  in  the  blood  of  calves,  which  have 
been  infected  with  the  blood  from  such  cattle,  during  or  after  the  second 
reaction.  Recently,  however,  these  forms  were  described  by  Theiler  as 
a  new  variety,  (Piroplasma  mutans),  (see  p.  782). 


Fig.  130.  Piroplasma  higemi- 
num.  Spherical  and  pear 
shapes.  Cattle  blood ;  stained 
with  methylene  blue. 


rig.  131.  Piroplasma  higem,i- 
num.  Rod  and  ring  shapes.  Blood 
of  a  cow  in  a  stage  of  commencing 
convalescence;  stained  after  Lav- 
eran. 


Koch  examined  material  from  ticks  which  sucked  themselves  full 
of  blood  from  affected  animals,  and  found  that,  after  leaving  the  blood 
corpuscles,  the  parasites  become  elongated  to  club  shape  in  the  intestines 
of  the  ticks  and  develop  lancet-like  projections,  which  may  be  slowly 
drawn  in  and  extended  (morning  star  shapes).  Later  the  extensions 
become  shorter,  and  diminish  in  number,  whereupon  the  parasites  change 
into  round  or  pear-shaped  bodies.  Such  bodies  are  found,  also,  in  the 
eggs  of  infected  ticks,  but  as  they  are  3-4  times  the  size  of  the  piroplasma 
in  the  blood  of  cattle,  it  is  possible  that  between  the  two  there  are 
still  other  transitory  forms.  (Kleine  observed  star  forms  also  in  dog 
piroplasma,  which  he  placed  in  strong  salt  solution.  Hartman,  however, 
considered  them  as  manifestations  of  degeneration.) 


Pathogenicity.  ygy 

Tenacity  Dofil.rinato.l  l.loo.l  kept  at  8°  C.  is  still  virulent  after  42  .lavs 
Willie  HI  the  hloo.l  of  rattle  which  have  died  or  have  been  slaughtered  hv  bleedine 
tiie  i.arasites  remain  alive  for  nine  days.  In  the  meat  of  slaughtered  animals  tliev 
(le  at  latest  after  twelve  hours  (Kossel,  Schiitz,  Weber  &  Miessner).  Their  rapid 
death  may  possibly  be  due  to  lack  of  oxygen,  as  well  as  to  the  acid  reaction  of 
tne  media  which   acts   destructively  on   the  piroplasma    (Jackschath). 

Pathog-enicity.    The  disease  may  be  transmitted  to  liealtliy 
cattle  Avith   blood  coiitainiiii,-  piroplasma   of  affected   animals. 
After  an^intravenons,  subcutaneous,  or  intramuscular  inocula- 
tion of  5-10  cc.   of  defibrinated   blood,   the  parasites   appear 
usually  m  from  8  to  9  days  in  the  blood  of  the  inoculated  ani- 
mals.    At  approximately  the  same  time  the  body  temperature 
becomes  elevated,  whereupon,  durin.^r  the  reaction  wliich  lasts 
tor  /or  8  days,  the  number  of  red  ])lood  corpuscles  diminishes, 
T]i   "\^.^*^"^^  of  t^ie  cases  hemoglobin  appears  in  the  urine. 
Atter  25  to  30  days  another  febrile  reaction  follows,  usually 
with  milder  symptoms.    In  some  animals  the  artificial  disease 
terminates  m  death,  in  the  majority  of  cases  however  recovery 
takes  place  in  one  to  two  weeks.    In  the  blood  of  such  recovered 
animals  the  parasites  may  be  demonstrated  for  a  long  time, 
although  in  smaller  numbers   (in  one  case  the  blood  was  still 
infectious  531  days  after  an  artificial  infection,  and  according 
to    Schroeder    &    Cotton    the    parasites    may   persist    for    10 
^^..p,  y^ars).     The  disease  may  also  be   produced,   although 
A\ath  less  certainty,  by  the  injection  of  blood  containing  piro- 
plasma into  the  serous  cavities,  lungs,  brain,  further  by  rubbing 
upon  the  scarified  skin ;  feeding  is,  on  the  other  hand,  always 
meftective.     To  an  infection  which  causes  a  severe  affection 
•among  older  cattle,  cattle  under  one  year  of  age  usually  react 
only  with  an  elevation  of  temperature  lasting  for  several  days. 
Other  species  of  animals  are  not  susceptible  to  the  infection.' 

In  America,  Africa,  Australia  and  Eastern  Asia,  as  well 
as  probably  in  Southern  Europe,  the  natural  infection  is  trans- 
mitted by  the  boophilus  species,  in  middle  and  Northern  Eu- 
rope, on  the  other  liand,  by  the  Ixodes  ricinus  (I.  reduvius). 

According  to  Salmon  &  Stiles,  the  carrier  of  the  parasite  is  the  bo- 
ophilus anniilatns,  m  North  America,  and,  according  to  Motas,  also  in 
Konmania ;  m  South  America,  Cuba,  Porto  Rico,  in  the  Philippines  and 
Australia,  the  B.  australis.  in  South  Africa  the  B.  decoloratus  (accord- 
nig  to  Theiler  also  the  Rh.  appendiculatus),  act  as  carriers,  while  of  the 
sub-family  ixodiae,  the  Ixodes  ricinus  has  only  been  knowTi  with  cer- 
tainty to  transmit  the  disease  in  Europe  (according  to  Krageriid  the  I 
li(^xaf?onus  acts  in  a  similar  way  in  Norway). 

The  piroplasmas  of  cattle  transmitted'bv  various  ticks  in  different 
localities  do  not  appear  to  be  entirely  identical,  but  probably  represent 
varieties  of  one  species,  and  Liihe  even  separates  them  into  two  species 
apparently  on  account  of  the  differences  in  size,  namely,  into  the  small' 
Babesia  bovis.  which  is  found  in  Europe  and  North  America  and  the 
larger,  Babesia  bigeminum,  which  is  prevalent  in  America,  Australia 
and  South  Africa.  Their  difference  appears  also  to  be  substantiated  by 
the  tact  that  animals  immunized  against  one  of  the  varieties  are  not 
always  immune  against  the  other  varieties.     This  has  been  established 


768 


Piroi^lasmosis  of  Cattle. 


by  Lignieres  for  the  European  and  Argentine  piroplasmosis,  by  Theiler 
for  the  English  and  South  African  redwater;  (on  the  other  hand,  cattle 
from  Texas  and  from  Queensland  were  immune  against  the  South 
African  redwater). 

Lignieres  describes  a  special  species,  the  piroplasma  Argentinum, 
which  is  considerably  smaller,  usually  only  found  singly  in  the  erythro- 
cytes, and  produces  in  Argentine,  Uruguay  and  Paraguay,  an  atypical 
form  of  Piroplasmosis,  which  is  frequently  characterized  by  a  protracted 
and  fatal  course,  and  by  nervous  symptoms. 


Fig.  132.  Ixodes  redavius.  1.  eggs;  2.  larvae;  3.  nymph,  several  days  old; 
4.  sexually  mature  female;  5.  male.  Enlarged  16  times.  (After  Kossel,  Schiitz, 
Weber  &  Miessner.) 


The  parasites  of  East  African  coast  fever,  and  of  tropical  piro- 
plasmosis represent  a  decidedly  independent  species  (see  p.  779  and 
p.  782). 

Development  of  the  Ticks.  The  Boophilus  annulatus  (Margaropus 
s.  Rhipicephalus  annulatus,  Boophilus  bovis)  transmits,  according  to  the 
investigations  of  Smith  &  Kilborne,  the  infection  in  the  following  way : 


Development  nf  Ticks.'  759 

The  larvae  migrate  from  the  grass  onto  the  l)0(lies  of  eattle,  and  suck 
their  hloocl.  After  about  eight  days  they  eliange  into  pupas,  and  after 
another  eight  days  into  nymphs,  which  after  anotlier  molting  develop 
into  sexually  mature  ticks.  The  nymphs,  as  well  as  the  sexually  mature 
ticks  nourish  themselves  with  the  blood  of  the  host  animal,  following  im- 
pregnation however  the  female  drops  from  the  body  of  the  cattle  and 
lays  from  2000  to  4000  eggs  in  the  grass,  from  which  the  larvae  hatch 
out  in  3-4  weeks.  They  remain  for  a  time  in  the  grass,  occasionally  how- 
ever they  crawl  on  the  skin  of  the  pasturing  cattle,  and  if  the  female 
tick  from  which  they  originated  has  sucked  infected  blood  during  its 
life,  the  larvae,  and  subseciuently  also  the  nymphs,  inoculate  the  virus 
into  the  l)ody  of  the  new^  host.  Larvae  and  nymphs  may  also  pass  over 
directly  from  affected  animals  to  healthy  eattle,  in  which  case  they 
transmit  the  blood  parasites  in  a  direct  manner. (  .') 

The  Ixodes  ricinus  s.  reduvius  transmits  the  infection,  according 
to  the  investigations  of  Kossel,  Schiitz,  Weber  &  Miessner,  in  a  singular 
manner;  the  female  tick  dropping  from  the  body  of  cattle  lays  in  the 
grass  100-1000  eggs,  from  which  the  larvae  hatch  out  after  an  average 
of  six  weeks.  If  the  larvae  attach  themselves  to  the  skin  of  cattle  or  of 
other  animals,  they  suck  themselves  full  of  their  blood,  and  drop  olf 
after  3-6  days,  whereupon  they  change  to  nymphs  on  the  ground  inside 
of  four  Aveeks.  These  attach  themselves  agani  to  the  skin  of  a  nuunmal, 
from  which  they  drop  to  the  ground  in  from  3-5  days,  where  they  de- 
velop in  eight  weeks  to  sexually  mature  ticks,  which  again  look  for  a. 
host,  where  they  suck  the  blood;  and  copulate.  Therefore  the  total 
development  from  the  laying  of  the  eggs  until  the  dropping  off  of  the 
impregnated  female  takes  about  nineteen  weeks,  provided  that  the  ticks 
in  their  different  stages  of  development  ahvays  meet  a  suitable  host  and 
that  the  weather  conditions  are  favora])le  for  their  development.  Ac- 
cordingly the  Ixodes  distinguish  themselves  from  the  Boophilus  among 
others,  in  that  they  leave  the  host  twice  during  their  development,  while 
the  Boophilus  passes  through  all  the  stages  of  its  development  on  one 
and  the  same  host. 

The  eggs  of  the  Ixodes  reduvius  are  0.50-0  .■).")  nnii  long,  and  0.27  to  0  3.*] 
mill,  liroad,  of  oval  shape,  and  brownish-yellow  to  lirownish-red  in  color.  The 
larva  is  0.7-0.8  mm.  long,  0.42-0.50  mm.  liroad,  has  a  mite-shaped  body,  and  three 
pairs  of  legs;  filled  with  blood  it  attains  a  length  of  1.25  mm.  and  a  breadth  of 
0.8  mm.,  when  it  takes  on  a  blackish-brown  color.  The  nymph  is  1.3  mm.  long, 
0.74  mm.  broad;  the  body  resembles  the  larva,  but  possesses  four  pairs  of  extrem- 
ities; sucked  full  with  l)lood  it  is  about  2.0  mm  long  an<l  1.25  mm,  broad  and 
of  a  dark  grayish  color.  The  develojied  female  is  3  4  mm.  long  and  1.5-2.5  mm. 
broad;  impregnated  and  sucked  full  with  blood  it  reaches  a  length  of  10-15  mm, 
and  a  breadth  of  5-8  mm.;  it  is  then  blue  or  ash-gray  in  color,  sometimes  slightly 
brownish  or  yellowish,  and  has  four  pairs  of  extremities.  The  male  is  similar 
in  appearance,  although  somewhat  smaller   (Fig.   132). 

The  larvae,  nymphs,  and  the  sexually  ripe  ticks  may,  with  suffi- 
cient moisture,  remain  alive  for  months  outside  of  the  animal  body,  and 
they  also  withstand  the  cold  of  the  winter  without  harm.  In  cold  weather 
they  are  benumbed,  but  as  soon  as  warm  weather  appears  they  liven  up, 
and  if  conditions  are  otherwise  favorable  they  continue  in  their  devel- 
opment.    They  are  harmed  however  by  direct  sunlight. 

Experiments  of  infection  conducted  with  both  species  of 
ticks  showed  that  when  larvae,  hatched  out  from  an  infected 
female  in  a  glass  container,  are  placed  on  the  skin  of  healthy 


770 


Piroplasmosis  of  Cattle. 


cattle,  the  piroplasma  appear  in  the  blood  in  about  eight  days, 
and  in  some  eases  fever  and  hemoglobinuria  sets  in  (Fig.  133). 
The  results  of  experiments  conducted  with  nymphs  which  as 
larvae  sucked  blood  from  affected  cattle,  are  similar,  and  the 
disease  may  be  also  produced  with  larvae,  which  have  wintered 
in  the  open  (the  infectiousness  of  the  sexually  mature  ticks 
of  the  species  described  here  is  as  yet  questionable). 

According  to  these  experimental  results,  which  correspond 
with  practical  observations,  the  natural  infection  of  cattle 
occurs  usually  on  previously  infected  pastures  in  which  one 
of  the  mentioned  species  of  ticks  are  present,  and  in  which 
the  larvae  and  nymphs  originated  from  females  which  had  the 
opportunity  to  suck  blood  from  affected  animals  or  in  wiiich 
the  nymphs  themselves  in  a  previous  stage  of  development 
sucked  infected  blood.     As  these  ecto-parasites   subsist  as   a 


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Fig-.  133.     Fever  curve  in  piroplasmosis  of  cattle.     After  placing  several  thou- 
sand infected  larvae  on  the  animal.     (After  Kossel,  Schiitz,  Weber  &  Miessner.) 


rule  in  marshy  places,  especially  in  forest  pastures  or  near 
forests  and  bushes,  the  disease  usually  affects  cattle  driven  to 
such  pastures.  On  the  other  hand  its  annual  reappearance 
may  be  explained  by  the  facts  that  the  virus  passes  from  the 
impregnated  female  ticks  to  their  progeny,  and  that  they  are 
capable  of  offering  considerable  resistance  to  unfavorable 
weather  conditions,  especially  the  cold  of  Avinter.  If  at  the 
onset  of  warmer  w^eather  the  larvae  have  already  hatched  from 
the  eggs,  the  first  cases  of  disease  among  cattle  driven  to  in- 
fected pastures  usually  appear  after  two  weeks  and,  in  case 
the  respective  pasture  was  badly  infected  the  previous  year, 
a  great  number  of  the  animals  may  become  affected  within 
a  short  time.  With  stable  feeding,  however,  the  disease  is 
observed  only  very  exceptionally,  and  only  in  cases  in  which 


Development  <if  Ticks.  ■j-ri 

infections  ticks  were  introdnced  into  tlio  stables  with  the  grass 
or  foliage  from  infected  jiastures. 

The  introduction  of  the  disease  into  localities  which  ha<l 
been  free  from  the  infection,  may  be  brought  about  bv  infected 
animals,  and  the  more  so  as  ])ii-o}ilasma  mav  be  present  in 
the  blood  of  cattle  years  after  their  recovery  from  the  disease. 
In  such  cases  the  disease  may  be  artihciallv  produced  witli 
the  blood  of  such  ap})arently  healthy  cattle.  If  ticks  which  are 
suitable  for  the  transmission  of  the  virus  are  present  in  these 
localities,  they  suck  blood  from  the  cattle  introduced  into  that 
locality,  and  pass  the  piroplasma  to  their  progenv,  which  then 
infect  healthy  animals.  Affected  or  healthy  cattle  mav  carry 
ticks  about  on  their  bodies,  and  these  will  continue  to"  propa- 
gate in  the  new  locality,  provided  the  requirements  for  their 
development  are  favorable,  where  they  may  then  infect  fresh 
animals.  In  both  cases  the  pasture,  formerly  free  of  the  in- 
fection, becomes  a  new  source  of  infection,  in  which  the  disease 
may  possibly  reour  from  year  to  year. 

*u  ^J^^  extensicn  of  the  disease  was  strikingly  observe.!  in  America,  where  in 
the  60s  and  -Os  of  the  last  centnry  it  was  introduced  bv  cattle  driven  from  Texas 
to  the  north,  to  the  states  of  Indiana  and  Illinois,  whence  it  extende.l  later  in 
a  similar  manner  almost  through  the  entire  territory  of  the  Unite-l  States  up  to 
Lake  Michigan.  After  the  trailing  of  the  cattle  from  the  south,  as  a  rule  in 
troni  dO-oO  days,  which  perio.l  corresponds  to  the  cvcle  of  .leyelonment  of  the 
Boophilus  tick,  the  native  cattle  became  affected  with  severe  symptoms  (Reverley 
•^u  i!^'  ^i^'^'^''"^'^-  The  disease  was  introduce.l  into  Australia  by  American  cattle' 
with  the  Boophilus  ticks,  which  had  been  unknown  there  up  to  "that  time  and  it 
causes  there  great  loss  from  year  to  year.  It  also  sprea.l  recently  in  Finland  to 
territories  which  had  heretofore  been   free   from   the  affection    (Krogius  &  Hellen). 

Although  the  disease  develops  exclusively  through  infec- 
tion by  ticks,  certain  accessory  conditions  have  an  influence 
on  its  appearance,  and  more  so  on  its  course.  Thus  as  a  rule 
very  young  animals  show  a  greater  resistance  against  the  in- 
fection than  older  cattle.  Poorly  nourished,  as  well  as  gener- 
ally weakened  animals  usually 'become  affected  with  severe 
manifestations;  unfavoral)le  weather  conditions,  especially 
damp,  cold  weather,  also  exert  an  unfavorable  influence  on  the 
course  of  the  disease.  This  explains  the  experience  that  the 
affection  is  often  obser\^ed  in  a  severe  form  in  the  damp,  cold 
spring  periods,  and  especially  among  improperlv  wintered  ani- 
mals of  poor  owners  ( Krageriid  observed  it  rei)eatedlv  in  such 
a  form  in  cows  12  to  14  days  after  parturition). 

Native  cattle  raised  in  affected  territories  usuallv  become 
affected  under  much  milder  symptoms  than  animals  brought 
from  uninfected  localities.  The  greater  resistance  of  the  for- 
mer may  be  explained  1)y  the  supposition  that  thev  became 
infected  while  young,  and  thereby  acquired  for  their  fater  lives 
a  relative  immunity,  which  vcas  still  more  increased  bv  infec- 
tions de^-eloping  in  the  meanwhile.  Such  animals,  however, 
may  also  carry  the  virus  in  their  blood  in  spite  of  their  healthv 
appearance,  and  this  may  sometimes  multiplv  rapidlv  on  ac- 


772  Piroplasmosis  of  Cattle. 

count  of  harmful  influences,  and  produce  a  severe  affection 
(such  acute  outbreaks  of  the  previously  latent  disease  have 
frequentl}^  been  observed  after  artificial  infection  with  rinder- 
pest blood)  (see  p.  255). 

Anatomical  Changes.  Animals  dead  from  the  disease  show 
changes  in  the  digestive  organs  and  in  the  spleen.  The  mucous 
membrane  of  the  abomasum  shows  a  catarrhal  swelling  and 
manifests,  especially  in  the  pyloric  region,  numerous  small 
hemorrhages  and  erosions.  Similar  changes  are  present  on  the 
mucous  membrane  of  the  intestines  and  especially  on  those 
of  the  rectum,  the  contents  of  which  is  colored  reddish  on 
account  of  the  numerous  and  extensive  hemorrhages  of  the 
mucous  membrane.  The  liver  is  enlarged,  the  substance  flabby, 
lusterless,  and  covered  with  yellowish  streaks  and  spots  on 
a  dull  reddish-brown  base.  The  gall  bladder  frequently  con- 
tains great  quantities  of  thickened  bile.  The  spleen  is  always 
strikingly  enlarged,  its  pulp  is  very  rich  in  blood,  brownish-red, 
or  brownish  gray-red,  and  frequently  softened,  almost  liquefied, 
the  capsule  extended  or  even  ruptured  (Witt).  The  bladder 
contains  a  great  quantity  of  pale  or  dark-red  urine,  its  mucous 
membrane  is  sprinkled  with  red  discolorations. 

The  autopsy  findings  are  further:  Hemorrhages  in  the 
serous  cavities,  sometimes  also  in  the  brain  substance  and  bone 
marrow,  cloudy  swelling  of  the  kidneys,  frequently  Avith  puncti- 
form  hemorrhages,  serous  infiltration  of  the  subcutaneous  and 
subserous  connective  tissue,  hypostatic  hyperemia  of  the  lungs, 
exceptionally  also  catarrhal  pneumonia  with  sero-fibrinous 
pleurisy.  The  blood  is  pale-red  and  thin,  the  red  blood  cor- 
puscles of  the  spleen  and  liver  contain  piroplasmas  in  a  propor- 
tion even  up  to  80%.  In  some  cases  icterus  is  also  present. 
(According  to  Plot  the  temperature  in  the  abdominal  cavity 
rises  after  death  to  44°  and  over.) 

Symptoms.  According  to  experimental  investigations  with 
larvae  of  ticks,  the  period  of  incubation  ranges  from  8  to  10 
days. 

The  disease  commences  with  a  rapid  rise  in  temperature, 
and  usually  with  pronounced  dullness  and  debility,  accelerated 
respiration  and  heart  action.  The  temperature  remains  for 
several  days  at  40°  to  42°  C,  whereupon  in  mild  cases  it  grad- 
ually returns  to  normal,  while  in  severe  cases  it  rapidly  drops 
below  normal  before  death. 

In  pasture  the  animals  rest  frequently,  fall  back  behind 
the  herd  and  ruminate  with  long  interruptions;  exceptionally 
symptoms  of  irritation,  involuntary  movements,  and  even 
delirium  are  observed  at  the  onset  of  the  disease.  At  first 
there  is  constipation,  later  the  animals  show  symptoms  of  colic 
and  tenesmus,  dry  yellowish-brown,  later  thin,  mashy  feces, 
mixed  with  mucous  or  blood  coagulum.     The  milk  secretion 


Symptoms.  yjo 

is  immediately  diminished ;  the  milk  drawn  in  small  quantities 
is  sometimes  yellowish  and  has  a  bitter  odor. 

In  a  later  stage  the  animal  manifests  a  staggering  gait, 
and  at  times  may  knuckle  over  with  the  hind  feet.  Muscular 
tr(Mn])]ing  uuiy  he  observed  in  some  parts  of  the  body,  especially 
on  the  upper  arm,  shoulders,  and  croup.  There'  is  profuse 
lachrynuition,  the  flanks  are  sunken,  the  skin  feels  dry  and 
hard.  The  lymi)li  glands  in  the  knee  folds  swell  early  'in  the 
disease  to  a  great  extent  (Schmidt).  The  mucous  membranes 
are  at  first  reddened,  later  they  become  pale,  and  show  svmp- 
toms  of  icteric  discoloration. 

The  blood  drawn  from  a  vein  is  more  or  less  pale  red 
and  watery;  after  coagulation  the  separated  blood  serum  also 
shows  a  red  discoloration.  The  number  of  red  blood  corpuscles 
drops  in  several  days  from  7  to  8  millions  per  emm.,  to  one-half 
or  one-third,  in  fatal  cases  even  one-fifth  to  one-sixth  of  the 
above  number.  Within  them  piroplasma  may  be  found  in 
varying  proportions,  in  severe  cases  from  5  to' 58%  (Fig.  130 
and  131).    The  hemoglobin  content  may  drop  to  12%  (Fleischl). 

The  microscopical  demonstration  of  the  parasites  mav  be  successful  even  in 
fresh  Mood  specimens,  where  thev  appear  in  the  l)]ood  ce'lls  as  pale,  shining,  on 
a  warm  object  staf,''e  somewhat  motile,  coccus-like  bodies  (easily  mistaken  for' the 
plasma  extensions  of  the  crenated  blood  cells!).  A  certain  result  is  obtaine.l  from 
dry  specimens  fixed  in  absolute  alcohol,  or  in  a  mixture  of  alcohol  and  ether  aa, 
and  stained  with  a  1%  aqueous  methylene  blue  solution.  The  ])arasites  on  such' 
slides  appear  colored  blue.  For  the 'demonstration  of  the  finer  structures,  and 
especially  of  the  chromatin  bodies,  Eomanowsky 's  method  of  staining  or  one  of 
its  modifications  (Giemsa  stain!)  must  be  used.  The  red  blood  corpuscles  proper 
show  indications  of  a  poikiloeytosis  and  in  their  interior  basophilic  granulations. 

The  urine  contains  even  in  the  early  stages,  albumen  in 
various  quantities;  even  when  normal  in  color  it  has  a  high 
specific  gravity,  later,  sometimes  as  early  as  on  the  second 
day,  it  becomes  of  a  reddish  or  greenish  color,  as  a  result  of 
the  appearance  of  methemoglobin,  probably  also  of  bile  pig- 
ments. The  color  gradually  becomes  more  intense  and  brownish 
to  blackish-red ;  at  the  same  time  in  shaking  much  foam  forms 
on  its  surface,  while  on  boiling  it  coagulates  to  a  jelly-like 
mass.  On  standing  a  great  amount  of  sediment  appears,  in 
which  numerous  yellow  granules,  likewise  also  kidney  epithelia 
and  casats  may  be  demonstrated,  while  red  blood  corpuscles 
are  found  only  very  exceptionally.  The  passing  of  the  urine 
is  always  accompanied  by  severe  straining. 

In  the  cases  with  unfavorable  termination  the  patients 
become  weakened  after  3  to  4  days  to  such  an  extent  that 
they  constantly  lie  down,  the  respiration  is  very  labored,  and 
from  time  to  time  a  painful  grunting  may  be  heard.  At  the 
same  time  convulsions  may  appear  in  certain  groups  of  muscles, 
tears  ooze  out  from  between  the  swollen  eyelids,  and  saliva 
drops  out  of  the  mouth,  until  finally  under  a  rapid  sinking 
of  the   body   temperature  death   ensues,   which   however  may 


774  Piroplasmosis  of  Cattle. 

occur  suddenly  under  symptoms  resembling  those  of  anthrax 
(de  Jong),  or  even  without  any  previous  indication. 

In  mild  cases  the  fever  disappears  about  the  middle  of 
the  first  week  of  illness,  at  the  same  time  the  urine  clears  up, 
and  the  appetite  as  well  as  rumination  returns.  The  animals 
which  in  the  meantime  have  become  greatly  emaciated,  do  not 
regain  their  former  condition  for  several  weeks. 

In  some  cases,  especially  in  young  animals,  only  a  moderate 
fever  which  lasts  but  a  few  days,  somewhat  accelerated  respira- 
tion and  pulse,  diminished  appetite,  as  well  as  evident  dullness 
are  observed.  The  color  of  the  urine  does  not  however  undergo 
any  change,  and  the  moderate  destruction  of  the  red  blood 
corpuscles  is  only  indicated  by  the  paleness  and  slightly  yel- 
lowish discoloration  of  the  mucous  membranes.  Such  patients 
recover  very  rapidly  after  the  disappearance  of  the  described 
s^niiptoms. 

Sexually  mature  ticks  may  be  found  on  the  body  surface 
of  affected  animals,  frequently  in  very  great  numbers  in  the 
parts  surrounding  the  vulva  and  the  rectum,  on  the  udder, 
on  the  inner  surface  of  the  thigh,  and  in  the  inguinal  region, 
while  the  larvae  and  the  nymphs  lodge  on  the  head,  in  the 
vicinity  of  the  muzzle,  on  the  eyelids  and  ears,  as  well  as  on 
the  udder. 

According  to  Dsehunkowsky  &  Liihs  a  piroplasmosis  of  the  type 
of  Texas  fever  occurs  in  Trans-Caucasia,  which  runs  a  very  rapid  course 
of  2-3  days.  It  is  always  associated  with  hemoglobinuria  and  char- 
acterized by  a  high  mortality.  No  paras.ites  are  found  in  the  peripheral 
blood,  while  almost  all  erythrocytes  of  the  parenchymatous  organs  are 
infested. 

Course  and  Prognosis.  If  affected  animals  continue  to 
remain  on  infected  pastures,  they  sometimes  die  with  a  rapid 
aggravation  of  the  s^^Tlptoms  as  early  as  from  4  to  7  days, 
but  the  course  may  also  extend  over  a  longer  time.  If  they 
are  however  removed  immediately  after  the  appearance  of  the 
first  symptoms  to  an  uninfected  place,  recovery  follows  in  most 
cases.  Dampness  and  cold,  likewise  very  hot  weather,  influence 
the  course  of  the  disease  unfavorably.  Accordingly  the  mor- 
tality varies  within  wide  limits  (5  to  50%),  and  is  usually  higher 
in  southern  warmer  localities  than  in  the  temperate  zone. 

Rapid  sinking  of  the  body  temperature  to  .S7°  and  below, 
during  continual  excretion  of  hemoglobin  with  the  urine,  in- 
dicates threatening  danger,  while  a  gradual  diminution  of  the 
febrile  symptoms  with  strong  pulse,  and  clearing  of  the  urine, 
indicates  improvement.  Sometimes  however  the  improvement 
is  only  temporary,  and  may  later,  as  a  result  of  a  reinfection, 
or  under  the  influence  of  unfavorable  weather  conditions,  again 
become  aggravated.  Cattle  which  have  passed  through  an 
attack  of  the  disease  are  usually  immune  against  later  infec- 
tions. 


Diagnosis.   Treatiuciit.  77^ 

Diagnosis.  Iloinoglobinemia  and  liemoglobiniiiia  which  ap- 
pear raijully  uiuler  febrile  symptoms,  cliaraeterize  severe  ai'fec- 
tions,  and  in  cattle  on  known  infected  pastures  a  red  discolora- 
tion of  the  urine  is  suflicient  for  a  well  founded  suspicion  of 
the  disease.  If  however  the  last-named  symptom  is  absent, 
the  i)resence  of  the  disease  may  l)e  suspected  on  the  ground 
of  febrile  symi)l()ms,  only  when  at  the  same  time  other  animals 
in  the  herd  are  alTected  with  characteristic  symptoms,  in  which 
the  probability  of  the  diagnosis  is  considerably  increased  by 
the  presence  of  ticks  in  various  stages  of  deveio])ment  on  the 
body  of  the  animals.  Absolute  certainty  is  ol)tained  by  the 
demonstration  of  i)ii-oplasmas  in  the  red'  blood  corpuscles  on 
microscopical  examination  (see  p.  773),  or  by  artificial  pro- 
duction of  the  disease  in  healthy  animals  (10  cc.  of  fresh  or 
dehbrinatod  blood   subcutaneously   or   intravenously). 

Anthrax  and  hemorrhagic  septicemia  may  be  confused  with 
the  acute  cases  of  piroi)lasmosis,  as  in  those  diseases  the  febrile 
syinptoms  are  sometimes  also  accompanied  by  a  red-colored 
urine,  but  their  course  is  more  rapid,  no  anemia  develops,  the 
urine  contains  red  blood  corpuscles,  the  examination  of  fresh 
blood  shows  long  rods,  or  small  bipolar  bacilli  between  the 
blood  corpuscles.  The  disease  is  distinguished  from  hematurias 
brought  on  by  other  causes,  by  the  aljsence  of  red  blood  cor- 
puscles in  the  urine,  from  the  so  called  "chronic  hematuria" 
it  is  distinguished  by  its  less  chronic  course,  and  the  much 
more  rapid  development  of  anemia. 

On  autopsy  the  above-mentioned  diseases  should  also  be 
kept  under  consideration,  and  especially  anthrax,  on  account 
of  the  acute  swelling  of  the  spleen,  and  the  numerous  hemor- 
rhages which  may  be  present. 

Treatment.  After  an  outbreak  of  the  disease  in  a  pasture 
the  herd  should  be  removed  immediately  from  the  infected 
locality  to  a  moderately  cool,  shady  place,  and  most  appro- 
priately to  stables  where  they  can  l)e  given  careful  attention. 
At  the  same  time  suitable  and  sufficient  feeding  (good  dry  food, 
with  the  addition  of  potatoes  or  beets),  is  of  great  importance. 
In  addition  to  this,  the  ticks  should  be  picked  from  the  body 
of  the  patients,  or  destroyed  by  washings  with  creolin,  lysol 
or  salt  solutions. 

Internal  treatment  has  so  far  been  of  but  little  value.  Salines 
may  be  administered  against  constipation,  and  the  diarrhea 
treated  with  slimy  gruels,  combined  with  astringents  or  opiates. 
In  great  weakness  stimulating  treatment  (rubbing  with  alcohol, 
internally,  alcohol  or  black  coffee)  is  indicated.  The  quinine 
treatment  (10-20  gm.  of  quinine  hydrochlorate  per  os),  which 
has  been  recommended  (Padovani,  Hellens,  Kroning),  probably 
on  account  of  the  similarity  of  the  disease  with  malaria  in 
inan,  has  not  given  uniform  results.  Krageriid  reconunends 
intravenous  injections  of  formalin  or  collargol  (100-500  gm. 
of  a  1%  solution),  and  later  carbolic  acid  or  Ivsol  internallv 


776  Piroplasmosis  of  Cattle, 

(Acid,  carbol.  or  Ivsol  10.0,  Spir.  frumenti  100.0,  Aqua  500.0; 
one  tablespoonful  every  hour  until  clearing  of  the  urine). 

Evers  warmly  recommends-  damholid  (a  hemoglobin  preparation).  The  treat- 
ment should  be  introduced  with  the  administration  of  50  gm.  (three  times  daily) 
per  OS.  If  no  improvement  results  or  if  even  an  aggravation  follows,  the  remedy 
should  be  injected  subcutaneously  or  even  into  the  blood  circulation  (200  gm. 
damholid  is  dissolved  in  one  liter  of  Vi%  itrol  solution,  and  of  this  500  cc.  or 
more  is  injected  subcutaneously,  or  of  a  10%  solution  100-250  cc.  is  injected  into 
the  jugular;  after  the  subcutaneous  injection  of  simple  watery  solutions  malignant 
edema  has  repeatedly  been  observed).  Westermann  and  Grabe  have  obtained  good 
results  with  this  treatment.  . 

Kecent  experiments  of  Nuttall  &  Hadweii,  which  have  since  been 
confirmed  by  Stockman,  appear  to  indicate  that  the  piroplasmas  are 
greatly  iuflnenced  by  tryj^anred.  In  five  artificially  infected  cattle  in 
Avhieh  the  blood  already  contained  numerous  parasites  and  the.  urine 
Avas  red  colored,  a  marked-  improvement  followed  immediately  after  an 
intravenous  or  subcutaneous  injection  of  130-200  cc.  of  a  1.5%  solu- 
tion, the  urine  cleared  rapidly,  and  the  number  of  blood  parasites 
diminished  to  a  great  extent.  Later  the  blood  was  entirely  free  of  par- 
asites for  5-18  days,  they  again  reappeared,  although  in  moderate  num- 
bers ;  but  all  of  the  five  cows  remained  alive,  whereas  one  of  four  controls, 
of  which  only  two  were  affected  with  hemoglobinuria,  died.  The  try- 
panblue  solution  should  ahvays  be  prepared  fresh  with  di.stilled  water. 
It  stains  the  body  tissues  blue. 

After  the  disappearance  of  the  symptoms  in  the  presence 
of  marked  anemia.,  subcutaneous  or  intravenous  injections  of 
physiological  salt-  solution  (1-2  liters  daily),  and  the  internal 
administration  of  iron  preparation  (5-10  gm.  iron  sulphate 
daily),  is  indicated. 

Prevention.  The  disease  may  be  prevented  absolutely  liy 
keeping  the  animals  from  infected  pastures  and  excluding  grass 
and  foliage  fodder  from  such  localities  for  food  purposes.  On 
the  other  hand  such  pastures  may  become  harmless  by  draiiiing 
their  swampy  areas.  Sucli  means  of  prevention  however  fre- 
quently cannot  be  carried  out  on  account  of  the  lack  of  funds 
of  the  owners..  As  some  animals  shoAV  very  little  resistance 
to  infection,  as  a  result  of  improper  wintering,  care  should  be 
taken  that  weakened  cattle  are  not  driven  to  Ioav  forest  pastures 
in  the  spring  and  early  summer  (according  to  Lignieres  alfalfa 
is  supposed  to  keep  the  ticks  away  from  pastures). 

In  order  to  prevent  the  introdu-ction  of  the  disease  to  pre- 
viously uninfected  territories,  it  is  aimed  in  America  and 
Aus-tralia  to '  free  the  suspected  animals  of  ticks.  For  this 
purpose  animals  in  the  southern  part  of  the  United  States 
are  dipped  in  vats  containing  20%  petroleum  or  Beaumont 
oil,  while  in  Australia  Avashing  with  various  insecticide  fluids 
.  (lysol,  petroleum)  is  employed  for  such  purposes.  In  order 
to  destroy  the  ticks  farmers  in  South  Africa  usually  spray 
the  animals  in  12  to  19  day  intervals,  with  a  mixture  of  oil 
and  water  (10-25:100)  (Lounsbury).  For  the  same  purpose 
a  fluid  is  also  suitable  consisting  of  0.2%  arsenic  and  0.2% 
wood  tar. 


Pivvt'iitiiiii.  Iniiiiunization.  --•■-• 


In  the  Unito.l  States  and  Nortli  America  the  destruction  of  ticks  was  inaue- 
urated  on  a  arge  scale  in  190G.  On  this  occasion  220,780  cattle  were  inS  el  whh 
ticks  in  2),51.  exan.ined  herds,  and  328,064  were  found  to  be  free  Seddom) 
The  procedure  consists  in  placing  the  herds  for  three  weeks  in  enclosed  pastures 
rioo  ot  ticks,  until  tiie  young  ticks  become  mature  ami  drop  to  the  ground  Then 
the  animals  are  .Iriven  to  another  uninfected  pasture,  and  their  former  stands  are 
disintectod.  It  IS  also  aimed  to  clear  the  cattle  pasture  from  ticks  by  keeping  the 
cattle  away  tor  about  six  months,  when  the  ticks  are  destroyed  by  starvation  or 
large  pasture  areas  are  burned  over  in  the  spring. 

Immunization.  As  cattle  recovering  from  the  disease  ac- 
(liiire  a  loiig-lastiii«>-  immmiity  in  North  America  (Schroeder) 
an(l  Australia  (Gray),  cattle  brought  from  non-infected  terri- 
tories into  affected  localities  are  infected  artilicially  with  blood 
of  calves  born  in  infected  territories  or  of  recovered  cattle, 
which,  as  a  rule  contain  piroplasma  sparingly.  After  such 
inoculations  the  animals  become  sick  after  8  to'lO  davs,  some- 
times with  s}niiptonis  of  anemia,  hemoglobinuria,  frequently 
also  with  bloody  diarrhea,  and  at  the  same  time  the  number 
of  red  blood  corpuscles,  some  of  which  may  contain  typical 
piroplasma,  diminishes  10%  or  more.  This'  symptom  disap- 
pears after  8  to  10  days;  after  a  month,  however,  a  second 
reaction  usually  appears,  which  lasts  8  to  10  days,  and 
the  red  blood  corpuscles  contain  only  atypical  piroplasma 
ill  very  small  numbers  (Theiler).  If  cattle  so  treated  are 
driven  to  infected  pastures  after  the  lapse  of  about  two 
months,  a  number  of  animals  resist  the  natural  infection,  in 
the  others,  however,  fever  appears  again  as  a  result  of  the 
tick  bites.  In  most  of  the  animals  recovery  tinallv  takes  place, 
but  a  certain  percentage  succumb  to  the  disease  (Francis)! 
Inasmuch  as  this  percentage  is  considerably  smaller  than  the 
loss  observed  from  non-inoculated  animals  under  the  same 
conditions,  the  inoculation  appears  to  be  advantageous  in 
strongly  infested  localities,  in  spite  of  the  fact  that  the  inocula- 
tion itself  causes  disturbance  of  nutrition,  and  sometimes  even 
direct  losses. 

Blood  from  older  cattle  which  have  recovered  shortly  before 
from  the  disease  is  also  suitable  for  immunization,  and  gives 
similar  results. 

The  immunizing  action  of  the  blood  from  animals  shortly  before 
recovered  has  been  confirmed  through  experiments,  by  Smith  &  Kil- 
borne,  also  Schroeder  in  North  America,  Francis  in  Texas,  Hellens  in 
Fniland,  Koch  in  Africa,  Theiler  in  Kossell,  Schiitz,  Weber  &  Miessner 
in  Germany. 

In  Germany  the  immunization  is  carried  out  with  blood  of  artifioiallv  infected 
','^?n^'.^"''  ^'^^  recently  been  employed  extensively  in  practice;  until  the  end  of 
I!t09,  (5,lo.3  cattle  were  iinmuni7ed,  principally  in  Prussia.  According  to  the  reports 
on  4,261  inoculated  cattle,  1.97Vf  became  mildly  ami  0.497r>  severelv  affected,  and 
recovered,  and  0.09%  died  or  were  slaughtered.  Besides,  during  pasturing  2.98% 
became  mildly,  0.54%  severely  affected  au<l  recovered,  0.54%  died  or  were  slaugh- 
tered. The  percentage  in  young  stock  amounted  to  only  0.04%,  in  adults  1.46%. 
In  10  herds  of  the  immuniyed  animals  4.147^  were  mildlv,  0.46%  severelv  affected; 
of  those  not  immunized  19.63%  mildly,  and  7.48%  severely  affected  "(Schmitt). 
Satisfactory    results    are    reported    by    "Orattunder    and    Bugge.      Less    satisfactory 


778  Piroplasmosi.-,  of  Cattle. 

were  the  iinmunizations  in  Texas,  where  np  to  the  eml  of  1001  out  of  1,251  immuu- 
ized  cattle  116  or  9.2%  died  later;  likewise  in  Australia  (Queensland,  where  immun- 
ization of  35,000  cattle  caused  a  loss  of  3-4%,  and  besides,  of  17,960  immunised 
animals  679,  that  is  3.6%  succumbed  later  to  the  natural  infection.  But  in  one 
experiment,  out  of  95  previously  immunii'ed  animals  all  remained  healthy  after 
attaching  ticks  to  them,  while  30  non-immune  cattle  became  affected  as  a  result 
of  it. 

Technique  of  Immunization.  For  the  inoculation,  blood  is  taken  from  the 
jugular  vein  of  cattle  which  have  passetl  through  a  natural  or  artificial  affection  about 
two  months  previously.  The  blood  is  deflbrinated,  and  either  used  immediately  or 
kept  in  the  ice  chest  until  the  inoculation.  According  to  Kolle,  blood  containing 
parasites  from  calves  reared  in  infected  localities  is  best  adapteil,  according  to 
Hchiitz  blood  from  artificially  infected  calves  which  ha^e  recovered  at  least  within 
83  days.  Three  cc.  of  the  "deflbrinated  blood  are  injected  subcutaneously,  and  if 
possible  the  operation  should  be  undertaken  during  the  winter  or  at  the  beginning 
of  spring.  It  is  best  to  undertake  the  inoculation  on  calves.  Cows  in  advanced 
pregnancy,  poorly  nourished,  or  in  general  animals  Avhich  are  not  entirely  well 
should  not  be  immunized. 

The  immunized  animals  should  be  kept  in  the  stable  for  three  weeks  and  fed 
moderately  before  they  are  driven  to  pasture. 

Other  Methods  of  Immunization.  Dalrymple,  IMorgan  &  Dodson 
also  obtained  satisfactory  results  in  America,  by  taking  from  the  body 
of  affected  animals  ticks  sucked  full  with  lilood,  grinding  them,  and  inoc- 
ulating cattle  subcutaneously  with  the  material,  while  Connaway  & 
Francis,  in  America,  recommended  the  application  of  infected  larvae 
or  nymphs  (the  first  time  20-50,  after  a  month  again  200-400)  on  the 
skin  of  healthy  animals. 

Lignieres  produces  vaccine  by  cultivating  (?)  the  piroplasma  in 
deflbrinated  blood  from  affected  animals,  Avhich  produce  in  healthy 
cattle  only  a  very  mild  affection  at  the  same  time  immunizing  them  (the 
immunization  requires  three  inoculations.  The  experiments  carried  out 
in  Buenos  Aires  and  Alfort  gave  satisfactory  results,  as  immunized 
cattle  resisted  artificial  as  well  as  natural  infections,  Init  there  are  no 
reports  available  relative  to  its  application  in  practice.  The  method 
of  preparing  the  vaccine  is  likewise  unknown. 

Blood  serum  of  cattle  which  have  recovered  from  the  disease  is 
not  suitable  for  the  immunization  of  cattle. 

Literature.  Babes,  C.  E.,  1888.  CVII.  692;  Y.  A.,  1889.  CXV.  81.  Smith  & 
Kilborne,  An.  Ind.,  1893.  Bull.  Nr.  1.  —  Theiler,  Schw.  A.,  1895.  XXXVII.  3; 
Fortschr.  d.  Vhyg.,  1903.  I.  133;  V.  J.,  1910.  98;  Bull.  Soc.  Path,  exot.,  1910.  III. 
135.  —  Lignieres,  La  tristeza,  etc.,  Buenos  Aires  1900;  Arch,  de  paras.,  1903.  VII. 
398.  —  Kossel  &  Weber,  Arb.  d.  (I.-A.,  1900.  XVII.  460.  —  Techn.  Dep.  f.  d.  Vet.  — 
Wesen.  A.  f.  Tk.,  1901.  XXVII.  41.  —  Krageriid,  Z.  f.  Tm.,  1901.  V.  284.  — 
Kossel,  Hb.  d.  p.  M.,  1903.  I.  840  (Lit.).  —  Kossel  &  Schiitz,  Weber  &  INIiessner, 
Arb.  d.  G.-A.,  1904.  XX.  1.  —  Schmidt,  A.  f.  Tk.,  1904.  XXX.  42.  —  Knuth,  Diss. 
Leipzig  1905.  —  Koch,  Z.  f.  Hyg.,  1906.  LIV.  1.  —  Evers,  B.  t.  W.,  1908.  458.  -- 
Witt,  ibid.,  1908.  628.  —  Nuttall  &  Hadwen,  ibid.,  1910.  38. 


(b)     East  African  Coast  Fever. 

(East  coast  fever,  Rhodesian  rechvafer,  Rhodesian  tick  fever; 
Ostafrikanisclies  Kiisfeiifieher  [German].) 

This  dangerous  form  of  piroplasmosis  in  cattle  is  dis- 
tingiiislied  from  the  previously  described  affection  especially 
in  that  it  cannot  be  transmitted  from  animal  to  animal  by 
the  blood.     Its  cause  is  the  Piroplasma  parvum. 


Occiirrt'iH-c.    Kti(>Ii>:;\-.  Xatui'al   TiitVction. 


779 


The  iiaturo  of  the  diseas-c  was  lietennined  by  the  investigations  of  Thcilor  in 
die  Transvaal,  and  of  Koch  in  Buluwayo. 

Occurrence.  The  disease  formerly  existed  in  a  latent  form 
along  the  East  African  coast,  a  severe  outhreak  however  oc- 
curred in  19U0  when  some  very  susceptil)le  cattle  were  brought 
to  the  Portuguese  territory,  to  l^cira  (Koch;  Creutz  believes 
that  the  Australian  cattle  introduced  the  virus).  "With  the 
severely  affected  cattle  it  was  then  spread  into  the  interior 
of  Africa,  especially  to  German  East  Africa,  Natal,  the  Trans- 
vaal and  Rhodesia,  where  it  caused  great  loss  among  the  cattle 
herds. 

In  1005  abont  500  farms  were  infected  in  tlie  Transvaal,  and  inside  of  a 
year  ahout  50,000  cattle  succumbed  to  the  clisoasc. 

Etiology.  The  Piroplasma  parvum  (Babesia  parva),  the 
smallest  of  piroplasma  known  at  the  present,  may  be  seen 
in  its  characteristic  form  as  a  line  rod-shaped  intracelhdar 
body,  which  on  one  end  contains  a  chromatin  gi'anule,  and  fre- 
(piently  apjx^ar  arranged  in  cross  or  willow  leaf-shaped  form; 
ring  and  disc  shapes  also  occur,  while  pear-shaped  twin  forms 
are  never  present  (Fig.  1.34). 

The  disease  cannot  l)e  ])r(»(!aced 
artificially  by  the  inoculation  of 
blood  containing  the  parasite. 
Healthy  cattle  withstand  subcu- 
taneous, intravenous  or  intraperi- 
toneal injections  of  such  blood  with- 
out harm,  only  when  they  are  inocu- 
lated two  weeks  later  for  the  second 
time,  a  rise  in  temperature  sets  in 
inunediately,  and  after  10  or  12  days 
more  a  mild  form  of  the  disease  ap- 
pears, whereupon  parasites  may  be 
demonstrated  in  the  blood.  Meyer 
obtained  positive  results  by  intro- 
ducing large  ]^ieces  of  spleen  from 
affected  animals  into  the  abdominal 
cavity  of  healthy  cattle,   whereupon 

after  12  days  the  parasites  appeared  in  the  blood  with  a  simul- 
taneous rise  in  tem]ie]-nture. 

The  natural  infection  is  ti-ansmitted  by  various  ticks, 
especially  by  n^^uplls  of  the  sexually  mature  forms  of  Phipice- 
phalus  appendiculatus,  further  by  sexually  mature  forms  of 
Rhip.  evertsi,  Rhip.  sinnis,  Rhip.  nitens,  and  Rhip.  capensis, 
which  in  the  earlier  stages  of  their  development  have  sucked 
blood  from  affected  cattle.  The  parasite  does  not  pass  through 
the  e^g  of  the  tick  as  is  the  case  with  the  piroplasma  bigeminum, 
neither  is  it  transmitted  from  immune  aTiimals  to  health  cattle 
(Theiler,  Lichtenheld).      Its   development   in  the   body  of  the 


Fijj.  134.  I'irophiftnia  jianuni. 
Cattle  Mood,  chroii.atin  stain. 
(After  Theiler.) 


780  East  African   Coast  Fever. 

tick  is  similar  to  that  of  the  piroplasma  bigeminum  (Koch  see 
p.  766). 

Stockman  succeeded  in  producing  the  disease  in  cattle  in  England  with 
nymphs  of  the  brown  ticks  sent  there  from  Africa. 

The  infection  always  occurs  during  pasturing,  especially 
easily  after  the  appearance  of  the  rainy  season  and  during 
the  high  grass  season  when  the  ticks,  which  are  present  in 
great  numbers^,  easily  jump  from  the  high  grass  blades  to  the 
cattle.  As  a  inatter  of  fact,  previously  healthy  cattle  become 
affected  with  a  dangerous  form  of  the  disease  after  tliey  are 
pastured  in  the  same  field  with  animals  from  infected  localities, 
or  if  they  are  driven  over  infected  pastures. 

In  the  endemicly  infected  territories  on  the  coast  and  in 
lowlands  cattle  under  one  year  of  age  usually  become  affected. 
In  these  the  loss  usually  amounts  to  60  to  90%,  while  older 
animals  are  immune  if  they  have  already  passed  through  the 
disease.  The  infection  in  the  highlands  is  less  severe,  as  there 
hardly  more  than  15%  of  the  increase  in  stock  die  of  the  disease. 
For  this  reason  older  cattle  in  these  localities  are  immune  only 
to  a  slight  extent,  and  a  certain  number  of  them  fall  victims  to 
the  disease  (Lichtenheld). 

Contrary  to  the  described  conception  on  the  etiology  of  coast  fever,  OUwig, 
as  well  as  Fulle))orn  is  of  the  opinion  that  the  cause  is  possibly  ultra-microscopic, 
as  it  does  not  produce  anemia,  is  not  directly  transmissible,  and  that  the  disease 
leaves  an  absolute  immunity.  Piroplasma  mutans  and  Piroplasma  parvum  are, 
according  to  their  views,  not  only  morphologically  but  also  etiologically  identical, 
and  both  types  probably  produce  the  piroplasmosjs  which  extends  in  all  tropical 
and  sub-tropical  localities,  and  whitdi  shows  variations  only  in  its  manifestations. 
This  conception  is  also  substantiated  by  the  experience  that  cattle  which  have  recov- 
ered from  coast  fever  are  no  longer  infectious  for  ticks,  and  thereby  tliey  are 
apparently  free  of  the  virus. 

Anatomical  Changes.  The  autopsy  reveals  punctiform 
hemorrhages  in  the  subcutis  and  the  subserous  connective 
tissue,  medullary  or  hemorrhagic  swelling  of  the  lymph  glands, 
edema  of  the  lungs  and  of  the  mediastinum,  hyperemia,  or 
ulcerative  inflammation  of  the  intestinal  mucous  mem])rane  and 
of  the  abomasum ;  further  grayish-white  spots  in  the  liver  sub- 
stance, and  as  a  specially  striking  lesion  hazelnut-sized,  w^edge- 
shaped  infarcts  in  the  cortex  of  the  kidneys.  The  s]ileen  is 
not  swollen. 

The  specific  bodies,  so-called  plasma  spheres  (Koch).  ar(^  present 
in  the  swollen  lymph  glands,  in  the  spleen,  further  in  the  spots  of  the 
liver  and  in  the  infarcts  of  the  kidneys,  as  Avell  as  in  the  borders  of  the 
ulcers  of  the  mucous  membrane,  likewise  also  in  the  blood.  By  Giemsa  's 
stain  they  appear  as  sharply  circumscribed,  blue-colored  spheres,  con- 
taining point  or  comma-shaped  chromatin  granules,  or  they  are  covered 
by  sueii. 

Collaud  considers  the  formation  of  infarcts  to  be  due  to  an  injury  of  the 
endothelia  of  the  vessels  by  eiidocellular  toxins  of  the  piroplasma.  Similar  toxins 
are  supposed  to  be  also  produced  by  the  Piroplasm?  bigeminum  only  that  they 
attack  the  erythrocytes. 


Syiiipfoins.   I'rovt'iitioii.  'J'g-J^ 

Symptoms.  The  incubation  period  is  10  to  12  days  (Tlieilor, 
Kleine),  visible  symptoms  however  appear  usually  only  20  days 
after  the  time  of  exposure  in  infected  pastures.  These  con- 
sist in  hi,<>h  fever,  diriicult  respiration  sometimes  associated  Avith 
a  coui^h,  salivation,  passinij:  of  vei-y  dry  or  ])loody,  tar-like 
feces,  marked  swelling  of  the  snlniiaxillary  lymph  c^lands, 
emaciation  and  weakness  of  the  liiiid  ({uarters/  Contrai-y  to 
Texas  fever  the  ai)p('tite  remains  normal  for  a  Ion,"-  time,  and 
anemia,  icterus  and  hemoglol)iiniria  are  oidy  seldom  observed. 
At  the  heiiiht  of  the  fever  parasites  may  be  demonstrated  in 
the  red  blood  corpuscles,  sometimes  infesting  80  to  90%.  At 
the  same  time  the  destruction  of  blood  corpuscles  is  only 
slightly  evident.  Cattle  infected  with  Piroplasma  bigeminum 
may  later  become  affected  with  coast  fever,  in  which  case  the 
symptoms  of  Texas  fever  are  also  pronounced,  and  the  para- 
sites of  both  diseases  may  be  found  side  by  side  in  the  blood. 

The  disease  is  very  destructive,  as  in  previously  non- 
infected  herds  95%  of  the  animals  die,  whereas  in  native  cattle 
on  the  coast  of  East  Africa  deaths  are  rare. 

Prevention.  The  infection  may  be  kept  at  least  temporarilv 
from  healthy  herds  by  the  careful  segregation  of  suspected 
or  affected  animals  (fenced  in!).  Dipping  and  spraviug  for 
the  destruction  of  ticks,  after  fresh  outbreaks,  and  driving  the 
cattle  into  non-infected  fields  are  advantageous  preventive 
measures.  In  severely  infected  pastures  the  ticks  may  be  in- 
fectious even  after  eight  months,  and  even  when  there  have 
been  no  cattle  pastured  there  in  the  meantime.  The  danger 
of  the  pasture  is  eliminated  after  15i{.  months,  if  during  that 
time  it  is  pastured  only  by  horses,  goa'ts  or  sheep. 

Immunization.  (Koch).  Animals  which  have  recovered  from  the 
disease  are  i)r()t('cted  against  a  second  attack  even  if  remaining  in  an 
infected  pasture,  repeated  injections  of  blood  containing  the  parasites 
Hkewise  produce  a  lasting  immunity.  For  this  purpose  cattle  are  in- 
jected subcutaneously  at  two  weeks  intervals  for  4-5  months  with  5  cc. 
of  defibrinated  blood  from  cattle,  which  have  recovered  from  a  severe 
attack  of  the  disease.  Cattle  treated  in  this  manner  remain  healthy  in 
infected  pastures,  and  even  their  offspring  are  supposed  to  resist  a  later 
infection  after  they  have  recovered  from  a  mild  form  of  the  disease. 

Theiler  &  Stockman  failed  to  obtain  favorable  results  from  Koch's  metlioil, 
and  the  conference  of  South  African  veterinarians,  held  in  Cape  City  in  1007,  also 
denied  its  practical  value.  According  to  Gray  the  method  has  been  emploved  in 
the  Victoria  District  on  5,700  cattle  -without  any  results,  as  the  animals  became 
spontaneously  infected,  even  after  11  to  12  inoculations. 

Cattle  which  have  recovered  from  Texas  fever  are  immune  against  the  coast 
fever,  while  animals  which  have  recovered  from  the  latter  are  not  immune  against 
Texas  fever. 

Literature.  Koch,  A.  f.  Tk.,  1904.  XXX.  281  u.  586;  D.  med.  W.,  1905. 
1867.  —  Thoiler,  Fortschr.  d.  A'.-Hvg.,  1003.  I.  133;  1905.  II.  256;  J.  of  the  Eov. 
Army  Med.  Corps,  1904;  Comp.  Path.,  1907.  XX.  1;  1909.  XX.  115;  Eep.  of  the 
Gov.-Bact.,  1906-1908.  —  Theiler  &  Stockman,  Comp.  Path.,  1904.  XVIL  3.  — 
Gray,  ibid.,  page  203.  —  Kleine,  D.  med.  W.,  1905.  912.  —  CoUaud,  Diss.  Ziirich 
1906.  —  Soulie  &  Roig,  C  R.,  1908.  CXLVTI.  192.  —  Lichtenheld,  A.  f.  Hvg., 
190S.  LXI.  261;   1910.  LXV.  378.  —  Mevcr.  Comp.   Path.,  1909.   XXTI.  213. 


782 


East  African  Coast  Fever. 


Tropical  Piroplasmosis  of  Cattle.  Dschunkovsky  &  Luhs  observed 
in  southern  Russia  a  disease  of  cattle  resembling  coast  fever,  in  which 
in  the  acute  cases,  up  to  80-967o  of  the  red  Ijlood  corpuscles  contained 
a  ring  and  punctiform,  also  a  rod-shaped  piroplasma,  which  could  not 
be  reproduced  artificially  by  inoculations  of  blood  containing  the  para- 
site, (up  to  several  liters  were  injected  subcutaneously,  intrj.peri- 
toneally,  or  intravenously).  On  the  other  hand,  according  to  more  re- 
cent experiments,  larvae  of  females  of  the  Boophilus  decoloratus,  which 
later  suck  the  blood  of  infected  cattle  caused,  after  10-15  days,  a  fever 
lasting  for  several  days,  mostly  however  without  any  parasites  in  the 
blood.  The  symptoms  were  fever  up  to  40°-41°  C,  at  intervals  of  8-12 
days,  then  continuous  at  40°-42°  C,  symptoms  of  nervous  irritation, 
sometimes  with  attacks  on  persons,  accelerated  heart's  action  and  res- 
piration, general  icterus  and  pronounced  emaciation,  frequently  bloody 
diarrhea,  and  shortly  before  death  sphincter  paralysis.  The  urine  was 
only  rarely  reddish-yellow,  the  number  of  erythrocytes  diminished  to 
as  few  as  800,000  per  cubic  millimeter. — The  autopsy  revealed  large 
hemorrhages  in  all  organs,  ulcerations  corresponding  to  the  hemorrhages, 
in  the  abomasum  and  small  intestines,  and  acute  swelling  of  the  spleen. 
The  disease  also  runs  a  more  chronic  cachectic  form  when  only  10-40% 
of  the  erythrocytes  contain  the  parasite,  and  on  autopsy  striped  and 
variegated  lesions  of  the  mucous  membrane  of  the  abomasum  are  found 
with  an  ocher-yellow  or  dark  base.     (Cbl.  f.  Bakt.,  1904.  XXXV.  486.). 

A  sinular  disease  was  observed  by  Kowalewsky  in  Taschkend,  only 
it  ran  a  more  rapid  course,  and  in  some  cases  grayish-yellow  deposits 
developed  on  the  mucous  mem])rane  of  the  lips  and  cheeks,  and  also  on 
the  tongues.     (J.  vet.,  1907.  330.) 

Further  it  appears  that  the  disease  observed  by  Penning  in  Java 
is  identical  with  the  above.  There  it  attacks  buffaloes,  and  a  transmis- 
sion to  sheep  wuth  larvae  of  the  Boophilus  australis  was  successful.  (Tier- 
iirztl.  Bl.  f.  Niederl.-Indien,  1906.  XVIII.  102.) 


Pseudo-Coast  Fever.     Lichtenfeld  designates  by  this  name  a  dis- 
ease of  African  cattle  which  manifests  itself  with  fever  up  to  41°   C, 

emaciation,  diminished  appetite,  and  which 
sometimes  causes  death.  The  blood  appears 
watery,  and  up  to  10%  of  the  erythrocytes 
contain  a  small  rod  or  ring-shaped  parasite 
resembling  closely  the  Piroplasma  parvum, 
which  had  been  found  previously  in  sparing 
numbers,  by  Theiler  in  the  blood  of  cattle, 
usually  simultaneously  with  the  Piroplasma 
bigeminum,  and  described  as  Piroplasma 
mutans.  (Fig.  135.)  After  the  inoculation 
of  such  blood  the  piroplasma  appears  after 
an  incubation  of  10-25  days  in  the  blood 
circulation  of  the  inoculated  animal,  and 
produces  anemia  with  poikilocj^tosis,  but 
never  hemoglobinuria.  The  natural  mode 
of  infection  is  still  unknown. 


Fior.  135.      Piroplasma   mutans 
(After  Theiler. ) 


Theiler  formerly  considered  the  parasite  as  an  immune  form  of  the  Piro- 
plasma bigeminum,  while  Koch  was  of  the  opinion  that  such  cases  were  mixed 
infectious  of  coast  fever  and  Texas  fever.     Eecently,  however,  Theiler  showed  that 


Pseii-lo-Coasl    Fe  ver.  783 

the  riioplasnm  nnitans  occurs  also  in  localities  free  from  coast  fever,  on  the 
other  hand  he  provt'd  that  c-attle  inmiiiiH"  against  Texas  fover  iiiav  be  infectetl  with 
it;  thorel'ori'  it  coiilil  not  be  a  special  I'oiiii  of  the  piioplasnia  hioemimiiii. 

i'aiasites  rosciiililiiiij  the  I'iroplasnia  iiiutaik?  were  also  fouiul  l»y  Miyajinia  &, 
Shibajaiiia  in  Japan,  bj  Martini  in  China,  by  Does  in  Netherlands-India,  by  Schein 
in  liidol'hina;  moreover,  the  i)ai-asites  seen  by  Dreyer  in  iO^^yptian  fever,  and  by 
Sprin^efeldt  in  Canierun  in  cattle,  appeared  to  be  identieal  with  them.  Lichten- 
held  ol  served  their  api)earan('e  in  calves  32-91  days  after  birth,  although  the 
animals  showed  no  symptoms  of  disease.  He,  as  well  as  Broden  &  Rodhain,  suc- 
eeedetl  in  projiayatinji  them  by  the  injection  of  blood  containing  piroplasma. 

Literature.  Tlieiler,  Rep.  of  the  Oov.-Bact.,  1905/06-1907/08;  Comp.  Path., 
1909.   XX.    11.1.  —  Schein,   A.   P.,    1908.   XXII.   730.   —  Lichtenheld,   Z.   f.   Ilyg., 


1910.  LXV.  378. 


Gall  Sickness.  (Galziekte).  Under  this  name  the  farmers  of  South 
Africa  (lesi^nuitc  in  fjcncral  those  diseases  in  the  course  of  which  a  dis- 
coloration and  thickening;  of  the  ])ile.  as  well  as  an  icteric  condition  of 
the  tissues  develops.  With  the  more  accurate  study  of  the  diseases 
it  was  found  that  llie  most  varied  diseases  are  grouped  under  that  name, 
(rinderpest,  coast  fever,  Texas  fever  without  red  urine,  heart  water,  and 
poisoning  by  plants).  Nevertheless  there  are  enzootic  infections  of  cattle 
which  cannot  lie  classed  with  any  of  the  known  types  of  disease,  and 
which  are  also  designated  hy  professional  men  as  gall  sickness,  in  the 
restricted  sense. 

The  etiology  of  these  affections  has  not  yet  been  cstablislicd  satis- 
factorily. AViiiie  Hutcheon,  who  in  1897  described  them  first  as  jaun-_ 
dice  or  "biliary  fever,  attributed  tliem  to  a  primary  affection  of  the  liver 
from  an  unknown  cause,  Spreull  identified  them  as  Pasteurellosis  with 
the  Lamziekte  (see  p.  109),  Eddington  with  heart  water  (see  p.  257). 
Theiler  was  formerly  inclined  to  connect  it  with  Trypanosoma  theileri, 
later  with  Piroplasma  mutans;  according  to  his  recent  investigations 
■however  he  determined  that  they  are  produced  by  the  anaplasma  mar- 
ginale  (Fig.  129  on  p.  763),  in  which  the  blood  corpuscles  are  attacked 
and  destroyed,  whereby  an  oligocythemia  is  produced,  which  is  associated 
with  high  fever,  and  which  later  leads  to  a  degeneration  of  the  large 
parenchymatous  organs. 

According  to  Theiler 's  conception  the  disease  would  be  identical  with  the 
mild  form  of  Texas  fever  described  by  Smith  &  Kilhourne,  which  is  observed  espe- 
cially in  North  America  in  the  fall,  as  a  second  attack  in  cattle  that  recovered 
froni  the  acute  affection  in  the  summer.  According  to  Knnth's  observations  it 
occurs  in  a  similar  manner  also  in  South  America,  and  the  cachectic  form  of  piro- 
plasmosis  described  by  Dschunkowsky  &  Lulis  in  Trans-Caucasia  is  supposed  also 
to  belong  to  it. 

The  disease  named  Anaplasmosis  l)y  Theiler  attacks  cattle  exclu- 
sively, and  especially  when  they  are  brought  from  highlands  into  low- 
lands, or  from  less  infected  localities  into  more  infected  territories. 
African  cattle  are  less  susceptible,  as  they  have  mostly  passed  through 
the  disease  as  calves,  whereas  fresh,  imported  animals  usually  become 
affected  severely. 

The  parasites  may  be  transmitted  to  healthy  cattle  with  the  blood 
of  affected  and  recovered  aninuils,  whereupon  in  the  first  case  they 
appear  in  the  blood  after  27-32  days,  in  the  second  after  16  days,  and 
may  be  demonstrated  during  the  febrile  period,  exceptionally  also  for 
some  time  after.  Aninmls  whicli  have  recovered  from  the  disease  show  a 
great  resistance  against  new  infections,  but  they  serve  as  virus  reservoirs 
for  the  Boophilus  decoloratus  tick,  which  according  to  Theiler  is  sup- 
posed to  transmit  the  natural  infection  in  a  way  similar  to  Texas  fever. 


784  Gall   Sickness. 

Mixed  infections  ooeur  especially  frequently  with  redwater.  According  to 
Theiler's  view,  Texas  fever,  as  it  has  been  formerly  described,  constitutes  two 
different  diseases,  namely  the  Texas  fever  in  the  restricted  sense  (piroplasmosis, 
led  water),  and  the  gall  sickness  (anaplasmosis).  As  the  Piroplasma  bigeminum 
and  the  Auaplasma  niarginale  occur  very  frequently  simultaneously  in  the  same 
animal,  the  development  of  redwater  with  piroplasma  in  the  blood  is  first  observed 
after  an  inoculation  of  blood;  when  the  animal  has  recovered  and  the  time  of 
incubation  for  the  anaplasmosis  has  elapsed  a  new  disease  results,  which  was  for- 
merly considered  as  a  relapse  of  redwater.  Mixed  infections  occur  also  with 
Piroplasma  niutans,  and  with  kfipirochaeta  theileri. 

The  symptoms  of  gall  sickness  are  high  fever  Avith  great  debility, 
labored  respiration,  and  very  frequent  heart's  action.  Constipation  or 
diarrhea,  further  moderate  swelling  of  the  eyelids,  with  lachrymation. 
Edematous  swellings  may  also  appear  in  different  parts  of  the  body ;  in 
the  later  course,  anemia  and  icterus  is  observed,  when  the  animals  rap- 
idly become  emaciated.  Some  animals  die  within  a  few  days,  others  in 
1-2  weeks;  the  greater  part  of  the  patients,  fre(iuently  even  80-907o 
recover,  but  outbreaks  with  losses  up  to  50%  may  occur  (Leipziger). 

According  to  the  course  of  the  disease  a  more  or  less  rapid  multipli- 
cation of  auaplasma,  with  a  corresponding  reduction  in  the  number  of 
erythrocytes  is  found  in  the  blood  at  the  beginning  of  the  fever.  Pale- 
ness of  the  remaining  blood  corpuscles  is  observed,  and  in  less  acute 
eases  polychromatophilia,  and  basophilia,  still  later  the  appearance  of 
normoblasts. 

The  anatomical  changes  consist  in  pronounced  anemia  and  icterus, 
moderate  gastro-intestinal  catarrh,  diffuse  swelling  of  the  lymph  glands, 
acute  spleen  tumor  with  reddish-brown,  soft  but  not  liciuefied  pulp,  small 
hemorrhages  and  degeneration  of  the  heart  muscles. 

For  the  prevention  of  the  disease  it  is  aimed  to  keep  animals  from 
marshy  pastures,  especially  from  overgrown  banks  of  rivers.  If  the 
disease  has  already  appeared  it  usually  subsides  after  the  herd  is  driven 
to  a  dry  elevation. 

Literature.  Edington,  Comp.  Path.,  1905.  XYIII.  155.  —  Theiler,  ibid., 
1907.  XX.  1;  Z.  f.  Infkr.,  1910.  VIII.  39.  —  Spreull,  ibid.  1908.  XXI.  193.  — 
Leipziger,  D.  t.  W..  1910.  150. 


(c)     Piroplasmosis  of  Horses.    Piroplasmosis   Equorum. 

{Biliary    fever;    Babesiosis    equi;    Pferdemalaria    [German]; 
Piroplasmose  equine   [French'].) 

History.  Guglielmi  (1889)  in  Italy  found  in  the  red  blood  corpus- 
cles of  horses  parasites  resembling  the  piroplasma  bigeminum,  but  th« 
disease  has  become  better  kno'wn  only  since  the  study  of  tlie  South  Afri- 
can horse  sickness  (see  p.  285).  Although  Rickmann  still  considered  the 
blood  parasites  as  the  cause  of  this  affection,  Theiler  proved  that  in 
South  Africa  there  exists  another  disease  of  horses  which  may  fre- 
quently be  complicated  with  the  latter ;  the  same  author  also  established 
more  closely  the  symptomatology,  and  pathological  anatomy  of  piro- 
plasmosis of  horses,  and  recently  showed  also  its  .identity  with  a 
similar  affection  of  mules  and  donkeys.  The  parasites  were  also  studied 
by  Laveran,  Koch  and  Marzinowski,  while  Italian,  English,  French  and 
Russian  veterinarians  contributed  especially  descriptions  of  its  spread 
and  symptomatology. 


Piro])lusuii>sis  oL  Horses.  735 

Occurrence.  Tlic  disease  appears  to  occur  frequently  in 
Italy  and  iiussia,  in  localities  with  forest  and  marshy  pastures. 
Xative  horses  as  a  rule  become  affected  only  when  young,  wliile 
animals  brought  from  uninfected  territories  into  infected 
localities  are  affected  at  all  ages,  and  almost  exclusively  in  the 
warm  season  (in  Hussia  it  is  wrongly  termed  "Spring  dis- 
ease").   The  disease  occurs  also  frequently  in  Africa  and  India. 

In  Germany  only  one  case  has  been  diagnos-ed  by  Zieniann  in  Oliloiibm^;,  while 
in  Sweden  Brickiijann  attribiiteil  a  diseaso  of  horses  to  an  iiifoction  with  j)iro- 
l)lasina. — In  Italy  Baiuchello  &  Piieolo,  also  Mori  are  iiu-lined  to  identify  |iiro- 
]dasniosis  with  catarrhal  inlhienza,  while  Perriicei  connects  it  with  purpura  hemor- 
rhagica. This  supposition  is  based  principally  on  the  similarity  of  the  sym])toni8 
and  evidently  does  not  apply  to  other  localities. —  In  Russia  the  disease  was  observed 
in  various  localities  after  the  demonstration  of  jiiroplasma  in  horses  liy  Michailof 
(1902),  also  by  Bielitzer,  ilarzinowski,  Feinschinidt,  Michin  and  Yakimolf,  espe- 
ciaH\'  freipiently,  however,  in  southern  Kussia  (here,  also,  in  donkeys),  causing 
sometimes  losses  up  to  ■)()'  r . 

It  is  wFdely  spread  in  Africa,  where  it  has  been  diagnosed  and  carefully  studied 
in  the  south  by  Theiler,  in  the  German  ]irotectorates  by  Koch,  also  by  Koger 
as  well  as  by  Lafargue,  Lussault  &  Savary  in  Algeria,  by  Piot  in  Egypt,  by  Dupuy 
&  Pierre  in  the  Sudan  and  in  Senegambia,  by  Thiroux  in  Madagascar.  Lingard  iS: 
Jinnings,    Axe    and    Williams    rei)orted    on   its    occurrence    in    Jndia. 

Etiology.  The  Piroplasma  equi  (Babesia  equi)  is  a  small 
blood  i)arasite  resembling  the  Piroplasma  parvuni.  It  is  0,5-2.5  ^ 
in  size,  of  coccus,  ring,  spindle,  rod  or  also  pear  shape.  In  tlic 
red  blood  corpuscles  it  is  present  singly,  in  pairs,  or  in  fours 
in  rosette  form,  which  latter  probably  originated  by  dii-ect 
division  of  the  single  individuals.  In  the  blood  plasma  tiicy 
are  found  only  singly.  By  the  Giemsa  stain  a  clump  of  chromatin 
granules  and  sometimes  also  a  second  chromatin  granule 
(Blepharoplast?)  may  be  in  their  body. 

Marzinowski  &  Bielitzer  observed  in  the  intestinal  contents  of  ticks  which 
previously  had  sucked  blood  from  infected  horses,  transitory  forms  similar  to  those 
described  by  Koch  in  piroplasma  of  cattle,  and  by  Christophers  and  Kleine  in 
piroplasma  of  dogs.  They  are  also  inclined  to  consider  oval  and  worm-sliai'r<l 
bodies  with  large  granular  cytoplasm  and  small  nucleus  as  one  form,  and  those 
■with  a  still  smaller  nucleus  and  paler  cytoplasm,  as  other  sexual  forms  from  which 
new,  Avormlike  actively  motile  forms  (Ookinetes  ?)  develop,  which  occur  in  great 
numbers  in  the  saliva  of  the  ticks  with  which  the  eggs  are  moistened.  The  demon 
stration  of  parasites  in  the  egg  of  the  ticks  was  not  successful,  but  various  stages 
of  development,  especially  the  worm  forms,  were  found  in  the  larvae  in  consider- 
able numbers. 

Marzinowski  also  reported  successful  cultivation  experiments  in  bloml  con- 
taining lOVf  sodium  citrate  solution,  in  which  the  parasites  passed  through  similar 
stages  of  development  as  in  the  intestines  of  ticks.  Their  multiplication  was  only 
moderate,  and  they  died  in  the  third  generation. 

Theiler  succeeded  in  producing  by  subcutaneous  or  intra- 
venous inoculations  of  lilood  of  immune  horses  a  febrile  affec- 
tion in  mules  and  donkeys  which  developed  after  an  incubation  of 
5  to  9  days,  and  in  the  course  of  which  the  parasites  appeared  in 
the  blood.  The  first  attack  was  followed  by  a  second  one,  during 
which  the  number  of  the  red  blood  corpuscles  diminished  to  one 
third,  and  wliicli  frequently  resulted  in  death.  The  disease  was 
likewise  reproduced  in  horses  with  the  blood  of  immune  mules 

Vol.  1,-50. 


786  Piroplasmosis  of  Horses. 

and  donkeys.  Positive  results,  also  with  the  blood  of  affected 
horses,  are  reported  by  Perrucci,  Pricolo,  Edington  and  Bie- 
litzer. 

According  to  Theiler  the  natural  infection  is  transmitted 
in  Africa  by  the  Rhipicephalus  evertsi,  in  Russia  according  to 
Marzinowski  &  Bielitzer  by  the  Dermacentor  reticulatus,  that 
is  by  sexually  mature  ticks  which  have  sucked  blood  containing 
piroplasma  as  larvae  or  nymphs.  As  horses  which  have  re- 
covered from  the  disease  harbor  piroplasma  for  years  in  their 
blood,  such  animals  may  spread  the  virus  by  transmission  to 
ticks.  Zebras  and  quaggas  appear  also  to  serve  as  virus  carriers. 

In  infected  localities  native  horses,  donkeys,  and  their  bas- 
tards, become  affected  in  later  periods  of  their  lives  only  when 
their  acquired  resistance  is  reduced  by  overexertion,  poor  nutri- 
tion, or  by  intercurrent  affections  to  such  an  extent  that  their 
latent  piroplasma  again  rapidly  multiply.  Such  relapses  occur 
especially  in  affections  of  horse  sickness,  the  course  of  which 
frequently  becomes  severe  because  of  such  relapses. 

Animals  of  the  horse  genus  which  are  brought  from  locali- 
ties free  from  piroplasma  to  infected  localities  are  very  sus- 
ceptible ;  thus  during  the  Boer  War  in  South  Africa  great  losses 
were  sustained  in  horses  brought  there  from  Europe  and  Aus- 
tralia, and  in  India  horses  from  Australia  become  especially 
affected. 

Anatomical  Changes.  On  autopsy  the  icteric  discoloration 
of  the  subcutaneous  and  of  the  subserous  connective  tissue,  as 
well  as  of  the  internal  organs  is  conspicuous,  after  a  somewhat 
protracted  course  a  general  anemia  is  present  which  is  also  man- 
ifested in  the  watery  consistence  of  the  Mood.  The  lymph 
glands  and  the  spleen  always  show  pronounced  acute  swelling, 
the  pulp  of  the  spleen  being  moderately  softened  but  not  blackish 
red.  Numerous  hemorrhages  are  present  on  and  in  the  serous 
and  mucous  membranes,  as  well  as  under  the  endocardium,  the 
intestinal  mucous  membranes  show  inflammatory  swelling,  that  of 
the  large  intestine  in  some  cases  also  contains  follicular  ulcera- 
tions. The  lungs  are  edematous,  the  kidneys  may  be  sprinkled 
with  punctiform  hemorrhages,  or  only  anemic  and  filled  with 
serous  fluid,  the  liver  lobules  are  yellow,  on  their  borders 
greenish  colored.  The  muscles,  including  those  of  the  heart 
show  cloudy  swelling,  in  places  also  fatty  degeneration.  The 
urinary  bladder  frequently  contains  more  or  less  reddish  colored 
urine. 

Symptoms.  After  an  average  incubation  of  about  two 
weeks  the  disease  commences  with  slow  or  rapid  rise  of  the  body 
temperature,  whereupon  the  fever  continues  for  a  long  time 
remittent  in  character.  The  first  visible  symptom  is  a  pale-yel- 
low, or  reddish-yellow  coloration  of  the  mucous  membranes,  the 
intensity  of  which  is  proportionate  to  the  severity  of  the  affec- 


Symptoms.  787 

tioii.  Ill  the  severe  cases,  hemorrhages  occur  hiter  in  the  con- 
junctiva in  varying  number  and  extent.  At  the  same  time  the 
patients  look  dull,  tears  ooze  from  the  half-closed  eyelids,  the 
animals  droop  their  heads,  lie  down  frequently,  and  in  general 
show  great  dullness,  which  is  very  pronounced,  especially  in 
cases  with  a  chronic  course,  so  that  the  disease  greatly  resembles 
chronic  encephalitis.  During  the  fever  the  heart's  action  is 
in  the  acute  cases,  greatly  accelerated  and  weak,  the  respiration 
is  of  the  abdominal  type* and  markedly  labored.  In  some  cases 
urticaria,  and  exceptionally  herpes  labialis  is  observed  in  the 
meantime. 

The  appetite  is  depressed  from  the  onset,  while  thirst  is  in- 
creased; at  first  or  through  the  entire  disease  there  is  constipa- 
tion, the  feces  are  passed  sparingly  in  small  l)alls,  which  are 
covered  with  a  vellowish  mucus;  later  diarrhea  appears  in  some 
of  the  cases,  sometimes  with  colicky  s^nuptoms.  The  urine  shows 
icteric  or  reddish-brown  coloration,  and  is  passed  in  large  quan- 
tities. The  animals  rapidly  emaciate,  their  legs  swell,  the  tissue 
at  the  same  time  showing  a  very  slight  resistance  against  trau- 
matic influences,  accidental  injuries  healing  very  slowly. 

Blood  drawn  from  a  vein  coagulates  rapidly;  the  coagiilum 
separates  immediately  in  an  upper  intensely  yellow,  and  a  lower 
red  layer,  while  the  serum  appears  brownish  yellow. 

Accordiug  to  the  phvsieo-chemical  examinations  of  Frei  in  Pretoria,  the  blood 
shows  during  the  disease  a  continually  diminishing  volume  of  red  blood  corpuscles, 
and  a  reduction  of  conductivity,  as  well  as  of  viscosity,  which  correspond  with  the 
■T)roeress  of  hemolysis;  these  changes  set  in  very  rapidly,  sometimes  ^i-ls  hours 
after  the  infection,  and  therefore  even  before  the  rise  of  temperature,  in  the 
urine  a  diminution  of  the  osmotic  concentration,  of  conductivity,  and  of  speciiic 
gravity  may  be  shown,  changes  which  appear  to  be  dependent  on  the  condition 
of  the'  serum,  and  on  the  polyuria  which  is  usually  present,  and  with  which  in  some 
eases  an  increase  of  the  total  quantity  of  the  eliminated  solids  is  associated. 

Staz7o  found  in  one  instance  only  2^2  millions  of  red  blood  corpuscles  per 
cubic  millimeter  of  blood. 

In  some  cases  the  course  is  very  mild,  inasmuch  as  the  dis- 
ease is  manifested  onlv  by  a  slight  icteric  discoloration  of  the 
mucous  membranes,  and  by  febrile  manifestations,  recovery  fol- 
lowing in  a  few  days.  In  severe  cases  death  ensues  with  a  sharp 
drop  of  the  temperature,  usually  in  2  to  5  days,  while  in  a  pro- 
tracted course  the  disease  lasts  from  2  to  -i  weeks,  and  may  even 
extend  over  several  months. 

In  chronic  cases  the  disease  is  manifested  by  the  presence  of  an 
almost  continnons  fever,  in  gradual  emaciation,  edematous  swellings, 
anemia  and  the  discharge  of  a  brownish  urine  (Stazzi).         ^^ 

In  the  disease  observed  by  Brickmann  in  Sweden  (  V  esterbol- 
tenslau"),  which  also  usually  followed  a  chronic  course,  the  symptoms 
consisted  in  fatigue  and  dullness,  itching,  nodular  skin  eruptions,  per- 
spiration and  yellowish  discoloration  of  the  conjunctiva.  The  disease 
rarelv  terminates  in  death.  . 

In  mules  icterus  is  rarely  present,  while  discoloration  ot  the  urine 
never  occurs ;  on  the  other  hand  frequent  urination  is  almost  regularly 


788  Piroplasmosis  of  Horses. 

observed  (Eassie  frequently  observed  a  luxation  of  the  patella  as  a 
result  of  a  relaxation  of  the  thigh  muscles).  In  donkeys  icterus  is  also 
rarely  present,  while  the  urine  frequently  shows  a  red  coloration;  a 
vesicular  eruption  is  also  observed  in  some  cases  on  the  back,  less  fre- 
quently also  on  other  parts  of  the  body,  and  is  followed  by  loss  of  the 
hair. 

The  autopsy  reveals  a  large  quantity  of  pale  yellow  fluid  in  the 
abdominal  cavity  and  in  the  pericardium. 

Piroplasma  may  be  demonstrated  in  the  circulating  blood  in  variable  ninnbers. 
While  in  severely  acute  cases  and  at  the  lieight  of  the  fever  they  may  be  found 
in  50-60%  of  the  red  blood  corpuscles,  and  some  of  these  may  contain  as  many  as 
5-()  parasites,  in  chronic  cases  hardly  1-2%  are  infested. 

Course  and  Prognosis.  Cases  with  severe  onset,  especially 
i^Teat  debility,  liigli  fever,  numerous  hemorrhages  and  hemo- 
globinuria, likewise  cases  of  a  chronic  character,  usual ly  run 
an  unfavorable  course,  whereas  cases  which  are  acute,  but 
without  severe  symptoms,  promise  a  favorable  termination.  In 
these  cases  the  improvement  sets  in  after  about  eight  days, 
whereupon  recovery  progresses  slowly  (according  to  E-ickmann 
the  benign  forms  are  as  a  rule  relapses). 

Diagnosis.  The  disease  differs  from  horse  sickness  princi- 
pally by  the  presence  of  marked  icterus,  and  on  the  other  hand 
hj  the  absence  of  extensive  edematous  s\vellings.  A  positive 
diagnosis  is  however  only  possible  by  the  demonstration  of  piro- 
plasma in  the  red  blood  corpuscles,  or  then  by  the  infectious- 
ness of  the  filtered  blood  in  horse  sickness,  as  well  as  in  perni- 
cious anemia.  The  microscopical  examination  makes  a  positive 
differentiation  of  pirolasmosis  from  trypanasomiasis  possible 
aside  from  the  fact  that  this  disease  is  less  acute,  and  does  not 
show  icterus  and  such  marked  debility.  Besides  this  the  symp- 
toms of  piroplasmosis  to  which  Italian  observers  have  repeat- 
edly pointed,  closely  resemble  also  those  of  influenza  and  pur- 
pura hemorrhagica. 

Treatment.  Horses  which  are  attacked  in  the  pastur9s 
should  immediately  be  placed  in  stables  or  in  dry  shady  jjlaces ; 
where  they  should  be  freed  from  ticks,  and  nourished  as  freely 
as  possible.  The  threatening  heart  weakness  is  combatted 
with  digitalis  or  camphor,  the  constipation  first  with  calomel, 
later  with  salines.  Arsenical  preparations  are  recommended  for 
the  after  treatment. 

The  specific  treatment  has  so  far  failed  to  give  uniform  results.  Formerly 
large  doses  of  quinine  (10-20  gm.)  alternating  VFith  ammonium  chloride  were 
given,  whereas  recently  mercurial  and  arsenical  preparations  are  preferred.  Thus 
Baroni  recommends  the  Hydrarg.  biiodatum  injected  into  the  muscle,  an<I 
Laf argue,  Lnssault  &  Savary  also  obtained  good  results  from  this  treatment  (1  gm. 
Hydrarg.  biiod.,  2  gm.  iodide  of  potassium,  100  gm.  aqua;  10-20  gm.  daily)- 
yaikowitseh  and  Marzinowski  &  Bielitzer  praise  intramuscular  injections  of  corrosive 
sublimate  (10  cc.  of  a  2%  solution  daily,  3-5  times  in  all"),  and  according  to 
Michin  &  Yakimoflt"  it  is  possible  to  reduce  the  mortality  by  this  treatment  to  20%. 
The  subcutaneous  application  of  arsenious  acid,  and  of  atoxyl  has  not  proved 
effective. 


Treatment,  Prevention.  jgg 

Prevention.  This  consists  in  keeping  non-immune  animals 
from  infected  pastures  especially  in  the  warmer  periods  when 
ticks  are  numerous.  Solipeds  from  countries  free  from  piro- 
plasma  should  be  imported  only  while  young,  and  during  the 
winter. 

Immunization.  Basod  on  the  exporionces  on  immunization  against 
piroplasmosis  of  cattle  with  infections  l)lood  of  calves,  Theiler  recom- 
mends the  immunization  of  horses  Avith  1  cc.  of  l)lood  of  artificially  in- 
fected donkey  colts.  tVom  the  fourth  generation  upwards.  Horses  tluis 
inoculated  remain  healthy.  Pregnant  mares  and  run-down  animals 
should  not  he  inoculated.  The  inoculation  was  also  well  borne  by  horses, 
mules  and  donkeys  imported  from  Argentine. 

Literature.  Guglielmi,  Clin,  vet.,  1899.  220.  —  Theiler,  Schw.  A.,  1901. 
XLTII.  23.3;  D.  Z.  f.  Tm.,  1904.  YIH.  382;  J.  of  comp.  Path.,  1905.  XYIII.  229; 
1906.  XIX.  283;  Rep.  of  the  Gov.  Baet.,  1905/06-1907/08.  —  Laveran,  Soc.  bio!., 
1901.  385.  — Rickniann,  B.  t.  W.,  1902.  4.  —  Roger,  Bull.,  190G.  120.  —  Baroni, 
Clin,  vet.,  1906.  1033.  —  Perrueci,  ibid.,  1907.  159.  —  Stazzi,  ibid.,  1907.  46.  — 
Axe,  Comp.  Path.,  1906.  XIX.  222.  —  Williams,  ibid.,  1907,  XX.  23.  —  Laf argue, 
Lussault  &  Savary,  Rev.  gen.,  1908.  XTI.  489.  —  Marzinowski,  Z.  f.  Hvg.,  1909. 
LXII.  417.  —  Marzinowski  &  Bielitzer,  ibid.,  1909.  LXITI.  17.  —  Miehin  & 
Yakimoff,  Z.  f.  Infkr.,  1909.  YT.  265.  —  Frei,  ibid.,  1910.  YII.  105.  —  Bielitzer, 
ibid.,  214. 

(d)     Piroplasmosis  of  Sheep.    Piroplasmosis  ovum. 

(Maiarial  catarrhal  fever;  Haemoglobinuria  s.  Ictero-IIaema- 
inria  ovum;  Bahesiosis  ovum;  Carceag,  Roumanian.) 

History.  In  Roumania  a  disease  occurs  among  sheep,  known  as 
''Carceag,*'  which  was  first  observed  by  Mazureano  (1884),  and  in 
which  Babes  (1892)  found  similar  hodies  in  the  red  blood  corpuscles 
to  those  occurring  in  the  infectious  hemoglobinuria  of  cattle.  He  also 
succeeded  in  infecting  healthy  animals  with  pulp  of  the  spleen  from 
affected  animals.  Since  then  the  disease  has  been  found  by  Bonome  in 
northern  Italy,  Leblanc  &  Savigne  in  France,  Dschunkowsky  &  Luhs 
in  Trans-Caucasia,  Laveran  &  Xicolle  in  the  vicinity  of  Constantinople, 
Ziemann  in  Venezuela  and  the  "West  Indies,  Eggebrecht  in  China,  and 
Paschen  believes  that  it  occurs  also  in  Germany.  Its  etiology  was  studied 
in  detail  by  Motas  in  Roumania. 

Occurrence.  The  disease  is  distributed  in  Eoumania  in  the 
flats  of  the  Danube  and  especially  in  the  islands  of  the  Danube 
whicli  are  frequently  exposed  to  inundations,  to  such  an  extent 
tiuit  in  some  years  up  to  20' ^  of  the  sheep  die.  It  is  obsei'Yed 
in  infected  localities  almost  exclusively  during  the  warmer 
season,  especially  in  the  low,  swampy  pastures,  more  rarely  in 
mountainous  pastures.  Native  sheep  are  considerably  more 
resistant  than  animals  brought  from  territories  free  from  the 
aft'ection,  whicli  succumb  in  great  numbers  under  conditions 
favorable  for  infection. 

Etiology.  The  piroplasma  ovis  (Babesia  ovis  is  similar  to 
the  piro]dasma  bigeminum,  only  somewhat  smaller,  1-1.8  ^) 
is  usually  found  in  the  red  blood  cells,  singly  or  more  rarely  in 


f 


ygO  Piroplasmosis  of   Sheep. 

double  pear  shapes,  also  in  rod  and  cross  shapes   (Fig.  136). 
The  disease  may  be  transmitted  with  the  blood  of  affected  ani- 
mals   artificially   to    older   sheep, 
<d^^     -.  but    still   more    easily   to    lambs. 

>^,„0    ^^  The     inoculated     animals     show, 

C/'C>^.<->  after  8  to  10  days,  febrile  symp- 

(*)      ^ O^       r%  toms,  and  at  the  same  time  para- 

r  \      <^/^  ^r:^  sites  may  be  found  in  their  rod 

V  ■"     ,     O  ]\       \      (^       blood  corpuscles. 
r^  '  y '^  ^^    C  J  The    disease    is    transmitted 

^    C    f-^     »*«;)      ^        under  natural  conditions  by  sex- 
1^       ^-^  ^'   ,  ,  ually  mature  ticks  (Rhipicephalus 

CIj';,     -'■■^  bursa),  which  as  larvae  or  nymphs 

®  O        ^  .  ^  have  sucked  the  blood  of  affected 

^- ,      ^-v  *^-^  sheep  (the  infection  also  succeeds 

^  artificially  with   such  females,   if 

Fig.  136.  7^(;o/^/as»ia  o I' is.  stained       .1  ■nlapPfl    hi    the    flppce    of 

with  carbo-thionin.    (After  Motas.)       \^^^1    ^\®^  piaceci    in    lue    neece    01 

Jambs  [Motas]). 

Dschuiikowsky  &  Luhs  have  observed  the  disease  also  in  goats,  and 
according  to  their  observations  in  Trans-Caucasia  these  animals  are 
affected  simultaneously  with  sheep,  although  they  are  of  the  opinion 
that  the  piroplasma  of  goats  (Ppl.  hirci)  differ  from  those  of  sheep, 
in  that  they  are  only  one-half  the  size  of  the  latter  (0.43-1-71  ^^  long). 
Similar  bodies  were  observed  in  goats  also  by  Pause,  in  East  Africa. 

Anatomical  Changes.  The  autopsy  findings  disclose  hem- 
orrhagic inflammation,  sometimes  also  superficial  necrosis  of 
the  mucous  membrane  of  the  pyloric  half  of  the  abomasum,  of 
the  duodenum  and  rectum ;  further  an  acute  swelling  of  the 
spleen,  parenchymatous  degeneration  of  the  liver  and  kidneys 
(their  dark  brownish-red  coloration  frequently  shows  a  greenish 
hue),  finally  a  gelatinous  or  gelatino-hemorrhagic  infiltration  of 
the  subcutaneous  and  the  mediastinal  connective  tissue.  Ap- 
proximately 5-6%  of  the  red  blood  corpuscles  in  the  pulp  of  the 
spleen  contain  piroplasma. 

Symptoms.  The  disease  commences,  after  an  incubation  of 
8  to  10  da^^s,  with  a  rise  in  the  body  temperature  to  40-42°  C, 
weakness,  loss  of  appetite  and  muscular  trembling.  Soon  diffi- 
culty in  respiration,  painful  bleating  appear,  and  1  to  2  days 
later  indications  of  anemia,  icterus,  and  lumbar  weakness.  The 
initial  constipation  is  followed  by  diarrhea,  in  which  the  animals 
pass  bloody  feces  under  symptoms  of  colic.  In  some  cases  the 
urine  is  red  colored,  as  a  result  of  oxyhemoglobinuria,  fre- 
quently however  also  through  hematuria.  The  number  of 
erythrocytes  in  the  blood  diminishes  to  ly^  millions  per  cubic 
millimeter,  under  the  microscope  they  contain  the  small,  mostly 
roundish  or  oval  parasites,  which  are  also  found  on  their  surface 
and  in  the  blood  plasma.  About  50-60%  of  the  affected  animals, 
mostly  older  sheep  and  3  to  4  months'  old  lambs,  die  in  2  to  5 


Symptoms,  Treatment.  791 

days,  while  the  othei\s  recover  after  a  convalescence  of  several 
weeks.  In  some  cases  however  the  affection  manifests  itself 
only  by  fever  lasting  2  to  4  days,  slight  intestinal  catarrh,  and 
sjTiiptoms  of  anemia. 

Kecovery  from  the  disease  conveys  to  the  animals  an  im- 
munity of  long  duration  against  new  infections. 

Treatment  and  Prevention.  Leblanc  &  Savigne  recommend 
for  the  treatment  internal  administration  of  sulphate  of  ([uinine 
(0.5  gm.  twice  daily),  and  Glauber  salts  (30-60.  gm.).  Prevention 
consists  in  avoiding  affected  pastures. 

Immunization.  According  to  Motas  the  inoculation  of  blood  con- 
taining only  a  few  parasites  produces  a  mild  affection,  after  recovery 
from  which  the  sheep  withstand  an  injection  of  16  cc.  of  virulent  blood, 
5  cc.  of  which  would  otherwise  be  fatal.  Blood  serum  of  hyperim- 
munized  animals  has  no  parasiticidal  properties  (in  vitro),  and  at  best 
protects  animals  only  against  mild  subsequent  infections,  while  bile 
is  supposed  to  be  effective  against  simultaneous  and  also  against  subse- 
quent infection.  Immunization  with  a  mixture  of  blood  containing 
])arasites  and  bile,  in  which  the  blood  corpuscles  are  destroyed  and  the 
piroplasma  eliminated,  are  supposed  to  produce  an  active  immunity, 
although  no  febrile  reaction  appears  either  after  the  inoculation  or  after 
a  later  injection  of  virulent  blood,  and  no  parasites  appear  in  the  blood 
of  the  immunized  animals. 

Literature.  Babes,  C.  R.,  1892.  CXV.  3.59.  —  BoBome.  V.  A.,  189.5.  CXXXIX. 
1  _  Laveran  &  Xieolle,  Soe.  biol.  1899.  800.  —  Hutcheon,  Vet.  Eec,  1902. 
XIY.  629.  —  Motas.  Soe.  biol.,  1904.  152.3;  Kong:r.  Haag.  1909.  —  Paschen,  Hyg. 
Bundschau,  1905.  XV.  545.  —  Dschunkowsky  &  Luhs,  Kongr.  Haag.  1909. 


(e)     Piroplasmosis  of  Dogs.     Piroplasmosis   canum. 

{Malignant    protozoon    jaundice.    Malignant    malarial    fever; 

Bosartige  Gelbsucht  [German];  Fievre  hiliense, 

Jaunisse  maligne  [French].) 

History.  After  Piano  &  Galli-Yalerio  (1895)  had  first  discovered  the 
blood  parasites  in  Italy,  the  disease  was  observed  in  South  Africa,  where 
it  is  one  of  the  most"  dangerous  diseases  of  dogs,  by  Purvis,  Duncan, 
Hutcheon,  Lounsbury  and  Robertson,  in  East  Africa  by  Koch  in 
Senegal  by  Marchoux.  In  France  it  was  diagnosed  by  Xocard  &  Almy 
at  the  clinic  of  Alfort,  principally  among  hunting  dogs,  and  was  later 
studied  more  closely  by  Nocard  &  Motas.  In  addition  to  the  work  of  these 
authors  the  biologj'  of  the  parasites  was  studied  by  Nuttal  &  Graham 
Smith.  Kinoshita  and  Christophers,  their  artificial  cultivation  by  Kleine 
and  Xuttall,  while  Xuttall  &  Hadwen  obtained  remarkable  results  with 
the  specific  treatment  of  the  disease. 

Occurrence.  The  disease  appears  to  occur  with  special 
frequency  in  tropical  countries,  and  particularly  in  imported 
dogs  it  runs  a  very  severe  course.  On  the  other  hand  in  mod- 
erate zones  it  is  considerably  more  rare,  and  usually  runs  a 


792 


Piroplasmosis  of  Dogs. 


chronic  course.    In  these  locations  hunting  dogs  usually  become 
affected,  which  have  previously  hunted  in  the  forests. 

In  Europe  the  flisease  has  been  diagnosed,  besides  in  Italy  and  France,  by 
Wetzl  in  Hungary,  by  Ljubenetzkij  and  by  Dschunkowsky  &  Luhs  in  Russia; 
Holterbach  believes  that  a  disease  of  dogs  which  he  observed  since  1907  in  German 
Offenburg,  should  from  its  clinical  picture  be  considered  as  a  piroplasmosis.  Of 
the  tropical  countries,  excluding  South  Africa,  India  and  China  are  especially 
infected. 


Fig.    137.     Piroplfifima  cnnis. 
Stained  with  niethvlene  IjIup. 


Fig.  138.      /'iioplasma 
Stained  after  Laveran. 


Etiology.  The  piroplasma  canis  (Ba])esia  canis)  is  mor- 
phologically closely  related  to  the  piroplasma  bigeminum  (Figs. 
137  and  138),  only  that  the  parasites  found  in  the  red  blood 
corpuscles  and  those  in  the  blood  plasma  are  relatively  larger 
(.7-3.6  '"),  and  that  single  blood  cells  contain  more  of  the  para- 
sites, sometimes  as  many  as  16  individuals.  The  extracellular 
ones  are  roundish,  those  inclosed  in  cells  are  pear-shaped  or 
poly-angular.  While  living  they  show  an  active  motility,  in 
which  they  send  out  very  fine  pseudopodia.  The  homogeneous 
plasma  encloses  a  spherical  or  oval  nucleus.  Propagation,  which 
is  especially  prolific  during  the  duration  of  the  fever,  is,  accord- 
ing to  Nocard  &  Motas,  supposed  to  occur  by  direct  fission,  in 
which  the  splitting  of  the  nucleus  precedes  that  of  the  plasma 
body. 

According  to  Nuttall  &  Graham  Smith  propagation  is  also  supposed  to  occur 
by  direct  fission.  They  observed  free  pear-shaped  parasites  in  the  blood  plasma, 
actively  swimming  around,  apparently  propelled  by  flagellae,  and  subsequently  to 
penetrate  red  blood  corpuscles.  In  these  they  assumed  a  spherical  shape,  sent  out 
pseudopodia,  and  divided  into  two  pear-shaped  bodies,  which  subsequently  separated, 
slipped  out  of  the  blood  corpuscles  and  looked  for  new  erythrocytes.  If  they  failed 
to  find  them  they  died.  Kinoshita  saw  similar  phenomena,  but  believes  that  the 
individuals  resulting  from  fission  should  be  differentiated  into  male,  possessing 
flagellae,  and  female  forms  without  flagella. 

If  the  defibrinated  blood  of  affected  dogs  is  mixed  with  equal  parts  of  physi- 
ological salt  solution  and  is  kept  at  a  temperature  of  from  24°-27°  C,  the  piro- 
plasma remain  alive  for  four  days,  they  show  similar  stages  of  development  (sta)' 
shapes)  to  those  described  by  Koch  for  the  piroplasma  of  cattle  in  the  intestines  of 
ticks  (see  p.  766)  (Kleine,  Nuttall).  Similar  forms  were  observed  by  Chris- 
tophers in  the  intestines  of  njonphs  and  of  mature  ticks,  besides  the  pear  shapes  are 
supposed  to  penetrate  the  cells  of  the  salivary  glands  and  the  eggs  in  the  body  of 
the  tick,  where  they  break  up  into  sporozoites  (?),  which  then  leave  the  body  of 
the  tick  with  the  saliva. 


Etiology,  Fathogeuicity, 


793 


Pathogenicity.  The  disease  may  easily  l^e  transmitted  to 
liealtiiy  do^s  by  subcutaneous  or  intramuscular  inoculation  of 
blood  containin.c:  parasites.  These  ai)i)ear  in  the  blood  after  2 
or  5-G  days,  and  the  infected  animals  usually  die  in  from  3-5  or 
9-11  days,  sonu'times  however  the  disease  may  extend  even  to  GO 
days,  or  excei)ti(»iially  recovery  may  take  j^lace.  Other  animals 
are  not  susceptible  to  the  infection. 

Tenacity.  Blooil  oontaininof  piroplasiua  remains  infective  for  25  days 
when  kept  in  a  cool  ami  dark  place.  At  summer  temperature,  however,  it  becomes 
inactive  after  14  .lays;  the  parasites  die  at  44°  C,  in  I14  hours,  at  50°  in  a  half 
hour. 

In  France  the  natural  infection  is  accordiuo-  to  Xocard  & 
Motas  transmitted  by  the  Dermatocentor  reticulatus  (possibly 
also  by  the  Ixodes  ricinus). 
In  South  Africa,  according- 
to  Lounsbury  &  Robert- 
son, by  the  Haemophysalis 
Leachi,  in  India  accordino- 
to  Christophers  and  Xuttall 
hy  the  Rhipieephalus  san- 
guineus. The  two  last 
named  species  of  ticks  pass 
their  development  as  larvae 
and  n^inphs  on  three  hosts, 
possibly  also  on  other  ani- 
mals than  dogs.  Females 
which  have  sucked  tlie  blood 
■  of  healthy  dogs  transmit  the 
virus  by  their  eggs  to  the 
larvae,  in  which,  as  well  as 
in  the  n^nnphs  it  remains 
latent,  and  only  the  sexually 
mature  ticks  are  capable  of 
again  transmitting  the  piro- 
plasma  to.  dogs  (Lounsbury, 
Theiler),  whereas  the  infec- 
tion does  not  succeed  Avitli 
mature  ticks  taken  from  affected  dogs.  Ticks  capable  of  infec- 
tion may  carry  virulent  piroplasma  in  their  bodies  even  for 
seven  months,  and  transmit  them  in  the  meantime  to  dogs 
(Xuttall). 

Young  dogs  are  much  more  susceptible  to  the  infection  than 
adults. 

Tt  is  queStioual)le  whether  the  piroplasma  of  dogs  are  identical  in  different 
parts  of  the  world.  MacFadyean  and  Xuttall  found  dogs,  which  had  recovered  from 
the  piroplasmosis  of  India,  to  be  still  susceptible  to  infection  with  the  African  para- 
sites. ^ 

Anatomical  Changes.  The  autopsy  of  dogs  dead  witli  tlie 
disease  shows  pronounced  acute  swelling  of  the  spleen,  with  a 
dark,  bluish-red,  somewhat  soft  pulp,  hyperemia  of  the  liver. 


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Fig.  139.  Fever  curve  in  piroplasmosis  of 
(htr/s.  After  subcutaneous  injection  of  viru- 
lent blood:  two-months-okldog;  fatal  termi- 
nation.  (After  Wetzl.) 


794 


Piroplasmosis  of  Dogs. 


kidneys,  and  the  bone  marrow.  In  tliese,  and  also  in  tlie  lungs 
and  pericardium  small  hemorrhages,  and  in  some  cases  acute 
catarrh  of  the  stomach  and  duodenum,  with  bloody  contents  in 
the  intestines  may  be  found,  and  in  many  cases  also  general 
icterus.  The  changes  are  generally  less  pronounced  in  very 
acute  cases,  while  in  chronic  cases  icterus  is  frequently  absent, 
on  the  other  hand  a  severe  anemia  is  present.  Piroplasma  may 
l>e  demonstrated  in  great  numbers,  especially  in  the  kidneys  and 
in  the  spleen. 

Symptoms.  After  an  incubation  of  7  to  10  days,  a  rise  of  the 
body  temperature  which  inside  of  2-3  days  reaches  40°-43^  C, 
and  which  is  associated  with  languor,  is  observed  in  the  acute 
cases  as  a  first  symptom.  The  visible  mucous  membranes  appear 
at  first  a  pale  red,  later  cyanotic,  and  in  about  half  of  the  cases 
also  icteric.  The  pulse  and  the  respiration  are  accelerated,  the 
latter  is  moreover  very  labored  and  panting.  The  patients  re- 
fuse food,  but  drink  a  great  deal.  They  move  listlessly  and 
stagger,  and  towards  the  end  they  can  scarcely  stand  on  their 
feet. 

The  urine  contains 
albumen  from  the  onset, 
and  in  some  of  the  cases 
up  to  31/2%  hemoglobin, 
sometimes  also  bile  pig- 
ments; for  this  reason 
it  shows  a  more  or  less 
intense  red  coloration 
with  a  greenish  hue.  Ac- 
cording to  Maignon  the 
quantity  of  urea  in- 
creases at  each  febrile 
attack  (up  to  95  gin.  per 
liter  of  urine),  and  sugar 
also  appears  in  the  urine. 
The  blood  is  pale 
red,  the  blood  serum  also 
reddish  or  greenish-red 
in  color.  The  number  of 
ervthrocytes  diminishes 
to"  1/2  to  1/3  of  the  nor- 
mal or  even  more,  while 
the  leucocytes  appear 
to  be  increased.  Piro- 
plasma are  found  at  first  exclusively  in  the  red  blood  corpuscles, 
later  also  in  the  blood  plasma.  In  the  later  course  of  the 
disease  their  number  increases,  so  that  finally  even  30%  of 
the  erythrocytes  may  be  infested  with  them.  With  their  in- 
crease the  percentage  of  the  red  blood  corpuscles  diminishes, 
and  an  increase  of  hemoglobin  in  the  plasma  occurs. 


Fig.  140.  Fever  curve  in'piropJasmosis  of  dogs. 
After  subcutaneous  injection  of  virulent  blood; 
7-year-old  dog;  recovery.      (After  Wetzl.) 


Syiuptoius.  Diagnosis.  795 

In  the  chronic  cases,  which  frequently  result  in  recovery, 
fever  is  observed  only  in  the  tirst  days  of  the  affection  or  may 
be  entirely  absent.  In  rare  cases  intermittent  fever  may  be 
present.  On  account  of  the  severe  anemia  the  animals  are  list- 
less and  languid,  their  mucous  membranes  are  strikingly  i)ale, 
while  icterus  is  usually  absent.  The  appetite  diminislies,  and  the 
patients  l)Ocome  greatly  emaciated.  The  urine  frequently  con- 
tains albumen,  while  hemoglobin  is  only  exceptionally  present, 
and  even  then  only  in  smairquantities.  The  number  of  red  blood 
corpuscles  in  the* blood  diminishes  up  to  1/4-1/5  of  the  nonnal 
while  a  simultaneous  and  marked  increase  of  the  colorless  cells, 
especiallv  of  the  polvnuclear  leucocytes  occurs. 

After  tlie  disease  has  lasted  for  3  to  6  weeks  the  s^nnptoms  of 
anemia  gradually  disappear,  and  finally  complete  recovery  takes 
place.  Such  recovered  animals  however  harl)or  the  parasites 
for  a  long  time  in  their  bodies,  as  their  blood  proves  infectious 
even  after  one  year  (Theiler),  and  sometimes  even  after  2^2 
years  (Robertson).  If  fever  is  produeed  in  such  animals,  the 
parasites  reappear  in  great  numbers  (Marchoux). 

Diagnosis.  This  can  he  established  with  certainty  only  by 
the  demonstration  of  piroplasma ;  in  those  cases  especially  in 
which  no  hemoglobinuria  and  icterus  but  only  anemic  symptoms 
are  observed.  There  exists  in  dogs  a  disease  which  in  its  clin- 
ical manifestations  corresponds  completely  with  piroplasmosis 
(anemia  with  disintegration  of  red  blood  corpuscles  transition 
forms  and  hyperleucocytosis,  albuminuria  and  hemoglobinuria), 
which  probably  develops  as  a  result  of  the  ingestion  of  putrefied 
meat.  In  this  disease  however  piroplasma  cannot  l)e  demon- 
strated microscopically  or  by  animal  inoculation  (Szoyka). 
Xevertheless  the  suspicion  of  piroplasmosis  is  justified  in  the 
presence  of  the  s-\nnptoms  mentioned,  especially  if  it  concerns 
hunting  dogs  and  "if  ticks  are  found  on  their  bodies.  In  the  case 
of  negative  microscopical  findings  a  positive  result  may  some- 
times be  obtained  by  inoculation  of  blood  into  very  voung  dogs, 
for  which  especially  intravenous  or  intraperitoneal  inoculations 
are  adapted ;  for  after  this  mode  of  infection  the  diser.se  usually 
develops  in  a  few  days. 

Treatment.  Xuttall,  Graham  Sniitli  &:  Hadwen  showed  l>y 
accuratelv  controlled  laboratory  experiments,  that  trypan  red, 
and  trvinm  blue,  have  a  specific  destructive  action  on  the  piro- 
plasma of  dogs.  In  dogs  which  already  have  harbored  nuiner- 
ous  parasites  in  their  l)iood,  they  disappear  from  the  circulating 
blood  inside  of  20  to  96  hours  with  the  simultaneous  subsiding  of 
the  fever,  after  a  single  subcutaneous  injection  of  5-6  cc.  of  a 
1%  solution  of  one  of  these  substances.  At  first  the  pear-shaped 
subside  later  the  roundish  ameboid  forms,  although  they  re- 
appear after  9  to  12  days,  but  the  animals  show  no  s>nnptoms 
outside  of  a  short  rise  iii  temperature,  and  finally  they  recover 


796  Piroplasmosis  nf  Dogs. 

entirely.  If  the  trypan  blue  is  applied  24  hours  after  artificial 
infection  the  affection  is  aborted.  The  treatment  has  only  this 
disadvantage  that  by  these  remedies  the  skin  and  the  mucous 
membranes  become  strongly  colored  for  a  time,  and  that  a 
painful  swelling  develops  at  the  point  of  injection,  which  some- 
times also  results  in  abscess  formation. 

The  recovery  is  of  course  hastened  by  good  nourishment 
and  careful  nursing. 

The  authors  mentioned  obtained  negative  results  from  treatment  with  hydro- 
ehlorate  of  quinine,  tartarus  stibiatus,  methylene  blue,  B-  uaphthilamin,  adrenalin, 
arsazetin  and  soamin.  Gender  also  obtained  unsatisfactory  results  from  atoxyl. 
Holterbach  recommends  damholid  (20%  solution,  taldespoonful  doses),  without 
however  jiroving  the  nature  of  the  disease  in  the  recovered  patients  by  the  demon- 
stration of  parasites  in  the  blood.  Stahn  observed  the  recovery  of  a  dog  from 
treatment  with  potassium  arsenate. 

Immunization.  According  to  the  investigations  of  Noeard  &  Motas, 
dogs  which  have  recovered  from  the  disease  are  still  immune  against  a 
virulent  infection  after  six  months.  Blood  from  such  animals  destroys 
the  piroplasma,  as  a  subcutaneous  injection  of  a  mixture  of  virulent 
blood  and  3-5  times  the  quantity  of  blood  serum  proves  entirely  inef- 
fective. The  action  of  such  serum  may  be  increased  by  inoculating  t\v 
recovered  dog  several  times  with  blood  containing  the  parasites.  Serum 
of  such  hyperimmunized  animals  protects  in  (juantities  of  3-5  cc.  against 
the  pathogenic  action  of  3-5  drops  of  virulent  blood,  which  otherwise 
produces  a  fatal  infection  in  5-6  days.  Twenty  cc.  of  serum  even  renders 
ineffective  an  infection  undertaken  24-42  hours  previously.  If,  however, 
parasites  have  already  appeared  in  the  blood  the  serum  treatment  no 
longer  produces  any  results.  Heating  the  serum  to  56°-57°  C.  for 
half  an  hour,  destroys  its  parasiticidal  action  but  does  not  influence  its 
protective  properties.  Theiler  confirmed  the  immunizing  action  of  the 
blood  serum  of  immune  dogs ;  he  found  however  that  blood  from  which 
such  serum  separates  is  virulent  for  young  dogs,  when  fresh  or  defibri- 
nated,  and  therefore  contains  parasites,  but  by  the  addition  of  serum 
of  the  same  serum-producing  dog,  it  loses  its  pathogenic  action. 

Literature.  Plana  &  Galli-Valerio,  II.  mod.  Zooiatrio,  1895.  165.  —  Huteheon, 
The  Vet.-J.,  1899.  XLIX.  398.  —  Marchoux,  Soc.  biol.,  1900.  97.  —  Noeard  eV: 
Motas  A.  P.,  1902.  257.  — Lounebairv,  J.  of  comp.  Path.,  1904.  XVII.  113.  — 
Wetzl,  Z.  f.  Tm.,  1906.  X.  369  (Lit.).  —  Kleine,  Z.  f.  Hyg.,  1906.  LIV,  11.  — 
Kinoshita,  A.  f.  Protk.,  1907.  TIT.  H.  2.  —  Christophers,  Brit  med.  J..  1907;  J,  of 
comp.  Path.,  1907.  XX.  175.  —  Nuttall  &  Graham  Smith,  J.  of  Hyg.,  1907.  V.  232. 
—  Nr-ttall  &  Hadwen,  Parasitology,  1909.  II.   156. 


Piroplasma  in  Man.  Leishman  (1900)  and  later  Donovan  (1903) 
found  in  the  vicinity  of  Calcutta,  in  the  l)lood  of  persons  affected  with 
febrile  manifestations  double  nuclear  bodies  which  resembled  the  piro- 
plasma of  cattle,  also  in  leucocytes  and  in  the  tissue  fluids  of  the  bone 
marrow  and  the  spleen,  more  rarely  also  in  the  blood.  These  have  since 
been  recognized  as  the  Leishman-Donovan  bodies,  (Leishmania  s. 
Piroplasma  Bonovani),  producers  of  the  tropical  splenomegaly,  a  febrile 
cachexia,  which  in  India  is  known  under  the  name  Kala  Azar)  (=Blaclv 
disease),  and  occurs  also  in  China.  North  Africa  and  Arabia.  Their 
classification   has   recently    again   become   questionable,   as   Rogers   & 


INSERT  FOLDOUT  HERE 


Malaria  of  Man.  707 

Leislinian  have  observed  their  transformation  into  trypanosome-like 
flagellates  in  blood  mixed  Avith  sodium  citrate,  and  for  tbis  reason 
Donovan  himself  placed  the  parasites  under  the  genus  Ilerpetomonas. 
Blood-sucking  bugs  are  supposed  to  transmit  the  natural  infection  to 
man.  Similar  bodies  were  found  by  Nicolle  &  Comte  in  a  dog,  and 
Nicollo  is  also  sui)posed  to  have  succeeded  in  infecting  dogs  artificially 
with  splenic  blood  from  man;  Patton  and  Donovan  however  had  abso- 
lutely negative  results.  (Slathis  &  Lcger  also  report  a  leucocytozoon 
in  a  Chinese  dog). 

The  parasites  of  endemic  boil  disease,  (Delhi  or  Aleppo  boils),  dis- 
covered by  Wright  and  named  TTelcosoma  tropicum,  later  as  Leishmania 
tropica,  are  similar  to  the  Leishman  bodies. 

Literature.  Liihe.  ITaiidb.  d.  Tropenkrankli.,  1906.  III.  202.  —  Leishman, 
ibi.l.,  S.  rr^l.  —  Donovau,  J.  of  troi>.  Med.,  1009.  XTT. 


Malaria  of  Man.  This  disease,  which  occurs  in  all  parts  of  the 
world  in  marshy  localities,  and  in  an  especially  severe  form  in  the 
tropics,  is  caused  by  a  blood  parasite  the  malaria  pasmodiiim,  discovered 
by  Laveran  (1880),  which  differs  entirely  from  the  piroplasma  of 
animals.  According  to  the  duration  of  their  asexual  development,  on 
which  also  the  appearance  of  the  recurring  attacks  of  fever  depend, 
Tertiana,  Quartana  and  Perniciosa  parasites  are  distinguished,  which 
correspond  with  each  other  in  that  besides  their  multiplication  in  the 
red  blood  corpuscles  of  man  by  schizogony,  they  also  multiply  sexually 
in  mos({uitoes  (Anopheles-species).  By  the  inoculation  of  young  forms 
(sporozoites)  of  the  parasites,  with,  the  saliva  of  mosquitoes  into  human 
blood,  where  they  continue  to  propagate,  a  brief  febrile  attack  sets  in 
after  each  development  of  a  generation  of  the  parasite  which  is  mani- 
fested by  chills,  then  fever,  and  perspiration.  As  at  each  attack  a 
number  of  red  blood  corpuscles  are  destroyed,  an  anemic  condition  de- 
velops gradually  which  in  severe  cases  increases  to  a  pronounced 
cachexia ;  in  the  tropics  however  febrile  attacks  may  result  in  early 
death  nnder  manifestations  of  hemoglobinnria,  (black  Avater  fever). 
The  disease  is  combatted  successfully  with  preparations  of  f|uinine. 
(Ziemann,  Menses  Handb.  d  trop..  Krankheiten,  1906.  III.  269; — 
Ruge,  lib.  d.  p.  M.,  Ergzsbd..  1907.  85.) 


2.    Trypanosome  Diseases. 

{Trypanosomiases,  Trypanosps.) 

Investigations  during  the  last  three  decades  have  proved 
that  various  tropical  diseases  of  domestic  animals  and  also  of 
man  are  caused  by  blood  parasites  of  the  flagellate  class  of 
protozoa,  the  so-called  trypanosomes  or  trj^ianozoa.  In  the 
thorough  investigation  of  tliese  parasites  in  various  localities 
as  well  as  in  different  species  of  animals,  and  in  various  dis- 
eases, certain  differences,  though  of  slight  signiticance,  have 
been  established  in  their  morpliolog>%  and  especially  in  their 
pathogenicity,  which  led  to  the  classification  of  a  number  of 
not  always  distinctly  characteristic  forms  of  trypanosomes  or 


J98  Trypan iisoiHc  Diseases. 

varieties,  and  of  several  diseases.  Considering  the  marked 
resemblance  of  the  morphological  characteristics  of  most  of  tlie 
parasites  belonging  to  this  group,  there  exists  a  possibility  that 
the  diseases  discussed  in  the  first  part  (Nagana,  Surra)  repre- 
sent a  pathological  unit,  while  the  unimportant  differences  noted 
in  the  others  depend  chiefly  on  the  variability  in  virulence  of 
the  several  kinds  of  trypanosomes,  Hkewise  also  on  the  geo- 
graphical and  climatic  conditions,  whereby  the  differences  in 
the  mode  of  natural  infection,  as  well  as  the  course  of  the  disease 
can  be  explained  readily.  In  deference  to  the  general  concep- 
tion, the  diseases  considered  at  present  as  independent  affec- 
tions will  be  treated  separately,  after  previously  explaining 
these  points  of  view. 

Besides  the  pathogenic  trypanosomes  there  exists  a  great  number 
of  others  which  occur  as  harmless  l)lood  parasites  in  domestic  animals 
and  in  other  species  of  animals. 

General  Morphology  and  Biology  of  the  Causative  Agents. 
The  trypanosomes  are  unicellular,  animal  microorganisms, 
containing  a  nucleus,  a  blepharoplast,  and  a  flagellum.  They 
propagate  by  longitudinal  division,  possibly  also  sexually.  The 
parasites  known  to  be  producers  of  disease  possess  slender, 
spindle-shaped  bodies,  the  posterior  ends  of  which  are  more 
or  less  blunt;  they  are  enclosed  by  a  periplastic  membrane. 
The  parasites  are  mostly  21-35  -"  long,  and  li/o-S  f^  broad,  in 
the  middle  portion  they  contain  a  spherical  or  oval  nucleus  and 
close  to  the  posterior  end  a  shining  nucleolus  (centrosoma, 
blepharoplast,  flagella  root,  trophonucleus)  (see  Table  IX). 
From  the  latter  a  fine  flagellum  runs  out,  Avliich  extends  forward 
on  the  outside  borders  along  the  undulating  membrane,  which 
is  present  on  one  side  of  the  body,  and  terminates  in  a  free 
portion  at  the  anterior  point  of  the  body.  In  the  fine  granulated 
protoplasm  there  are  distributed  one  or  more  vacuoles,  and 
also  various  sized  granules  in  varying  numbers. 

By  means  of  lashing  movements  of  the  flagellum  and  spiral 
contraction,  the  trypanosomes  are  capable  of  lively  motions 
in  fluid  as  well  as  in  the  blood  between  the  blood  corpuscles, 
usually  in  the  direction  of  the  flagellated  extremities. 

On  the  addition  of  certain  substances,  especially  of  immune  serum, 
the  trypanosomes  unite  in  pretty  rosette  shapes  (agglomeration),  by 
approaching  each  other,  usually  M'ith  the  posterior  ends,  in  radiating 
arrangement  and  executing  whip-stroke  movements  with  the  free  flagel- 
lated extremities  directed  outwardly. 

Propagation  occurs  thus  that  first  the  centrosome,  then 
the  flagellum  and  nucleus  split  longitudinally  in  two  parts,  and 
finally  the  plasma  body  breaks  into  two  halves  from  front  to 
back.  Sometimes  the  division  of  the  body  does  not  follow  that 
of  the  centrosome  and  the  flagellum  immediately,  so  that  irregular 


(u'lUM-nl    Morijliolo-zv   and    Biology,  ygo 

ameboid  forms  result,  wliicli  contain  two  or  more  clnoimitin 
sn))stanees,  and  oidy  later  separate  into  more  individuals. 

Bosiclos  this  simple  mode  of  multiplieation,  a  sexual  i)roi)agatiou, 
or  a  special  development  is  considered  possible  in  the  transmitting  in- 
sects as  intermediary  hosts  (Ziemann,  Prowazek,  Koch,  Sehaudin, 
Stuhlmann,  Kleine  and  others). 

This  opinion  is  based  principally  on  the  investigations  of  the  intes- 
tinal contents  of  stinging  Hies  ( (ilossinae),  infected  with  trypanosomes, 
in  which  besides  typical,  broad  forms  rich  in  plasma,  very  tliiii  forms 
are  found  containing  only  a  snudl  (piantity  of  plasma  with  elongated 
nucleus,  and  sometinu's  without  flagella.  According  to  Koch  the  former 
are  considered  as  fenuiles,  the  latter  as  male  trypanosomes,  and  they  are 
supposed  to  copulate  with  each  other.  According  to  Kleine 's  investiga- 
tions of  sleeping  sickness,  the  development  is  supposed  to  extend  over 
several  weeks,  so  that  infected  flies  may  ])e  capable  of  causing  infection 
for  that  period. 

Aoeordiiijr  to  the  experimental  results  of  Battaglia,  obtained  bv  a  study  of 
the  multiplication  of  the  Trypanosoine  Lewisi  and  the  Trvpauosonie  Brueei,  a  niul- 
tijdieation  by  sporojjeiiy  oi-curs  also  in  the  blood  of  the  same  animal,  inasnuuh  as 
atter  an  infection  with  small  motile,  intra-Klobular  ameboid  forms,  first  similar 
extra-globular  forms  develoj.,  later  larger,  roundish  or  pear-shaped  unflagellated 
forms,  and  only  from  these  finally  result  the  fully  develope.l  forms,  and  these 
then  multiply  by  longitudinal  division.  This  conception  is  supi)orted  by  the 
experience  that  it  is  possible  to  transmit  the  disease  artifieiallv  with  filtrates  of 
infected  blood,  after  passing  it  through  Berkefeld  (not  Reichel  or  Chamberland) 
filters. 

Staining,  The  trypanosomes  are  even  with  slight  magnification 
easily  recognizable  by  their  peculiar  form,  aiul  by  their  livelv  snake- 
like movements.  They  stain  uniformly  with  the  ordinary  aqueous  anilin 
dyes,  while  the  structure  may  be  brought  out  by  the  use  of  Roman- 
owsky's  or  a  similar  stain  by  which  the  nucleus,  the  Blepharoblast  and 
the  flagella  appear  pale  red  (chromatin  stain)  and  the  plasma  pale  blue. 

Recently  Giemsa's  stain  is  used  almost  exclusively  with  the  azure  prepared 
by  him  in  pure  form.  Staining  fluid:  to  each  cc.  of  distilled  water,  one  drop  of 
Giemsa's  solution,  always  to  be  freshly  prepared.  Staining  of  the  smear  i)repara- 
tion  which  has  been  fixed  in  alcohol  or  alcohol-ether  (aa)  for  15-20  minutes  then 
washing  in  running  water,  ' 

Cultivation.  Xovy  &  IMcXeal  succeeded  in  cultivating  the  try- 
panosomes of  rats  and  later  also  those  of  nagana  on  agar  to"\vhicli  iiad 
been  added  about  50%  of  blood,  at  a  temperature  of  25°-84°  C.  in  the 
cultures  non-motile  forms  develop  1-2,  up  to  50-60m  long,  and  the  first 
of  them  may  pass  through  porous  filters.  Trypanosomiasis  was  produced 
artificially  in  rats  with  Berkefeld  filtrates  of  cultures.  Since  then  the 
cultivation  of  other  disease-producing  trypanosomes  was  successfully 
earned  out  in  a  similar  manner  (Irikura  cultivated  them  in  blood 
bouillon  of  1/2-2:10). 

Tenacity.  The  parasites  can  be  kept  alive  outside  of  the  animal  body  for 
several  days,  but  only  in  defibrinated  blood,  to  which  pure  serum  is  added  Cool 
temperature  usually  lengthens  their  lives,  while  airainst  higher  temperatures  (43° 
and  over)   and  chemical  influences  they  are  in  general  verv  sensitive. 

The  differentiation  of  the  various  types  depends,  aside  from 
marked  deviations  in  the  form  of  the  trypanosomes,  almost  ex- 


800  Trypan osome  Diseases. 

clusively  on  their  occurrence  in  certain  species  of  animals  and  in 
well-defined  localities,  further  on  the  variance  in  their  pathogeni- 
city towards  the  different  species  of  animals;  and  also  on  the 
fact  that  animals  immunized  against  one  type  are  still  suscepti- 
ble to  others.  However  these  differences  are  not  constant,^  as  it 
is  often  possible  to  increase  the  virulence  of  one  strain  of 
trypanosomes  for  otherwise  slightly  susceptible  or  apparently 
immune  species  of  animals  by  passage-inoculations.  Morpho- 
logically the  trypanosomes  of  surra,  nagana,  and  dourine,  as 
well  as'  of  sleeping  sickness,  correspond  absolutely,  and  tliose 
of  Mai  de  Caderas  are  supposed  to  be  different  from  them 
only  in  that  their  blepharol)last  is  smaller,  and  that  they  are 
more  difficult  to  stain. 

Distinctly  different  types  are:  the  relatively  large  (50:3.5-4.0/^) 
Trypanosome  Theileri,  the  even  much  larger  Trypanosonie  giganteum 
some  non-tlagellated  trypanosomes,  thus  especially  the  Tr.  dimorphon 
(see  p.  837),  further  the  Tr.  Lewisi  occurring  in  the  blood  of  rats,  which 
hasH)een  most  thoroughly  studied,  and  in  which  the  nucleus  is  not  in 
the  center,  but  in  the  posterior  third  of  the  plasma  body. 

Pathogenicity.  Artificial  transmission  to  susceptible  ani- 
mals succeeds  most  readily  by  subcutaneous,  intraperitoneal, 
or  intravenous  inoculations,  with  less  certainty  by  applying 
blood  containing  trypanosomes  to  fresh  wounds.  After  a  cer- 
tain time  the  parasites  appear  in  the  blood  in  large  numbers, 
when  in  certain  species  of  animals,  especially  in  dogs,  cats  and 
rabbits,  fever  appears  as  a  usual  symptom,  in  addition  to 
edematous  swellings  on  different  parts  of  the  body,  resulting 
sometimes  in  tlie  loss  of  hair,  emaciation,  sometimes  also  in- 
flammation of  the  cornea  and  of  the  eyelids,  whereupon  the 
anemic  animals  emaciate  rapidly  and  succumb.  If  virulent 
blood  is  inoculated  into  an  animal  of  the  same  species  from 
which  it  originated,  a  severe  or  mild  disease  results,  which  is 
identical  with  the  original  affection. 

Dourine  may  be  produced  artificially  by  applying  material 
containing  trypanosomes  on  the  uninjured  mucous  membrane 
(Vrijburg  obtained  in  one  case  positive  results  in  a  horse  with 
surra  material). 

The  virulence  of  the  trypanosomes  varies  in  different 
species  of  animals,  and  may  be  increased  for  certain  species 
and  reduced  for  others  by  passage  experiments.  Generally 
native  animals  are  less  susceptible  in  infected  localities  than 
those  brought  to  such  places  from  non-infected  countries. 

Natural  infection  in  the  domestic  animals,  exclusive  of 
dourine  in  which  it  occurs  by  coitus,  usually  results  from  the 
stings  of  flies,  namely,  Glossinae,  Tabanidae  and  Stomoxys 
species,  they  transmit  the  trypanosomes  mainly  in  a  purely 
mechanical  manner  by  sucking  blood  from  afl^ected  animals  and 
inoculating  it  to  healthy  individuals.    If,  however,  the  trypano- 


Natural    Iniectioii,  Patbiijjeiiei»is.  gQI 

somes  may  nndergo  sexual  propagation  in  the  insects  as  inter- 
mediate hosts,  as  appears  probable  from  recent  investigations 
(see  p.  799),  there  would  be  a  possibility  that  they  may  harbor 
the  parasites  in  their  bodies  for  a  longer  time,  and  in  the  mean- 
time transmit  it  to  susce))tible  mammals. 

Tlie  infection  results  apparently  only  exceptionally  through 
fresh  wounds  in  the  skin  and  mucous  membranes,  whereas  an 
infection  through  the  uninjured  mucous  membrane  of  the  diges- 
tive tract,  as  it  was  accom])lished  experimentally  by  Yakimoff 
&  Schiller,  has  not  been  observed. 

Pathogenesis.  As  trypanosomes  are  always  present  in  the 
blood  plasma  and  the  tissue  fluids,  they  apparently  exert  their 
pathogenic  action  oidy  indirectly  by  the  production  of  toxic 
]>roducts,  which  principally  cause  the  destruction  of  the  red 
blood  corpuscles,  and  thereby  anemia.  They  probably  influence 
the  metabolism  of  the  host  in  other  harmful  ways.  The  fever, 
the  marked  emaciation  (with  good  appetite!),  as  well  as  the 
affection  of  the  nervous  system  (neuritis,  later  degeneration) 
can  be  explained  only  by  a  toxic  action,  but  it  has  so  far  not 
been  possible  to  demonstrate  the  supposed  toxins  of  the 
trypanosomes  objectively  (Laveran,  Mesnil,  flayer  and  others). 
Tlie  fact  however  that  the  parasites  multiply  outside  of  the 
animal  body  only  on  media  containing  a  great  amount  of  hemo- 
globin appears  to  indicate  that  they  require  hemoglobin,  and 
the  destruction  of  the  erythrocytes  may  be  explained  by  the 
fa-ct  that  they  abstract  this  substance  from  them. 

Following  the  infection  a  marked  increase  of  trypanosomes 
in  the  blood  occurs  periodically  in  the  animals,  and  this  is 
usually  accompanied  by  an  elevation  in  temperature.  Then 
again  they  disappear  rapidly,  only  to  return  again  in  great 
numbers  after  a  longer  or  shorter  time,  having  probably  matured 
meanwhile  in  certain  organs  (spleen,  bone  marrow?)  from  the 
young  forms.  Their  disappearance  is  according  to  the  investi- 
gations of  Massaglia  and  Rodet  &  Vaillet,  supposed  to  be  due 
to  tr^7)anolytic  substances,  which  appear  in  the  blood  of  in- 
fected animals  and  the  quantity  of  which  increases  until  the 
crisis.  To  what  extent  the  leucocytes  participate  in  this  has 
not  yet  been  determined;  as  a  matter  of  fact  their  number 
greatly  increases  during  the  disease  simultaneously  with  a 
hyperplasia^  of  the  spleen,  and  a  great  numl)er  of  leucocytes 
which  contain  in  their  bodies  broken-down  products  of  tr>T)ano- 
somes  are  to  be  found  in  the  spleen  tissue,  as  well  as  in  the 
bone  marrow. 

General  Symptoms.  They  appear  after  a  longer  or  shorter 
incubation  period,  and  excluding  the  acute  and  peracute  cases, 
which  are  manifested  under  severe  febrile  symptoms,  consist 
in  general  in  intermittent  or  recurrent  fever,  transitory  or 
constant  edema  of  the  lower  parts  of  the  body,  and  jirogressive 

Vol.  1-51. 


802  Trypauosonie  Diseases. 

anemia  as  well  as  emaciation,  with  usually  a  good_  appetite. 
Nervous  functional  disturbances,  especially  peripheric  paraly- 
ses, are  also  frequently  observed.  Death  is  usually  preceded 
by  a  comatose  condition. 

Treatment.  While  in  former  years  the  trypanosome  affec- 
tions have  been  treated  mainly  with  quinine,  corrosive  subli- 
mate and  iodine  preparations,  although  without  apparent  re- 
sults, Lingard  obtained  in  surra,  and  Bruce  in  nagana,  note- 
worthy results  w^ith  arsenious  acid,  inasmuch  as  with  this  treat- 
ment the  numlier  of  the  blood  parasites  Avas  sometimes  reduced 
very  markedly.  The  improvement  was  however  usually  only 
temporary,  as  after  a  certain  time  the  trypanosomes  reappear 
in  the  blood,  so  that  the  final  results,  at  best,  showed  only  a 
prolongation  of  the  course  of  the  disease. 

More  recent  investigations,  above  all  the  great  laboratory 
experiments  of  Ehrlich  and  his  school,  show  that  certain 
chemical  substances  have  a  specific  destructive  action  on 
trypanosomes  in  the  infected  animal  bodies,  or  at  least  exert 
an  inhibitive  action  on  their  development,  and  in  suitable  ap- 
plication may  even  result  in  permanent  recovery  from  the 
disease.  Such  substances,  excluding  some  of  the  basic  triphenyl- 
metlian  dyes  (parafuchsin,  methylviolet,  pyronin),  are  certain 
azofar  stains,  such  as  the  trypan  red,  the  trypan  blue,  the 
trypan  rosan,  and  the  trypan  violet,  certain  arsenical  deriva- 
tives, especially  atoxyl,  arsazetin,  the  arsenophenyglyzin,  and 
the  dioxydiamidoarsenobenzol  (Ehrlich-Hata  606),  also  some 
antimony  preparations,  such  as  tartar  emetic. 

Special  study  was  given  to  atoxyl  (sodium  arsanilate)  first  recom- 
mended by  Thomas  and  Breinl,  and  Mesnil  &  Xicolle.  It  was  found 
that  this  remedy,  different  from  the  l)asic  stains  mentioned,  which  are 
effective  even  in  test-tube  experiments,  does  not  even  in  concentrated 
solution  affect  the  trypanosomes  harmfully  in  vitro,  while  in  the  animal 
body  it  causes  the  disappearance  of  the  parasite  even  in  a  dilution  of 
1 :120000.  Ehrlich  believes  that  the  action  of  the  atoxyl  in  vivo  is  due 
to  the  fact  that  the  sul^stance  is  reduced  to  paraaminophenylarsenoxyd, 
which  kills  the  trypanosomes  also  in  the  test  tubes,  even  in  dilutions  of 
1  rlOOOOOO.  This  is  corroborated  by  the  experimental  results  of  Levaditi, 
Yamanouchi  &  Brimont,  as  these  authors  have  found  that  the  atoxyl 
is  reduced  in  the  animal  body  (to  a  hypothetical  trypanotoxyl)  ;  al- 
though later  they  supposed  that  the  reduction  product  in  such  a  reduced 
condition,  combines  with  proteid  molecules,  to  form  a  toxic  arsentox- 
albumin. 

Breinl  &  Nierenstein  however  believe  that  the  atoxyl  coml)ines  with 
the  serum  proteids.  whereupon  arsenic  is  set  free  through  oxydation 
of  the  atoxyl  in  the  serum,  and  this,  in  statu  nasccndi  exerts  a  de- 
structive influence  on  the  parasites.  The  correctness  of  this  conception 
appears  to  be  substantiated  by  the  experimental  results  of  Loeffler,  who 
obtained  the  best  and  most  lasting  recoveries  in  nagana-guinea  pigs 
and  cats  from  the  administration  of  atoxyl,  together  with  arsenious  acid 
in  subtoxic  doses  (3-5  mg.  arsenic  per  os.,  and  315  eg.  atoxyl  subcutan 


Treat  men  (.  gQ3 

eoiisly).  Similarly  Holmes  o1)Sorvo<l  (wcollont  cnrativo  rosnlts  in  horses 
affected  with  surra,  after  the  use  of  arscnious  acid.  However  in  orih-r 
to  make  the  recovery  complete  all  trypanosomes,  even  tlie  latent  forms 
in  the  internal  organs  must  be  destroyed  (therapia  sterilisans  magna), 
therefore  the  remedy  should  be  used  in  as  heavy  doses  as  i>ossiblc,  that 
is  in  sub-toxic  doses  (as  formerly  the  arsenic  has  been  used  in  too  small 
doses,  and  the  i)arasites  -which  were  not  destroyed  were  cai>able  of 
causing  relapses).  The  good  results  obtained  with  the  auripigment  can 
also  be  explained  by  the  fact  that  it  usually  contains  free  arscnious  acid. 
In  the  experimental  treatment  it  was  further  observed  that  the 
trypanosomes  are  capable  of  adai)ting  themselves  to  the  remedies  under 
discussion,  for  instance  tryjianosomes  whicii,  after  atoxyl  treatment 
Avitli  incomplete  recovery,  remain  alive  in  the  animal  and  later  again 
multii)ly,  are  no  longer  influenced  by  the  same  remedies,  antl  likewise 
not  by  other  derivatives  of  phenyl  arscnious  acids.  This  resistance  is 
transmitted  by  sul)se(iuent  passages  through  the  same  species  of  animals 
from  generation  to  generation.  This  condition  may  become  objection- 
able in  practice,  inasmuch  as  from  animals  which  have  been  subjected 
to  such  speciflc  treatment  and  which  have  not  completely  recov(>red.  flies 
may  later  transmit  to  other  animals  atoxyl-  (arsenic-,  trypanbhie-, 
fuchsin-,  etc.)  resisting  trypanosome  strains.  Such  animals  then  resist 
treatment  with  the  same  or  with  a  related  remedy.  Most  recently  how- 
ever Ehrlich  succeeded  in  producing  new  arsenical  preparations,  the 
arseuophenyglycin,  and  the  above-mentioned  arsenobenzol,  which,  with 
a  slight  toxicity  for  mannnals  are  capable  of  attacking  even  arsenic- 
resisting  strains  of  tryponosomes  and  which  have  also  otlierwise  proven 
most  satisfactory  for  trypanosome  affections  out  of  the  great  number  of 
chemicals  that  have  been  tested. 

Ehrlich  aimed  to  explain  the  mechaiiisni  of  the  specific  therapeutic  action 
through  certain  groupings  (chenioceptors)  in  the  proto}>lasin  of  the  trypanosomes, 
-n-hich  possess  for  certain  chemical  substances,  for  instance  for  the  trivalent  arsen 
as  it  occurs  in  arsenical  acids,  a  special  affinity,  and  are  cajjable  of  anchoring 
such  to  the  plasma.  The  resistance  of  already  treated  strains  may  result  from 
the  fact  that  the  respective  chemoceptor  experiences  a  reduction  of  its  afiinity  to 
the  applied  remedy,  therefore  its  resistant  strain  is  destroyed  only  by  a  greater 
quantity  of  the  remedy,  or  by  a  more  strongly  avidious  remeily,  for  instance  the 
arsenophenylglycin. 

Based  on  these  experimental  results,  wliieli  have  repeatedly 
been  substantiated  especially  by  Uhlenlmth,  Hiibener  &  Woitlie 
for  the  treatment  with  atoxyl  of  experimental  donrine,  by 
Loeffler  with  arsenic  in  experimental  nagana,  by  Levaditi  and 
his  co-workers  for  the  action  of  atoxyl  on  various  strains  of 
trypanosomes,  arsenical  preparations  are  used  in  practice  for 
the  treatment  of  these  diseases.  They  are  employed  either 
combined  with  each  other,  or  alternately;  further  antimony 
preparations,  especially  tartar  emetic,  and  with  these  treat- 
ments satisfactory  results  are  generally  obtained,  or  at  least 
encouragement  for  further  therapeutical  experiments.  In 
general,  the  rule  shoukl  be  observed  to  administer  the  remedy 
as  soon  as  possible  after  the  infection,  in  a  single,  or  at  most 
in  two  subtoxic  doses,  as  only  in  this  manner  can  relapses  and 
the  development  of  hypersensitiveness  be  prevented.  (For 
details  see  the  individual  affections.) 


804  Trypan osome  Diseases. 

Prevention.  Excepting  dourine,  which  can  be  controlled 
by  comparatively  simple  measures  in  the  supervision  of  breed- 
ing and  may  be  entirely  eradicated,  the  prophylaxis  of  the 
trypanosome  diseases  consists  above  all  in  the  eradication  of 
the  flies  which  play  a  part  as  transmitters,  and  probably  also 
as  hosts  for  the  virus.  The  procedure  must  of  course  be  suited 
to  their  habits  of  life  and  their  modes  of  development.  In  the 
glossinae  and  tabanidae,  which  confine  themselves  to  certain 
forests  and  marshy  localities,  and  probably  also  to  certain  wild 
species  of  animals,  the  eradication  in  practice  succeeds  at  least 
in  small  territories,  by  cutting  of  the  bushes,  and  draining  of 
the  meadows.  Besides  regular  cultivation  of  the  soil,  the  de- 
struction of  the  game,  or  keeping  it  from  the  roads  of  traffic, 
or  confining  it  to  certain  reservations  would  aid  in  the  elimina- 
tion of  the  source  of  infection.  The  species  of  stomoxys  which 
exist  in  close  proximity  to  living  houses  and  stables,  may  be 
reduced  in  numbers  by  cleanliness,  as  well  as  by  the  destruction 
of  all  vegetable  refuse. 

As  the  flies  do  not  accompany  the  cattle  herds  for  great 
distances,  and  as  they  do  not  swarm  during  the  night,  threatened 
herds  may  be  protected  from  infection  by  driving  them  at  night 
to  non-infected  localities,  avoiding  rivers,  thus  keeping  them 
from  the  virus  carriers. 

In  practice  the  control  of  trypanosomiasis  is  rendered  more 
difficult  by  the  fact  that  not  only  affected,  but  also  apparently 
perfectly  healthy,  and  especially  the  animals  which  have  re- 
covered from  the  disease  harbor  trypanosomes  in  their  blood 
for  years.  Such  virus  carriers  constantly  produce  virulent 
material  for  flies  in  infected  territories,  and  may,  on  the  other 
hand,  disseminate  the  virus  into  previously  non-infected  terri- 
tories. By  the  destruction  of  all  such  virus  carriers  the  source 
of  the  infection  for  the  flies  could  be  destroyed,  but  such  a  pro- 
cedure could  only  come  into  consideration  in  small,  freshly 
infected  territories. 

For  countries  which  are  free  of  certain  trypanosome  affec- 
tions careful  quarantine  measures,  or  even  the  prohibition  of 
the  importation  of  susceptible  species  of  animals  from  infected 
territories,  comes  into  consideration. 

Immunization.  Immunization  experiments  with  serum  of  recov- 
ered animals  and  those  repeatedly  treated  with  virulent  blood  (Zie- 
mann),  or  with  blood  containing  parasites  and  subjected  to  high  or  low 
temperatures,  have  not  yet  given  manifest  results  (Uhlenhuth,  Gross  & 
Bickel).  The  same  applies  to  the  experiments  which  have  been  carried 
out  by  passage  of  the  virus  through  various  species  of  animals  (Koch, 
Schilling,  Martini ) .  In  the  efforts  to  work  out  a  method  for  active  im- 
munization the  fact  must  be  considered  that  the  immunized  animals 
harbor  the  parasites  for  years,  and  these  may  later  become  virulent,  and 
sometimes  may  be  transmitted  to  healthy  animals  in  such  a  condition. 

The  fact  that  animals  acquire,  through  recovery  from  certain  trypanosomiasis, 
a  lasting  although  not  an  absolute  immunity  against  the  same  and  not  against  other 


Iinimuiization.  gQg 

trypanosonics,  indicates  that  strictly  specific  immune  bodies  develop  in  the  affected 
animals.  Such,  however,  have  not  yet  been  demonstrated  with  certainty  in  an 
objective  manner.  In  this  regard  the  comjdemeut  fixation  method,  in  which  blood 
containing  parasites  or  material  from  organs  was  used  as  antigen,  gave  uncertain 
and  varying  results  (Weber,  Manteufel  &  Woithe).  Better  results  were  obtained 
by  Levaditi  &  Mutcrmilch,  when  they  carried  out  experiments  with  trypanosonies 
separated  from  blood  corpuscles.  They  could  always  demonstrate  complement 
fixing  bodies  in  the  serum  of  guinea  pigs  treated  with  trypanosome  extract  or  in 
the  course  of  infection.  These  substances  were  specific  for  the  genus  trypanosoma, 
but  not  for  the  individual  species  and  varieties,  therefore  they  could  not  be  differen- 
tiated by  this  method.  Further,  the  complement  fixing  sul)stances  proved  different 
from  the  tryjianolysines,  which  form  in  great  numbers  at  the  height  of  the  infec- 
tion (see  p.  SOI),  and  exert  their  dissolving  action  also  in  test  tube  experiments. 

According  to  Laverau  &  Mesnil,  human  blood  serum  has  a  similar  destructive 
action  on  the  trypanosomes  of  nagana,  surra  and  nial  de  caderas,  as  the  arsenic 
acid.  Serum  of"  animals,  even  of  those  which  have  recovered  from  the  disease, 
or  which  have  been  repeatedly  infected,  has  no  such  action,  and  on  the  other  hand 
the  human  serum  is  harmless'  for  the  trypanosomes  of  sleeping  sickness. 

Literature.     Xocard  &  Leclainche,  Maladies  microbiennes,  Paris  1903.  II.  575. 

—  Lavoran  c^-  Mesnil,  Trvpanosomes  et  trypanosan-iases,  Paris  1904.  — Liihe,  Handb. 
d.  Tropenkrkh.,  1906.  HI.  92.  —  Sander,"  ibid.,  690.  —  Nocht  &  Mayer,  Hdb.  d.  p. 
M.  Ergiinzgsb.,  1906.  1.  —  Sauerbeck,  Ergebn.  d.  allg.  Path.,  1906.  X.  305.  — 
Kaestner,  ibid.,  1907.  XI./l.  455.  —  Ehrlich  B.  kl.  W.,  1907.  Nr.  9-12.  —  Man- 
teufel  &  Woithe,  Arb.  d.  G.-A..  1908.  XXIX.  452.  —  Koch,  Beck  &  Kleine,  ibid., 
1909.  XXI.  1.  —  Levaditi  &  Yamanouchi,  Soc.  biol.,  1908.  LXV.  23.  —  Levaditi 
&  Mutermilch,  Z.  f.  Immf.,  1909.  II.  702.  —  Kleine,  D.  m.  W.,  1909.   924  u.   1257. 

—  Doflein,  Protozoenkunde,  11.  Aufi.  1909.  350.     (Mostly  with  literature.) 


(a)    Nagana. 

{Tsetse  disease.) 

History.  The  disease  was  described  as  a  destructive  cattle 
disease  l)y  Livingstone  (1857)  during  his  voyage  in  Zambesia,  and  was 
connected  by  him  with  the  sting  of  the  native  tsetse  tiy.  Its  cause  was 
discovered  by  Bruce  in  1894,  in  the  territory  of  the  Zulu  Kaffirs, 
(nagana=without  strength,  debilitated),  and  the  first  detailed  descrip- 
tions of  the  clinical  symptoms  were  also  made  by  him.  Shortly  after- 
ward the  disease,  as  well  as  its  cause  was  investigated  thoroughly  by 
Kanthaek,  Durham  &  Blandford  and  by  Plimmer  &  Bradford,  while 
Theiler  deserves  special  credit  for  the  epidemiology.  The  problem  of 
the  propagation  of  the  nagana  trypanosomes  was  studied  by  Koch  and 
recently  by  Kleine  and  Battaglia,  while  McXeal,  and  Laveran  &  Mesnil 
were  successful  in  their  artificial  cultivation. 

Occurrence.  The  disease  used  to  be  spread  widely  through 
the  entire  Central  and  South  Africa,  where  it  annihilated  at 
times  the  cattle  of  entire  districts.  Recently  it  disappeared 
from  the  south,  so  that  at  present  it  occurs  only  in  some  out- 
of-the-way  localities  of  Zulu  land.  The  infected  territory  was 
limited  partly  by  the  driving  northwards  of  the  game,  prin- 
cipally how-ever  by  the  invasion  of  rinderpest  in  1896  and  1897, 
as  at'  that  time  besides  cattle,  numerous  game  animals  and 
Imffaloes  fell  victims,  and  at  the  same  time  the  tsetse  fly  also 
disappeared  from  those  localities  (Theiler). 

Trypanosome  affections  occur  also  in  Northern  Africa,  but  the 
classification  of  these,  with  the  exception  of  dourine..  has  not  been  cleared 


806 


Nayana. 


up  with  certainty.  Some  enzootics  have  a  great  similarity  to  nagana, 
while  others  are  more  closely  related  to  surra  (see  also  p.  837  and 
p.  812). 

Etiology.  The  Trypanosoma  brucei,  recognized  as  the  cause 
of  nagana,  is  on  an  average  25-33  ^  long,  1.5-2.5  /^  broad,  and 
possesses  a  central  oval  nucleus,  a  blunt,  Indian-club-shaped 
posterior  end,  slightly  developed  undulating  membrane,  and 
long  flagellum  (Fig.  141).  Under  the  microscope  it  exerts  a 
lively  snake-like  movement,  but  without  pronounced  locomotion. 

Pathogenicity.  Inoculation  of  blood  containing  trypano- 
somes,  under  the  skin  or  into  the  blood  circulation  of  horses, 

causes  after  from  2  to  6  days  a  marked 
elevation  of  temperature  and  in  the 
first  case  also  a  painful  sw^elling  at 
the  point  of  injection.  About  the  end 
of  the  first  week  the  fever  diminishes 
but  reappears  later  at  certain  inter- 
vals, and  during  the  duration  of  the 
febrile  attack  trypanosomes  may  be 
demonstrated  in  great  numbers  in  the 
blood.  In  the  meantime  edematous 
swellings  appear  on  the  lower  abdo- 
men, and  in  the  vicinity  of  the  ex- 
ternal genital  organs;  the  animals 
emaciate  in  spite  of  continuous,  and 
often  ravenous  appetite ;  marked  mus- 
cular atrophy  and  also  pronounced 
anemia  develop.  Sometimes  turbidity  and  ulceration  of  the 
cornea  results  w-ith  subsequent  iritis.  Finally  a  condition  re- 
sembling lumbar  paralysis  sets  in,  whereupon  the  animals  die 
from  15  days  to  4  months  after  the  appearance  of  the  first 
symptoms.  In  donkeys  and  mules  the  clinical  picture  is  similar, 
although  sometimes  with  a  still  more  j^rotracted  course  after 
artificial  infection;  the  zebra  is  also  susceptible  to  artificial 
inoculations  (Martini). 

In  cattle,  also  in  sheep  and  goats  the  inoculation  usually 
results  in  a  chronic  disease. 

Dogs  and  cats  are  very  susceptible  to  infection,  and  likewise  become 
affected  under  symptoms  of  recurrent  fever,  edamatous  swelling  of  head, 
chest,  gradual  emaciation  and  loss  of  strength.  Guinea  pigs,  rabhits,  rats 
and  mice,  are  very  easily  infected  artificially,  while  hogs  show  consider- 
ahle  resistance  to  artificial  inoculation.  Monkeys  are  very  susceptible  and 
usually  die  a  few  weeks  after  the  infection.  Of  fowls  only  geese  (Schil- 
ling) and  chickens  (Goebel)  could  be  infected  artificially,  while  other 
birds  showed  no  symptoms  of  disease. 

Horses  and  other  solipeds,  then  cattle,  more  rarely  sheep 
and  other  ruminants,  become  most  frequently  affected  as  a 
result  of  natural  infections. 


Fig.  141.  Trypanosoma  Bru- 
cei. Guinea  pig  blood.  Stain- 
ed after  Romanowsky-Zieniann. 


Pallioi;eiiicity. 


807 


The  infectiGn  Ts  tiTinf^mittod  l»y  the  f^o-oalled  tsetse  fly, 
wliicli  soniewliat  resembles  the  house  lly  although  it  is  some- 
what larger,  principally  by  the  glossina  morsitans  (Fig.  14:2), 
in-  such  a  way  that  it  sucks  blood  from  the  infected  animal,  and 
then  carries  the  parasites  into  the  body  Ijy  its  bite.  Freshly 
mulled  flies  are  liarndess,  if  however  they  have  alighted  u[)()n 
an  affected  animal  only  a  single  time  they  may  transmit  the 
disease  and  trypanosomes  may  be  demonstrated  in  their  pro- 
boscis and  stomach  shortly  after  sucking  the  blood.  By  the 
trans])ortation  of  affected  (lies  the  disease  was  successfully 
])roduced  in  previously  non-infect(Ml  localities,  while  on  the 
other  hand  animals  driven  during  the  day  in  infected  localities 
became  affected  even  when  they  had  not  partaken  of  food  nor 
water  while  p)i  roiifp.  Furthermore,  the  extension  of  the  in- 
fected territory  corresponds  accurately  with  the  geographical 
distribution  of  the  tsetse  fly  (between  the  10th  deg.  north,  and 
30  deg.  south  latitude),  where  its  appearance  in  great  numbers 
is  usually  followed  bj-*  severe  out])reaks. 


Fig.  112.     Cilussiua  innrs-ifaiis.     A  witli  i-Io.sed,     /?  with  sjiread  winj. 
part  in  profili'.     .1  ami  />'  fiilar.^tnl  2.5  times.      (After  J'.ruce. ) 


C  anterior 


Where  affected  animals  are  present  or  those  which  have 
passed  through  the  disease  Avithin  a  short  time,  the  flj"  is 
afforded  ample  opportunity  for  taking  up  trypanosomes;  flies 
may  also  ol)tain  the  infectious  material  from  wild  animals 
(l)uffaloes,  antelopes,  hyenas,  zebras  and  quaggas),  in  the  l)lood 
of  which  it  may  occur  as  a  liarndess  parasite.  The  tsetse  fol- 
lows these  animals  everywhere;  with  the  appearance  of  the 
summer  season  the  infectious  material  is  then  taken  fi'om  them 
by  the  young  flies,  and  transmitted  to  domestic  animals,  while 
with  the  eradication  of  the  game  the  tsetse  fly  also  disappears, 
so  that  infected  territories  mav  thus  become  free. 


According  to  Koch's  experience  in  western  and  northern  Africa, 
where  the  glossina  morsitans  is  unknown  the  disease  is  ti-ansniitted  li\' 
the  closely  related  Gl.  i'usca.     According  to  Bruinpt  tlie  (il.  pallidipes. 


808  Nagana. 

the  Gl.  lougipemiis,  the  Gl.  palpalis  and  the  Gl.  Decorsei  are  also  capable 
of  transmission. 

According  to  former  vicTTs  the  tsetse  fl.y  transmitted  the  infection 
only  mechanically,  and  as  trypanosomes  could  be  demonstrated  in  their 
intestines  48  hours  after  sucking  the  blood,  it  was  supposed  that  after 
that  time  healthy  animals  could  liecome  infected  only  when  the  flies 
had  in  the  meantime  again  alighted  on  infected  animals.  According  to 
the  newer  results  of  investigations  on  the  generation  changes  of  the 
parasites  (see  p.  799),  the  possibility  must  be  considered  that  the  flies 
may  transmit  the  parasites  for  weeks. 

Ill  accordance  with  the  part  played  by  the  insects  in  the 
transmission  of  the  disease  this  usually  rages  in  low-lying 
localities  w^itli  damp  soil,  especially  during  warm  periods  and 
rainy  seasons,  the  animals  being  exposed  to  the  infection  es- 
pecially during  the  day,  as  long  as  they  are  in  the  vicinity  of 
marshes,  lakes,  water  canals  and  rivers.  The  transmission  of 
the  disease  from  animal  to  animal  is  also  possible  by  contamina- 
tion of  fresh  wounds  on  the  skin  or  mucous  membrane,  with 
blood  containing  parasites,  while  the  possibility  of  natural  in- 
fection through  the  uninjured  mucous  membrane  of  the  digestive 
tract  has  not  yet  been  proven. 

Anatomical  Changes.  The  autopsy  usually  reveals  pro- 
nounced anemia  and  emaciation.  The  subcutaneous  connective 
tissue  shows  in  many  places  gelatinous  infiltration,  and  in  the 
serous  cavities  transudate  is  found  in  variable  quantities. 
Small  hemorrhages  may  be  present  in  the  serous  membranes, 
in  the  mucous  membrane  of  the  stomach  and  intestines,  as  well 
as  in  the  kidneys.  If  the  animal  dies  during  a  febrile  attack 
the  spleen  shows  acute  s^velling,  whereas  otherwise  a  chronic 
splenic  tumor  is  usually  present;  sometimes  however  it  may 
have  an  entirely  normal  appearance.  The  lymph  glands  are 
moderately  swollen.  In  some  cases  hemorrhages  and  catarrhal 
pneumonic  areas  are  present  in  the  lungs.  No  trypanosomes 
can  be  demonstrated  in  the  blood  or  in  the  internal  organs  24 
hours  after  death. 

Symptoms.  The  manifestations  of  the  disease  are  similar 
in  their  nature  in  the  different  species  of  animals. 

In  horses  the  temperature  rises  rapidly  after  an  incubation 
of  2  to  10  days,  according  to  the  severity  of  the  mfection,  to 
40°  to  41°  C,  and  at  the  same  time  other  febrile  symptoms, 
such  as  languor,  accelerated  and  weak  pulse  or  diminished 
appetite  make  their  appearance.  The  mucous  membranes  are 
reddened,  there  is  profuse  lachryination,  and  at  the  same  time 
edematous  swellings  form  on  the  extremities  and  low^er  abdo- 
men, especially  around  the  genital  organs,  also  in  the  sub- 
maxillary space,  and  on  the  e3^elids. 

The  febrile  condition  remains  unchanged  for  2  to  3  days, 
sometimes   for  a  week,   then   the   temperature   drops   rapidlv 


Syiui)tuius.  gQQ 

to  normal  or  below,  whereupon  the  animals  become  livelier 
and  the  other  sjDiptonis  diminish  or  may  disapi^ear  entirely. 
If  the  fever  has  lasted  for  a  longer  time  the  patients  have  in 
the  meantime  become  emaciated  in  spite  of  the  fact  that  the 
appetite  has  not  been  impaired  much.  After  a  certain  time 
the  afebrile  i)oriod  is  again  followed  by  fever,  and  from  then 
on  several  fever  days  alternate  with  fever-free  intervals,  only 
that  the  rises  of  temperature  in  the  later  course  are  lowcV 
than  in  the  first  attack. 

Under  such  variations  of  temperature  the  animals  l)ecome 
emaciated,  although  their  appetite  continue.s  very  good,  and 
a  pronounced  anemia  usually  develops  in  which  the  hemoglobin 
content  may  drop  to  25 'a  of  the  normal,  while  the  number 
of  red  blood  coi-puscles  may  diminish  to  21/4  millions  per  cubic 
^^1^11-  with  a  simultaneous  moderate  increase  of  leucocytes 
(Schilling;  Nierenstein  found  in  experimental  migana  an  in- 
creased acidity  of  the  blood,  proba])ly  due  to  the  pi'oduction 
of  amido  acid).  Accordingly  the  mucous  membranes  appear 
pale  and  in  the  later  stages  frequently  icteric  in  color. 

The  edematous  swellings  which  develop  on  different  parts 
of  the  bodies  vary  in  the  first  period  in  their  intensitv  and 
may  sometimes  disappear  entirely;  in  the  later  course,^  how- 
ever, _  they  remain  constant.  Urticaria  sometimes  appears 
especially  at  the  beginning  of  the  affection,  but  soon  disappears 
again. 

With  the  progressive  emaciation  and  anemia  the  animals 
become  steadily  weaker,  their  motions  are  incoordinated  and 
staggering,  the  animals  knuckle  frequently,  and  graduallv  a 
condition  resembling  lumbar  paralysis  develops,  so  that  the 
patients,  in  which  difficulty  in  respiration  has  appeared  in  the 
meantime,  remain  continually  lying  down  until  tliev  die,  greatly 
emaciated  and  completely  exhausted. 

After  artificial  infection  of  dogs,  Si)ielnioyor  observed  recent  degeneration  of 
nerves  in  the  posterior  roots  of  the  spinal  cord,  in  the  roots  of  the^  f-ensorv  tri- 
geminus, and  of  the  optic  nerve. 

In  some  of  the  chronic  cases  an  opalescence  or  an  ulcerative 
breaking  down  of  tlio  cornea  results  later  or  a  hemorrhage 
follows  into  the  anterior  chamber  of  the  eye,  which  becomes 
associated  with  an  iritis,  and  finally  leads  to  blindness. 

The  urine  periodically  contains 'albumen  in  varying  quan- 
tities. The  blood  contains  trypanosomes  in  great  numbers  dur- 
ing the  first  febrile  attack,  while  later  thev  are  found  more 
sparingly,  usually  only  during  the  febrile  attack.  In  the  very 
acute  cases  they  usually  occur  constantly,  and  their  nund)er 
may  amount  to  70,000  per  cubic  centimeter  of  blood.  They 
may  also  frequently  be  demonstrated  in  the  serous  fluid  of  the 
swellings. 

The  course  usually  extends  to  IV2  or  2  months,  but  mav 
sometimes  last  for  4  or  5  months.     In  some  cases,  which  for 


810  Xagana. 

a  time  show  a  chronic  course,  a  sudden  aggravation  of  the  con- 
dition may  develop  during  a  febrile  attack,  whereupon  the  ani- 
mals die  in  a  few  hours  (cerebral  embolus).  Some  cases  may 
be  very  acute  and  in  these  almost  continuous  fever  is  present, 
the  animals  emaciate  very  rapidly,  and  death  ensues  after  2 
or  3  weeks. 

Recovery  has  so  far  been  observed  only  very  exceptionally 
(most  likely  in  donkeys). 

In  cattle  the  symptoms,  which  consist  of  emaciation  and 
anemia,  periodical  fever  and  edematous  swellings  (especially 
on  the  dewlap),  sometimes  do  not  become  manifest  for  several 
weeks,  or  even  months  after  the  infection,  and  even  later  they 
become  aggravated  only  very  gradually.  The  eyes  are  rarely 
affected.  "The  disturbance  in  their  movements  is  only  slightly 
pronounced,  while  the  emaciation  may  reach  a  very  high  degree. 
Trypanosomes  are  present  in  the  blood  only  in  very  small 
numbers,  and  frequently  can  only  be  demonstrated  by  inocula- 
tion of  the  blood  into  susceptible  animals.  Acute  cases  are 
observed  only  exceptionally.  Recovery  is  more  frequent  tlian 
in  horses. 

The  disease  in  sheep  and  goats  manifests  similar  symptoms 
to  those  exhibited  by  cattle.  Parasites  are  also  found  only  in 
small  numbers. 

In  the  advanced  stages  of  the  disease  in  dogs,  emaciation, 
labored  labial  respiration,  acute  swelling  of  the  lymph  glands, 
shifting  edema,  especially  on  the  extremities,  edematous  swell- 
ings of  the  feet,  incoordination  of  movements,  keratitis  and 
iritis,  as  well  as  general  falling  of  the  hair  may  be  oliserved. 

Diagnosis.  The  sudden  and  rapidly  changing  edema  as- 
sociated with  feljrile  manifestations,  in  the  later  stages  the 
emaciation,  anemia  and  muscular  weakness  in  association  with 
recurrent  fever  which  progress  in  spite  of  good  appetite,  offer 
in  infected  localities  a  sufficient  basis  for  a  probable  diagnosis 
of  the  disease.  Absolute  certainty  however  is  only  obtained  by 
the  demonstration  of  the  trypanosomes  in  the  blood  and  in  the 
fresh  edematous  swellings. 

For  the  examination  of  trypanosomes  a  drop  of  Wood  should  he  taken  from 
a  superficial  vein,  mixed  with  several  cc.  of  physiological  salt  solution,  and  the 
mixture  examined  in  fresh,  unstained  or  stained  specimens   (see  p.  799). 

The  inoculation  of  blood  into  small  test  animals  (also  dogs)  is  valuable  in 
the  establishment  of  a  positive  diagnosis,  especially  since  it  accomplishes  its  pur- 
pose not  infrequently,  even  in  cases  of  negative  microscopical  findings. 

Montgomery  &  Kinghorn  recommend  puncturing  of  the  swollen  lymph  glands, 
as,  according  to  their  experience,  trypanosomes  may  frequently  be  demonstrated  in 
the  glandular  juice  thus  obtaine<l,  even  when  the  examination  of  the  blood  gave 
negative  results. 

Treatment.  At  present  the  reports  on  the  results  of 
Ehrlich's  chemo-therapy  (see  p.  802),  which  has  been  employed 
in  nagana  of  domestic  animals  in  Africa  are  quite  insufficient 
(in  sleeping  sickness  of  man  which  is  also  prevalent  in  Africa, 


Treatment.  Prevention.  g11 

atoxyl  hns  boon  used  successfully  for  several  years).  Zioiiiaiiii 
meiitioiLs  that  atoxyl  acts  favorably  in  horses  in  chronic  cases, 
while  Schilling  recently  warmly  recommends  arsenophenylglycin 
(dose  for  horses:  0.05  gm.  per  kg.  body  weight)  (see  also  the 
treatment  of  surra  on  v).  81-1-). 

Bruce  foiiinl  tJiat  allVite<l  horses  an<l  donkeys  treated  with  arsenical  i.rtM)ara- 
tions  lived  lonycr  tiian  those  which  wtre  not  treated,  and  Laveran  Ac  MesiuV  also 
obtained  favoralde  action  from  ar^^enious  acid  in  experiments  on  animals  artificially 
infected  with  na>iana  trypanosomes  (rats,  mice  and  doj^'s).  According  to  Bruce  & 
Theiler,  also  Schilling:,  the  arsenical  treatment  is  useless  in  na^jana  of  cattle. 

Thiroux  iVc  Teppaz  recently  reported  lastiii}^  recoveries  with  auripif^ment  and 
atoxyl,  iu  the  closely  related  trypanosomiasis  of  horses  in  Sene},'aniliia  (Tryp. 
(Timorphon,  Ca^alhoni  and  Pecaudi').  The  treatment  coiisistod  either  in  the  achnin- 
istration  per  os  of  7-12  doses  auripijjment  of  2()'M)  gm.  each  at  '■)  days'  intervals, 
or  alternating  with  atoxyl  at  2  days'  intervals  (12-25  gm.  auripigiiient  per  os;  o  gm. 
of  a  1%  atoxyl  solution  suhcutaneously). 

According  to  Diesing  the  serum  of  hyper-imniuni?ed  donkeys  is  supposed  to 
improve  the  general  condition  of  artilicially  infected  horses  and  cattle,  inasmuch 
as  the  number  of  blood  parasites  considerably  .liuiinishes  after  each  injection. 

Prevention.  In  addition  to  general  ])i'()])hy]actic  measures 
(see  p.  eSU4),  attemjjts  are  made  in  infected  localities  to  protect 
the  animals  from  the  infection  by  keeping  the  flies  away  from 
the  animals  ])y  smoke  and  also  by  inunctions  with  disagreeably 
smelling  salves  or  oils  (creolin,  peti'oleum,  also  stomach  anil 
intestinal  contents  of  ruminants,  etc.).  Limiting  pasturing  to 
the  night-time  also  reduces  the  chance  of  infection.  (In  Uganda 
it  was  found  that  citronella  grass  keeps  the  dangerous  flies 
away.) 

Literature.  Bruce,  Further  rep.  on  the  Tsetse-flv  disease  or  nagana,  London 
1S97.  —  Theiler,  Schw.  A.,  1901.  XLIII.  97.  —  Schilling,  Cbl.  f.  Bakt.,  1902,  XXX  i. 
452.  —  Laveran  &  Mesnil,  A.  P.,  1902,  XVI.  1  u.  785  (Lit.).  —  KoqIi,  D.  m.  W\, 
1905.  1865.  —  Sauerbeck,  Z.  f.  Hvg.,  1905.  LI.  31.  —  Schilling,  A.  f.  Schiffs-  u. 
Trophyg.,  1900.  Xr.  1.  —  Battaglia,  Cbl.  f.  Bakt.,  1910.  LIIT.  11.3  (Lit.).  —  See 
also  the  general  Lit.  on  page  805. 


(b)    Surra. 

History,  Griffith  Evans  found  in  1880  in  the  territory  of  Punjali. 
in  the  blood  of  horses,  mules  and  camels  affected  with  the  disease  known 
fhere  under  the  name  of  surra  (=spoiled),  a  flagellated  parasite,  the 
etiological  importance  of  which  he  innnediately  succeeded  in  estal)lishing 
l)y  snccessfnl  inoculation  cxix-rimcnts.  Scvt'i-al  years  later  flic  i)arasite 
Avas  recognized  as  a  trypanosome.  English  physicians  and  veterinarians, 
especially  Lingai-d  liavc  studied  the  disease  in  detail.  Rogers  was  the 
first  to  discover  the  agfucy  of  the  insects  as  transmitters  of  the  virus. 

Occurrence.  Tlio  disease  occurs  in  eastern  and  western 
India,  also  in  the  adjoining  Chinese  territories.  It  has  also 
been  established  on  the  coast  of  Persia,  on  the  Mauritian, 
Malayan  and  Philippine  Islands,  and  in  Java  and  Siuuati-a 
(it  appears  tliat  it  has  only  recently  been  inti'oduced  to  these 
islands).  It  exists  everywhere  in  marshy  localities,  esjiecially 
during  the  warm  season,  and  causes  great  losses  among  soIii)cds 


812  Surra. 

and  camels,  while  cattle  and  dogs  are  affected  less  severely. 
According  to  some  authors  (Laveran,  Pease  and  others),  Mboire 
and  the  El  Debab  of  the  camels  in  North  Africa  (see  p.  838) 
is  supposed  to  be  identical  with  surra,  having  been  introduced 
with  camels  from  India.  Surra  appears  to  occur  also  in  north- 
eastern Africa. 

In  1906  the  disease  was  brought  to  Xew  York  with  an  importation  of  cattle 
from  India,  but  was  suppressed  by  the  slaughter  of  the  infected,  and  prolonge<l 
quarantine  of  the  other  animals.  Camels  have  introduced  the  disease  from  India 
to  Australia. 

Etiology.  The  Trypanosoma  Evansi  is  morphologically 
aimost  identical  with  the  producer  of  nagana.  As  an  only, 
although  not  constant  difference  is  given  a  somewhat  more 
slender  form,  somewhat  longer  flagella,  a  more  pointed  posterior 
part  of  the  body,  and  a  smaller  proportion  of  chromatin 
granules,  and  finally  more  active  motility. 

The  possibility  of  differentiating  surra  from  nagana  consists  at 
the  present  time  principally  in  the  fact  that  goats  and  cattle  immimized 
against  the  usually  more  virulent  nagana  virus,  are  still  susceptible  to 
surra  (Laveran  &  Mesnil,  Nocard  &  Vallee),  which  although  a  differ- 
ential sign,  is  declared  by  Koch  to  be  not  conclusive. 

As  Trypanosoma  vivax,  Ziemann  described  in  Kamerun  a  trypanc- 
some  which  is  characterized  by  very  lively  motility  and  resembles  the 
virus  of  surra  in  other  particulars. 

Relative  to  the  pathogenicity  between  the  trypanosomes 
of  surra  and  those  of  nagana,  the  only  difference  is  that  in 
artificial  infection  experiments  the  nagana  trypanosomes  are 
usually  slightly  more  virulent. 

The  natural  infection  is  transmitted  according  to  Eogers 
and  Musgrave  &  Clegg  by  horse  flies,  namely,  the  Tabanus 
tropicus,  the  T.  lineola  and  the  Stomoxys  calcitrans,  according 
to  Leese  also  by  the  Hamatopa  fly.  Carnivora  may  infect  them- 
selves also  by  the  ingestion  of  blood  from  affected,  or  of  meat 
from  dead  animals,  also  through  losses  of  substance  in  the 
skin  and  mucous  membranes  (Lingard;  Vrijburg  succeeded  in 
infecting  a  mare  by  smearing  the  urethral  secretion  of  an  in- 
fected stallion  upon  the  mucous  membrane  of  the  vagina). 

Cattle  and  zebus  are  generally  considered  in  the  first  place 
as  virus  carriers  (virus  reservoirs),  although  they  are  only 
slightly  susceptible  to  the  disease  and  usually  become  affected 
but  mildly;  nevertheless  they  may  harbor  trypanosomes  in  their 
blood  for  years.  In  the  second  place  camels,  when  recovering 
from  the  disease,  may  likewise  carry  the  parasites  in  their 
blood  for  a  long  time.  Wild  animals'  (foxes,  jackals,  hyenas) 
may  also  supply  the  virus  to  stinging  flies. 

For  all  stinging  flies  which  have  hitherto  been  considered  as  transmitters  of 
the  natural  infection  of  surra,  it  is  generally  accepted  that  they  transmit  the 
trypanosomes  entirely  in  a  mechanical  way;  at  least  the  experiments  carried  out 
failed  to  show  that  the  surra  trypanosomes  pass  through  any  stages  of  development 


Etiology.    Anatomical    Ciiaiiges,    Symiitoms.  813 

(.Loose)    ill    tho    bodies   of   the    flies,    wliicli    latter   are    infectious   only   the    first    day 
after  sucking  the  blood.  * 

The  (luestion  as  to  the  mode  and  nature  of  natural  infection  cannot  yet  be 
considered  as  sohotl,  and  oidy  recently  Holmes,  among  others,  expressed  himself 
negatiyoly  on  the  exclusive  transmission  by  liorse  flies,  pointing  out  that  the  disease 
rages  sometimes  in  the  months  from  October  to  Decendjcr  inclusively,  ^vht■reas  the 
flies  usually  fly  oidy  in  the  months  of  June  to  August. 

Anatomical  Changes.  Besides  marked  emaciation  and 
('liani;es  indicating-  anemia  and  cacliexia,  a  yellow,  gelatinous 
inliltration  of  the  subentis  is  present  in  dilTerent  regions  of 
the  body,  also  small  hemorrhages  in  the  serous  and  mucous 
meml)ranes,  serous  exudates  in  the  ])ericardium  and  in  the  ab- 
dominal cavity,  more  or  less  pronounced  acute  swelling  of  the 
spleen  (especially  in  acute  cases),  and  swelling  of  the  lymph 
glands ;  in  some  cases  superficial  ulcerations  also  appear  on  the 
tongue  and  on  the  gastric  mucous  membrane. 

Symptoms.  These  resemble  in  general  those  of  nagana. 
In  solii)eds,  wliicli  are  the  most  susceptible  animals  to  natural 
infection,  the  disease  conmiences  after  an  incubation  of  4  to  13 
days  (Lingard)  with  fever  (rise  of  temperature  up  to  40.5-41°), 
great  languor  and  weakness,  whereupon  petechiae  soon  develop 
on  the  mucous  membranes,  especially  on  the  conjunctiva. 
Urticaria-like  eruptions  appear  on  the  skin,  and  edematous 
swellings  on  the  extremities,  the  genital  organs,  in  the  sub- 
maxillary region,  and  on  the  lower  abdomen. 

A  fatal  termination  may  result  even  in  the  first  days  of 
the  disease,  usually  however  a  marked  improvement  sets  in 
after  several  days,  but  the  febrile  attack  returns  after  a  short 
time.  The  febrile  stages  usually  last  for  four  days,  and  alter- 
nate with  fever-free  periods  lasting  for  several  days,  whereby 
the  animals  become  more  and  more  weakened,  the  paleness, 
and  later  also  the  icteric  discoloration  of  the  mucous  membranes 
becomes  more  pronounced,  the  superficial  hmph  glands  swell, 
the  respiration  becomes  accelerated  and  labored,  the  pulse  fre- 
quent and  small.  In  spite  of  good  appetite  the  animals  become 
greatly  emaciated,  their  gait  is  staggering,  finally  they  lose 
the  use  of  their  hind  parts  and  die  Anth  symptoms  of  'severe 
dyspnea. 

Of  other  symptoms  there  may  be  observed  hemorrhages 
in  tlie  anterior  chamber  of  the  eye,  diffuse  keratitis,  petechiae 
in  the  mucous  membrane  of  the  vagina,  albimiinuria  during  the 
febrile  attacks,  continuous  erection  of  the  penis  (formation 
of  thrombi  in  the  corpus  cavernosum?),  etc. 

Trypanosomes  are  found  in  the  blood  especially  at  the  be- 
ginning of  the  febrile  attacks,  otherwise  their  number  fluctuates 
in  the  course  of  the  disease  within  wide  borders. 

The  course  extends  usually  from  1  to  2  months,  more  rarely 
from  1  to  2  weeks,  or  on  the  contrary  for  3  to  4  months,  the 
febrile  attacks  becoming  graduallv  weaker  in  the  later  stasres. 


814  Surra. 

The  disease  appears  almost  witliout  exception  to  terminate  in 
death. 

In  cattle  the  disease  occnrs  nnich  less  freqnenth^  and  is 
manifested  by  less  pronounced  intermittent  feln'ile  symptoms, 
becoming  apparent  only  with  the  gradual  development  of  anemia 
and  emaciation,  which  sometimes  reach  a  very  high  degree. 
In  most  cases  ultimate  recovery  takes  place. 

There  occur  however  outbreaks  in  which  the  disease  ap- 
pears in  numerous  cattle  with  severe  manifestations,  such  as 
high  fever,  reddening  of  the  mucous  membranes,  diarrhea  and 
hemorrhages,  and  runs  an  unfavoral)le  course,  although  even 
in  such  instances  recovery  may  follow. 

Buffaloes  rarely  become  'affected,  and  then  usually  only  in  very 
chronic  form,  although  their  blood  frequently  contains  the  parasites. 

In  camels  the  disease  usually  has  a  fatal  termination,  and  as  in 
solipeds  it  may  run  an  acute  and  severe  course,  or  it  may  occur  in  a 
chronic  form.  "  Thus  Pease  &  Gaiger  observed  two  camels  affected  for 
four  years,  during  which  time  they  noted  more  than  100  febrile  attacks. 

Of  dogs,  animals  used  in  hunting  become  affected  most  frequently. 
The  symptoms  consist  in  a  periodical  fe1)rile  temperature,  reddening  of 
the  conjunctivae,  swelling  of  the  head,  the  throat  region  and  extremities. 
also  incoordination  of  movement.  In  some  cases  there  is  a  bloody  serous 
infiltration  in  the  joints,  keratitis,  and  falling  out  of  hair.  Among  im- 
ported hunting  dogs  in  Indo-China  the  disease  is  severe,  while  native 
animals  sometimes  recover  (Blin). 

Treatment.  Lingard  recommended  arsenious  acid  in  daily 
doses  of  0.8  gm.  for  the  treatment  of  horses  affected  with  surra, 
Holmes  recently  reports  continuously  good,  permanent  results 
in  ten  ponies  after  the  use  of  considerably  larger,  namely, 
subtoxic  doses,  at  the  height  of  the  febrile  attack.  For  ponies  of 
150  kg.  weight,  1  gm.  is  recommended,  while  for  horses  of 
450-500  kg.  weight,  3  gm.  should  be  given  in  the  form  of  bolus, 
or  electuary  immediately  after  feeding,  5  to  10  doses  being 
administered  with  intervals  of  one  day.  It  is  not  recommended 
in  solution  either  per  os,  subcutaneously,  or  intravenously. 
Somewhat  less  satisfactory  were  the  results  from  Loffler's 
treatment  with  arsenious  acid  and  atoxyl,  inasmuch  as  out  of 
16  solipeds  thus  treated,  four  failed  to  recover  (alternately 
4%  atoxyl  solution  subcutaneously  and  arsenic  in  bolus  form 
with  one-day  intervals ;  the  dose  of  the  atoxyl  solution  is  30-50 
cc.  for  ponies,  100-150  cc.  for  horses  and  mules ;  of  the  arsenic 
0.5-1  gm.  for  ponies,  1.5-3  gm.  for  horses  and  mules;  5  doses 
in  all). 

Thiroux  &  Teppaz  found  auripigment  effective  in  experimental 
surra ;  they  used  it  either  alone,  in  doses  of  15-25  gm.  every  3-4  days, 
or  alternately  with  tartar  emetic  (1.0-1.2  gm.  intravenously),  continued 
for  weeks. 

Gaiger,  Hallot  ami  Holmes  obtained  only  a  temporary  disappearance  of  try- 
pauosomes  from  tbe  blood  with  atoxyl,  and  likewise  little  satisfaction  was  obtained 
from  the  treatment  with  corrosive  sublimate,  soamin,  atoxyl  and  tartar  emetic 
(Holmes),  with  atoxyl  and  corrosive  sublimate  (Fraser  &  Simmonds),  also  with 
methylene  blue   (Gaiger). 


Trcatiucut.    l'iX'\oiitiuii.  g]^^ 

Prevention.  In  this  general  i)riiiciples  apply  (see  p.  804), 
also  tile  pi-ecautioiis  advisetl  for  the  control  of  iiagana  (see  p! 
Sll).  Jn  fresh  outbreaks  it  is  advisable  to  select  the  infected 
animals  with  the  aid  of  takin.i>- their  tenii)eratnre,  blood  examina- 
tions, and  inoculation  of  mice  and  rats,  and  subse(|uent ly  their 
isolation  oi-  destruction.  In  this  way  it  was  possible  in  Java, 
amon.i;-  other  places,  to  eradicate  the  disease  which  had  been 
introduced  there  not  very  long-  before. 

Literature.  Kvaiis,  Vot.  J.,  1881.  1.;  1882.  97.  —  Linganl,  Rei*.  on  Horsc- 
Siiria,  Boiiil.ay,  is}):!.  —  Rogers,  Proc.  of  the  Roy.  Soc,  1901.  LVIII.  1G:5.  — 
Vrijbiirs-,  I^iiH..  1007.  29H.  —  Ziemann,  Cbl.  f.  Bakt.,  190.5.  XXXVIIl.  H07.  — 
8i'liein.  Trop.  \ot.,  1008.  III.  101.  —  Lcose,  il)i(l.,  1009.  IV.  107.  —  Holmes,  ibid., 
1910.  V.  1.  —  Thiroux  &  Teppaz,  A.  1'.,  1910,  XXn'.  220  ii.  2:54.  —  (See,  also, 
general  Lit.  ou  i)age  805.) 

(c)    Dourine. 

{E.riitifhriH(f     coitale     patalyticum,     Polyneuritis     infectiosa; 

BescJidlseuche  [Gennan];  Maladie  du  coit  [French]; 

Marho  coitale  mnligno   [Italian].) 

Dourine  is  the  name  of  a  usually  chronic,  contagions  in- 
fectious disease  of  breeding  horses,  which  commences  shortly 
after  an  infective  coitus  and  is  at  first  characterized  by  a  local 
inflammatory  affection  of  the  external  genital  organs,  with  which 
subsequently  symptoms  of  paralysis  become  associated  as  a 
result  of  an  aifection  of  the  peripheral  nerves  and  the  inter- 
vertebral ganglia.  It  is  caused  by  the  Trypanosoma  equiper- 
dnm. 

History.  The  disease  was  first  described  by  Amnion,  based  on  his 
experience  (1796-1799)  in  the  Prussian  stud  at  Trakehnen.  At  the  be- 
ginning of  the  last  century  it  had  already  been  recognized  that  it  is  most 
etfectively  spread  during  coitus,  and  the  disease  has  frequently  been 
confounded  Avith  coital  exanthema  of  the  genital  organs.  At  the  same 
time,  however,  it  was  also  assumed  that  the  affection  is  identical  with 
s.yphilis  in  man,  with  Avhich  it  doubtlessly  has  much  similarity.  This 
view  wiiH  also  prevalent  long  since  in  Algeria,  where  the  Arabs,  in  their 
belief  that  syphilis  can  be  cured  by  copulation  with  asses,  followed  such 
unnatural  intercourse  whereby  the  disease  was  supposed  to  have  been 
transmitted  from  the  affected  female  asses  to  the  stallions  (Daumas; 
hence  also  the  old  designation  of  the  disease :  Lues  venerea  equi,  Avhich 
has  been  introduced  by  Veith  into  the  literature  of  this  subject.)  Laquer- 
riere  aimed  to  prove  this  view  in  F'rance,  in  1883,  by  theoretical  con- 
siderations; its  incorrectness,  however,  was  esablished  by  Knauert  & 
Ilaxthausen  (1837),  and  the  negative  results  of  experiments  for  the 
transmission  of  syphilis  to  domestic  animal  also  proved  these  concep- 
tions conclusively  as  erroneous.  The  difference  of  dourine  from  coital 
exanthema  of  the  genitals  was  established  by  Hertwig  in  1842,  and  still 
more  conclusively  in  1847,  and  he,  also  Mares  and  later  Prince  & 
Lafosse,  proved  further  that  the  disease  results  exclusively  through 
specific  infection. 

In  the  second  half  of  the  last  century  it  was  observed  especially  by 
French  veterinarians  in  Algeria    (Signol.  Viardot),  and  by  Rodloff  in 


816  Dourine. 

Russia.  In  Hungary  the  Department  of  Agriculture  appointed  in  1877 
a  special  commission  for  the  study  of  the  disease,  at  which  occasion 
Thanhoffer  (1882)  examined  histologically  the  organs  of  more  than 
30  aft'ected  horses,  while  Azary,  besides  making  artificial  experiments 
of  transmission,  thoroughly  studied  the  clinical  manifestations. 

Rouget  (1894)  found' in  Constantine  in  the  blood  of  a  stallion  af- 
fected with  dourine,  a  trypanosome  in  which  he  immediately  suspected 
the  cause  of  the  disease.'  This  finding  and  its  etiological  importance 
was  later  confirmed  in  Algeria  by  Schneider  &  Buffard,  in  Netherland- 
ish-India by  Does,  in  India  by  Pease,  in  Hungary  by  Marek,  and  in 
Germany  by  Kleinpaul  &  Neumann,  and  Lorenz. 

Artificial  experiments  of  infection  were  recently  carried  out  by 
Schneider  &  Buffard,  Marek  and  Zwick  &  Fischer,  while  careful  clin- 
ical investigations  were  undertaken  by  Marek  and  Fr5hner. 

Occurrence.  Dourine  Avas  fairly  prevalent  in  Europe 
previous  to  the  middle  of  the  last  century,  and  caused  heav}^ 
losses  by  its  frequent  enzootic  extension,  especially  in  the  horse- 
breeding  establishments.  The  veterinary  police  measures  sub- 
sequently adopted  resulted  in  a  rapid  diminution  of  the  dis- 
ease, so  that  at  present  it  prevails  only  in  some  southern  and 
eastern  states,  whereas  in  other  parts  of  the  world  it  occurs 
more  frequently. 

In  Germany  the  disease  was  formerly  widely  disseminated,  especially  in  the 
northern  territories  (Hanover,  Silesia,  Posen),  but  has  been  eradicated  since  the 
inauguration  of  the  infections  disease  law.  After  a  decade  of  freedom  from  the 
disease  it  was,  through  a  mare  imported  from  Russia,  introduced  again  in  1906 
into  the  districts  of  eastern  Prussia,  Angerburg  and  Lotzen,  from  which  it  spread 
into  the  districts  of  Johannisburg  and  Lyck.  By  the  end  of  1908,  82  horses  had 
been  affected  on  62  premises,  in  40  townships. 

In  Hungary  the  disease  was  first  observed  in  1819  at  Mezohegyes,  and  later 
by  Pillwax  (1833)  in  the  stud  of  Babolna.  As  a  result  of  the  measures  adopted 
in  1877  the  disease  has  been  observed  only  sporadically  since  the  year  of  1890,  and 
after  the  eradication  of  two  local  outbreaks  in  the  counties  of  Abauj-Torna  and 
Szabolcs  in  1896,  the  entire  country  has  remained  free  since  1901.  In  1905,  how- 
ever, the  disease  was  imported  from  Croatia  into  the  county  of  Zala,  where  it  spread 
to  16  townships.  In  this,  and  in  the  following  year,  a  total  of  129  horses  were 
affected,  Init  in  May  of  1907  the  entire  country  was  free. 

In  Croatia  dourine  was  widely  prevalent  at  the  end  of  1901  in  nine  town- 
ships of  three  districts  (26  horses  had  to  be  destroyed  during  the  year).  In 
Austria  it  was  first  observed  in  1813  at  the  veterinary  school  of  Vienna,  the  last 
time  in  1878  in  Bohemia.  In  France  it  has  recently  always  been  confined  to  small 
territories,  occurring  as  a  result  of  importation  from  Algeria  and  Spain,  and  par- 
ticularly in  the  Department  of  Basses-Pyrenees  cases  occur  almost  annually.  Spain 
appears  to  be  infected  considerably,  likewise  Russia,  where  the  disease  was  diagnosed 
by  Tschernogoroflf  in  1897-1902  among  37  stallions  in  the  stud  of  Oldenburg.  In 
Roumania,  where  it  was  found  by  Motas  in  1898,  it  is  also  widely  distributed  (Pav- 
losevici). 

Dourine  (  =  dirt,  unclean  copulation)  is  widely  disseminated  in  North  Africa, 
and  especially  in  Algeria,  where  it  causes  an  annual  loss  of  at  least  150,000  francs, 
it  likewise  occurs  in  Asia  Minor,  Syria  and  Persia. 

In  America  the  disease  was  recently  encountered  repeatedly  in  the  States  of 
Illinois  and  Nebraska,  and  also  in  Chili;  the  principal  focus  of  infection,  however, 
exists  on  the  Indian  reservation  of  South  Dakota,  where  in  1903,  on  the  occasion 
of  the  examination  of  the  horses,  511  were  found  to  be  affected,  277  suspected, 
and  1,889  stallions  had  to  be  castrated.  The  energetic  measures  appear  to  have 
been  crowned  with  good  results,  as  since   1906  no  other  cases  have  been  noted. 

Etiology.  Dourine  is  caused  by  the  Trypanosoma  equider- 
dum,  which  strikingly  resembles  the  trypanosome  of  nagana. 


Etiology,  Pathogenicity.  317 

According  to  Lavoraii  &  Mesiiil  the  only  distingiiisliing  signs  are 
the  sometimes  ])ointe(l,  at  otlier  times  blunt,  or  sometimes  split 
posterior  extremity,  fnrtlier  in  tlie  parasites  originating  directly 
from  the  horse,  the  absence  of  granulations  is  mentioned. 

Pathogenicity.  Material  containing  trypanosomes  taken 
directly  from  horses  is  always  virnlent  for  horses,  ^vllile  it  a})- 
pears  to  possess  for  otlier  animals  a  varying  virulence,  while 
in  Algeria,  rabbits  and  dogs  are  nsnally  infected  very  easily, 
and  a  virus  constantly  effective  for  rats  and  mice  was  obtained 
by  further  inoculations,  similar  nmterial  from  horses  in  Hun- 
gary proved  pathogenic  only  for  solipeds.  During  the  last 
invasion  in  Prussia,  similar  experiences  were  recorded,  although 
in  some  instances  mice  were  successfully  infected.  Zwick  & 
Fischer  then  cultivated  a  strain  by  further  passage  thi-ough 
mice  with  which  they  succeeded  in  infecting  not  only  small  test 
animals,  but  also  dogs,  cats  and  sheep,  and  like\vise  goats  and 
cattle. 

Mares  covered  by  stallions,  the  urethi'al  secretions  of  which 
contains  trypanosomes,  develop  after  about  2  to  4  weeks,  some- 
times even  later,  an  acute  inflannnation  of  the  vagina  and  an 
edematous  infiltration  of  the  surrounding  tissue,  while  later 
''dollar-spots"  and  still  later  s;snnptoms  of  paralj'sis  appear 
which  continually  become  more  intensive  until  the  aninuil  dies. 
During  the  existence  of  the  inflammation  of  the  vagina,  try- 
panosomes may  be  demonstrated  in  the  vaginal  discharge,  in 
the  edematous  swellings  and  in  the  dollar-spots,  much  less  fre- 
quently also  in  the  blood.  An  affected  mare  may  also  infect 
the  stallion,  in  which  case  the  effects  are  first  manifested  in 
an  edematous  swelling  of  the  sheath  and  an  accumulation  of 
mucous  secretion  in  tlie  urethra  which  contains  trj^oanosomes. 
The  disease  may  also  be  produced  artificially  by  smearing  such 
secretion  or  blood  containing  trypanosomes  on  the  mucous 
membrane  of  the  vagina  or  urethra,  as  well  as  by  dropping  it 
into  the  conjunctival  sack. 

The  injection  of  au  eimilsion  of  tlie  spinal  cord  substance  from  aii  affected 
horse,  into  the  anterior  chainher  of  the  eye  of  a  healthy  animal,  is  also  effective 
(Xocard;  Hutyra  observed  in  a  pony  in  such  an  instance  the  a])])earance  of  dollar 
spots  as  early  as  in  one  week,  and  subsequently  a  rapi<l  develoimient  of  paralysis.) 

After  the  inoculation  of  virulent  blood  under  the  skin  of 
a  horse  an  edematous  swelling  appears  at  the  point  of  injection 
in  7  to  12  days ;  after  3  to  6  weeks  transitory  swellings  of  the 
skin  appear  on  different  parts  of  the  body,  especially  in  the 
vicinity  of  the  genitals;  after  six  weeks,  sometimes  not  until 
after  five  months,  a  paralysis  of  the  hind  parts  develops  with 
knuckling  of  the  hind  legs,  until  the  animal,  which  has  become 
greatly  emaciated  in  spite  of  constantly  good  appetite,  suc- 
cumbs with  s>inptoms  of  a  lumbar  paralysis.  During  the  course 
of  the  disease  intermittent  fever  is  observed.     In  some  cases 

Vol.  1--52. 


gl8  Douriiie. 

periods  of  improvement  are  observed  in  tlie  course  of  the  dis- 
ease or  complete  recover}^  may  take  place. 

In  rabbits  a  subcutaneous  or  intravenous  injection  results 
sometimes  in  acute,  septicemic,  at  other  times  in  a  chronic 
affection.  In  the  latter  an  inflammatory  swelling-  of  the  genital 
organs,  falling  of  the  hair,  necrosis  of  the^  skin,  crustaceous 
eczema  on  the  forehead,  purulent  conjunctivitis,  or  panoph- 
thalmia is  observed,  while  copulation  of  an  affected  with  a 
healthy  animal  produces  in  the  latter  a  gangrenous  inflamma- 
tion of  the  genitals.  Infected  guinea  pigs  remain  apparently 
healthy  in  spite  of  the  periodical  appearance  of  the  parasites 
in  their  blood,  and  suddenly  succumb  months  later. 

In  dogs  a  warm  and  painful  swelling  appears  at  the  point 
of  inoculation,  also  extensive  edematous  infiltration  of  the 
abdomen,  in  the  parts  surrounding  the  genitals  and  in  the 
inguinal  region;  also  acute  balanitis;  in  bitches  inflammation 
of  the  vaginal  mucous  membrane  with  a  profuse  discharge 
is  observed.  The  back  is  sensitive,  round  flat  swellings  of  the 
size  of  the  palm  of  the  hand  which  again  disappear  within 
2  to  3  days  appear  on  the  skin,  in  some  cases  an  inflammation 
of  the  joints,  purulent  conjunctivitis,  and  ulcerative  keratitis 
may  be  present.  In  the  later  stages  rapid  emaciation,  in  spite 
of  good  appetite,  stiffness  of  the  hind  parts,  general  hyperes- 
thesia, and  in  the  last  stages  complete  inappetence  without 
fever,  marked  emaciation,  as  well  as  very  laborious  respiration 
are  noted. 

In  dogs  that  are  paired  with  affected  animals  an  acute 
inflammation  of  the  external  genital  organs  develops,  in  which 
the  discharge  contains  trypanosomes,  and  similar  results  are 
obtained  from  an  injection  of  blood  containing  trypanosomes 
into  the  vagina  of  the  bitch. 

In  sheep  plaques  develop  in  different  parts  of  the  body, 
which  leave  in  their  places  large  bare  spots ;  besides  this  an 
inflammation  of  the  genitals  develops  while  the  general  condi- 
tion remains  undisturbed  for  months.  In  cattle  a  positive  result 
of  the  infection  can  be  only  established  by  the  demonstration 
of  trypanosomes  in  the  blood.  Fowl  can  be  infected  only  ex- 
ceptionally (positive  results  are  reported  by  Yakimoff  &  Kohl). 

The  natural  infection  is  usually  transmitted  by  coitus. 
Dourine  afTects  almost  exclusively  stallions  and  breeding  mares, 
and  the  disease  has  repeatedly  been  reproduced  intentionally 
by  allowing  affected  mares  to  be  covered  by  healthy  stallions, 
and  healthy  mares  by  affected  stallions  (Prince  &  Lafosse, 
Trasbot,  Azary,  Marek).  In  studs  it  is,  as  a  rule,  mares  covered 
by  certain  affected  stalHons  that  become  affected,  and  only  much 
later  are  other  stallions  infected  as  a  result  of  an  infection 
through  affected  mares,  and  these  may  in  their  turn  infect  many 
mares. 

During  coitus  the  healthy  genital  organs  are  infected  l)y 
the  secretion  of  the  urethra  or  of  the  vaginal  mucous  mem- 


Natural  Infection.  g29 

l)raiie.  Trypanosomes  at  times  in  varying  numbers  are  present 
in  these  for  months  even  before  the  appearance  of  tlie  synij)- 
toms,  and  also  in  the  hiter  course  of  tlie  disease,  even  Avhen  the 
aninuils  otherwise  sliow  no  symj)toms  or  at  most  only  a  very 
moderate  swelling  of  scrotum  or  vulva.  During  the  periodical 
aggravations  of  the  local  manifestations,  an  increase  of  tlieir 
number  may  usually  be  demonstrated. 

In  the  rare  cases  in  which  the  disease  appears  in  horses 
not  used  for  l)reeding,  sometimes  even  in  geldings,  the  infe.'tion 
is  probably  conveyed  by  sponges  or  by  the  hands  of  the  at- 
tendants. 

Tlio  possil)ility  of  transmission  by  sliiif^in^  flics  cannot  be  discarded 
entirely.  Lingard  has  already  indicated  such  a  possibility,  and  Sieber  & 
Gonder  have  observed  the  infection  in  a  horse  which  stood  in  a  stable 
alongside  of  an  artificially  infected  animal.  Schn])ert  &  Kuhn  also 
succeeded  in  an  intentional  transmission  with  tlie  aid  of  the  stomoxys 
calcitrans.  Further  than  this  Rabinowitsch  has  infected  laboratory 
animals  with  dourine  trypanosomes  tliroiigli  lice  and  fleas,  while  Uhlcn- 
huth  &  Woithe,  Manteufel,  also  Zwick  &  Fischer,  have  proved  in  rats 
the  possibility  of  infection  through  the  intact  skin.  As  however  try- 
panosomes occur  at  least  in  northern  countries,  only  rarely  in  the  blood 
of  horses,  and  even  then  but  few  in  numbers,  stinging  flies  have  only 
slight  opportunity  for  taking  up  the  parasites  (most  likely  from  the 
fresh  pla(|ues).  Therefore  such  a  mode  of  transmission  is  apparently 
of  very  minor  importance  as  is  also  confirmed  by  experience  in  practice 
(according  to  Sieber  &  Sender  the  trypanosomes  remain  viable  only  for 
three  hours  in  the  stomachs  of  flies) . 

In  former  times  an  important  part  in  the  extension  of  the  disease  was  attrib- 
uted to  heredity  (Roloff,  Jessen).  With  the  experience  acquired  in  its  eradica- 
tion, and  with  the  establishment  of  the  etiology  of  the  disease,  this  conception  is  no 
longer  tenable. 

In  general  the  susceptibility  of  solipeds  for  infection  is 
considerable,  but  it  varies  individually,  as  not  all  mares  covered 
by  an  infected  stallion  become  affected.  This  may  however  be 
explained  by  a  temporary  disappearance  of  the  tr\^Danosomes 
from  the  secretions  of  the  genitals. 

According  to  EoU  about  66%  of  mares  which  are  exposed  to  the  infection 
become  affected.  Rodloff  in  Sierakowo  observed  in  all  of  107  mares  which  were 
covered  by  an  infected  stallion, mild  or  severe  symptoms  occurring  later  on  (.54  of 
these  died),  while  in  the  experiments  of  Prince  &  Lafosse  only  10  out  of  15  mares 
became  infected  under  similar  conditions.  Kern  reports  24  cashes  in  105  mares 
which  were  covered  by  an  affected  stallion. 

Pathogenesis.  The  trypanosomes  which  penetrate  into  the 
mucous  meml)rane  of  the  external  genital  organs  first  multiply 
at  the  point  of  entrance  where  they  produce  a  serous  and  in 
part  a  cellular  inflammation.  Later  they  enter  the  blood  and 
with  it  pass  to  distant  parts  of  the  body.  This  mode  of  dis- 
semination is  indicated  not  only  by  the  possibility  of  demon- 
strating at  times  the  parasites  in  the  blood,  but  also  by  the  fact 


820  Dourine. 

that  in  some  cases  paralysis  develops  in  the  region  of  some 
of  the  peripheral  nerves  (Facialis!)  even  in  the  early  stage  of 
the  disease,  and  further  that  in  the  affected  tissues  the  round 
cell  infiltration  is  always  observed  in  the  immediate  vicinity 
of  small  blood  vessels. 

The  intermediate  attacks  of  fever  appear  to  be  produced 
by  periodical  invasions  of  large  masses  of  trypanosomes  into 
the  blood  stream,  or  by  their  temporarily  rapid  multiplication 
in  the  blood.  Their  disappearance  appears  to  be  the  result 
of  the  development  of  trypanolytic  substances.  The  trypano- 
somes apparently  exert  their  pathogenic  action  by  the  produc- 
tion of  certain  toxins,  which  have  not  yet  been  demonstrated; 
these  on  the  one  hand  produce  a  serous  inflammation  of  the 
w^alls  of  the  vessels,  on  the  other  hand  they  principally  attack 
the  substance  of  the  peripheral  nerves,  and  the  intervertebral 
ganglia.  In  these  a  cellular  infiltration  of  the  nerve  tissue 
develops  (neuritis  interstitialis),  wdiereupon  the  nerve  fibres, 
as  well  as  the  nerve  cells,  degenerate  and  finally  disappear 
entirely.  The  sensitive  nerve  bundles  become  involved  in  great 
numbers,  and  in  a  more  severe  form  than  the  motor  fibres, 
the  affection  of  which  results  in  a  degeneration  of  the  cor- 
responding muscle  fibres.  The  disturbances  observed  in  the 
movements  and  in  the  sensibility  of  the  living  animals  are 
the  direct  result  of  the  inflammation  and  degeneration  of  the 
peripheral  nerves,  while  the  emaciation  indicates  the  action  of 
a  toxin  circulating  in  the  blood. 

In  cases  in  which  the  parasites  disappear  entirely  from 
thebody  a  complete  recovery  may  result  even  in  cases  in  which 
conspicuous  nervous  symptoms  have  already  appeared,  and 
such  instances  are  not  rare  in  northern  regions.  As  long  as 
the  motor  cells  of  the  medulla  and  the  spinal  cord  are  intact, 
new  nerve  fibres  may  form  from  the  nerve  cells  or  from  the 
stumps  of  their  prolongations  of  the  axis  cylinder.  This  is 
proved  by  the  microscopical  examination  of  cases  in  which  the 
disease  process  showed  improvement,  when  the  nerves  will  be 
found  to  show  fine  pale  stained,  new  nerve  filaments  (Marek). 

The  dourine  trypanosomes  have  a  pronounced  predilection 
for  the  mucous  membrane  of  the  genitals,  for  they  may  be 
demonstrated  in  these  even  after  subcutaneous,  intravenous  or 
conjunctival  infections.  They  are  evidently  capable  of  passing 
out  of  the  blood  vessels,  producing  exudation  of  blood  plasma 
and  a  cellular  infiltration  on  the  irritated  place,  and  thus 
cause  among  other  sjniiptoms  an  urticaria-like  eruption  of  the 
skin,  the  so-called  dollar  spots. 

Anatomical  Changes.  Carcasses  of  animals  dead  from 
dourine  are  extremely  emaciated,  and  show  on  the  prominent 
parts  of  the  body  sores  resulting  from  continuous  lying  down. 
The  subcutaneous  connective  tissue  is  poor  in  fat,  and  in  places 
shows  gelatinous  infiltration. 

In  stallions  the  connective  tissue  of  the  scrotum  is  in  many 


Anuti'iuifal   Changes.  821 

cases  edematoiisly  swollen;  the  layers  oi"  tli<i  tunica  propria  are 
adherent  by  tou^di  connective  tissue  in  their  entire  extension 
or  only  in  parts,  or  they  may  be  covered  by  shredded  granula- 
tions, \vliile  the  cavity  contains  a  clear  or  slightly  clouded 
serous  fluid.  In  rare  cases  small  purulent  foci  are  also  found 
in  the  tissues  of  the  testicles  or  between  the  pseudo-membranes, 
otherwise  the  tissue  of  the  testicles  and  the  epididpiiis  ai)i)ears 
unchanged,  although  the  cord  may  show  gelatinous  inliltra- 
tion.  In  mares  the  tissue  of  the  udder  and  the  vulva  may  some- 
times show  an  edematous  infiltration  or  selei'otic  thickening. 
On  the  glans  i)enis,  also  on  tlie  hiueous  membrane  of  the  urethra 
near  the  outside  orifice,  in  mares  on  the  mucous  membrane  of 
the  vaginal  opening  and  the  vulva,  spots  freed  from  pigments 
may  be  observed,  as  well  as  fine  or  thick  radiating  slirunken 
cicatrices.  The  lym]ih  glands,  especially  tiiose  in  the  region 
of  the  genital  organs,  are  swollen,  soft,  and  show  on  the  cut 
surface  a  moist  glistening  appearance. 

The  muscles,  especially  those  of  the  croup  and  of  the  pos- 
terior extremities  are  pale  red,  in  places  intermixed  with  butter- 
yellow^  stripes  and  liemorrhages,  or  with  blackish-red  or  yel- 
lowish-red areas.  The  capsular  ligaments  of  some  joints  are 
reddened,  the  cartilages  of  tlie  epiphyses  are  ulcerated,  while 
the  synovial  fluid  appears  cloudy  and  reddish-gray  in  color. 
The  intra-  and  intermuscular  connective  tissue  shows  serous 
infiltration  or  may  be  changed  in  places  into  cicatricial  tissue. 

The  internal  organs  show^  pronounced  anemia  and  edema- 
tous infiltration,  sometimes  a  hypostatic  pneumonia  or  mani- 
festations of  a  general  septic  infection.  In  cases  Avhich  have 
had  a  rapid  course,  an  acute  sw^elling  of  the  spleen  and  of 
the  hnnph  glands  may  also  be  present.  Frohner  describes  a 
thrombosis  of  several  peripheral  arteries  by  masses  of  leuco- 
cytes as  a  rare  lesion. 

According  to  the  descriptions  of  older  authors  portions 
of  the  spinal  cord,  especialh'/' in  •  the  lumbar  section,  contain 
softened  areas  in  the  gray  substance,  besides  small  punctiform 
hemorrhages;  as  a  matter  of  fact  however  changes  visi])le  with 
the  naked  eye  may  be  entirely  absent,  even  in  cases  with  fatal 
termination.  The  meninges  of  the  spinal  cord  may  in  parts 
contain  smeary,  fria])le  masses.  The  larger  nerve  branches, 
especially  those  of  the  extremities,  are  either  serously  infiltrated 
or  changed  into  connective  tissue  cords,  which  are  strongly 
adherent  to  tlie  intra-  or  intermuscular  connective  tissue. 

The  histological  examination  of  the  nervous  system  (Marek)  in  the  chronic 
eases  shows  in  the  extra-spinal  nerve  trunks,  and  most  pronounceil  in  the  nerves 
of  the  posterior  extremities,  sometimes  also  in  some  of  th«  cerebral  nerves  (V.,  VII. 
pair)  a  cellular  infiltration,  depsneration  and  atrophy  of  some  of  the  nerve  fibres, 
and  an  increase  of  nuclei  of  the  endoneurium.  These  changes  reach  the  highest 
degree  near  the  sensory  ganglia  and  in  the  facial  nerve  In  the  Fallopian  canal.  The 
nerve  cells  of  the  inter-vertebral  ganglia  in  general,  especially  in  the  lumbar 
portion  of  the  spinal  canal,  show  an  atrophy,  chromatolysis,  sclerosis,  and  peripheral 
displacement  of  the  nuclei,  while  the  connective  tissue  of  the  nerve  fibres,  which 
shows  round   cell   infiltration,  has  partially   disappeared.     The  peri-   and   endoneural 


822 


Dourine. 


nuclei,  however,  are  increased.  The  cellular  infiltration  extends  also  to  the  sensory 
roots  of  the  entering  zone  of  implantation,  while  the  degeneration  of  some  of  the 
nerve  fibers  may  be  followed  into  the  posterior  trunks  of  the  spinal  cord,  and  up  to 
the  nuclei  of  the  medulla.  The  other  trunk,  as  well  as  in  general  also  the  nerve 
cells,  are  intact  in  the  spinal  cord,  as  well  as  in  the  medulla,  otherwise,  however,  the 
chronic  cases  which  have  been  examined  manifested  no  changes,  with  the  exception 
of  some  perivascular,  inflammatory  foci  in  the  gray  substance  of  the  spinal  cord. 
This,  however,  does  not  exclude  the  occurrence  of  intensive  inflammatory  changes 
in  other  cases. 

A  fatty  degeneration  of  the  muscle  fibers,  also  i^erivascular  cellular  infiltra- 
tion of  the  intramuscular  connective  tissue,  the  intensity  of  which  varies  in  different 
parts  of  the  body,  is  present  in  the  muscles.  It  is  most  pronounced  in  the  muscles 
of  the  croup  and  the  posterior  extremities  (Fig.  143).  Marek  failed  to  find  spe- 
cial changes  either  in  the  corium,  or  in  the  subcutaneous  connective  tissue,  corre- 
sponding with  the  location  of  the  dollar  spots,  whereas  he  met  a  focal  cellular 
infiltration  under  the  mucous  membrane  of  the  vagina,  even  in  chronic  cases. 


^   «_  oO  X  " 
^  .  O   •  •  o  »  »  *      »  *a   /» 


Fig.  143.  Transverse  section  through  the  N.  cruralis  of  a  horse  affected  with  dou- 
rine. a  pronounced,  ft  slight  absence  of  nerve  fibres;  c  distended  nerve  sheath;  d 
and  e  epineural  cell  infiltration.     (Marek.) 


Symptoms.  In  the  appearance  of  the  symptoms  two  stages 
must  be  distinguished,  for  which  essentially  different  symptoms 
are  characteristic,  and  which  moreover  are  separated  from  each 
other  by  shorter  or  longer,  apparently  normal  periods.  The 
symptoms  of  the  first  stage  affect  principally  the  genital  organs 
and  differ  from  each  other  according  to  the  sex  of  the  animals, 
while  in  the  second  stage  the  sjmiptoms  predominate  which 
point  to  an  affection  of  the  nervous  system  and  which  are  not 
influenced  by  the  sex  of  the  patient. 

The  characteristic  symptoms  of  the  first  stage  develop  sub- 
sequently to  the  infectious  coitus,  after  an  incubation  of  from 
5  to  6  days  up  to  one  month,  sometimes  however  apparently 
after  several  months,  as  in  some  cases  the  disease  is  manifested 
only  by  moderate  febrile  attacks  which  may  be  unnoticed. 


Syiiiptonis. 


823 


Prinoo  &  Lal'osse  observed  after  the  infectious  coitus  an  incubation  of  7-60 
(lays,  Hcrtwijj  2-s  days  (?),  Kodloff  814  days.  h>chnei<lcr  &  Buffard,  also  lialdrey, 
observed  recently  in  experimental  infections  the  develoimient  of  the  lirst  syinjitonis, 
or  at  least  the  iirst  febrile  attacks  after  8-2U  days,  Buoy  after  40-4.3  days,  Marek 
after  '>'M  days. 

Trypanosonies  may  sometimes  be  demonstrated  in  the  uretliral  or  vaginal 
secretion  as  early  as  4-5  days  after  the  infection;  in  spite  of  this,  liowever,  except- 
injj  the  rise  of  temperature,  tlie  local  symptoms  may  not  develop  for  months 
(accor<Iing  to  Kern  sometimes  only  after  0  months). 

Ill  stallions  tlic  disease  usually  eomineiices  with  an  edema- 
tous inliltratioii  of  the  sheath,  which  i^raduall}'  extends  fi'oin 
one  place  over  the  entire  skin  of  the  part,  and  especially  to 
the  anterior  pendulous  portion.     The  swollen  sheath  does  not 


Fig.  144.     Dourine.     Swelling  of  the  sheath  and  the  lower  chest;  plaques  on  the 
croup  and  on  the  uecdv  of  a  stallion. 

feel  warmer  and  is  not  painful.  It  is  of  doughy  consistence, 
resembling  somewhat  a  fat  bag,  only  that  the  skin  is  stretched 
and  not  wrinkled  (Fig.  144).  The  swelling  spreads  along  both 
folds  which  jjass  from  the  orifice  of  the  sheath  to  the  abdomen 
and  forwards  and  backwards  to  the  scrotum.  At  the  same 
time  the  glans  penis  also  swells  and  the  animal  protrudes  a 
lon.ger  or  shorter  portion  of  this  organ  from  the  sheath.  The 
glans  proper  shows  hardly  any  perceptible  changes,  excepting 
the  edematous  swelling  which  however  may  also  be  very  slight, 
and  a  grayish  transparent,  or  yellowish-gray  mucus  oozes  out 


824  Dourine. 

from  the  urethra.  In  infrequent  cases  the  swollen  glans  appears 
of  higher  temperature  and  more  sensitive.  The  border  of  the 
urethral  opening  is  also  frequently  swollen,  slightly  reddened 
and  the  mucous  membrane  protrudes  slightly  (especially  in 
jacks).  Later  lentil  to  pea-sized,  yellowish-red  nodules  on  an 
infiltrated  base  develop,  sometimes  singly,  at  other  times  in 
groups,  on  the  mucous  membrane  of  the  urethra  in  the  vicinity 
of  the  urethral  opening,  also  on  the  glans  and  on  the  body 
of  the  penis,  and  change  into  round,  flat  ulcers  in  12  to  36  hours ; 
these  usually  heal  after  a  time,  leaving  behind  roundish  white 
spots.  In  some  cases  however  they  may  persist  for  a  long 
time,  and  even  enlarge,  after  which  their  base  is  lardaceous, 
their  borders  raised,  and  on  final  healing  prominent  scars  re- 
main. 

During  the  development  of  these  changes  the  animals  mani- 
fest a  continuous  desire  to  urinate,  but  they  pass  only  small 
quantities  of  urine  and  nervously  raise  one  of  the  hind  legs 
or  arch  their  backs.  Besides  tliis  frequent  erections  of  the 
penis  are  observed  and  the  animals  usually  show  an  increased 
sexual  desire. 

In  mares  the  first  manifestations  consist  in  an  edematous 
swelling  of  the  vulva,  discharge  from  the  vagina,  also  redden- 
ing and  inflammatory  swelling  of  the  vaginal  mucous  mem- 
brane. The  lal)ia  of  the  vulva  usually  appear  sw^ollen  on  both 
sides,  frequently  however  not  uniformly ;  at  the  same  time  they 
are  dense,  elastic,  not  painful,  and  frequently  covered  with 
non-pigmented  spots,  similar  to  those  sometimes  occurring  in 
the  vicinity  of  the  rectum  (so-called  toad  spots).  Sometimes 
the  clitoris  is  swollen,  so  that  it  protrudes  from  the  lower 
gaping  opening  in  the  vulva.  The  mucous  membrane  of  the 
vagina  is  loosened,  shows  dark  red  spots  on  a  reddish-yellow 
])ase  and  is  sometimes  thickened  into  gelatinous,  quivering, 
longitudinal  pads.  The  mucous  follicles  are  also  swollen, 
especially  in  the  superior  commissure,  and  in  the  vicinity  of 
the  clitoris  gelatinously  translucent,  and  may  be  felt  as  millet- 
seed-sized,  rarely  larger  nodules.  The  nodules  may  later  break 
down,  whereupon  in  their  place  small  round  ulcers,  with  sharp 
borders  and  yellowish  bases  appear.  The  ulcers  finally  heal, 
either  without  leaving  any  trace,  or  in  their  places  light  yellow 
spots  may  remain  for  a  time  (proliferated  epithelium)  (Fig. 
145).  Besides  the  nodules,  pea-sized  vesicles  may  develop  ex- 
ceptionally on  the  mucous  membrane  of  the  vagina  and  on  the 
vulva,  in  rare  cases  also  in  the  surrounding  portions  of  the 
skin,  these  contain  a  yellow  serous  fluid,  and  similar  small  ulcers 
develop  after  they  burst. 

In  severe  cases  the  ulcerations  increase  in  size,  their  bases 
becoming  covered  ^nth  necrotic  tissue  and  the  dark  red  borders 
showing  an  elevated  swelling.  They  heal  very  slowly,  and 
in  their  places  round,  smooth  scars  remain  for  a  long  time. 
Meanwdiile  the  discharge  from  the  vagina  increases;  first  it 


Syiuptoius. 


825 


is  white  or  yellowish  and  slimy,  later  more  teuat'ious  and  iinally 

purulent,  dirty  yellow,  or  reddish,  dries  on  the  Hps  of  the  vulva 

to  dirty  brown  crusts  and  glues  the 

hairs    of   the    tail   together.      The 

edematous  swelling  may  extend  to 

the  udder  and  the  abdomen,  as  well 

as  to  tlie  thighs. 

During  the  development  of  the 
local  changes  the  mares  manifest 
oestrum-like  behavior,  they  shift 
their  feet  restlessly,  swing  their 
tails,  strain  frequently  to  urinate, 
sometimes  passing  only  a  little 
mucus  and  at  other  times  a  small 
quantity  of  urine  after  which  they 
arch  the  back. 

The  symptoms  do  not  always 
reach  so  high  a  degree  that  atten- 
tion may  be  attracted  to  their  pres- 
ence. Cases  are  relatively  frequent 
in  which  the  characteristic  changes 
are  only  observed  in  the  later 
stages,  when  by  subsequent  careful 
examination  the  traces  of  the  pre- 
existing ulcerative  processes  may 
be  found  on  the  genitals  in  the  form 
of  white  scars.  If  how^ever  nodules 
and  ulcers  develop  only  on  the 
mucous  membrane  of  the  urethra, 
as  sometimes  occurs  in  stallions, 
not  even  traces  of  the  local  affec- 
tion may  be  found  on  the  genital 
organs.  The  initial  s^^nptoms  are 
sometimes  unnoticed,  especially  in 
mares  in  breeding  establishments, 
Imt  carefully  watched  stallions  may  direct  the  attention  to  the 
affection  by  the  appearance  of  the  nervous   sjTiiptoms. 


Fig.  145.  Dourinc.  Un]ugnient- 
ed  spots  on  the  lips  of  the  vulva; 
pronounced  eiuaeiation. 


The  uk't'1-.s  on  the  vaginal  luueous  iiienil)rane  are  described  hy  all 
authors,  with  the  exception  of  Rodloff,  who  never  ohserved  them.  INIares 
observed  a  discharge  from  the  vagina  only  in  17  out  of  197  affected 
mares. 


In  the  second  stage,  which,  as  a  rule,  follows  the  lirst  after 
several  weeks,  and  sometimes  after  a  temporary  improvement, 
exceptionally  however  without  any  period  of  transition,  symp- 
toms appear  which  partly  indicate  an  affection  partly  of  the 
skin,  partly  of  the  peripheral  nerves  and  the  intervertebral 
ganglia. 

The  so-called  dollar  spots  appear  first,  usually  on  the  sides 


826 


Douriue. 


of  tlie  cliest  and  on  the  croup,  more  rarely  on  the  neck,  shoulder, 
withers  or  on  other  parts  of  the  body  (Fig.  146).  They  are 
either  round  or  semi-circular,  or  again  irregular  in  shape.  The 
former  have  a  diameter  of  4-8-15  cm.,  and  may  be  recognized 
in  that  their  periphery  is  formed  by  a  ring  1-3  cm.  broad,  over 
which  the  hair  stands  erect  or  disarranged  as  a  result  of  an 
edematous  infiltration  of  the  capillary  bodies,  on  account  of 
which  the  ring  appears  darker  and  less  glistening.  Within  the 
ring  the  skinis  not  swollen,  the  hair  is  smooth,  and  therefore 
this  portion  appears  sleek  and  glistening  like  the  skin  outside 

of  the  ring.  The  second 
category  of  the  dollar 
spots  is  a  very  irregular, 
zigzag-shaped  form,  fre- 
quently extending  15-20 
cm.  in  one  direction,  and 
covered  with  roughened 
hair.  Besides  these  spots, 
lentil  to  bean-sized  nod- 
ules develop  on  the  skin, 
over  which  the  hair  is 
also  rough;  such  nodules 
are  mostly  oliserved  on 
the  inner  surface  of  the 
thighs,  in  the  flanks,  and 
more  rarely  on  the  sides 
of  the  thorax  and  on  the 
shoulders.  The  fourth 
form  resembles  urticaria 
and  the  designation  of 
"dollar  spots"  is  really 
appropriate  only  for  this 
form  of  eruption.  Sometimes  on  the  inner  surface  of  the  thigh, 
sometimes  in  the  flanks,  lentil  to  dollar-sized,  uniform  protuber- 
ances appear,  over  which  the  hair  appears  rough  and  dull.  The 
number  of  the  dollar  spots  may  be  considerable,  even  exceeding 
one  hundred.  They  usually  persist  for  1  to  8  days,  when  they 
disappear  without  leaving  a  trace,  whereupon  however  fresh 
plaques  soon  appear  on  other  parts  of  the  body.  All  forms  of 
eruptions  are  painless,  are  not  of  a  higher  temperature,  and 
are  not  associated  with  itching. 


Fig.  146.  Doiirine.   Plaques  on  the  left   side 
of  the  abdomen. 


Straiisz  in  Mezohegyes  observed  besides  the  dollar  spots  a  severe 
vesicular  and  crustaceous  eczema  on  the  abdomen,  on  the  chest,  also  on 
the  croup,  and  at  the  base  of  the  tail.  The  intensely  itching  eruption 
("itch  disease")  which  caused  the  patients  to  rub  and  scratch  severely, 
resisted  all  treatment,  but  after  a  time  it  was  arrested  of  its  o\ni  ac- 
cord, and  finally  healed !  later  however  hair  failed  to  grow  on  the  hair- 
less spots,  and  if  in  these  places  the  pigment  of  the  skin  had  disappeared 
the  affected  part  of  the  body  showed  a  variegated  appearance. 


Syiiiptouis.  yoj 

Kern  obsorvt'd  in  some  cases  persistent  perspiration  aiul  snh- 
seiinmlly  alopecia,  FrOliner  saw  white  hair  appear  on  the  rump  of  a 
stallion. 

Ilyporestliosia  oitlior  over  tiie  entire  body  suri'ace  or  only 
in  tlie  region  of  certain  nerve  trunks,  may  be  estal)lislied  either 
simnltaneonsly  Avitli  the  appearance  of  the  dollar  spots  or  later. 

On  account  of  the  increased  sensitiveness  of  the  skin,  some- 
times a  slight  touch  or  a  slight  prick  on  the  skin  causes  the 
animal  to  offer  opposition,  while  stroking  the  back  witli  the 
lingers  causes  the  i)atients  to  groan  and  depress  the  back. 

At  the  same  time  an  increased  sensitiveness  of  certain  nerve 
trunks  may  be  ascertained;  thus  the  animal  manifests  sharp 
pains  on  pressure  or  stroking  over  the  N.  ischiadicus  and 
peroneus,  the  Nn.  intercostales,  the  N.  medianus  and  infraor- 
bitalis.  As  the  contraction  of  certain  groups  of  muscles  ])ress 
or  stretch  the  nerves  lying  between  them  a  disturbance  in  their 
movements  results  owing  to  their  sensitiveness.  The  walk  of 
the  patients  is  stiff,  they  hold  one  or  the  other  leg  more  flexed, 
especially  on  trotting  and  galloping,  also  during  quick  turns 
and  therefore  evince  lameness.  If  the  animal  stands  still  it 
periodically  raises  a  foot  spasmodically,  as  if  tortured  by 
lancinating  pains,  and  holds  it  high  for  a  while  treml)ling. 
Similar  manifestations  are  observed  when  the  animal  starts 
to  move  and  during  passage  of  the  bowels.  These  spasms  occur 
more  frequently  during  nighttime  than  during  the  day  and  are 
sometimes  observed  when  the  animal  is  lying  down.  In  some 
animals  a  sudden  lameness  sets  in,  which  however  disappears 
after  a  few  days.  On  account  of  the  sensitiveness  of  the  inter- 
costal nerves  the  respiration  is  accelerated  and  superficial, 
while  owing  to  irritation  of  the  vagus  nerve,  the  patients  cough 
periodically. 

The  increased  sensibility  gradually  passes  into  a  hyperes- 
thesia, exceptionally  into  a  complete  anesthesia,  and  as  a  rule 
paralysis  of  certain  motor  nerves  appears  in  the  meantime. 
This  is  observed  in  almost  every  case  in  the  hind  extremities, 
quite  frequently  in  some  of  the  facial  nerves,  especially  the 
X.  facialis,  while  the  nerves  of  the  anterior  extremities,  and 
those  in  other  parts  of  the  body  are  but  rarely  affected. 

The  symptoms  of  paralysis  are  usually  not  even  on  both 
sides  of  tiie  body.  On  the  head  they  are  almost  invariably 
unilateral.  As  a  result  of  paralysis  of  the  nerves  on  the  pos- 
terior extremities,  the  animals  show  a  staggering  gait,  Avhich 
is  noticeable  while  walking  in  a  straight  direction,  but  more 
so  while  walking  in  a  circle.  On  trotting  they  hold  the  hind 
legs  spread  apart  or  drag  them  with  the  flexed  hock  on  the 
ground;  when  halted  they  usually  knuckle  (Fig.  147).  The 
paralyses  of  certain  nerves  of  the  head  are  manifested  in  cor- 
responding disturbances  of  motion  and  in  distortions.  Accord- 
ing to  Lorenz  and  Frohner  a  peripheral  recurrens-paralysis 


828 


Dourine. 


occurs  frequently  sometimes  in  spite  of  its  long  existence  with- 
out leading  to  a  demonstrable  atrophy  of  the  posterior  muscles. 
The  sphincter  muscles  of  the  anus  and  the  bladder  are  not 
paralyzed. 

The  superficial  reflexes  are  increased  over  the  region  of 
the  hyperesthesia,  but  they  become  weaker  after  the  appearance 
of  the  muscular  paralysis  and  finally  disappear  entirely.  The 
tendinous  reflexes,  corresponding  to  the  affected  nerves,  are 
diminished  from  the  beginning  or  entirely  absent,  especially 
the  patellar  reflex.  The  electrical  irritability  of  the  nerves 
and  muscles  is  likemse  reduced  in  the  regions  of  the  paralysis 
or  a  partial  and  even  a  total  degeneration  reaction  may  be 
established  (Marek). 

The  s}anptoms  of  paralysis  diminish  sometimes  consider- 
ably after   several  weeks   and  may  disappear  entirely,   even 


Fig.  147.     Dourine.     Paraparesis  in  an  affected  mare.      (Snapshot.) 

when  a  degeneration  reaction  had  previously  been  ascertained. 
In  other  cases  they  become  more  aggravated,  the  withering 
muscles  become  markedly  atrophied,  and  finally  the  paralysis 
of  the  hind  parts  reaches  such  a  degree  that  the  animals  are 
no  longer  capable  of  rising  from  the  ground. 

Frequently  affections  of  certain  joints  and  tendons  become 
associated  with  the  nervous  sjanptoms.  The  hock  joint,  more 
rarely  the  tarsal  joints,  or  some  articulations  of  the  front  legs, 
swell  from  day  to  day,  together  with  the  corresponding 
tendinous  sheaths.  The  swellings  are  produced  by  the  ac- 
cumulation of  a  large  quantity  of  fluid  in  the  synovial  cap- 
sule or  in  the  tendinous  sheath,  but  at  the  same  time  there 
are  no  inflammatory  symptoms  perceptible.    On  palpation  they 


Symptoms. 


829 


show  lluctuation, 
at  the  same  time 
they  are  not 
wanner  or  pain- 
ful. Besides  they 
may  retrogress  as 
rapidly  as  they 
develop  and  recur 
again  after  a  cer- 
tain time. 

The  respira- 
tion is  quiet  and 
slower  than  nor- 
mal, but  even 
after  short  exer- 
cise it  becomes 
very  much  accel- 
erated, calming 
down  only  grad- 
ually. Toward 
the  end  of  the  dis- 
ease a  catarrh  of 
the  air  passages 
or  broncho-pneu- 
monia may  de- 
velop. The  heart 
action  is  mostly 
normal,  only  the 
heart  is  more 
easily  excited,  as 
even  after  short 
exercise  accelera- 
tion, and  some- 
times also  an  ar- 
rhythmic pulse 
may  develop. 

The  superfi- 
cial lymph  glands, 
most  frequently 
the  inguinal, 
sometimes  also 
the  submaxillary 
glands,  occasion- 
ally become  swol- 
len, when  they 
feel  soft,  elastic 
and  painless  or 
only  moderately 
sensitive. 


'830  Dourine. 

The  number  of  red  blood  corpuscles  in  the  blood  may 
dmiinish  to  one-tenth  of  the  normal,  while  white  corpuscles 
may  increase  10  to  30  times.  In  many  cases  a  pronounced 
eosinophilia  may  also  be  demonstrated  (Marek,  Frohner). 

The  daily  quantity  of  the  urine  fluctuates  within  normal 
limits;  its  specific  gravity  is  1,023  to  1,060  and  on  an  average 
it  is  lower  than  in  healthy  horses.  Of  the  normal  constituents 
the  quantity  of  phosphoric  acid  is  markedly  increased  in  about 
70%  of  the  cases  (up  to  4-5  gm.) ;  besides  the  quantity  of  urea 
is  also  increased  (Liebermann;  according  to  Eoger  the  urine 
contains  glucose). 

In  the  eyeground  the  papillae  and  their  surroundings  ap- 
pear congested  in  some  cases,  and  in  time  blood  pigment  is 
deposited  in  the  tissues  surrounding  them.  These  changes  may 
later  reduce  the  vision  and  even  result  in  blindness.  Conjunc- 
tival catarrh  is  a  frequent  symptom,  in  some  cases  however  also 
an  exudative  iritis  develops  which  finally  leads  to  atrophy  of 
the  bulbus.  Frohner  observed  in  one  case  a  unilateral  con- 
traction of  the  pupil. 

The  body  temperatures  show  a  periodical  rise  of  remittent 
character  (Fig.  148).  In  the  later  course  a  continuous  fever 
may  set  in,  probably  produced  in  part  by  suppurative  processes, 
especially  in  the  genital  organs,  but  towards  the  termination 
of  the  disease  also  by  the  gangrene  of  the  sores  from  constant 
lying  down.  With  the  temporary  febrile  attacks,  fresh  plaque 
eruptions  develop  frequently,  but  the  course  of  the  disease  may 
continue  without  fever  even  for  months. 

Mares  which  are  impregnated  by  an  infected  stallion  fre- 
quently abort  during  the  second  or  third  month  of  pregnancy. 

The  affected  animals  become  greatly  emaciated  during  the 
paralytic  stage  of  the  disease,  although  the  appetite  remains 
good  almost  to  the  end.  Besides  the  paralysis,  the  weakness 
brought  on  by  the  emaciation  contributes  to  the  inability  of 
the  animals  to  rise  in  the  later  stages  of  the  disease.  The  im- 
mediate cause  of  death  is  either  a  hypostatic  pneumonia  or  a 
septicemic  affection  in  association  "SNith  the  gangrene  caused  by 
the  pressure  sores. 

Course  and  Prognosis.  In  northern  regions  dourine  usually 
runs  a  chronic  course.  After  the  local  affection  of  the  genital 
organs,  several  weeks  or  even  months  usually  elapse  before 
the  nervous  symptoms  are  markedly  perceptible,  while  the  dollar 
spots  may  appear  earlier,  sometimes  simultaneously  with  the 
swelling  of  the  sheath.  After  the  appearance  of  the  nervous 
symptoms  the  disease  may  in  unfavorable  cases  take  a  rapid 
course,  so  that  the  animal  succumbs  in  3  to  4  weeks,  completely 
exhausted,  or — and  this  is  more  frequently  the  case — the  disease 
extends  over  several  months,  frequently  from  1  to  2  years.  In 
such  cases  more  or  less  pronounced  improvement  may  be 
noticed  periodically,   which  is   however  only  temporary,   and 


Course  and  Proyiuisis.  831 

finally  tlio  disease  passes  into  the  aggravated  condition  which 
leads  to  a  fatal  termination. 

In  southern  regions  the  disease  appears  to  run  a  more 
acute  course,  so  that  the  patients  may  die  after  1  to  2  months 
and  even  inside  of  6  to  8  days  (^Monod).  At  the  same  time 
tlie  fel)rile  attacks  are  more  conspicuous  following  each  otlier 
in  more  rapid  succession,  and  the  paralytic  symptoms  also  de- 
velop more  rapidly,  therefore  there  are  no  marked,  and  es- 
pecially no  chronic  interstitial  changes  of  the  nerves  in  the  dead 
nninials. 

The  termination  of  the  disease  varies  in  different  outbreaks. 
While  sometimes  about  half  of  the  affected  animals  die  (in 
India,  according  to  Pease,  the  mortality  amounts  to  70-80%), 
in  other  cases  tlie  loss  is  much  smaller  (thus  for  instance  in 
A.-Vadiisz  and  vicinity,  out  of  30  nuires  in  which  the  disease 
was  established  with  certainty  only  two  died).  Kecovery  is 
possible  even  after  the  appearance  of  the  nervous  sjonptoms, 
dollar  spots  and  paralysis,  and  such  animals  may  then  perform 
liard  work  for  years.  It  is  probable  that  in  some  cases  only 
the  local  chang-es  of  the  genitals  develop  after  an  infection, 
which  definitely  heal  A\nthout  the  later  development  of  nervous 
symptoms. 

Some  authors  are  of  the  o])inion  that  the  disease  develops 
more  ra])idly  in  stallions  and  that  it  runs  a  more  unfavoraV)le 
course  than  in  mares,  and  in  Algeria  it  is  supposed  to  limit 
itself  in  asses  in  the  majority  of  cases  to  a  local  affection  of 
the  genital  apparatus. 

Diagnosis.  In  northern  regions  where  dourine  apparently 
represents  the  only  trypanosome  affection  of  solipeds,  the 
diagnosis  is  definitely  established  by  the  demonstration  of 
trypanosomes ;  but  this  is  associated  with  considerable  difficulty, 
as  the  parasites  are  present  but  rarely  in  the  blood,  and  even 
tlien  only  in  very  small  numbers.  Their  occurrence  in  the 
serous  fluid  of  the  dollar  spots,  especially  immediately  after 
these  appear,  is  more  constant,  as  is  also  the  case  in  the  edema- 
tous swellings  in  the  vicinity  of  the  external  genital  organs, 
but  even  here  the  examination  requires  great  patience.  Their 
demonstration  in  the  nmcous  secretion  of  the  urethra  and 
vagina  is  much  easier  (Fig.  149),  but  even  there  it  is  to  be 
remembered  that  they  may  disappear  periodically  from  the 
secretion. 

A  sufficient  (juautity  of  secretion  is  obtaineil  from  the  vagina  by  serapinjj  the 
mucous  membrane  with  a  scalpel  or  with  a  glass  slide.  In  stallions  the  penis  is 
drawn  out  with  the  left  hand,  and  then  a  long-handled,  bean-shaped,  oval  spoon 
with  dull  eilges  is  introduced  into  the  urethra,  with  which  the  mucous  mendjraue 
is  scraped  off. 

In  dou])tful  cases  blood  may  be  injected  subcutaneously  into  dogs.  In  the 
swellings  which  subsequently  develop  trjiianosomes  are  always  present  in  great  num- 
bers (Buflfard  Sc  Schneider).  Mice  may  also  be  used  for  this  ])urpose.  Since  the 
material  is  frequently  non-pathogenic  for  test  animals,  even  from  horses  ])ositively 
affected  with  dourine  (see  p.  817),  only  a  positive  result  of  the  inoculation  has 
a  diagnostic  siguilicance. 


832  Dourine. 

As  the  ring  and  semi-circular  dollar  spots  have  been  ob- 
served in  northern  regions  only  in  dourine,  they  may  be  con- 
sidered as  characteristic  for  the  disease,  or  at  least  accepted 
as  suspicious  in  a  high  degree.  Their  repeated  appearance 
for  weeks  and  months,  and  frequently  also  their  persistence 
for  several  days,  distinguish  them  from  the  ordinary  urticaria. 

In  tropical  regions  the  differentiation  of  dourine  from 
nagana,  surra  and  Mai  de  caderas  may  evidently  cause  diffi- 
culty, but  as  according  to  the  reports  so  far  available,  trypano- 
sonies  in  the  secretions  of  the  genital  organs  are  found  only 
in  dourine,  their  presence  there  would  clear  the  diagnosis ;  like- 
wise an  infection  which  may  be  shown  to  have  been  trans- 
mitted bv  coitus  speaks  for  dourine. 


Fig.  149.  Vaginal  secretion-  of  a  mare  affected  with  dourine.  a  tryjaanosomes ;  h 
epithelial  cells  from  the  deepei",  d  from  the  superficial  layer  of  the  mucous  membrane ; 
c  leucocytes;    e  erythrocytes.     After  a  fresh,  unstained  preparation. 

According  to  Baldrey  the  disease  may  he  distinguished  from  surra 
in  that  the  latter  usually  occurs  in  epizootics",  geldings  and  unbred  mares 
become  affected,  the  body  temperatures  reach  high  degrees  and  last 
longer,  and  trypanosomes  are  present  in  the  blood  in  great  numbers  at 
the  beginning  of  the  fever.  According  to  Davison,  Bursattee  (see  p. 
739)  also  resembles  dourine  as  it  also  is  associated  with  a  swelling  of 
the  genitals  and  inflammation  of  the  skin;  these  however  are  very 
painful. 

At  times  where  there  exists  no  suspicion  of  infection,  the 
initial  stage  of  dourine  is  sometimes  mistaken  for  a  traumatic 
inflammation  of  the  genitals ;  however,  the  traumatic  origin  may 


DiajjiKisis,  Tit-atiuent.  333 

easily  be  excliidetl  by  the  abseiu-e  of  a  visible  injury,  or  on 
the  ground  of  the  torpid  eharaeter  and  [)ersist('nt  presence  of 
the  edematous  swelling-.  The  coital,  vesicular  exanthema  can 
readily  be  taken  for  dourine,  as  both  affections  develop  after 
coitus  with  quite  similar  symptoms.  In  the  coital  exantliema 
however  the  eruptions  disaj)pear  nuich  more  rapidly  and  are 
almost_  invaria))ly  benii^n;  fnrtlier  the  vaginal  mucous  mem- 
brane is  reddened,  the  atfected  parts  are  painful,  tiie  usually 
numerous  ulcers  heal  within  a  few  days  and  with  this  the  dis- 
ease terminates,  that  is,  no  nervous 'symi)toms  develop  with 
the  local  affection.  Glanders  may  also  come  into  considei-ation, 
as  in  its  later  course  edematous  swellings  may  result  on  the 
sheath  and  on  the  alidomen,  but  a  mistake  is  prevented  by 
the  other  symptoms,  which  are  usually  pi-esent.  The  swelling 
of  the  subnuixillary  lymph  ghuids  may  readily  be  distinguished 
by  its  soft  elastic  consistency  from  the  glaiidulai'  swelling  of 
the  glands. 

The  weakness  of  tlie  hind  parts  is  only  characteristic  of 
dourine  when  associated  with  the  otlwr  nervous  syni])to]ns.  From 
other  diseases  in  which  similar  weakness  of  the  Jiind  parts 
occurs,  the  ])aralysis  of  the  musculus  (piadratus  lumborum 
muscle,  and  the  tearing  of  the  lumbo-sacral  articulation  should 
be  mentioned,  in  which  however  the  animal  is  not  capa])le  of 
backing  up  at  all,  while  a  horse  with  dourine  is  capable  of  per- 
forming this  function,  although  with  difliculty  and  staggering. 
Paralysis  of  the  facial  nerves  from  other  causes  may  be  dis- 
tinguished from  dourine  by  the  absence  of  edenuitous' swelling 
of  the  genitals  and  the  plaques  as  well  as  other  symptoms  of 
paralysis. 

Besides  frequent  accessory  conditions,  the  affection  of 
several  animals  in  association  with  coitus,  and  the  multiplicity 
of  the  symptoms  in  different  animals  are  as  a  rule  sufficient 
points  for  establishing  the  diagnosis  of  the  disease  in  question. 

Experiments  by  riilonhiith  &  Woitlio,  ;Nraiitoiifel,  also  Zwick  &  Fischer,  with 
the  complement  tixation,  the  precipitation  and  the  a<rf;lomeration,  furtlier  the  cntanc- 
ons  and  ophthalmo  reactions  for  the  diagnosis  of  dourine,  gave  iie:rative  results 
throughout. 

Treatment.  Already  formerly  arsenical  prei)arations  had 
been  used  f  re(iuently  in  treatment,  Trelat  having  obtained  satis- 
factory results  from  the  internal  administration  of  ai-senious 
acid  (3-6  gm.daily),  Arkhangelsky  &  Xovikoif  from  subcutaneous 
injections  (0.01-0.05  gr.  in  increasing  doses),  rhleiiliuth  & 
Woithe  found  atoxyl  very  effective  on  small  animals  in  lal)ora- 
tory  experiments.  In  horses  the  conditions  for  such  i\  treat- 
ment are  rather  unfavorable,  as  the  large  doses  requii-ed  at 
the  beginning  of  the  disease  are  badly  tolerated  by  tlu'se  ani- 
mals, also  on  account  of  the  presence  of  the  parasites  in  the 
secretion  of  the  genitals,  in  the  edematous  fluid  of  the  swell- 
ings and  in  cavities  of  joints,  where  they  nuiy  elude  the  destruc- 
voi.  1—53 


834  Dourine. 

tive  action  of  the  remedy.  Nevertheless  there  are  reports  which 
appear  to  indicate  the  possibility  of  a  recovery  of  the  disease 
processes  following  such  treatment. 

Uhlenluith  &  Woithe  succeeded  in  keeping  an  artificially  infected  horse  in 
good  strength  for  one  year  by  increasing  doses  of  atoxyl  (0.3-5.0  gni.  intravenously), 
its  blood,  however,  contained  trypanosomes  throughout  the  entire  period  in  vary- 
ing quantities,  and  it  suddenly  died  from  acute  septicemia  with  extensive  intestinal 
hemorrhages.  Eennes  obtained  better  results  in  an  artificially  infected  horse,  which 
he  injected  at  intervals  of  3-4  days,  alternately  with  4  gni.  of  atoxyl  subcutaneously 
and  3  gni.  kalium  tartaricuni  intravenously;  after  the  administration  of  32  gm. 
atoxyl  and  21  gm.  kal.  tart,  the  horse  was  permanently  cured.  Yakimoff  treated 
10  horses  by  injecting  atoxyl  ten  times  in  succession,  either  subcutaneously  (4-8 
gm.)  or  intravenously  (0.5-3.0  gm.),  in  increasing  doses,  and  this  treatment  was 
repeated.  The  results  were  good,  as  a  relapse  was  observed  in  only  one  case.  Monod 
also  is  supposed  to  have  succeecled  in  permanently  curing  an  affected  stallion  with 
similar  treatment  (first  0.5  gm.  intravenously,  then  every  second  day  an  increase  of 
0.1  gm.  until  the  maximum  dose  of  1.0  gm.  was  reached). 

The  atoxyl  solution  must  be  freshly  prepared  at  each  application  Ity  boiling 
on  a  water-bath. 

Of  other  arsenical  preparations,  Miessner  fonnd  in  one 
case  arsenophenylgiycin  very  effective,  in  which  the  nutritive 
condition  and  strength  of  an  already  greatly  w^eakened  animal 
was  materially  improved  by  two  injections  of  the  remedy 
(dose?)  and  tlie  edematous  swellings  retrogressed.  Frohner, 
on  the  other  hand,  not  only  failed  to  observe  an  improvement 
in  one  case  after  an  intravenous  injection  of  24  gm.  atoxyl, 
but  even  noted  severe  symptoms  of  intoxication,  such  as  marked 
psychic  irritation,  severe  colic  and  on  the  second  day  nephritis. 
Finally  Monod  reported  lasting  results  in  three  stallions,  which 
in  part  were  treated  with  arsen-trisulfid  alone  (15-30  gm.  per  os), 
the  others  alternately  receiving  atoxyl. 

The  local  treatment  of  the  swellings  with  astringent  washes 
and  the  suppuration  of  the  testicles  or  lymph  glands  in  accord- 
ance with  the  rules  of  surgery  are  only  of  subordinate  im- 
portance. 

Prevention.  Stallions  and  mares  should  be  examined  before 
coitus  as  to  their  health,  and  horses  with  inflammatory  changes 
on  the  genital  organs  should  be  excluded  from  coitus  on  general 
principles.  Besides  this  it  is  advisable  to  wash  the  penis  of  the 
stallion  after  every  covering  with  a  sponge  dipped  in  clean 
water. 

Veterinary  Police.  The  veterinary  police  measures  depend 
on  the  principle  that  horses  affected  with  dourine  should  be 
excluded  from  breeding  once  and  for  all.  Such  measures  appear 
to  be  justified  in  spite  of  the  possibility  of  a  complete  recovery, 
by  the  frequent  relapses  and  also  by  the  fact  that  trypanosomes 
may  be  present  for  months  in  the  genital  organs  of  apparently 
recovered  animals.  Accordingly  affected  stallions  should  be 
castrated,  while  affected  mares  should  receive  a  distinctive 
branding.     The  relatively  late  development  of  the  symptoms 


Prevent  inn,  \  ek-iinary  Puliee. 


835 


cbaraeteristic  of  tlie  disease,  as  well  as  the  possibility  of  a 
healthy  stallion  transmitting-  the  disease  from  an  afrected  maro 
to  a  healthy  animal,  ajjpear  to  justify  an  action  rcciuii-iiii;-  tliat 
healthy  stallions  which  have  covered  mares  affectecl  with  doiii-iiic 
should  be  considered  the  same  as  those  affected. 

Literature.  Ilertwijj,  Mag.,  1S42.  VIII.  1209;  1847,  XI 11.  :57:i.  —  RoiiKot, 
A.  P.,  isTil.  717.  —  Schneidor  &  Buffani,  Kiv.,  1900.  SI;  J.  vet.,  1902.  144;  A.  i'., 
1900.  XIX.  71;").  —  Marek,  Z.  f.  Tin.,  1900.  IV.  401;  D.  t.  W.,  1909.  121.  —  Korii, 
Z.  f.  Till.,  190.5.  IX.  2r.9.  —  Liiiganl,  Cbl.  f.  B.,  1904.  XXXVII.  ;j:?7.  —  BaMrey, 
J.  of  I'oinp.  Path.,  1905.  XVTII.  1.  —  Sieber  &  Goiuler,  A.  f.  Schiffs-  u.  Trophyg., 
1908.  XII.  24ti.  —  riilenhiith  &  Woithc,  Arb.  d.  G.-A.,  1908.  XXIX.  4u:i  (Lit.  on 
cheiiiotlierapv).  —  FriilimT.  Moiili.,  1909.  XX.  :585.  —  Zwi.-k.  D.  t.  W.,  19ln.  Xr.  9 
Beibl. 


(d)    Mai  de  Caderas. 

History.  The  etiology  of  the  disease  (Mai  de  caderas=hip  disease) 
was  cleared  up  by  Elmassian,  when  in  li)0]  he  found  trypaiiosomes  in 
the  blood  of  horses  at  Argentine.  Voges,  Za])ala  and  Ijignieres  eon- 
lirmed  the  finding,  and  furnished  further  eontri1)Uti(ins  on  the  etiology 
as  well  as  symptomatology  of  the  disease. 

Occurrence.  Until  the  present  time  the  disease  has  been 
diagnosed  exclusively  in  the  sub-equatorial  countries  of  South 
America:  Brazil,  Argentine,  Bolivia  and  Paraguay,  as  well  as 
on  some  islands  of  the  delta  of  the  Amazon  River. 


According  to  Lacerda  the  disease  is  supposed  to  have  been  introduced  from 
the  islands  of  Marajo,  westward  and  southward,  and  resulted  in  some  localities 
of  Brazil  in  a  complete  annihilation  of  the  horses.  There  are  marshy  localities  in 
Argentine  in  which  up  to  25%  of  the  horses  die,  and  it  is  stato<l  that  a  cavalry 
regiment  lost  100  out  of  600  newly  purchased  horses  within  half  a  yeai-  (Voges). 

Etiology.  The  trypanosoma 
equinum  (Th.  Elmassiani)  is  similar 
to  the  parasite  of  nagana,  with  the 
only  difference  that  its  blepharoplast 
is  very  small  and  can  be  stained  only 
with  difficulty  (Lignieres;  Fig.  150). 

Ruminants  and  hogs  are  only 
slightly  susceptible  to  artificial  infec- 
tions; other  animals  have  a])out  the 
same  susceptibility  as  for  the  organ- 
ism of  nagana.  In  horses  infected 
subcutaneously  with  blood  disturb- 
ances in  locomotion  develop  in  the 
later  stages  of  the  disease  in  a  strik- 
ing manner  (similarity  with  dourine). 
The  disease  cannot  be  reproduced,  even  in  susceptible  animals, 
by  feeding  fresh  blood  containing  numerous  parasites  (Zabala). 
Animals  immunized  against  nagana  or  surra  are  still  suscep- 
tible to  caderas  and  vice  versa. 


Fig.  150.  Tri/iKiiioi^oma  equi- 
num s.  Klniussiuni.  Guinea  ])ig 
blood;  stained  after  Komanow- 
sky-Zieman. 


836  Mai  de  Caderas. 

The  natural  mode  of  infection  lias  not  yet  been  elucidated. 
At  first  it  was  thought  that  stinging  flies  were  the  transmitters 
of  this  disease,  especially  the  stomoxys  brava  (Mosca  brava) 
and  tabanidae  as  well  as  possibly  also  mosquitoes  (Lignieres  & 
Zabala,  Voges) ;  according  to  the  observation  of  Elmassian  & 
Migone,  however,  horses  which  are  separated  from  affected  ani- 
mals only  by  a  fence  remain  healthy  in  spite  of  ])eing  swarmed 
by  stomoxys  flies. 

Later  the  last-named  authors  connected  a  rodent  with  the  appearance  of  the 
disease  (Hydroehoeriis  capibara,  vidg.  Oarpincho),  observing  that  these  animals 
sometimes  die  in  great  numbers,  and  that  hunting  dogs  which  have  eaten  their 
flesh  also  become  aft'ected,  whereupon  the  disease  soon  breaks  out  among  horses. 

Anatomical  Changes.  These  consist  usually  in  an  acute 
swelling  of  the  spleen  and  the  hnnph  glands,  accumulation  of 
sero-fibrinous  exudate  in  the  serous  body  cavities  and  in  the 
joints,  hemorrhagic  nephritis,  parenchymatous  degeneration  of 
the  internal  organs,  besides  hemorrhages  and  serous  infiltra- 
tion of  the  muscles  of  the  croup. 

Symptoms.  A  weakness  of  the  hind  parts  is  noticeable 
from  the  onset  of  the  disease,  as  the  animals  show  a  staggering 
gait,  bringing  forward  the  hind  legs,  dragging  them  on  the 
ground,  and  frequently  knuckling  in  the  tarsal  joints.  With  the 
rapidly  progressing  emaciation,  the  paraparesis  reaches  a  very 
high  degree,  so  that  the  patients  rise  from  the  ground  with 
difficulty,  after  which  they  stand  with  legs  spread  apart,  and 
can  not  be  made  to  move.  Finally  they  are  unable  to  rise, 
and  then  the  sphincter  ani  becomes  relaxed  and  the  rectum 
fills  with  balls  of  feces  or  defecation  becomes  involuntary. 

The  body  temperature  shows  a  febrile  elevation  atypical 
in  character,  urticaria-like  swellings  appear  on  the  skin  which 
become  covered  with  small  crusts;  subcutaneous  edemas  are 
observed  but  rarely,  and  then  only  on  the  lower  al)domen,  while 
swelling  of  some  of  the  joints  is  frequently  observed.  The 
urine  contains  albumen  and  frequently  some  blood,  the  latter 
sometimes  in  great  quantities.  Inflammation  of  the  conjunc- 
tivae and  cornea  is  a  frequent  complication.  The  appetite  re- 
mains good  until  the  end. 

The  course  is  always  unfavorable.  After  the  appearance 
of  the  disturbances  in  locomotion  the  animals  usually  succumb 
in  1  to  2  months,  but  there  is  also  a  chronic  form  of  the  affec- 
tion (known  in  Paraguay  as  Baacy-poy^slow  emaciation), 
which  develops  very  gradually,  so  that  the  emaciation  and  weak- 
ness of  the  hind  parts  becomes  apparent  only  after  months. 

Trypanosomes  are  found  in  the  blood  only  in  acute  cases 
in  considerable  numbers,  while  otherwise  tlieir  demonstration 
is  successful  only  by  inoculation  of  test  animals  (mouse,  rat). 

The  disease  runs  under  similar  manifestations  in  mules 
and  asses. 


Syiuptoius,  Treatment   and   I'leveiitiuii.  ^i^J 

Treatment  and  Prevention.  Eliiiidi  &  Slii^a  found  trypan 
red  el't'i'ctive  in  t'X]»i'rinieiits  on  niice  a.i^ainst  the  trypanosomes 
of  Mai  de  caderas.  For  practice  however  no  satisfactory  method 
of  treatment  is  known. 

In  consideration  of  the  fact  that  the  mode  of  natural  in- 
fection is  still  unknown,  no  certain  })reventive  measures  can 
l)e  established.  Nevertheless  keeping-  the  solii)eds  from  marshy 
pastures,  and  tlie  destruction  of  affected  horses,  may  prove 
beneficial. 

Literature.  Klmassian  &  Mi^one.  A.  P.,  190.3,  XVI T.  241  u.  1904.  XVIII.  587. 
—  Vo^es.  Z.  f.  HvK.,  1902.  XXXIX.  323.  —  Ligiiieres,  Bull.,  1903.  .51. 

Other  Trypanosome  Diseases,  liesides  the  affections  considered 
above  other  diseases  of  domestic  animals  have  been  described,  the  classi- 
fication of  which  however  is  at  present  still  donbtful.  The  most  im- 
portant will  be  set  forth  briefly  in  the  following: 

1.  Gambia  Fever  of  Horses.  This  is  caused  by  the  trypano.some 
dimoi'phon  iliscovered  by  Dutton  &  Todd  in  Senegaml)ia.  It  occurs  in 
the  blood  of  horses  shortly  after  infection  in  a  short  tadpole  form,  and 
in  the  latter  stages  in  a  longer,  more  slender  form,  in  both  of  which  the 
plasma  extends  almost  to  the  anterior  end  of  the  flagella.  The  clinical 
symptoms  resemble  those  of  nagana,  only  subcutaneous  edema  is  alisent 
(for  treatment  see  p.  802). 

The  transmission  of  the  parasite  is  supposed  to  occur  by  the  C'los- 
sina  palpalis.  In  recent  times  the  same  trypanosome  has  been  demon- 
strated in  different  localities  of  Africa,  not  only  in  horses,  but  also  in 
other  domestic  animals,  as  the  cause  of  an  affection  which  is  mostlv 
chronic  (Laveran  &  :\Iesnil,  C.  R.  1904.  CXXXVIII.  732). 

2.  Zousfana.  0])served  by  Szewczyk  and  Rennes  in  Algeria  in 
solipeds.  and  attributed  to  a  particular  trypanosome  similar  to  the  Tr. 
sudanense.  The  disease  runs  a  chronic  course,  with  symptoms  of  anemia 
and  hemoglol)inuria,  hut  without  edema.  Possiblv  identical  with  nagana 
cr  surra,     i  Sz.-wezyk.  Bull..  1903.  220.— Rennes. "ihid.,  1907.  298.) 

3.  Soumaya  (Souma).  Described  by  C'azalbou  as  a  disease  of 
horses  in  the  French  Sudan  and  supposed  to  occur  also  among  mules, 
cattle  and  sliet-p  in  the  upper  valley  of  the  Xijcer  and  the  adjoining 
territories.  Its  cause,  the  Trypano.soma  Cazalhoui,  was  described  as  a 
new  species,  its  nucleus  being  placed  near  the  rounded  posterior  end. 
Dogs  and  small  test  animals  are  not  susceptible.  According  to  Buft'ard 
it  is  also  virulent  for  cattle,  and  is  transmitted  by  stomoxys  flies.  Symp- 
toms in  horses  are  anemia,  swellings  of  the  skin  and  weakness  of  the 
iiind  parts.  The  course  is  sometimes  acute,  covering  about  50  days,  at 
other  times  it  nuiy  extend  over  a  year.  Thiroux  &  Teppaz  reported  good 
results  from  treatment  with  atoxyl  and  aurijugment.  or  with  auri])ig- 
ment  alone.  (Cazalbou.  Acad,  de  med..  1904. — Laveran.  A.  P..  1907, 
XXI.,  325.— Buft'ard.  Soc.  biol..  1907,  71.— Thiroux  &  Teppaz,  C.  R., 
1908,  CXL,  651.) 

4.  Baleri.  r)ccurs  quite  frequently  among  solipeds  in  certain  lo- 
calities in  the  Sudan,  with  symptoms  of  fever,  infiltration  of  the  skin, 
anemia.  <^maciation.   and  muscular   weakness.     Its  course   is  from   3-4 


838  Trypanosome  Diseases. 

months.  The  Trypanosoma  Pecaiuli,  named  by  Laveran,  resemliles  the 
Tr.  diraorphon,  and  is,  according  to  Buffard,  said  to  be  transmitted  by 
the  Glossina  palpalis.  Dogs  are  also  susceptible.  ^  Thiroux  &  Teppaz 
found  the  auripigment  effective.  (Cazalbou,  Rev.  gen.,  1907,  IX,  564. — 
Boufifard,  A.  P.,  1908,  XXII,  1.) 

5.  Mbori  and  El  Debab  of  Camels.  (Maladie  de  la  mouche.)  The 
Sergent  brothers  in  Algeria,  and  Cazalbou  in  Timbuctu,  have  described 
this  as  an  independent  affection,  but  according  to  Laveran  it  is  supposed 
to  be  identical  with  surra.  The  camels  become  affected  with  symptoms 
of  anemia  and  emaciation,  also  turning  the  head  and  neck  to  the  side, 
while  edema  and  disturbances  in  locomotion  are  not  usually  observed. 
About  10%  of  the  dromedaries  are  supposed  to  be  affected  in  Algeria. 
(Laveran,  Acad,  de  med.,  1904. — Sergent  &  Ledoux,  Soc.  de  Path,  exot., 
1908,  22.) 

Other  Trypanosomes.  Besides  those  deserilied,  other  species  of 
trypanosomes  have  recently  been  found  in  domestic  animals;  some  of 
these  will  be  briefly  described  in  the  following : 

Trypanosoma  Theileri ;  first  demonstrated  by  Theiler  in  cattle  in 
South  Africa,  later  by  Schilling  in  Togo,  Szewczyk  &  Rennes  in  North 
Africa,  Sander  on  the  Island  of  Mafia  of  the  German-East  African 
protectorate,  Yalladares  in  Madras,  Luhs  in  Trans-Caucasia,  Pease  found 
it  in  India  also  in  buffaloes.  It  is  characterized  by  its  considerable 
size  (30-70  i^  long.  2-5  m  broad,  and  a  long  flagella.  First  it  was  con- 
sidered by  Theiler  as  the  cause  of  gall  sickness  (see  p.  783),  but  it 
appears  to  be  a  harmless  habitant  of  the  ])lood  of  cattle.  (Theiler, 
Comp.  Path.,  1903,  XVI,  192.— Mayer,  Z.  f.,  Infkr.,  1909,  VI,  46  [Lit.].) 

A  similar  trypanosome  was  found  by  Prank  in  great  numbers 
in  the  blood  of  German  cattle  in  Stein-Wingert  (Wiesbaden),  and 
named  by  Frosch  Tryp.  Frank.  Further  Knuth,  Rauchbaar  &  Morgen- 
stern  succeeded  in  demonstrating  trypanosomes  of  the  same  type  by 
inoculation  of  defibrinated  cattle  blood  into  sterile  be(^f  bouillon ;  in 
the  District  of  Oberwesterwald  in  7  out  of  25,  in  another  stable  10 
out  of  17,  and  in  a  third  6  out  of  9  otherwise  healthy  cattle,  which 
originated  from  various  localities  of  Germanv.  (Z.  f.  Infkr.,  1909,  V. 
313.— B.  t.  W.,  1910,  539  u.  610.) 

Also  very  similar  is,  according  to  Lingard,  the  Tryp.  himalayanum 
and  the  Tryp.  indicum,  further  the  Tryp.  muktesari,  this  however 
somewhat  smaller,  and  with  shorter  flagella  (C.  R.,  1908,  452),  also 
the  Tryp.  americanum,  which  was  by  Crawlev  found  frequently  in 
healthy  cattle  in  North  America  (An!  Ind.  Bull.,  119,  1909). 

Broden  described  the  Tryp.  congolense  as  a  special  species,  which 
frequently  causes  disease  in  the  Congo  especially  among  horses,  but 
also  among  other  domestic  animals  and  has  also  been  found  in  the 
northern  part  of  Rhodesia.  It  is  smaller  than  the  nagana  trypanosome, 
has  no  free  flagella,  and  otherwise  resembles  the  small  form  of  the 
Tryp.  dimorphon.  (Laveran,  A.  P.,  1910,  XXIV,  81.)  This  closely 
resembles  the  Tryp.  nanum,  which  was  demonstrated  by  Theiler  in 
Zambesia  and  in  Limpopo  in  cattle,  and  in  Zuzuland  in  a  horse.  (Soc. 
de  pathol.  exot.,  1909.) 

Mathis  &  Leger  observed  a  trypanosome  in  a  chicken,  which  they 
named  Tryp.  Calmettei.    (Soc.  biol.  1909,  LXVI,  452.) 

(See  also  Liihe,  Handb.  d.  Tropenkrkh.,  1906,  III,  124,  u.  Doflein, 
Lehrb.  d.  Protozoenkunde,  1909,  390.) 


TiyinuiosDUR'  Art'cctioiis  in    Man.  839 

Trypanosome  Affections  in  Man.  hy  Ihc  lindin^'s  of  Nepvcu 
(1898),  J)iittoii  (1902)  and  Castcllani  (19(n),  as  well  as  by  mimcrous 
sul)se(iiu'iit  confinnalions,  it  was  t'slal)lislu'(l  that  the  so-called  sleepiiifij 
sickness  of  the  negroes  is  caused  by  a  blood  parasite,  the  Trypanosoma 
gambiensis.  It  greatly  resembles  the  parasite  of  nagana,  and  is  also 
transmitted  into  the  healthy  body  of  man  by  the  tsetse  fly,  especially 
by  the  Glossina  ]^alpalis.  The  disease,  which  occurs  in  tropical  Africa, 
manifests  itself  in  the  first  stage  (Trypanosome  fever)  in  irregular 
fever,  ti-ansilory  edema,  and  erythema,  also  swelling  of  the  lymph 
glands  and  spleen.  If  the  patients  survive,  symptoms  of  the  slee])ing 
sickness  ])roi)er  develop  in  a  few  months.  Fatigue  with  frequent  head- 
aches, subcutaneous  edema,  diminution  of  the  intelligence,  and  tiiially 
symptoms  of  a  severe  meningitis,  especially  conspicuous  somnolence, 
whereupon  the  patients  die  in  a  deep  comatous  condition.  Good  results 
were  obtained  in  the  treatment  with  arsenical  preparations,  especiallv 
with  atoxvl.  (S.  Mense,  Handb.  d.  Tropenkrankh.,  1906,  III,  617.— 
Koch,  Beck  &  Kleine,  Arb.  d.  G.-A.,  1909,  XXXI,  1,  H.) 

Chagas  found  in  a  child  in  Brazil  a  trypanosome  (Tr.  Cruzil), 
which  supposedly  is  transmitted  by  the  Cinorrhinus  insect.  The  symp- 
toms were  similar  to  those  of  the  African  trvpanosome  fever.  (A.  f. 
Schiffs,  u.  Tropenhyg.,  1909,  XIII,  351.) 


3.    Spirochaetosis  of  Fowls.    Spirochaetosis  avium. 

(SpiriUosis  or  Spirochaefosis  of  Chickeus;  Spirillosis  f/dllinarion 

ef  anscrum.) 

SpiriUosis  represents  usually  a  fatal  septicemia  of  cliickeiis, 
^eese  and  ducks,  caused  by  a  screw-shaped  blood  parasite,  the 
Spirochaete  gallinarum. 

History.  Spirillae  were  first  demonstrated  as  disease  producers 
by  Sakharott'  (1891)  among  geese  in  Trans-Caucasia,  later  by  Marclioux 
&  Salimbeni  (1903)  in  Brazil.  At  first  it  appeared  as  if  two  different 
diseases  were  concerned,  but  Williamson  (1908)  and  Galli-Valerio 
(1909)  have  established  the  identity  of  their  causative  agents.  In  the 
meantime  Levaditi,  Borrel  &  IMarchoux.  Xeufeld  &  Prowazek  and 
Nuttall  have  contributed  to  the  etiology.  Uhlenhuth  and  his  co-workers, 
then  Levaditi  &  Mcintosh,  Dschunkowsky  &  Luhs  to  the  atoxyl  treat- 
ment of  the  disease. 

Occurrence.  The  disease  occurs  frequently  as  a  danj^erous 
plag-ue  among  cliickens  in  the  most  varied  localities,  while  in 
geese  and  ducks  it  has  been  found  only  sporadically. 

Outside  of  Brazil  the  chicken  spirillosis  has  been  met  with  to  the 
present  time  in  Bulgaria  (Gareitschnoff),  in  Roumania  (]\lezinescu), 
in  Cyprus  (Williamson),  in  Egypt  (Dreyer,  Balfour,  Bitter),  in  Tunis 
(Galli-Valerio,  Comte  &  Bou(|uet),  in  South  Africa  (Johnsohn.  Bevan, 
Mohr),  in  xVustralia  (Cleland),  and  in  India  (Greig,  Montgomery, 
Rainey)  ;  the  spirillosis  of  geese,  outside  of  Trans-Caucasia  (Sakharoff, 
Dschunkowsky  «&  Luhs)  only  in  Tunis  (Ducloux). 


840 


Spirillosis  of  Fowls. 


Fig.  151.      tSpirocJtaete    aiiserind.      Goose 
blood.      (After  Cantacuzene.) 


Etiology.  The  causative  agent  of  the  disease  (Spirochaete 
gallinarum,  Sp.  aiiserura)  is  a  blood  parasite,  probably  belong- 
ing to  flagellated  protozoa,  which  closely  resembles  the  cause  of 

recurrent  fever  of  man 
(Spirochaete  Obermeieri) 
which  has  been  known  for 
several  decades.  It  occurs 
in  fine  threads,  10-20  /^ 
long,  formed  similarly  to 
the  spiral  thread  of  a 
screw,  supplied  with  one 
or  more  cilia  (Borrel) 
which  move  actively  be- 
tween the  blood  corpuscles 
in  the  blood  of  living  ani- 
mals affected  with  the  dis- 
ease (Fig.  151).  They  dis- 
appear from  the  blood  shortly  after  death  and  in  drawn  blood 
they  remain  alive  at  best  only  for  2  to  3  days. 

Dschunkowsky  &  Luhs  are  reported  to  have  succeeded  in  cultivating  the  spiro- 
chaete of  geese  in  blood  plasma  of  geese  by  means  of  reed  sacks  in  the  body 
of  a  rabbit  up  to  the  third  generation;  later  indications  of  degeneration  became 
apparent  on  the  threads,  but  the  fluid  possessed  a  protective  action  against  artificial 
infections. 

The  disease  may  be  produced  easily  by  subcutaneous  in- 
jection of  blood  containing  spirillae  from  geese  to  geese,  from 
ducks  to  young  chicks,  but  only  with  difficulty  to  grown  chickens, 
w^hile  the  transmission  from  affected  chickens  to  chicken  species, 
as  well  as  to  water  fowl  is  readily  accomplished  (it  was  not 
possible  to  infect  monkeys  with  the  spirilla  of  chickens).  After 
a  subcutaneous  infection  in  chickens  a  considerable  number  of 
parasites  appear  on  the  second  day  independently  of  the  quan- 
tity of  inoculated  blood  wdiich  continue  to  increase  until  the 
fifth  day,  and  in  the  meantime  clump  together,  forming  great 
agglomeration  masses.  On  the  sixth  day  after  the  temperature 
has  fallen  rapidly,  they  disappear  from  the  blood,  whereupon 
death  ensues  or  the  animal  gradually  recovers. 

The  artificial  infection  is  also  successful  by  placing  infected 
ticks  upon  the  birds  (see  lower  down),  further  by  feeding  blood 
containing  spirillae,  as  w^ell  as  by  cohabitation  of  affected  with 
healthy  chickens. 

Brmnpt  described  the  Sp.  Nicollei  from  Tunis,  also  the  Sp.  Neveuxi  as  varieties 
of  the  chicken  spirochaete,  which  are  also  transmitted  to  chickens  by  the  Argas 
persicus;  between  this  and  the  chicken  spirochaete  only  immunizing  differences 
exist. 

The  natural  infection  is  in  chickens  transmitted  principally 
by  the  Argas  miniatus  tick,  more  rarely  by  the  Argas  persicus 
and  reflexus,  further  by  the  Ornithodorus  moubata.  These  ticks 
exist  freely  in  the  bushes  at  the  borders  of  forests,  etc.,  attach 


Etiuluj;y,     Aiiatoinical   Cliange.s,     Syiiii)toins.  g^\ 

tliemselvos  at  night  to  oliickeiis  and  suck  tlicir  hlood.  If  the 
blood  contains  spirocliaetes,  they  are  found  for  3  to  4  days 
in  the  digestive  canal  of  the  ticks,  whereupon  they  disappear 
from  there,  but  they  may  remain  infections  for  a  longer  time, 
according  to  Nnftall  even  after  six  montlis.  If  they  are  kept 
at  35  C,  the  pai'asites  innltii)ly  in  tlieir  bodies,  and  after  4 
to  5  days  they  may  ))e  found  in  the  excretory  duct  of  the  salivary 
ghuid  of  the  ticks  (Borrel  «t  Marclionx). 

Anatomical  Changes.  In  birds  dead  with  the  disease  tlio 
spleen  is  considerably  enlarged  and  swollen,  the  liver  swollen, 
showing  fatty  degeneration  and  focal  necrosis;  the  heart  muscle 
also  shows  at  times  fatty  degeneration  and  the  epicardinm  is 
covered  with  fibrinous  membranes.  No  spirillae  are  found  in 
the  blood. 

Symptoms.  The  incubation  is  in  chickens  7  to  9  days  after 
placing  infected  ticks  upon  them;  spirochaetes  may  however  be 
demonstrated  in  the  blood  as  early  as  from  the  fifth  day  on 
(Marchoux  &  Salimbeni,  Uhlenlmtli  &  Gross). 

The  symptoms  consist  in  inappetence,  rise  of  temperature 
as  high  as  42.5-43^  C,  marked  weakness  and  somnolence,  pale- 
ness of  the  comb,  diarrhea  and  emaciation,  with  wdiich  in  some 
cases  paralysis  of  the  legs  becomes  associated.  (Mohn  observed, 
even  before  the  appearance  of  spirochaetes  in  the  blood,  the 
feet  swollen  and  the  toe  turned  nnder  and  backwards..) 

After  the  somnolence  has  reached  a  high  degree,  the  crisis 
sets  in  1  to  2  days  later,  the  comb  taking  on  a  bluish-red  colora- 
tion, the  temperatnre  falls,  and  soon  death  follows,  usually 
nnder  severe  convulsions  or  recovery  commences.  Sometimes 
however  this  is  only  apparent,  as  the  paralysis  of  the  legs  in- 
creases and  gradnally  extends  to  the  wings,  the  birds  become 
greatly  emaciated,  and  finally  die  with  a  few  rare  exceptions 
(chronic  form). 

According  to  Xuttall  the  spirochetes  are  totally  or  mostly  destroyed 
by  bactericidal  and  agglomerating  substances  after  having  midtipiied 
for  a  time  in  the  blood.  The  more  resistant,  and  therefore  the  surviving 
parasites  are  then  the  cause  of  the  supervening  chronic  affection.  Serum 
of  birds  which  have  recovered  from  one  attack,  destroys  in  test  tube 
experiments  the  spirochetes  of  the  first  attack,  but  not  those  of  later 
attacks.  The  appearance  of  parasiticidal  substances  in  great  (inantitics 
in  the  blood  l)efore  the  crisis  is  reached  has  also  been  demonstrated  })v 
(labritschewsky^  and  Uhlenhuth. 

Bv  microscopical  oxaiiiiiiation  B]iiiocliaotes  may  l)o  ilemoiistratod  in  jjreat 
rmmbors  in  fresh  blood  ]>rei)arations  made  with  jdiysiolof^ical  salt  solution  until  the 
api)earance  of  the  crisis,  but  later,  and  also  in  animals  dead  of  the  disease,  they  are 
no  lnii<;er  present. 

The  duration  of  the  disease  in  the  more  frequent  acute 
cases  is  mostly  4  to  5,  in  the  chronic  cases  8  to  15  days. 


842  Spirillosis  of  Fowls. 

Treatment.  According  to  the  experiments  of  Ulilenlmth  & 
Gross,  which  were  later  confirmed  by  Levaditi  &  Mcintosh,  three 
subcutaneous  injections  of  0.05  gm.  each,  likewise  two  adminis- 
trations of  0.1  gm.  atoxyl  per  os,  protected  chickens  against  a 
simultaneous  or  an  immediately  preceding  or  subsequent  sub- 
cutaneous virulent  infection,  and  chickens  treated  in  this  man- 
ner apparently  acquired  a  lasting  immunity. 

Affected  chickens,  which  have  already  harbored  spirochetes 
in  their  blood  for  2  to  3  days,  but  which  are  not  yet  severely 
affected,  recover  from  a  single  intra-muscular  injection  of  0.05 
gm.  atoxyl,  when  the  parasites  disappear  from  the  blood  after 
34  hours  and  the  animals  survive.  In  the  internal  application 
of  the  remedy  double  doses  (0.1  gm.  per  os)  appear  to  have 
the  same  action. 

Uhlenhuth  &  Manteufel  found  atoxylate  of  mercury  more 
effective  than  atoxyl;  by  its  intra-muscular  application  (in  sus- 
pension with  olive  oil  and  gum  arable),  in  closes  of  0.1  gm., 
it  produced  recovery  even  at  the  height  of  the  blood  infection, 
and  in  earlier  stages  it  prevented  a  fatal  termination  even  in 
doses  of  0.04-0.06  gm.  Such  recovered  chickens  remain  immune 
against  later  infections. 

Dschunkowsky  &  Luhs  obtained  good  results  in  geese  with 
2  or  3  subcutaneous  injections  of  0.1-0.15  gm.  each  of  atoxyl, 
per  kilogram  of  body  weight. 

Finally,  according  to  the  favorable  results  in  the  treat- 
ment of  the  human  recurrent  fever  and  syphilis,  Ehrlich's 
amidoarsenobenzol  may  also  prove  effective. 

Immunization.  Blood  drawn  from  infected  chickens  is  no  longer 
infectious  after  48  hours,  and  if  injected  subcutaneoiisly  into  healthy 
chickens  produces  an  immunity  against  a  virulent  affection.  Fresh 
blood  heated  for  five  minutes  to  55°  C.  has  a  similar  action,  whereas 
when  heated  for  10  minutes  at  that  temperature  it  no  longer  produces 
immunity  (Marchoux  &  Salimbeni).  An  active  immunity  may  further 
be  produced  in  geese  with  emulsion  from  organs  of  geese  dead  of  the 
disease,  also  with  atoxyl  and  a  simultaneous  injection  of  virulent  blood, 
as  well  as  with  blood  from  infected  geese  which  have  been  kept  on  ice 
for  some  time  (Dschunkowsky  &  Luhs).  Blood  serum  from  geese  and 
chickens,  which  after  recovery  from  the  disease  were  treated  Avith  blood 
containing  spirillae,  protects  in  quantities  of  2  cc.  against  virulent 
infection.  Finally  horses  produce  serum  after  repeated  injections  with 
blood  containing  spirillae  which  in  a  quantity  of  3-5  cc.  renders  ineffec- 
tive in  geese  an  inoculation  made  24  hours  previously   (Sakharoff). 

Injections  of  immune  serum  in  the  blood  circulation  of  affected  birds  results 
in  death,  as  it  produces  an  agglomeration  of  the  spirochaetes  and  thereby  thrombosis 
of  the  blood  vessels   (Levaditi). 

Literature.  See  also  literature  in  Uhlenhuth  &  Gross,  Arb.  d.  G.-A.,  1907. 
XXVII.  231.  —  Further:  Sakharoff,  A.  P.,  1891.  V.  564.  —  Gabritschewskv,  Cbl. 
f.  Bakt.,  1898.  XXIII.  365.  —  Cantacuzene,  A.  P.,  1899.  XIII.  529.  —  Borrel  & 
Marchoux,  Soc.  biol.,  1905.  362.  —  Borrel,  ibid.,  1906.  —  Levaditi,  A.  P.,  1906.  XX. 
924.  —  Levaditi  &  Mcintosh,  Soc.  biol.,  1907,  XLII.  1090.  —  Neufeld  &  Prowazek, 
Arb.  d.  G.-A.,  1907.  XXV.  494.  —  Thlenhuth  &  Manteufel,  Z.  f.  Immf.,  1908.  I.  108. 
—  Dschunkowsky  &  Luhs,  Kongr.  Haag  1909.  —  Brumpt,  Soc.  path,  exot.,  1909.  TI. 


Spirochaeti's  in    Mammals.  §4.3 

Spirochaetes  in  Mammals.  Parasites  resembling  the  spiroehaetes 
of  fowls  niorpliologically  occur  sometimes  also  in  mammals,  their 
etiological  part  however  is  at  present  not  yet  cleared  up,  as  they  were 
met  with  either  in  healthy  animals  or  in  such  as  are  infected  with 
piroplasma  or  trypanosomes.  Transmission  experiments  have  not  given 
conclusive  results.  The  available  findings  are  therefore  described  only 
very  briefly  in  the  following: 

1.  Spirochaete  (Spirillum)  Theileri.  First  demonstrated  by 
Theiler  (l!)02)  in  the  Transvaal  in  febrili;  animals  together  with  piro- 
l)lasina  and  trypanosomes.  They  are  20-30  m  long,  spiral-sliaped  bodies. 
The  first  experiments  of  transmission  were  without  resulls,  later  how- 
ever Theiler  reported  that  lie  succeeded  in  transmitting  the  parasite 
from  cattle  to  cattle  and  to  sheep,  and  Dodd  also  found  that  they 
may  be  transmitted  from  aninuil   to  animal. 

According  to  Theiler  the  natural  infection  is  transmitted  by  the 
Boophilus  decoloratus  and  the  Rhipicephalus  Evertsi,  and  Laveran 
&  Vallee  succeeded  in  infecting  a  cow  at  Alfort,  by  placing  larvae 
of  the  first-named  species,  Avhich  originated  from  ticks  taken  from 
cattle  in  the  Transvaal.  In  this  case  spirochetes  appeared  in  the  blood 
between  the  fifteenth  and  the  nineteenth  day  without  the  development 
of  perceptible  symptoms.  Nevertheless  Theiler  lielieves  that  these 
l^arasites  are  independently  capable  of  producing  a  disease,  the  autopsy 
tindings  of  which  resemble  those  of  piroplasmosis. 

Evidently  the  ^aiiie  spirochetes  were  foiuul  by  Zieniaiiu  in  Kamerun  in  a 
f-alf,  by  Heanley  in  two  Chinese  buffalo  calves,  ami  by  Koch  in  Daressalam  in 
cattle. 

2.  Spirochaetes  Tschischir,  demonstrated  by  Djatsclienko  in 
Kuban  (Russia)  in  the  l)lood,  spleen  and  liver  of  cattle  which  were 
atfected  with  symptoms  of  an  infectious  hemoglobinuria.  The  parasite 
has  the  form  of  a  comma  or  of  an  "S"  and  can  i.e  cultivated  artificially 
(Vibrio?).     Transmission  experiments  were  negative. 

3.  Spirochaete  Ovina,  found  by  Martoglio  &  Carpano  in  Erythtaea 
simultaneously  with  endoglobular  parasites  in  a  sheep  affected  with 
febrile  symptoms.  It  forms  threads  10-20  m  long,  with  4-10  spiral 
windings;  artificially  they  could  not  be  transmitted. 

Theiler  also  reports  finding  spirochaete  in  sheep  in  the  Transvaal,  and  Zie- 
mann  in  Kanienm   (Dodd  considers  them   identical  with  the  Sp.  Theileri). 

4.  Spirochaete  Suilla,  found  by  Dodd  in  Pretoria  in  the  tissue 
of  superficial  ulcers  of  the  skin,  which  extended  over  the  entire  body 
of  hogs  (10-14  M  long,  with  2-6  spiral  M-indings).  Material  from  the 
ulcers  rubbed  into  the  scarified  skin  of  healthy  hogs  produced  a  similar 
skin  affection,  which  under  progressive  emaciation  usually  led  to  death. 
Similar  parasites  were  found  by  Cleland  in  West  Australia  in  fibrous 
nodules  of  castration  wounds. 

5.  Spirochaete  Equina.  Stordy  in  East  Africa  found  spirillae 
in  very  great  numliers  in  the  blood  of  a  horse  which  showed  a  fatal 
affection  with  symptoms  of  high  fever,  swelling  of  the  subcutis  and 
emaciation.      A    similar   finding   is    reported    by    Stordy   in    a   severely 


^44  Spirochaetosis  in   Man. 

affected  pony,  whose  blood  transmitted  the  parasite  to  horses,  cattle  and 
sheep,  and  he  considers  them  identical  with  the  Sp.  Theileri. 

Literature.  Theiler,  J.  of  Comp.  Path.,  1904.  XYIT.  47;  Bull.  P.,  1905.  II. 
617.  —  Djatschenko,  Cbl.  f.  Bakt.,  1904.  XXXV.  737.  —  Martoglio  &  Carpano,  Ann. 
d'Igiene  sperim.,  1904.  XIV.  577.  —  Laveran  &  Vallee,  C.  K.,  1905,  CL.  1515.  — 
Ziemann,  Cbl.  f.  Bakt.,  1905,  XXXVIIL  447.  —  Dodd,  J.,  of  Comp.  Path.,  1900. 
XIX.  318.  —  Heanley,  ibid.,  S.  322.  —  Stordy,  ibid.,  S.  226.  —  Tit^e,  Z.  f.  Infkr., 
1908.  IV.  139.   (Eeview  with  literature).  —  Knuth,  ibid.,  1910.  VII.  149  (recent  lit.). 


Spirochaetosis  in  Man,  Recurrent  fever  (Fehris  recurrens)  is 
known  as  a  spirochetosis  and  is  caused  by  the  Spirochaete  recnrrentis 
s.  Obermeierei  discovered  by  Obermeier  (1868).  The  affection  is  mani- 
fested by  severe  febrile  attacks  lasting  from  3  to  12  days,  and  recurring 
after  2  to  11  days.  In  most  cases  lasting  recovery  results  after  several 
febrile  attacks.  The  natural  transmission  appears  to  result  through 
the  agency  of  blood-sucking  arthropodes,  possibly  also  by  insects  and 
lice.  According  to  the  most  recent  observations  of  Iversen  in  Russia 
the  disease  may  be  cured  quickly  and  permanently  with  Ehrlich's 
Amidoarsenobenzol. 

A  similar  affection  in  the  tropics,  the  African  recurrent  fever,  or 
"tick  fever,"  is  produced  by  the  Spirochaete  Duttoni  (according  to 
Koch  identical  with  the  above),  and  is  transmitted  to  healthy  man  by 
a  tick  (Arnithodorus  moubata).  (Schilling,  JMense's  Handb.  d.  Tropen- 
krankheiten,  1906,  III,  668.) 

Since  the  discovery  by  Schaudinn  of  fine  spirochaetes  (Sp.  pallida, 
Treponema  pallidum)  in  the  syphilitic  organs,  syphilis  is  also  con- 
sidered as  a  spirochetosis.  This  view  has  received  material  support  by 
the  splendid  results  of  Ehrlich's  chemotherapy.  Besides  a  spirochete 
(Sp.  pertenuis)  was  found  by  Castellani,  as  a  probable  cause  of  the 
disease  in  Framboesia  tropica,  a  skin  affection  of  the  tropics  which 
clinically  resembles  syphilis.    (A.  f.  Schiffs-  u.  Tropenhyg.,  1907,  XI,  22.) 


Diseases  of  the  Blood  and   Blood- 
Producing  Organs 


1.    Anemia.    Anaemia. 

The  name  anemia  designates  the  absohite  diiniiintion  of 
the  hemoiilohin  in  the  blood  witliont  a  visible  alTection  of 
the  blood-producing  organs  and  without  symptoms  of  al)normal 
leucocytes  in  the  blood.  These  pathological  conditions  may 
depend  either  upon  a  more  or  less  uniform  diminution  of  ail 
of  the  constituents  of  the  blood  (Oligemia),  on  the  diminution 
of  red  ])lood  corpuscles  (Oligocythemia),  or  on  a  simple  dimi- 
nution of  the  blood-coloring  matter  in  the  presence  of  otherwise 
normal  numbers  of  red  blood  corpuscles  (Oligochromemia). 
In  the  majority  of  cases  Oligemia  and  Oligocythemia  are 
present  simultaneously,  and  in  severe  cases  the  water  contents 
of  the  blood  is  considerably  increased  at  the  expense  of  the 
other  constituents  (Hydremia). 

Etiology.  After  profuse  losses  of  blood  a  severe  anemia 
may  develop  in  a  short  time,  sometimes  even  in  a  few  minutes 
(Anemia  acuta)  ;  thus  after  phlebotomy,  epistaxis,  after  injury 
of  larger  blood  vessels,  after  bursting  of  aneurysms,  after  very 
profuse  parenchjTnatous  bleeding  (hemoglobinuria,  intestinal 
hemorrhages,  etc.),  also  after  severe  hemoglobinemia. 

In  the  majority  of  cases  the  development  of  the  anemia 
occurs  slowly  and  gradually  (Anemia  chronica).  Thus  re- 
peated losses  of  blood  may  in  time  produce  anemia.  A  con- 
tinuously insufficient  nutrition  has  an  important  part  in  the 
etiology  of  anemia.  The  unfavorable  action  of  the  food  may 
become  manifested  either  as  a  result  of  an  insufficient  quantity 
by  feeding  foods  deficient  in  proteids  or  in  iron.  The  effect  of  a 
qualitatively  insufficient  nutrition  may  be  assumed  in  anemia  of 
sheep  (the  so-called  chlorosis,  Cachexia  aquosa),  which  develops 
when  the  animals  are  pastured  in  marshy  moorland  pastures, 
or  after  failures  of  crops  if  the  animals  are  fed  in  winter  in- 
sufficiently on  poor  food-stuffs  such  as  beet  leaves,  etc.  In 
cattle  a  continuous  feeding  on  food  lacking  in  nutritive  ma- 
terial may  also  cause  severe  anemia    (Hydremia).     Thus  the 

845 


g46  Anemia. 

affection  results  with  relative  frequency  in  cattle  kept  near 
alcohol  distilleries  or  sngar  refineries  (Jost,  Hildebrandt, 
Arloing),  where  the  principal  food  consists  of  the  very  watery 
(up  to  95%)  slops,  beet  shavings  or  the  syrup-like  fluid  remain- 
ing after  the  refining  of  the  sugar.  _  The  affection  attacks 
preferably  working  oxen,  which  must  utilize  a  part  of  the  other- 
wise insufficient  nutritive  substances  for  the  execution  of  their 
work;  also  because  they  have  less  opportunity  after  satiating 
themselves  with  food  substances  abounding  in  water,  to  partake 
of  additional  solid  fodder  (Eoloff).  Horses,  sheep  and  goats 
become  affected  from  the  same  cause  much  more  rarely.  In 
this  form  of  anemia  toxic  substances  and  acids  which  form 
during  the  storing  of  these  foods  apparently  have  an  accessory 
action.  (Arloing  attributes  the  development  of  the  disease 
exclusively  to  the  action  of  these  substances.)  Werner  observed 
anemia  and  hydremia  in  hogs  in  connection  with  the  feeding 
of  watery  food. 

The  anemia  of  sheep  and  cattle  previously  mentioned  is  considered  by  various 
authors  as  an  independent  affection  under  the  name  of  chlorosis  of  sheep,  or  as 
hydremia  of  cattle.  This  does  not  appear  well  founded  on  account  of  the  fact  that 
these  conditions  are  differentiated  from  the  other  forms  of  anemia  only  by  special 
etiological  factors,  the  pathological  changes  corresponding  with  those  of  other 
forms. 

The  investigations  of  Carre  &  Bigoteau  appear  to  show  that  the  chronic 
intoxication  of  sheep  produced  by  the  bacillus  pseudo-tuberculosis  ovis  (Preisz) 
may  result  in  a  hydremic  condition  of  sheep. 

The  keeping  of  animals  in  poorly  ventilated  places  as  well 
as  lack  of  exercise,  may  in  itself  produce  anemia,  as  is  some- 
times observed  in  fattening  hogs,  in  milch  cows,  house  dogs,  etc. 

Anemia  may  develop  as  a  regular  symptom  in  chronic 
affections  with  disturbances  of  appetite  or  of  digestion,  or  in 
affections  with  great  loss  of  proteids  (long  lasting  suppuration, 
albuminuria,  persistent  diarrhea,  effusion  of  copious  transudate, 
exudate,  helminthiasis,  etc.),  or  in  increased  splitting  up  of 
proteids  (fever,  action  of  bacterial  toxins  in  various  chronic 
infectious  diseases,  mineral  poisons,  malignant  tumors). 

Blood  parasites  may  be  mentioned  as  another  cause  of 
anemia   (piroplasma,  trypanosomes,  Filaria  immitis). 

The  anemia  of  sucking  pigs  and  young  hogs,  which  has  been  ob- 
served by  Braasch  in  Schleswig-Holstein  and  which  caused  great  losses 
in  some  locahties,  is  not  yet  sufficiently  cleared  up.  This  very  severe 
anemia  which  appears  already  in  the  first  M-eeks  of  life,  may  be  the 
result  of  an  unnatural  keeping  of  the  breeding  hogs,  but  the  action 
of  an  infectious  substance  (bacillus  pyogenes)  cannot  be  excluded  with 
certainty. 

Guittard  reported  on  a  disease  in  chicks  which  appeared  in  some 
localities  of  France  as  an  infectious  anemia  with  symptoms  of  severe 
anemia  and  weakness,  developing  soon  after  hatching,  and  resulting 
in  death  in  a  few  days. 

The  occurrence  of  chlorosis  in  animals  is  not  yet  proven.  In  human  medicine 
a   disease  is   designated   by  this   name,   which  usually   occurs   during  the  period   of 


Etioloyy,  Anatomical   Changes,  Symptoms.  847 

Iiuberty,  cspciMally  in  girls,  ami  is  associated  with  a  (liiniuution  of  the  heiiiOf,'lobin 
contents  of  tiie  red  bIoo«l  corpuscles.  It  subsides  after  a  systemic  administration 
of  iron.  The  allection  of  slieep  designated  under  this  name  is,  as  aheady  men- 
tioned, not  identical  with  tliis  disease. 

Anatomical  Changes.  All  organs  of  animals  which  have 
died  as  a  result  of  hemorrhage  are  characterized  by_  a  con- 
spicuous paleness  and  by  the  absence  of  blood;  this  is  most 
readily  recognized  in  the  lungs,  which  appear  pale  pink  in  color. 
At  the  same  time  the  heart  and  the  large  blood  vessels  con- 
tain only  small  amounts  of  loose  blood  coagulum.  In  chronic 
anemia  blood  is  frequently  found  in  nearly  normal  amount  in 
the  heart  and  in  the  blood  vessels,  but  it  appears  paler,  more 
watery,  stains  the  hand  only  slightly  and  contains  only  little 
loose  gelatinous  coagulum.  Fatty  degeneration  of  the  parenchy- 
matous organs,  especially  of  the  lieart  muscles  and  of  the 
kidneys  is  "not  infrequent.  Dropsical  development  is  almost 
constantly  found  in  chronic  fatal  anemia. 

Symptoms.  The  s^miptoms  of  acute  anemia  develop  in  ac- 
cordance with  the  severity  of  the  hemorrhage,  sometimes  very 
rapidly,  at  other  times  somewhat  more  slowly.  The  animals 
become  much  depressed,  perspire  profusely,  stagger  and  sway 
in  walking.  The  mucous  membranes  become  gradually  more 
and  more  pale,  finally  even  porcelain  white;  the  heart  action 
is  throbbing,  the  pulse  at  first  frequent,  tense  and  small,  later 
however  soft  and  empty.  The  respiration  is  accelerated  and 
labored;  a  conspicuous  cooling  off  develops  in  the  peripheral 
.parts  of  the  body;  there  is  also  muscular  trembling.  If  the 
animal  has  lost  great  quantities  of  blood  within  a  short  time 
its  entire  behavior  expresses  great  anxiety,  it  sways,  finally 
falling  to  the  ground,  becomes  unconscious  and  dies  in  con- 
vulsions if  the  bleeding  continues. 

The  sjmiptoms  of  chronic  anemia  develop  much  more 
slowly  and  persist  for  a  longer  time.  The  mucous  membranes 
appear  very  pale,  pink  colored,  in  severe  cases  almost  milky 
or  porcelain  white.  There  is  langiior,  easy  fatigue  even  on 
quiet  walking;  after  j^rolonged  exercise  the  animals  commence 
to  sway  and  sometimes  even  fall  to  the  ground.  At  rest  they 
appear  somnolent  and  indifferent  and  lie  down  a  great  deal. 
The  frequency  of  the  heart  action  increases  considerably,  even 
on  very  slight  external  causes.  The  heart  sounds  sometimes 
become  imperceptible  or  indistinct  owing  to  the  false  sounds; 
the  pulse  is  at  the  same  time  weak.  In  severe  cases  slight 
hemorrhages  appear  in  various  organs.  Further  sjmiptoms  of 
severe  anemia  are  diminished  appetite,  irregular  movement  of 
the  bowels,  accelerated  and  superficial  respirations,  lusterless 
hair,  in  sheep  drjmess  and  dullness  of  the  wool.  The  nutrition 
is  at  first,  and  sometimes  also  in  the  later  stages  satisfactory, 
the  anemia  however  which  is  caused  by  organic  affections  or 
insufficient  feeding  causes  emaciation. 


348  Anemia. 

Corresponding  to  tlie  intensity  of  tlie  affection  tlie_  blood 
appears  lighter,  its  hemoglobin  content  diminished  (in  the 
determination  with  Fleisclil's  or  Gower's  hemoglobinometer 
under  70°,  in  very  severe  cases  even  between  30-40°).  The 
nnmber  of  red  blood  corpuscles  is  diminished  and  may  fall  to 
3,000,000  to  2,000,000  per  cubic  millimeter.  Besides  in  severe 
cases  the  red  blood  corpuscles  may  show  a  poikilocytosis ;  that 
is  they  are  smaller  or  larger,  angular,  elongated,  supplied  with 
projections,  club  or  biscuit-shaped.  Not  infrequently,  especially 
in  an  anemia  which  has  developed  rapidly  nucleated  red  blood 
corpuscles  may  be  found  (erythroblasts)  in  suitably  stained 
preparations  (with  hemotoxylin-eosin),  further  in  some  of  the 
red  blood  corpuscles  basophilic  granules,  the  remains  of  broken- 
down  nuclei  of  the  erythroblasts  are  observed.  The  number  of 
white  blood  corpuscles  is,  as  a  rule,  increased  on  account  of  the 
increase  of  polynuclear  leucocytes  (in  one  of  the  authors'  cases 
180,000  white  blood  corpuscles  could  be  counted  per  cubic  milli- 
meter of  blood).  Through  these,  also  as  a  result  of  the  diminu- 
tion of  the  red  blood  corpuscles,  the  numerical  relation  of  the  two 
becomes  much  closer  (in  one  case  of  anemia  caused  by  the 
Filaria  immitis,  the  authors  observed  the  relation  of  red  blood 
corpuscles  to  the  white  as  18:1),  so  that  the  examination  of 
unstained  blood  preparations  may  cause  confusion  with 
leukemia. 

As  the  clinical  methods  of  blood  examination  give  only  relative  values  of 
a  certain  volume,  the  degree  of  anemia  cannot  always  be  established  from  the 
number  of  red  blood  corpuscles  or  from  the  hemoglobin  content,  especially  so 
since  the  proportional  values  may  be  normal  in  spite  of  the  present  anemia,  for 
instance  in  the  oligemia  which  occurs  exceptionally  without  qualitative  changes  of 
the  constituents  of  blood,  as  well  as  in  all  those  cases  of  anemia  in  which  the 
animal  lost  eitlier  too  much  water  or  had  not  taken  any  water,  and  in  which 
a  thickening  of  the  blood  resulted  in  consequence   (Wetzl). 

After  a  time  edematous  swellings  appear  on  different  parts 
of  the  body,  on  the  lower  abdomen,  lower  chest,  in  the  sub- 
maxillary space,  at  the  lower  part  of  the  extremities,  being  not 
sharply  circumscribed,  but  flat  swellings  of  doughy  consistence. 
The  eyelids  may  show  a  pad-like  swelling  and  an  effusion  may 
take  place  into  the  body  cavities.  The  edematous  swellings 
are  especially  extensive  and  prominent  after  feeding  very 
watery  food  stuffs,  thus  in  anemias  of  cattle  in  sugar  factories 
the  swelling  may  increase  to  such  an  extent  that  it  renders  the 
movement  of  the  animal  entirely  impossible.  In  this  stage  of 
the  disease  the  animals  are  usually  affected  with  diarrhea,  by 
which  they  are  weakened  still  more,  finally  they  are  unable  to 
stand  up  and  succumb. 

Jost,  Hildebrandt  and  Moussu  have  described  other  peculiar  mani- 
festations in  hydremia  of  cattle  in  sugar  factories.  Sometimes  the 
affected  animals  suddenly  collapse  during  walking,  others  die  after  a 
sickness  lasting  but  a  few  days  in  the  course  of  a  few  hours  as  if  struck 
by  apoplexy.     Some  are  entirely  incapable  of  passing  feces  as  a  result 


Symptoms,  Course,  Prognosis.  349 

of  the  weakness  of  the  al)doniina]  and  ])ody  iiiust-lcs.  Then-  is  polyuria, 
in  Avhieh  a  vei-y  pale  Avatery  urine  of  low  specific  gravity  is  passed; 
sometimes  profuse  salivation  is  present.  In  acute  cases  the  autopsy 
may  reveal  a  gastro-intestinal  inflammation. 

Course.  Great  losses  of  l)lood  may  produce  death  inside 
of  a  few  lioiirs,  or  even  in  a  few  minutes,  wiiile  the  duration 
of  chronic  anemia  may  extend  to  sevei-al  inontlis  ami  even  years. 
This  occurs  esjiecially  in  anemia  whicli  develops  in  association 
with  chronic  diseases.  Ascites  of  sheep  and  cattle  lasts  at 
least  from  3  to  6  months  or  even  lon,2:er,  but  some  animals  may 
die  in  a  shorter  time.  The  last  mentioned  sliort  course  may 
however  be  only  apparent  if  the  first  indications  escape  de- 
tection. 

Diagnosis.  The  recognition  of  anemia  causes,  as  a  rule, 
no  diflieulty.  It  may  be  confounded,  especially  on  a  single 
examination,  with  pronounced  weakness  of  the  heart  and  a 
general  collapse  of  the  blood  vessels  which  result  also  in  a 
conspicuous  paleness  of  the  peripheric  parts  of  the  body. 
Simple  anemia  is  distinguished  from  pseudo-leukemia  or  from 
leukemia  by  the  normal  condition  of  the  l)lood-forming  organs, 
and  also  by  the  condition  of  the  wdiite  blood  corpuscles.  Fur- 
ther the  milder  cases  may  be  distinguished  from  pernicious 
anemia  by  the  normal  appearance  of  the  blood  corpuscles,  on 
the  other  hand  from  the  severe  cases  by  the  absence  of  giganto- 
cytes  and  gigantoblasts,  as  well  as  by  the  severe  general  affec- 
tion._  In  horses  infectious  anemia  should  also  be  taken  into 
consideration. 

In  all  cases  of  anemia  however  it  should  be  aimed  to  de- 
termine the  fundamental  affections,  the  recognition  of  which  is 
of  great  value  from  a  prognostic  and  therapeutic  standpoint. 

Prognosis.  The  acute  anemia  which  develops  after  great 
losses  of  blood  terminates  with  suitable  nutrition  of  the  animal 
almost  without  exception  in  a  relatively  short  time  in  recovery. 
By  the  ingestion  of  large  amounts  of  water  the  blood  attains 
within  a  few-  days  its  original  quantity,  the  salts  and  the  proteids. 
being  rapidly  replaced  from  the  food.  Only  the  replacement 
of  the  red  blood  corpuscles  requires  a  longer  time,  up  to  several 
weeks ;  after  exceedingly  large  losses  of  blood  the  recovery  may 
require  even  several  months,  and  may  not  follow^  at  all  even 
after  suitable  treatment.  If  the  animal  has  lost  at  least  half 
of  the  normal  quantity  of  its  blood  within  a  short  time,  there 
exists  no  longer  any  hope  for  its  improvement. 

The  prognosis  of  chronic  anemia  depends  on  the  nature 
of  the  fundamental  affection.  In  the  independent  forms  how- 
ever the  prognosis  depends,  not  only  upon  the  degree  of  anemia, 
but  also  upon  the  condition  that  the  cause  of  the  disease  is 
capal)le  of  removal,^  although  under  favorable  conditions  the 
disease  us'.ially  terminates  in  recovery,  the  course  of  an  already 

Vol.  1—54 


850  Anemia. 

existing  dropsy  can  no  longer  be  influenced  in  spite  of  suitable 
care  and  treatment. 

Treatment.  In  acute  anemia,  if  bleeding  still  continues, 
the  hemorrhage  should  first  of  all  be  arrested ;  in  external  hemor- 
rhage by  surgical  measures,  internal  bleedings  by  the  adminis- 
tration of  hemostatic  remedies.  Most  satisfactory  are  Ergot 
(15-25.0  or  0.5-2.0  gm.  of  the  extract;  5-10.0  or  0.2-1.0  gm. 
per  os;  the  extract  may  also  be  used  subcutaneously  in  half 
doses).  Ergot  in  (1-2.0  or  0.02  to  0.2  gm.)  Extractum  Hydrastis 
(10-15.0  gm.  subcutaneously  for  horses) ;  very  good  results  may 
further  be  obtained  by  intravenous  injections  of  adrenalin  or 
suprarenin  (1-5  cc.  of  a  solution  of  1:1000  per  100  kg.  body 
weight).  The  transfusion  of  blood  from  a  healthy  animal  of  the 
same  species  can  hardly  be  accomplished  in  practice,  while  the 
infusion  of  physiological  salt  solution  into  the  veins  (combined 
with  adrenalin  or  suprarenin),  or  into  the  rectum  is  frequently 
carried  out  and  may  be  a  life  saver.  In  cases  developing  less 
suddenly  an  increased  partaking  of  water  may  increase  the 
fallen  blood  pressure,  the  ingestion  of  water  should  however 
be  permitted  only  after  the  cessation  of  the  hemorrhage. 

Berger  always  obtained  good  results  by  infusions  of  salt  solutions  into  the 
rectum  (10-20  liters  of  a  0.6%  solution  for  horses  and  cattle).  The  infusion  should 
be  made  slowly  and  the  rubber  tube  of  the  irrigator  should  be  introduced  far  into 
the  rectum. 

Flatten,  Dorn  and  Frick  constructed  suitable  appliances  for  the  application 
of  intravenous  injections  of  physiological  salt  solution,  but  the  infusion  may  be 
carried  out  in  emergency  with  the  aid  of  a  simple  rubber  tube  and  funnel.  The 
solution  should  be  sterilized  by  boiling  and  then  cooled  down  to  body  temperature. 

Albrecht  repeatedly  injected  defibrinated  blood  drawn  from  healthy  horses 
under  the  skin  of  affected  horses.  The  blood,  which  was  kept  at  40°  C,  was 
injected  in  quantities  of  80  cc.  with  the  aid  of  a  syringe  of  suitable  size  into 
various  parts  under  the  skin  of  the  abdomen  and  facilitated  the  absorption  by  mas- 
saging the  place  of  injection.  In  this  manner  he  succeeded  in  injecting  l^^ 
liters  of  blood  under  the  skin  of  the  abdomen  in  a  short  time. 

In  all  cases  of  anemia  special  care  must  be  taken  in  regulat- 
ing the  diet.  The  necessary  substances  for  the  formation  of 
blood  (proteids  and  nutritive  salts)  should  in  the  first  place 
be  given  in  increased  amounts.  Best  adapted  are  nutritious 
food  stuffs  (oats,  barley,  legumin,  good  hay,  meat,  etc.),  in 
very  weakened  animals  yolks  of  eggs,  milk,  strong  bouillon 
mixed  with  eggs,  in  the  absence  of  appetite  the  animals  should 
be  drenched  with  this  food.  In  primary  anemia  with  normal 
digestion  the  purely  dietetic  treatment  alone  frequently  pro- 
duces an  improvement  progressing  from  day  to  day  and  even 
complete  recovery  may  result  in  a  relatively  short  time.  The 
food  should  be  given  in  small  rations  but  frequently.  In  anemia 
brought  on  by  feeding  food  stuffs  lacking  in  nutritive  qualities, 
above  all  substances  saturated  with  water,  recovery  may  be 
obtained  in  such  cases  which  are  not  very  severe,  by  a  suitable 
change  in  food,  particularly  by  the  substitution  of  dry  foods. 
An  edema  which  may  be  present  does  not  require  any  special 
treatment. 


Treatment.  351 

Of  tlie  medicinal  agents  iron  is  first  to  be  considered.  Tlie 
selection  of  the  iron  preparations  is  considerably  influenced 
by  its  price,  otherAvise  the  iron  preparation  should  be  adminis- 
tered for  a  long  time  and  in  not  too  small  doses.  Of  the 
nnmerons  prei)arations  employed  Ferrum  pnlveratmn  (2-5  gm. 
for  large  animals,  0.5-1.0  gm.  for  sheep,  0.02-0.1  gm.  for  dogs, 
should  be  given  for  a  dose  three  times  a  day),  Ferrum  sulfuricum 
(in  same  doses)  may  be  mentioned.  It  is  advisable  to  administer 
both  with  stomachics  and  salines.  For  drinking  water  the 
water  in  which  the  red  hot  pieces  of  iron  are  cooled  in  black- 
smith shops,  may  be  given.  For  small  animals  Ferrum  hydr. 
reductum  (0.005-0.01  gm.  with  sugar  in  powder),  Ferr.  lacticum 
(0.02-0.1  gm.),  or  Tinct.  Ferri  pomati  (10-20  drops),  are  suita- 
ble. In  the  presence  of  ina])petence  a  small  quantity  of  hydro- 
chloric acid  should  be  added  to  the  drinking  water.  Arsenic 
(of  Fowler's  solution  10-30  gm.  for  large  animals,  2-10  drops 
for  small;  0.1-0.3  gin.  or  0.001-0.005  gm.  of  the  arsenious  acid) 
may  also  be  administered,  as  according  to  experience  it  aids 
metabolism.  In  small  animals  the  Tablettae  ferri  peptonati 
cum  arseno  sec.  Bleyer  may  be  conveniently  administered  (daily 
1  to  3  tablets).  Evers  treats  anemia  with  Damholid  (100  gm. 
of  a  fresh  solution  subcutaneously  for  large  animals,  for  small 
animals  the  same  amount  per  os). 

Literature.  Ailoing,  C.  R.,  1892.  770.  —  Berger,  B.  Mt.,  1902.  8.  — 
Braasch,  Monh.,  1891.  II.  59.  —  Carre  &  Bigoteau,  Eev.  gen.,  1908.  XI.  4.33.  — 
Dorn,  B.  t.  W.,  1906.  433.  —  Dralle,  A.  f.  Tk.,  1886.  XII.  71.  —  Evers,  B.  t.  W., 
1905.  201.  —  Flatten,  Ibid.,  1906.  697  —  Frick,  D.  t.  W.,  1904.  253.  —  Guittard, 
Pr.  vet.,  1897.  32.  —  Hildebrandt,  Pr.  Mt.,  1857/58.  114;  1858/59.  120.  —  Jost, 
Ibid.,  1857/58.  114.  —  Petzold,  S.  B.,  1863.  86.  —  Pflug,  W.  f.  Tk.,  1857.  413.  — 
Plate,  B  t.  W.,  1906,  713.  —  Pr.  Vb.,  1902.  II.  34.  —  Werner,  W.  f.  Tk.,  1897. 
186.  —  Wetzl,  Klinische  Blutuntersuchungen,  Diss.  Budapest  1908. 

2.    Infectious  Anemia  of  Horses.    Anaemia  Infectiosa  Equorum. 

(Swamp  fever  of  Itorses,  Malarial  fever  of  the  horse,  River 

bottom  disease,  Loin  distemper;  lufel'tiose  BJutarmut  der 

Pferde  [German] ;  Anemie  infectieuse,  Anemie  per- 

nicieuse,  Typho-anemie  infectieuse  du  cheval 

[Carre  S  Vallee],  Anemie  perniciense 

progressive,  Anemie  epizootique 

[French  ] . ) 

Infectious  anemia  is  a  specific  infectious  disease  of  the 
horse  species  which  is  manifested  sometimes  as  an  acute,  at 
other  times  as  a  chronic  septicemia,  and  causes  a  destruction 
of  great  numbers  of  red  blood  corpuscles.  It  is  caused  by 
an  ultra-microscopical  microorganism. 

History.  Originally  it  was  without  a  donbt  confounded  with  the 
idiopathic  simple  anemia.  As  an  independent  disease  it  was  first  de- 
scribed by  Lignee  (1843).  and  almost  simultaneously  by  Charlier  (1843) 


352  Infectious  Anemia  of  Horses. 

and  Denoc  (1843),  and  was  associated  with  conditions  of  feeding,  the 
more  so  as  later  Delafond  (1851)  failed  in  its  artificial  transmission. 
Its  infectious  nature  was  first  indicated  by  Anginiard  (1859).  Later 
Zschokke  (1883)  reported  several  cases  of  pernicious  anemia  observed 
by  him  in  Switzerland,  which  in  part  developed  as  an  outbreak,  and 
clinically  as  well  as  anatomically  completely  corresponded  with  the 
infectious  anemia,  the  same  as  the  cases  observed  somewhat  later  by 
Frohner  (1886)  and  Ostertag  (1890)  in  Germany.  As  a  matter  of 
fact  Frohner  considered  the  pernicious  anemia  of  horses  even  at  that 
time  as  an  infectious  disease.  The  nature  of  the  disease  was  cleared 
up  in  all  details  by  Carre  &  Vallee  (1904-1906)  ;  further  contributions 
on  the  disease  were  furnished  by  Ostertag  (1907),  Marek  (1907)  and 
Hempel  (1909). 

Ekwall   (1895)   described  an  enzootic  anemia  of  horses  in  Sweden, 
which    also    corresponded   with    the    infectious   anemia   clinically    and 
.anatomically,  but  its  identity  with  infectious  anemia  cannot  be  estab- 
lished positively  for  the  reason  that  Brickmann  recently    (1904-1906) 
demonstrated  parasites  in  the  blood  in  a  similar  affection  of  horses. 

Occurrence.  The  disease  is  observed  among-  horses,  al- 
though other  solipeds  may  be  infected  artificially,  and  it  is 
probable  that  they  may  here  and  there  become  also  affected 
by  natural  infection.  It  appears  in  more  or  less  circumscribed 
localities,  in  the  first  place  in  marshy  places,  usually  as 
a  disease  confined  to  single  or  several  adjoining  premises,  and 
causes  considerable  economic  loss  because  the  disease  as  a  rule 
leads  sooner  or  later  to  death.  Sporadic  cases  of  the  disease 
may  also  be  observed,  namely,  through  the  introduction  by 
newly  purchased  affected  or  infected  horses,  which  then  under 
certain  conditions  may  alone  become  affected,  wdiile  the  otlier 
animals  of  the  premises  may  be  spared. 

lu  France  infectious  anemia  prevails  in  the  northeastern  territories,  above 
all  in  the  entire  valley  of  the  Meuse,  further  in  the  districts  of  Aube,  Marne, 
Cote-d'Or,  Meurthe-et-Moselle,  and  was  recently  observed  by  Dupas  also  in  Chalons. 
In  some  of  the  localities  it  causes  very  great  losses,  which  according  to  Vallee  are 
estimated  for  the  Department  at  200,000  francs  annually. 

In  Germany  the  disease  occurs  less  extensively  than  in  the  adjoining  terri- 
tories of  the  infected  French  districts,  especially  in  Lorraine  (Kopke,  Jarmatz, 
Ostertag),  further  in  the  district  of  Trier.  Hochstein  observed  it  in  a  horse  stable 
in  Bavaria. 

In  Hungary  the  disease  was  established  by  Marek  upon  three  premises  m 
three  different  counties. 

From  what  was  already  said  it  appears  that  the  disease  occurs  also  in 
Switzerland  and  probably  in  Sweden.     It  was  likewise  observed  in  Mexico. 

To  all  appearances  infectious  anemia  of  horses  has  a  far  greater  geographical 
distribution  than  appears  from  the  data  mentioned,  only  it  is  frequently  confounded 
with  other  internal  diseases.  Thus  in  certain  cases  the  so-called  skalma  is  probably 
as  a  matter  of  fact  an  infectious  anemia. 

Etiology.  The  fundamental  investigations  of  Carre  & 
Vallee,  the  results  of  wdiich  ^vere  later  fully  confirmed  by  Oster- 
tag and  Marek,  show^ed  that  the  contagion  of  infectious  anemia 
belongs  to  the  ultra-microscopical  microorganisms.  The  virus 
passes  the  porous  (Chamberland-Berkefeld)  porcelain  filters 
and  cannot  be  demonstrated  by  staining  methods  or  by  cultiva- 
tion. 


Etiology,  Patliugenicity,  Natural  Infection.  853 

The  virus  is  present  in  llic  liUxjd,  in  the  urine  and  in  the 
feces  of  the  alfected,  also  of  the  apparently  recovered  animals. 
The  saliva  has  no  infectious  pr()i)erties  (Ostertag).  Whether 
there  exists  any  kind  of  a  relation  between  infectious  anemia 
and  horse  pest  has  not  been  decided  (see  p.  28G). 

Tenacity.  Tlio  virus  lo>es  its  virulence  entirely  when  heated  to  58°  C,  dry- 
injj  at  rouin  teniiierature  does  not  influence  it;  thus  dry  blood  perum  was  found 
liarndess  onlv  after  seven  months  (Carre  &  Vallee).  In  storing  the  Mood  without 
dryiujr  it  loses  its  infectiveness  oidy  after  three  months.  Tlie  virus  resists  putre- 
faltion  for  a  lonj,'  time,  even  in  stronjjly  ammoniacal  substances  (urine,  manure). 
Thus  Carre  &  Vallee  found  urine  of  an  infected  horse,  kept  in  a  manure  pit,  virulent 
even  after  2i-l>  months. 

Pathogenicity.  The  disease  may  be  produced  artificially 
in  horses  by  intravenous  or  subcutaneous  administrations  of 
virulent  blood  or  blood  serum,  immaterially  whether  larger 
quantities  (up  to  750  cc.)  or  very  small  quantities  (1  cc.) 
are  injected  (Carre  and  Vallee).  The  disease  of  the  test 
animals  is  indicated  by  a  febrile  rise  of  the  temperature,^which 
according  to  Carre  and  Vallee  always  occurs  within  5  to  9 
<lays;  in  one  of  Marek's  cases  however  the  incubation  lasted 
for  18  days.  The  disease  in  test  animals  rarely  develops  with 
the  same  characteristics  as  in  animals  from  which  the  blood 
has  been  procured.  To  produce  a  successful  infection  per  os, 
larger  quantities  (at  least  15  cc.)  of  virulent  blood  or  urine 
are"  necessary  according  to  Ostertag,  and  in  such  cases  the 
incubation  also  extends  over  a  longer  time,  15  to  24  days.  The 
incubation  period  may  however  be  shortened  by  the  repeated 
administration  of  great  quantities  of  virulent  material.  Donkeys 
cannot  always  be  infected  (Carre  &  Vallee,  Marek),  while  other 
domestic  animals,  also  small  test  animals  are  entirely  resistant 
(Carre  &  Vallee,  Ostertag,  Marek).  Man  also  resists  the  in- 
fection. 

The  experiments  of  Ostertag  and  Marek  proved  that,  after  an  intestinal  as 
well  as  subcutaneous  or  intravenous  infection,  the  disease  in  test  horses  not  infre- 
quently runs  a  chronic  course,  and  aside  from  i>eriodical  rises  in  temperature,  for 
a  long  time  causes  no  noticeable  disturbances,  a  condition  which  deserves  notice 
in  transmission  tests. 

Natural  infection  may  occur  indirectly  through  the  inges- 
tion of  food  or  drinking  water  contaminated  by  urine  or  with 
feces  of  aifected  animals.  As  the  urine  and  feces  always  con- 
tain the  virus,  but  especially  during  the  febrile  attack,  and  as 
it  is  very  resistant  against  outside  influences,  there  is  an  ample 
opportunity  aiforded  for  indirect  infection.  The  virus  is  taken 
up  either  with  the  bedding  or  with  the  grass  in  the  pasture, 
or  the  food  may  become  contaminated  by  attendants  or  in 
other  ways,  especially  in  insanitary  staldes.  AVith  the  ichor, 
or  more  directly  with  feces  or  urine,  the  virus  may  contaminate 
the  drinking  Avater,  for  instance  by  draining  from  the  manure 
pit  or  in  the  pasture.  On  the  other  hand  a  direct  transmission 
does  not  appear  to  occur.    Carre  tV:  Vallee  failed  in  demonstrat- 


854  Infectious  Anemia  of  Horses. 

ing  an  intermediate  action  by  any  parasitic  insects.  Contrary 
to  this  Ries  asserts  that  the  infection  is  transmitted  by  the 
larvae  of  gad-flies  or  mosquitoes.  He  failed  however  to  sub- 
stantiate his  contention  by  experimental  proof. 

Infection  only  results  when  either  large  quantities  of  viru- 
lent material  are  taken  at  one  time,  or  from  the  taking  of  smaller 
quantities  at  frequent  times.  Accordingly  the  occasional  in- 
gestion of  a  mouthful  of  contaminated  hay  or  straw  does  not 
appear  at  all  dangerous  (Ostertag), 

AVhether  the  affection  which  sometimes  occurs  in  the  suck- 
ing foals  of  affected  mares,  results  from  an  intrauterine  con- 
tamination or  an  infection  through  the  milk  cannot  be  decided. 

The  introduction  of  the  disease  in  previously  uninfected 
premises  invariably  occurs  through  newly  bought,  affected  or 
apparently  recovered  horses,  whose  blood  however  continues  to 
retain  its  infectiousness  (Marek).  As  long  remissions  are  by 
no  means  rare  in  the  chronic  forms  of  the  disease,  and  as  in 
the  cases  of  slow  course  only  very  few  apparent  sjanptoms 
are  generally  noticeable,  it  happens  not  infrequently  that  horses 
suffering  with  the  disease  are  offered  for  sale. 

Anatomical  Changes.  The  infectious  anemia  of  horses  is 
characterized  by  the  anatomical  changes  of  an  acute  or  chronic 
septicemia,  with  visible  changes  of  the  blood,  in  which  the 
changes  depending  on  the  duration  of  the  disease  may  show 
very  pronounced  variations. 

The  spleen  in  acute  cases,  or  in  animals  which  have  died 
during  a  relapse  of  the  disease,  appears  considerably  enlarged, 
sometimes  double  or  four  times  its  size.  Its  capsule  is  tense 
and  covered  with  hemorrhages,  the  pulp  is  blackish-red,  dis- 
tended, mushy,  sometimes  even  liquefied,  as  in  anthrax.  Some- 
times in  the  otherwise  normal  or  more  or  less  enlarged  spleen, 
various  sized  nodulated  protuberances  are  found,  which  repre- 
sent softened  areas  of  a  blackish-red  color.  The  slower  the 
course  the  less  marked  is,  as  a  rule,  the  swelling  of  the  spleen, 
while  in  a  very  protracted  course  it  may  be  entirely  absent, 
but  in  such  cases  the  consistency  of  the  organ  is  rather  some- 
what increased.  All  of  the  h^npli  glands  of  the  body  show 
acute  swelling  and  a  hemorrhagic  condition  is  noted  in  cases 
in  which  hemorrhages  have  occurred  in  the  corresponding 
organs;  in  chronic  cases  however  the  lymph  glands  either  fail 
to  show  an  edematous  swelling  or  it  is  but  slight.  Subserous 
hemorrhages  are  usually  found.  In  chronic  cases  however 
they  are  not  prominent.  Hemorrhagic  ppots  up  to  the  size 
of  a  silver  dollar  are  especially  numerous  under  the  peri- 
toneum of  the  cecum  and  colon,  they  occur  also,  but  in 
smaller  numbers  in  other  parts  of  the  peritoneum.  A  yel- 
lowish or  reddish  serous  fluid  may  be  present  in  small  quan- 
tity in  the  abdominal  cavities.  Usually  numerous  hemorrhagic 
spots  are  seen  in  acute  cases  under  the  capsule  of  the  more 


Anatomical  Changes. 


855 


or  less  enlarged  liver,  the  substance  of  which  is  usually  yellowisli, 
discolored,  and  may  be  so  brittle  that  a  rupture  may  result 
(Carre  &  Vallee).  In  the  intestinal  mucous  membrane  either 
single,  roundish  hemorrhages  appear,  or  the  mucous  membrane, 
especially  in  the  large  intestines,  may 
manifest  diffuse  hemorrhages,  when 
a  more  or  less  bloody  consistency  of 
the  intestinal  contents  is  noted. 
Hemorrhages  are  less  frequent  in  the 
stomach,  but  they  may  sometimes  oc- 
cur. The  heart,  with  the  exception  of 
the  very  slow  cases,  shows  subperi- 
or  subendocardial  and  intramuscular 
hemorrhages,  their  number  and  size 
being  usually  in  an  inverse  proportion 
to  the  duration  of  the  disease  (in  very 
acute  cases  the  heart  appears  as  if 
sprinkled  with  blood).  The  kidneys 
and  the  lungs  contain  small  hemor- 
rhages only  in  acute  cases,  at  the  same 
time  there  is  always  a  parenchyma- 
tous inflammation  of  the  kidneys, 
heart  muscle,  and  the  liver  substance. 
The  mucous  membranes  of  the  urinary 
bladder  sometimes  show  hemon-hagic 
spots  of  recent  or  older  origin. 

■  Conspicuous  and  constant  changes 
are  present  in  the  bone  marrow,  in  the 
proximal  long  bones  of  the  extremi- 
ties, especially  so  in  the  bones  of  the 
upper  thigh  or  upper  arm,  the  bone 
marrow  is  changed,  either  for  its  en- 
tire length  or  only  in  parts,  to  a  dark 
brownish-red  or  blackish-red  mass 
(Fig.  152).  In  the  cases  with  slower 
course  only  various  sized  circum- 
scribed areas  are  found  in  the  fat 
marrow  or  this  may  appear  normal. 
At  the  same  time  however  the  spong\^ 
bone  marrow  shows  the  above  changes 
or  at  least  a  reddish  discoloration.  The 

spongy  bone  marrow  of  the  vertebrae,  ribs,  etc.,  numifests  simi- 
lar changes.  Even  in  the  most  chronic  cases  at  least  small  hem- 
orrhages are  found,  which  however  appear  of  a  pecuHar  ink- 
black  color  if  of  earlier  origin.  This  condition  of  the  bone 
marrow  does  not  result  from  hemorrhages,  but  represents,  as 
in  older  losses  of  blood  in  general,  only  a  regenerative  process, 
and  consists  in  an  increased  activity  of  the  blood-forming  ele- 
ments of  the  red  marrow  areas,  the  normal  occurrence  of  which. 


Fio;.  152.  Infectious  anemia. 
Femur  of  a  horse.  Longitudinal 
section ;  a  dark  red  area  in  fat 
marrow  ;  h  normal  yellow  bone 
marrow  ;  c  ditVuse  dark  red  dis- 
coloration of  the  sponirj'  mar- 
row; d  small  dark  red  foci. 


856 


Infectious  Aiienua  of  Horses. 


in  tlie  fat  or  gelatinous  marrow,  especially  in  the  femur  and 
humerus  was  already  indicated  by  Skiba. 

In  acute  cases  of  the  disease  the  blood  shows  no  peculiar 
macroscopical  changes  with  the  exception  of  slower  coagula- 
tion, while  in  the  more  chronic  cases  indications  of  an  anemia 
appear.  This  is  increased  in  proportion  to  the  duration  of 
the  disease.  Moderate  edematous  infiltrations  of  the  subcu- 
taneous, perirenal,  as  well  as  in  the  intermuscular  connective 
tissue  between  the  mesenteric  layers,  further  icteric  discolora- 
tion of  the  tissue  are  not  infrequent  occurrences,  while  marked 
emaciation  is  frequently  observed. 

Symptoms.  The  period  of  incubation  after  a  subcutaneous 
or  intravenous  infection  varies  between  live  and  nine  da3^s, 
and  may  also  be  the  same  after  an  intensive  natural  infection. 
Ordinarily  however  it  probably  lasts  for  2  to  3  weeks,  as  was 
noted  in  the  experiments  of  Ostertag  and  Marek  (see  p.  854). 
With  respect  to  the  duration  and  the  symptoms,  two  clinical 
forms  of  the  disease  may  be  recognized  to  good  advantage, 
between  which  however  no  sharp  line  can  be  drawn,  and  con- 
sequently Carre  &  Vallee  have  even  described  a  subacute  form. 

The  acute  form  appears  quite  suddenly  with  distinctly 
pronounced  s^nnptoms.  A  conspicuous  depression  and  general 
weakness  develops,  as  a  result  of  which  the  animals  rapidly 
tire,  and  sometimes  even  fall  down  while  in  motion.  Then 
they  rise  only  with  great  difficulty  or  can  regain  their  feet  only 


Fig.  153.     Fever  curve  in  the  acute  form  of  infectious  anemia  of  horses. 

with  human  assistance.  At  the  same  time  the  weakness,  as 
in  all  general  infectious  diseases,  is  distinctly  noticeable  in  the 
hind  parts.  Frequent  tripping,  or  an  uncertain  use  of  the 
hind  leg  may  also  be  observed  quite  frequently.  Sometimes  the 
position  of  the  body  is  similar  to  that  in  laminitis. 

Fever  sets  in  at  the  same  time  (see  Fig.  153),  and  after 
a  gradual  rise  of  the  temperature,  reaches  its  height  on  the 
second   or   third   day    (40-40.5°,   sometimes    even   42°    [Carre 


Symptoius.  857 

&  Valleo]),aiid  then  it  may  remain  at  the  same  height,  at  least 
intermittentlv,  nntil  the  fatal  termination  of  the  disease. 
Sometimes  intermissions  of  1  to  2  days  are  observed  (see  F'lii;. 
153).  The  number  of  pulse  beats  increases  up  to  GO  to  1)0 
per  minute,  the  pulse  appearing  weak  and  soft,  the  heart's 
action  however  stronger.  Exercise  of  even  short  duration 
produces  a  considerable  increase  of  frecjuency  of  the  heart's 
action  and  a  temporary  irregularity  of  the  pulse. 

The  conjunctivae  a])pear  somewhat  swollen  and  of  a  uni- 
form washed-out  red  color  with  a  somewhat  yellowish  tint, 
sometimes  sliowing  hemoi-rhages  ui)  to  the  size  of  a  dime,  ir- 
regular in  shape  (principally  in  the  membrana  nictitans).  At 
the  same  time  slight  lachr\Tnation  is  present.  The  nasal  mucous 
mend)rane  also  appears  reddened  and  shows  punctiform  hemor- 
rhages, especially  on  the  nasal  septum.  Not  infrequently  there 
is  a  scanty  serous,  sometimes  also  reddish  colored  nasal  dis- 
charge, in  some  instances  a  cough  is  also  observed. 

Diarrhea,  with  passing  of  l)roken  ])alls  of  feces  or  fluid 
excrement,  which  may  be  stained  reddish  or  covered  with  blood 
coagulum  is  frequently  present.  The  urine  is  passed  at^  short 
intervals,  and  contains  albumen,  which  may  reach  ISi^o  in 
amount  but  is  usually  found  in  much  smaller  quantities.  In 
the  sediment  of  the  lirine  granular  or  epithelial  casts  may  be 
found. 

The  appetite  is  depressed  from  the  beginning.  At  the  same 
time  a  rapidly  increasing  emaciation  is  noticeable  which  may 
progress  so  rapidly  that  the  animals  may  lose  one-fourth^  to 
one-third  of  their  body  weight  in  a  few  days  (Carre  &  Vallee), 
or  they  mav  emaciate"  inside  of  two  weeks  almost  to  skeletons. 
Verv  slight  edematous  swellings  in  the  distal  parts  of  the 
extremiti'es,  the  lower  chest  and  the  lower  abdomen,  are  also 
not  infrequentlv  observed. 

Coagulation  of  the  blood  is  retarded,  the  separated  blood 
serum  appears  darker  yellow,  or  even  somewhat  greenish  and 
dichroic.  The  numl)er  of  red  blood  corpuscles  diminishes  in 
proportion  to  the  duration  of  the  disease,  so  that  after  10  to 
15  davs  a  diminution  of  1,000,000  to  2,000,000  may  be  demon- 
strated. Immediately  before  the  fatal  termination  however  the 
number  may  be  reduced  to  one-half  (Carre  &  Vallee).  xVs  the 
relative  number  of  the  red  blood  corpuscles  depends  also  con- 
sideral)lv  on  the  existing  water  contents  of  the  blood,  there  may 
be  decided  variations  in  this  respect,  in  spite  of  the  fact  that 
a  considerable  reduction  of  the  absolute  quantity  of  the  red 
blood  corpuscles  exist  (see  p.  848). 

The  detemiination  of  the  relative  quantity  of  nd  bloo.l  corpuscles  with  a 
test  tube  as  first  recommended  by  Zschokke,  is  particularly  suitable  for  practical 
purposes  Auv  desired  test  tube  is  filled  with  blood  drawn  from  the  veins,  then  is 
allowed  to  stand  in  water  at  a  temperature  of  10-12°  C.  for  a  half  hour;  then  the 
length  of  the  sections  of  the  test  tube  measured  are  those  which  contain  the  blood 
plasma  and  the  laver  of  the  deposited  red  blood  corpuscles.  Finally  the  ratio 
between    the    two    is    calculate    from    these    measurements.      (Normally    the    length 


858 


Infectious  Anemia  of  Horses. 


1? 


"^ 


of  the  blood  plasma  in  the  tube,  com- 
pared with  that  of  the  layer  of  the  red 
blood  corpuscles,  is  in  a  ratio  of  6:4.) 
It  is  advisable  to  employ  specially  gradu- 
ated test  tubes  for  this  purpose. 

The  red  blood  corpuscles 
appear  pale,  and  in  their  cell 
bodies  basophilic  granules 
(fragments  of  the  cell  nuclei) 
may  be  recognized,  which  may 
be  mistaken  for  endoglobular 
parasites  (Carre  &  Vallee). 
Contrary  to  the  observations 
of  Carre  &  Vallee,  Ostertag 
and  Marek  found  no  changes 
in  the  form  of  the  red  blood 
corpuscles. 

According  to  the  view  of  the  authors 
the  apparent  poikiloeytoses  are  frequently 
only  artifacts.  If,  for  instance,  the  blood 
is  smeared  onto  a  cover  glass  in  a  some- 
what thicker  layer  or  in  a  moist  place, 
the  red  blood  corpuscles  assume  the  most 
varied  changes  of  form  because  of  the 
somewhat  slow  drying. 

Under  gradual  loss  of  the 
strength,  finally  an  apparent 
paralysis  of  the  hind  parts  de- 
velops; not  infrequently  how- 
ever the  animals  are  capable 
of  standing  almost  until  the 
time  of  death.  In  pregnant 
mares  al)ortion  results  almost 
invariably. 

The  duration  of  this  acute 
form,  according  to  Carre  & 
Vallee,  is  from  5  to  15  days, 
on  an  average  one  week,  but 
according  to  Marek 's  observa- 
tions the  disease  may  in  young 
foals  last  only  1  to  2  days,  and 
in  adult  animals,  on  the  other 
hand,  not  infrequently  for  3 
to  4  weeks   (see  Fig.  154), 

The  chronic  form  of  the 
disease  manifests  itself  with 
periodical  febrile  attacks  and 
with  indications  of  anemia, 
which  is  not  recognizable  in  the 
acute  form,  on  account  of  the 
peculiar  diffuse  red  coloration 
of  the  mucous  membranes. 
The  febrile  attacks  appear  at 


Syiuptouis.  g^t) 

intervals  ol'  several  ilays,  up  to  several  weeks  or  even 
loiii>er,  exceptionally  even  after  months  (Carre  &  Vallee). 
They  develop  without  any  ol)vioiis  course,  and  last  from 
2  to  3  (lays  or  even  for  several  days.  The  rise  and  also 
the  fall  of  the  tem])erature  always  occurs  gradually  (see  Fi^. 
154).  Durinp:  the  febrile  rise  of  temperature  the  pulse  is  also 
more  or  less  increased,  sometimes  however  only  vei'y  slightly. 
In  cases  which  are  not  too  chronic  a  moderate  increjise  in  pulse 
exists  also  in  the  afebrile  jx'riods  which  becomes  well  nuirked 
even  on  unimportant  external  influence,  and  then  appears 
weaker.  Other  febrile  symptoms,  such  as  diminished  appetite, 
depression,  muscular  tremblinii:  are  absent  in  very  ])rotracted 
cases,  so  that  if  no  systenu^tic  temperatures  are  taken,  in  these 
cases  they  can  only  be  recognized  in  the  advanced  stage  of 
their  development. 

The  mucous  membranes  a])pear  at  the  beginning  either 
normal  in  color  or  slightly  reddened,  in  the  later  stages  how- 
ever they  become  continuously  paler  in  color,  while  during  the 
febrile  attack,  or  during  a  temporary  improvement  of  the  con- 
dition, they  may  present  normal  or  at  least  nearly  normal  color. 
Heinorrliages  are  rare  in  the  visible  mucous  membranes,  but 
they  may  nevertheless  occur. 

The  urine  usually  contains  small  quantities  of  albumen 
in  the  not  very  protracted  cases,  otherwise  however  it  may 
only  ai)pear  periodically,  especially  during  the  febrile  attacks. 
Not  infrequently  a  periodical  fetid  diarrhea  sets  in,  and  here 
and  there  colicky  s}^nptoms  are  observed. 

Edematous  sw^ellings  of  the  extremities,  or  of  the  low^er 
parts  of  the  rump  or  the  head  (on  the  head  especially  in  pastur- 
ing animals)  are  a  not  infrequent  occurrence. 

The  blood  coagulates  only  slowly  also  in  this  form,  so  that 
hemorrhages  resulting  from  external  causes  can  be  stopped  only 
with  difficulty.  The  number  of  red  corpuscles  diminishes  con- 
sideral)ly,  even  to  2,000,000  per  cubic  millimeter  of  blood 
(Carre  &  Vallee).  The  number  of  blood  corpuscles  however 
varies  not  a  little  in  accordance  wdth  periodical  improvement 
or  aggravation,  and  their  diminution  may  in  very  protracted 
cases  persist  continuously  moderate ;  or  on  the  contrary,  after 
partaking  of  food  and  water  there  may  be  present  a  relative 
increase  in  red  blood  corpuscles  (see  p.  848).  Changes  in  the 
form  of  the  red  blood  corpuscles  are  missed  also  in  this  form 
of  the  disease  in  suitably  prepared  l)lood  specimens. 

The  nutrition  may  be  affected  from  the  onset  of  the  disease, 
or  on  the  contrary  in  a  slowly  progressing  case  it  may  remain 
satisfactory  for  weeks  or  even  for  months.  Finally  however 
emaciation  becomes  noticeable  even  in  these  cases.  It  does  not 
progress  uniformly,  but  at  times  may  come  to  a  standstill  or 
the  nutritive  condition  of  the  patients  may  improve  for  a  certain 
time. 

In  this  foi-m  the  dnrnticui   of  the  disease  is  from   one  to 


860  Infectious  Anemia  of  Horses. 

several  months;  not  infrequently  however  it  may  even  extend 
over  several  years  (Marek). 

Course  and  Prognosis.  The  acute  form  of  the  disease 
usually  leads  to  a  gradual  aggravation  of  the  symptoms,  deatli 
ensuing  without  any  struggle.  Sometimes  however  it  passes 
into  a  chronic  form.  Death  may  occur  unexpectedly  in  the 
acute  as  well  as  in  the  chronic  forms.  The  chronic  form  de- 
velops from  the  acute,  with  a  gradual  diminution  of  the  severe 
general  symptoms,  or  the  disease  may  have  developed  from 
the  beginning  with  a  chronic  character,  wdien  periodical  im- 
provements or  aggravations  of  varying  duration  may  be  ob- 
served. Tlie  fatal  termination  results  either  after  the  develop- 
ment of  the  cachectic  condition  or  because  the  disease  assumes 
an  acute  course. 

Recovery  is  observed  only  exceptionally  (Carre  &  Vallee, 
Ostertag,  Marek).  One  should  not  be  deceived  by  the  some- 
times very  lasting  improvement  in  the  chronic  form,  as  later 
a  relapse,  or  a  progressive  anemia  with  emaciation  usually 
occurs. 

In  a  large  stud  in  Hungary  with  a  great  number  of  horses,  in  which  the 
disease  prevailed  for  five  years,  there  were  several  horses  which  originally  were 
affected  visibly,  but  for  several  years  had  sliowed  no  symptoms  whatsoever,  but 
even  in  those  rare  eases  recovery  occurred  only  in  a  clinical  sense,  as  in  one  case 
blood  from  one  of  the  apparently  recovered  animals  proved  infectious  (Marek). 
A  similar  occurrence  had  previously  l)een  observed  by  Carre  &  A'^allee. 

The  epidemiology  of  the  disease  varies  greatly  with  the 
duration  of  the  individual  cases.  Usuall}^,  in  connection  vrith 
the  introduction  of  new  horses,  only  isolated  affections  occur 
at  first,  the  disease  taking  a  rapid  course  from  its  onset,  while 
in  very  chronic  cases  the  disease  is  only  recognized  when  a 
large  number  of  the  horses  have  already  become  infected  and 
affected  because  the  symptoms  are  for  a  long  time  very  obscure. 
If  in  such  cases  no  preventive  measures  are  introduced,  their 
number  increases  from  w^eek  to  week  and  the  animals  become 
attacked  without  reference  to  age  or  breed.  In  stables  how- 
ever, which  have  been  infected  for  a  long  time,  the  newly  in- 
troduced animals  become  affected  first  and  most  severely.  For 
this  reason  the  disease  is  usually  acute  in  newly  infected 
stables  (Carre  &  Vallee).  At  the  same  time  animals  in  otlier 
stables,  or  of  the  same  stable  kept  in  other  pastures  and 
watered  in  separate  places,  remain  temporarily  free  from  the 
disease  at  times  even  for  several  years. 

In  a  stud  in  Hungary  the  disease  did  not  appear  among  foals,  which  had  been 
kept  in  an  isolated  stable  or  on  a  separate  pasture,  until  four  years  after 
apparently  recovered  mares  had  been  placed  among  them. 

Diagnosis.  In  infected  localities  or  in  infected  stables,  the 
clinical  symptoms,  the  course  of  the  disease,  and  the  negative 


Diagnosis.  g(3]^ 

finding's  in  tlio  varions  organs,  nsnally  afford  snflicient  indica- 
tions for  a  diagnosis.  On  the  other  hand,  in  localities  which 
have  been  free  from  the  infection  the  disease  is  recognized 
Avith  certainty  only  on  antopsy  or  from  animal  inocnlations, 
while  the  clinical  syi>ii)toni8  aronse  oidy  well  fonuded  suspicion. 
Infections  anemia  is  indicated  especially  by  changes  of  a  sep- 
ticemic character,  such  as  hemorrhages  in  the  serous  mem- 
branes or  in  the  nnicons  membranes,  further  by  the  regular 
discoloration  of  the  bone  marrow  of  the  bones  of  the  upper 
extremities  (not  to  be  mistaken  for  the  normal  inclosures  of 
red  marrow!),  degeneration  of  the  parenchymatous  organs, 
swelling  of  the  spleen  and  edematous  infiltration,  without  other 
changes  in  the  organs.  The  complement  fixation  has  no 
diagnostic  value  (llempel). 

From  the  standpoint  of  differential  diagnosis  the  catarrhal 
form  of  influenza  barely  comes  into  consideration,  in  spite  of 
the  fact  that  its  s\nnptoms  resemble  the  acute  form  of  infectious 
anemia  not  a  little.  Nevertheless  it  can  always  be  easily  ex- 
cluded, above  all  on  account  of  its  rapid  extension  in  the 
affected  stables  and  by  the  fact  that  its  course  is  almost  always 
rapid  and  favorable;  in  influenza  the  catarrhal  symptoms  pre- 
dominate while  hemorrhages  in  the  mucous  membranes  are 
absent.  The  disease  may  be  mistaken  for  anthrax  in  the  acute 
form  of  infectious  anemia  in  the  living  animal  as  well  as  on 
autopsy.  Contrary  to  infectious  anemia  however,  in  anthrax 
the  rise  of  temperature  is  rapid,  and  at  the  same  time  cir- 
cmnscribed,  rapidly  extending  inflannnatory  edemas  appear  not 
infrequently  on  certain  parts  of  the  body,  also  colicky  pains 
are  not  infrequent,  the  conjunctivae  are  cyanotic,  there  is 
dyspnea,  and  the  disease  usually  terminates  in  1  to  3  days. 
If  death  occurs  later  than  after  10  days  anthrax  may  be  ex- 
cluded on  post-mortem  on  this  ground  alone,  aside  from  the 
slight  anemic  indications  in  the  subcutis,  and  in  certain  internal 
organs,  which  in  anemia  are  already  perceptible  after  such 
a  duration.  On  the  other  hand  in  cases  of  death  resulting 
within  a  short  time,  the  bacteriological  examination  of  the 
blood  or  test  inoculations  are  confirmatory.  Enzootic  spinal 
meningitis,  the  nature  of  which  cannot  be  yet  considered  as 
definitely  cleared  up  (see  Vol.  II),  corresponds  as  described  'u\ 
its  original  by  Schlegel,  clinically  and  anatomically  with  anemia 
to  such  an  extent  that  it  can  be  excluded  with  certainty  only 
by  careful  bacteriological  examination  or  by  animal  jnocula- 
tion.  The  piro|)lasmosis  of  horses  is  differentiated"  by  the 
distinct  icteric  discoloration  of  the  visible  nuicous  mem])ranes, 
but  especially  by  the  microscopical  demonstration  of  piroplasma 
in  the  blood.  At  the  same  time  however  it  is  advisable  to  be 
cautious,  as  in  the  acute  cases  of  infectious  anemia  fragments 
of  nuclei  resembling  piroplasma  may  be  present  in  the  red 
blood  cells ;  besides  this,  the  piroplasmosis  of  horses  cannot 
be    transmitted    to    healthv   animals.      Sclerostomiasis    in    its 


gg2  Infectious  Anemia  of  Horses. 

elironic  form  (Glage)  runs  an  afebrile  course  contrary  to 
chronic  infectious  anemia,  and  attacks  colts  exclusively,  while 
in  its  more  acute  form  (Schlegel)  only  the  autopsy  or  the 
demonstration  of  sclerostome  larvae  in  the  intraabdominal 
hemorrhages  is  decisive.  At  the  same  time  however  the  pres- 
ence of  a  few  sclerostome  larvae  in  the  subserous  or  submucous 
tissues  must  not  be  misleading.  Simple  anemia  is  distinguished 
by  its  afebrile  course  and  by  the  demonstration  of  dietetic 
errors  of  some  primary  affection  or  indications  of  some  out- 
side influence. 

Treatment.  A  treatment  of  infectious  anemia  which 
promises  positive  results  is  at  present  unknown.  The  remedies 
used  so  far,  such  as  quinine,  coliargol,  arsenical  preparations, 
have  either  proved  powerless  or  at  best  only  result  in  temporary 
improvement,  the  same  as  intensive  feeding  and  keeping  the 
animals  from  work.  Nevertheless  the  arsenical  preparations 
appear  to  have  a  favorable  influence  on  the  disease,  at  least 
in  certain  cases,  thus  Ostertag  obtained  at  times  a  striking  iin- 
provement  from  atoxyl  (0.5-1.0  gm.  intravenously  in  physio- 
logical salt  solution;  according  to  Loewenthal  up  to  3  gm.  of 
atoxyl  are  well  tolerated).  Marek  observed  similarly  good  re- 
sults from  the  cheaper  natrium  arsenicosum,  which  he  adminis- 
tered in  gradually  increasing  doses,  from  1-4  gm.  per  os  for 
two  weeks,  and  then  suspended  for  a  period. 

Prevention.  In  order  to  prevent  the  introduction  of  the 
disease  the  greatest  care  should  be  exercised  in  the  purchase 
of  horses.  Horses  which  are  in  any  way  suspicious,  and 
especially  those  which  without  any  apparent  cause  are  poorly 
nourished,  anemic,  or  easily  fatigued,  or  in  which  the  frequency 
of  the  heart  increases  considerably  from  insignificant  outside 
causes,  and  in  which  at  the  same  time  the  urine  contains  albu- 
men, should  not  be  placed  in  the  horse  stable  until  after  sys- 
tematic isolation  and  observation  extending  over  three  months 
(for  instance  in  the  cattle  stable).  Every  newly  purchased 
horse  in  infected  localities  should  be  subjected  to  a  quarantine 
of  three  months.  At  the  same  time  the  sanitary  conditions 
of  the  horse  stables  should  be  given  full  consideration. 

In  already  infected  premises  the  attempt  should  be  made 
first  of  all  to  isolate  all  affected  horses  by  systematic  tempera- 
ture measurements  and  then  to  disinfect  the  stables  thoroughly. 
The  excrements  of  the  affected  animals  are  best  disinfected 
by  packing  them  for  at  least  one  month  in  piles  of  about  one 
cubic  meter  (Ostertag).  At  the  same  time  the  food  and  drink- 
ing water  should  be  prevented  from  coming  in  contact  with 
the  feces  and  urine  of  horses.  If  the  disease  appears  among 
pastured  horses  the  apparently  healthy  animals  should  be 
driven  to  a  pasture  which  has  not  yet  been  used  by  horses, 
and  the   affected  animals   should  be  stabled.     Finally  efforts 


Prevention.  §63 

should  bo  iiiaik'  to  remove  all  alfected  horses  as  soon  as  possil)le. 
This  is  usually  carried  out  easily  in  si)oradic  occurrences  of 
the  disease  or  in  localities  where  horse  insurance  is  maintained. 

Immunization.  The  oxperiinents  wliieh  have  been  undertaken  by  Carre  & 
Vallee  aloii^;  this  line  with  tlie  blootl  of  a|>iiarfntiy  retovere.l  animals,  also  with 
blood  from  .ionkeys  or  cattle  which  have  been  inocidated  repeatedly  with  virulent 
material,  were  unsatisfactory;  likewise  Marek 's  exiieriments  with  the  blood  of  an 
apparently  recovered  horse  or  with  blood  exjjos-ed  to  various  hij;h  temi)eratures, 
or  which  had  been  treated  with  a  trichloride  of  iodine  solution. 

Literature.  Brickmann,  D.  t.  W.,  1907.  724.  —  Carre  tS:  Yallce,  Eev.  gen., 
1900.  VI II.  .*-!•.!;  1907.  IX.  113  (French  Lit.).  —  Ekvall,  Tidsskr.,  iSOo.  20S.  - 
Francis  &  Marsteller,  Te.xas  Ayricult.  Exper.  Station,  1908.  —  Frohnor,  A.  f.  Tk., 
18S6.  XII.  382.  —  Hempel,  Z.  f.  Infkr.,  1909.  V.  3Sl  (Lit.).  —  llochstein,  \V.  f. 
Tk.,  1907.  145.  —  .larmatz,  Z.  f.  Vk.  1904.  08.  —  Kopke,  Z.  f.  Vk.,  19(il.  :5."jO.  — 
Meier,  Z.  f.  Tni.,  1900  X.  1.  —  Mohler,  The  Vet.  Journ.,  1909.  391.  —  Ostertai^, 
Monh.,  1*^90.  I.  127;  Z.  f.  Infkr.,  1907.  III.  1.  —  Hies,  Rec,  1908.  11.  —  Vallee, 
Bull,   19(17.  .320.  —  Zschokke,  Schw.  A.,   1883.   XXV.    11. 

3.     Progressive  Pernicious  Anemia.  Anaemia  Perniciosa 

Progessiva. 

By  the  name  of  progressive  pernicious  anemia  is  desi.a:nated 
in  huinan  medicine  a  severe  and  gradually  progressing  anemia, 
with  the  ap|)ea ranee  of  gigantocytes  and  gigantoblasts  in  the 
blood  (Ehrlieh)  or  with  a  change  in  the  pro])ortion  l)etween 
the  hemoglobin  content  and  the  number  of  Ijlood  corpuscles 
in  favor  of  the  blood  coloring  matter  (Tallquist),  in  which 
the  form  of  the  red  blood  corpuscles  undergoes  conspicnous 
changes.  The  disease  appears  without  any  apparent  cause 
(cryptogenetic  form  of  pernicious  anemia)  or  in  connection 
witii  certain  organic  diseases  (secondary  form  of  pernicions 
anemia). 

History,  The  disease  was  first  described  in  hiniian  medicine  in 
1868  by  Biermer,  but  was  mentioned  previously  already  as  idiopathic 
anemia  by  Lebert  and  Addisson.  Since  that  time  the  disease  has 
been  observed  in  a  large  number  of  cases  in  certain  localities,  especially 
in  Switzerland,  England  and  Sweden.  There  exist  several  publica- 
tions relative  to  the  occurrence  of  pernicious  anemia  in  animals,  but 
most  of  them  prol)ably  allude  to  the  infections  anemia  of  horses,  which 
is  a  specific  infections  disease,  and  according  to  the  blood  findings 
does  not  correspond  with  the  progressive  pernicious  anemia  (see  p.  851). 
R(^garding  the  few  remaining  cases  it  is  undecided  whether  they  should 
be  considered  as  pernicious  anemia,  ])ecause  in  these  cases  the  diagnosis 
was  based  only  on  the  severity  of  the  anemia  and  on  the  demonstration 
of  a  poikilocytosis,  which  however  cannot  by  any  means  be  considered 
as  a  proof  of  the  pernicious  nature  of  the  anemia,  since  the  poikilocytosis 
may  represent  artifacts  (see  p.  857).  At  any  rate  it  remains  for 
thorough  liematohigical  investigations  to  decide  how  fre(|uently  true 
l)rogressive  pei-nicious   anemia  occurs  in   domestic   aninuds. 

Etiology.  Nothing  positive  can  be  said  at  present  relative 
lo  the  cause  of  primary  cryptogenetic  pernicious  anemia. 
Human  ])hysicians  freriuently  associate  the  origin  of  the  disease 


854  Pi'ogressive  Pernicious  Anemia. 

with  certain  gastro-intestinal  disturbances,  at  the  same  time 
accepting  the  action  of  absorbed  toxic  substances  from  the 
intestines  as  its  cause.  This  hypothesis  recently  received  a 
substantiation  by  the  investigations  of  Tallquist,  which  proved 
that  certain  lipoid  substances  which  develop  in  the  intestines 
during  qualitative  or  quantitative  changes  of  the  splitting  of 
the  fat  and  are  then  absorbed,  possess  a  distinctly  hemolytic 
action.  Berger  &  Tsuchipa  found  in  fact  a  lipoid  substance 
in  the  gastric  and  intestinal  mucous  membrane  of  such  patients, 
which  could  be  extracted  by  ether,  and  showing  about  a  ten  times 
stronger  hemolytic  action  than  the  lipoid  substances  of  normal 
mucous  membranes. 

The  development  of  the  disease  as  a  result  of  a  lipoid  action 
was  established  experimentally  also  in  secondary  pernicious 
anemia  by  Tallquist,  which  disease  sometimes  develops  in  man 
in  the  presence  of  the  Dibothriocephalus  latus  in  the  intestines. 
A  similar  origin  of  the  disease  is  further  suspected  by  Tallquist 
in  those  cases  in  which  the  disease  develops  in  connection  with 
malignant  growths  in  the  gastro-intestinal  canal. 

Certain  iiifeetioiis  diseases  (s^i^hilis,  malaria,  tuberrmlosis")  also  play  an  etio- 
logical part  in  man. 

From  the  veterinary  standpoint  severe  anemias  are  fre- 
quently included  in  this  affection,  which  are  caused  by  gastro- 
intestinal parasites  (dochmiasis,  strongylosis),  blood  parasites 
(trypanosomiasis,  piroplasmosis),  even  those  which  are  pro- 
duced by  chronic  suppurations  or  other  exhausting  diseases. 

To  what  extent  this  broadening  of  the  conception  of  pernicious 
anemia  is  justified  can  only  be  determined  when  in  such  cases  the 
characteristic  changes  of  the  blood  in  the  presence  of  pernicious  anemia 
are  established  by  thorough  hematologic  examinations.  It  is  probable 
that  all  of  these  affections  belong  to  the  simple  secondary  chronic 
anemia,  which  in  severe  cases  may  be  associated  with  poikilocytosis, 
although  in  some  cases  the  pernicious  nature  of  the  affection  cannot 
be  disputed  without  further  consideration. 

Many  human  physicians  count  only  those  cases  as  pernicious  anemia 
which  at  least  apparently  develop  independently  (Grawitz). 

Pathogenesis.  Ehrlich  explains  the  development  of  the 
disease  in  man  in  such  a  manner  that  the  unknown  causative 
agent  produces  on  the  one  hand  a  destruction  of  the  red  blood 
corpuscles,  and  on  the  other  a  degeneration  of  the  bone  marrow, 
thereby  producing  the  formation  of  megaloblasts  or  megalocytes 
in  the  bone  marrow.  In  opposition  to  this  Tallquist  lays  the 
principal  stress  on  the  exhaustion  of  the  regenerative  power  of 
the  bone  marrow,  Avhile  he  conceived  the  formation  of  megalo- 
blasts only  as  a  result  of  the  increased  functions  of  the  bone 
marrow. 

Anatomical  Changes.  The  autopsy  shows  outside  of  the 
changes  of  the  blood  yet  to  be  mentioned,  in  general  the  same 


Aiialuiuical   C'Langes,     Symptoms.  355 

changes  as  in  severe  simple  anemia.  The  bone  marrow  appears 
to  be  rephiced  by  a  raspberry-like  mass  or  sometimes  re.^emljles 
embryonic  bone  marrow;  it  contains  fat  ceils  si)aringly,  but 
on  the  other  hand  numerous  different  kinds  of  red  blood  cor- 
puscles with  one  or  two  nuclei,  which  are  either  very  small  or 
very  large  (J^>abes,  Kindlleisch).  Not  infrequently  a  relatively 
large  layer  of  fat  is  conspicuous  under  the  skin  and  surrounding 
the  internal  organs. 

Grolie  fouii'l  iron  in  larjie  quantities  in  the  spleen  and  the  liver,  Quincke  in 
the  spleen  and  in  the  kidneys;  it  was  demonstrable  by  auinioniuin  sulphide,  and 
probably  resulted  from  the  jjreat  destruction  of  red  blood  corpuscles.  Quincke 
found  2.1%  of  iron  in  the  asli. 

Symptoms.  The  disease  always  commences  insidiously. 
Ready  fatigue,  somewhat  disturbed  appetite,  and  as  a  result 
a  failing  of  the  nutrition  as  well  as  a  decrease  of  the  circum- 
ference of  the  abdomen,  first  direct  attention  to  its  presence. 
At  the  same  time  the  paleness  of  the  mucous  membranes  con- 
tinually increases.  Difficulty  of  respiration  a|)pears  during 
work  or  even  during  slow  walking.  The  heart's  action  is  ac- 
celerated, now  and  then  throbbing,  the  pulse  is  later  thread- 
like, the  heart  sounds  sometimes  appear  indistinct. 

The  blood  is  pale  red  in  color,  sometimes  with  a  yellowish 
tint,  it  coagulates  slowly,  its  specific  gravity,  as.  well  as  its 
hemoglobin  content,  is  lower  (Lindquist  found  in  one  case  the 
hemoglobin  content  diminished  to  60-80%,  Friedberger  to 
60%).  In  affected  man  the  hemoglobin  content  of  the  blood 
is  always  found  to  be  too  high  in  proportion  to  the  existing 
number  of  red  blood  corpuscles.  The  number  of  red  blood 
corpuscles  diminishes  considerably,  and  they  show  changes  in 
form.  First  of  all  their  non-uniformity  in  size  is  conspicuous, 
inasmuch  as  some  appear  much  larger  and  at  the  same  time 
are  frequently  pale  (macrocytes,  gigantocytes),  others  again  are 
very  small,  and  of  an  intensely  yellow-red  color  (microcytes) ; 
in  addition,  a  variable  number  of  nucleated  red  blood  corpuscles 
may  be  seen  (erythroblasts).  At  the  same  time  the  red  blood 
corpuscles  form  "small  money-roll-like  groups  and  some  appear 
peculiarly  wasted,  angular,  elongated,  containing  one  or  more 
projections,  club  or  biscuit-shaped,  and  sometimes  entirely 
shrunken  (poikilocytosis).  Friedberger  observed  in  one  case 
an  increase  of  white  blood  corpuscles  and  blood  plaquelets.  In 
blood  of  affected  man  large  or  sometimes  nucleated  red  blood 
corpuscles  are  sometimes  found,  the  diameter  of  which  may 
reach  up  to  20  ^  and  the  presence  of  which  is,  according  to 
Ehrlich,  supposed  to  possess  a  high  diagnostic  value;  this  is 
however  disputed  by  some  authors.  As  the  pernicious  anemia 
of  man  and  animals  should  not  show  any  marked  differences 
in  the  blood  findings,  more  attention  should  be  attributed  to 
the  presence  of  gigantocytes  or  gigantoblasts  in  the  diagnosis 
of  pernicious  anemia  in  animals,  and  also  to  the  relation  be- 

Vol.  1 — 55 


866  Progressive  Pernicious  Anemia. 

tween  the  hemoglobin  content  of  the  blood  and  the  nnml3er  of 
red  blood  corpuscles. 

The  examination  of  the  blood  may  be  carried  out  by  placing  a  very  small 
drop  of  blood  on  a  cover  glass  from  which  the  fat  has  lieen  carefully  removed  by 
washing  with  ether,  and  whose  borders  have  previously  been  covered  with  a  layer 
of  fat,  while  a  drop  of  physiological  (0.9%)  salt  solution  is  placed  on  one  of 
its  surfaces.  The  blood  which  is  placed  into  the  salt  solution  is  immediately  diluted 
suitably  and  is  then  placed  upon  a  clean  slide  with  the  surface  containing  the 
blood  drop.  The  fat-covered  borders  of  the  cover  glass  enclose  the  blood  air  tight, 
so  that  the  evaporation  of  water  and  consequently  the  shrinking  of  the  blood 
corpuscles  is  prevented. 

If  it  is  desired  to  stain  the  blood  corpuscles,  several  thoroughly  clean  cover 
glasses  are  smeared  with  a  layer  of  blood  by  placing  a  small  drop  of  blood  upon 
the  middle  of  the  border  of  the  cover  glass,  and  then  this  cover  glass  is  drawn 
over  another  at  an  angle  of  45°,  so  that  the  drop  of  blood  is  spread  in  a  thin 
layer  over  the  lower  glass.  The  specimens  are  dried  in  the  air  and  fixed  by  dry 
heat  (107°  to  110°)  for  %-2  minutes,  or  in  alcohol  and  ether  (aa)  for  two  hours, 
or  in  methyl-alcohol  for  2-3  minutes.  They  may  be  stained  with  a  mixture  of  eosin 
and  hematoxylin,  or  more  suitably  with  Ehrlich's  triacid  mixture,  especially  when 
finer  details  of  the  white  blood  corpuscles  are  desired.  This  is  prepared  as  follows: 
Concentrated  aqueous  solutions  of  Orange  G.,  acid  fuehsin  and  methyl  green  are 
prepared  in  separate  containers,  and  cleared  by  allowing  them  to  stand  for  some 
time,  then  13-14  cc.  of  the  orange  solution,  6-7  cc.  of  the  acid  fuehsin  solution, 
15  cc.  of  distilled  water,  15  cc.  absolute  alcohol,  and  12.5  cc.  of  the  methyl  green 
solution  are  mixed  in  the  order  given ;  after  the  addition  of  the  methyl  green 
solution  the  mixture  is  thoroughly  shaken,  and  10  cc.  of  alcohol  and  10  cc.  of 
glycerin  are  added  during  further  shaking.  (The  mixture  may  be  obtained  ready 
for  use.)  The  cover  glasses  are  laid  with  the  smeared  surfaces  upon  the  mixture, 
which  should  not  be  filtered.  After  about  five  minutes  they  are  washed  in  run- 
ning water  and  dried.  In  staining  with  the  triacid  mixture  the  cell  nuclei  appear 
pale  green,  the  red  blood  corpuscles  either  orange,  yellow  or  red,  the  acidophilic 
granules  of  the  leucocytes  copper  red,  the  neutrophilic  granules  of  the  leucocytes 
bluish  red,  while  the  basophilic  granules  remain  unstained.  Instructive  pictures 
are  further  obtained  by  Eomanovsky's  method,  with  its  modifications  by  Gienisa 
or  May  &  Griinwald  (the  necessary  stains  for  these  methods  may  be  obtained  ready 
mixed). 

In  the  further  course  of  the  disease  edematous  swellings 
develop  on  the  lower  a])domen  and  on  the  extremities.  Not  in- 
frequently hemorrhages  from  the  nasal  and  buccal  mucous  mem- 
brane may  be  observed,  hematuria  or  intestinal  lileedings  may 
also  occur.  The  urine  sometimes  contains  albumen  and,  as  in 
man,  probably  also  urobilin  and  more  iron. 

The  temperature  shows  in  some  cases  variable  elevation. 

The  sensorium  appears  disturbed  from  the  onset  of  the 
disease.  The  nutrition  always  suffers,  in  some  cases  however 
the  emaciation  is  not  especially  pronounced  in  proportion  to 
the  severity  of  the  affection. 

Course.  The  disease  either  develops  acutely  so  that  the 
animals  die  in  6  to  8  weeks  after  the  appearance  of  the  first 
s;s^nptoms,  or  it  runs  a  chronic  course  and  extends  over  several 
months.  In  a  more  protracted  course  remissions  and  exacerba- 
tions are  observed.  The  animals  die  either  from  exhaustion  or 
a  sudden  hemorrhage  terminates  the  disease  within  a  short  time. 

Diagnosis.  The  recognition  of  the  disease  is  always  as- 
sociated with  considerable   difficulty.     Of  importance  in   this 


Diagnosis,    Prognosis,    Trcatniunt.  ggy 

regard  is  the  very  marked  diminution  of  red  blood  corpuscles, 
Avitli  \vliieli  tlie  falling  of  the  henioglohin  content  is  not  propor- 
tionate; the  striking  poikilocytosis  and  tiie  presence  of  large 
ervthroblasts  are  further  indicative  of  the  disease.  The  inter- 
current febrile  manifestations  which  may  be  present  and  tlic 
relatively  good  a]ipearance  of  the  animals  also  desei'v^e  full 
consideration. — Leukemia  and  pseudo-leukemia  may  be  excluded 
by  the  absence  of  swelling  of  the  hnnph  glands. — Tn  infectious 
anemia  of  horses  the  blood  examination  reveals  indications  of 
a  simple  anemia,  moreover  the  appearance  of  the  disease  in 
connection  with  the  introduction  of  newly  purchased  horses,  as 
well  as  its  infectious  nature,  points  to  that  disease.  It  appears 
to  be  advisable  to  eliminate  tlie  suspicion  of  infectious  anemia 
only  when  the  non-infectious  nature  of  the  disease  has  l)een 
established  on  the  ground  of  long  continued  observations,  his- 
tory, animal  experiments,  and  by  accessory  conditions. — 
Although  sub-acute  encephilitis,  and  cerebral  meningitis  are 
associated  with  similar  depressions,  in  these  conditions  the  blood 
shows  no  important  changes.  Special  stress  should  be  laid 
upon  excluding  septicemic  affections  of  slow  development, 
wliich  can  usually  l)e  accomplished  when  the  blood  and  tlie 
other  organs  are  carefulh"  examined  and  all  accessory  condi- 
tions are  considered.  The  form  of  influenza  of  horses  which 
was  named  "Skalma"  by  Dieckerhoff  often  produces  a  long- 
lasting  severe  anemia. 

Prognosis.  The  prognosis  is  always  unfavorable.  In 
human  medicine  there  is  not  a  single  unobjectionable  case  known 
which  did  not  terminate  fatally.  The  recoveries  oliserved  in 
animals  must  be  judged  carefully,  since  confusion  with  other 
diseases  cannot  be  altogether  excluded. 

Treatment.  According  to  observations  made  hitherto,  even 
a  rational  treatment  can  at  the  best  only  prolong  the  course 
of  the  disease.  A  suitable  regulation  of  the  diet,  koepin^g  the 
animals  out  of  doors  or  in  well-ventilated  stables  and  moderate 
exercise,  should  first  of  all  be  considered.  Of  medicinal  remedies 
iron  and  arsenical  preparations  (arsenic,  Fowler's  solution, 
atoxyl,  see  p.  850),  natrium  kakodylicum  (for  dogs  0.1-0,3  gm. 
subciitaneously),  may  l)e  employed.  In  human  medicine  intra- 
venous infusion  of  blood  and  of  salt  solution,  as  well  as  sub- 
cutaneous injections  of  blood  give  relatively  satisfactory  results 
(Bencziir).  Of  these,  especially  the  last-named  method  could 
occasionally  be  utilized  also  in  animals. 

Literature.  Ehrlich.  Lazarus  &  Pinkus,  Die  Aniiniie.  Wien.  1S98.— Orawit?, 
D.  m.  W.,  1904.  1092.  —  Johne,  S.  B.,  1884.  60.  —  Tallquist,  Z.  f.  kliii.  Met].,  LXI. 
427. 


868  Progressive  Pernicious  Anemia. 

Progressive  Pernicious  Anemia  in  Cattle.  Imminger  (W.  f.  Tk. 
1886,  1-37)  described  under  this  name  a  disease  of  cattle  which  first 
occurred  around  Kemnath  in  Bavaria  sporadically,  but  in  the  years 
of  1883-1889  in  an  enzootic  form.  It  affected  cattle  mostly  at  an  age 
of  from  %  to  2  years.  The  disease  occurred  more  frequently  in  stabled 
animals  or  in  those  fed  on  dry  feed  than  in  pastured  cattle,  or  during 
the  time  of  green  feeding. 

The  disease  commences  -wiih.  a  gradual  emaciation  in  spite  of 
satisfactory  appetite.  From  the  fourth  to  tenth  week  a  severe  diarrhea, 
edematous  swelling  of  the  dewlap,  paleness  are  observed,  and  at  the 
same  time  yellowish  discoloration  of  the  visible  mucous  membranes, 
and  of  the  unpigmented  parts  of  the  skin  (especially  on  the  ears), 
tightness  of  the  skin  and  staggering  gait.  The  pulse  is  thread-like, 
accelerated  (70-80  per  minute),  and  the  systolic  sound  of  the  heart 
is  frequently  accompanied  by  a  hissing  murmur.  The  blood  shows 
poikilocytosis.  In  the  further  course  the  respiration  is  accelerated 
and  a  cough  appears.  The  temperature  usually  remains  normal,  very 
rarely  it  rises  toward  the  fatal  termination  of  the  disease  or  it  falls 
on  the  contrary  to  subnormal.  After  2  to  3  weeks  the  appetite  also 
becomes  suppressed,  and  sometimes  hemorrhages  occur  in  the  retina. 
"With  the  appearance  of  the  inappetence  the  loss  of  strength  makes 
rapid  progress,  and  the  animals  soon  succumb.  Sometimes,  especiallj' 
however  in  older  animals  or  after  parturition,  the  disease  takes  a  rapid 
course.     The  mortality  amounts  to  about  50%. 

The  autopsy  reveals  a  severe  general  anemia,  here  and  there 
hemorrhages  in  the  muscles,  moderate  hydropic  signs,  and  a  reddish 
discoloration  of  the  otherwise  softened  bone  marroAV. 

The  treatment  consisted  in  the  administration  of  iron  and  arsenical 
preparations  (see  p.  850). 

Anemia  of  Sheep  and  Goats  in  Punjab.  Walker  &  Baldrey  (J.  of 
trop.  vet.  science,  1906,  410)  observed  an  enzootic  affection  in  sheep 
and  goats  which  is  known  to  the  natives  as  "Gillar"  (swelling  of  the 
neck).  The  disease  is  confined  to  the  swampy  lowlands  and  the  terri- 
tories of  the  Punjab,  which  are  frequently  flooded,  it  attains  its  highest 
extension  during  the  months  of  December  to  February  and  rapidly  dis- 
appears during  the  summer  months.  Its  causative  agent  is  supposed 
to  be  some  parasite,  but  the  investigations  carried  on  in  this  direction 
have  given  negative  results. 

The  symptoms  of  the  disease  are  languor,  separation  from,  the  herd, 
tenacious,  sticky  nasal  discharge  and  a  hoarse  cough.  After  about 
one  week  an  edematous  swelling  of  the  submaxillary  space  appears, 
which  may  in  severe  cases  extend  to  the  breast  bone  and  which  usually 
disappears  during  the  night.  After  three  weeks  a  bloody  diarrhea 
and  increased  thirst  appear,  the  visible  mucous  membranes  become  pale 
and  yellowish.  In  the  meantime  ascites  develops.  The  animals  die 
from  loss  of  strength  after  3  to  4  weeks;  less  frequently  death  ensues 
only  after  six  weeks  or  even  later.    The  mortality  amounts  to  90%. 

The  autopsy  reveals,  in  addition  to  the  manifestations  of  a  severe 
anemia  and  ascites,  inflammatory  areas  on  the  intestinal  mucous  mem- 
brane. 

Treatment  is  without  effect ;  a  change  of  pasture,  with  the  adminis- 
tration of  iron  sulphate  and  salt  is  recommended. 


Leukoiiiia  of  Maininals,  869 


4.    Leukemia.    Leukaemia. 


{Leucocytemia;  Leukamischc  Lymphadcnlc   [German];  Leuco- 
cythnn'ie,  Lymphadcuie  [French].) 

(a)    Leukemia  of  Mammals. 

Leukemia  of  mammals  is  a  severe  and  oenoral  systemic  af- 
fection or  proliferation  of  the  lymphoid  or  myeoloid  tissue,  as  a 
result  of  which  swellinj^s  of  the  blood  and  hmiph-formin^  organs 
develop  and  the  numl)er  of  white  blood  corpuscles  increases 
more  or  less,  partlv  at  the  expense  of  the  red  blood  corpuscles. 
According  to  whether  the  increase  affects  the  lymphocytes  or 
the  leucocvtes,  two  forms  of  leukemia  are  distinguished,  namely, 
the  lymphatic  leukemia  and  the  myeologenous  leukemia  (L. 
myeloides). 

History.  The  first  descriptions  of  the  disease  were  given  inde- 
pendently of  each  other  in  1845,  l)y  Virchow  in  Berlin,  and  Bennett 
in  Edinburgh.  By  Virchow  it  received  the  name  by  which  it  is  known 
at  the  present  "Leukemia"  (Xcffcffs^ white,  a«Ma=blood).  The  con- 
nection between  tlie  aft'ection  of  the  spleen  or  the  lymph  glands  and 
the  increase  of  white  blood  corpuscles  was  early  recognized  by  Virchow, 
the  part  of  the  bone  marrow  however  was  first  established  by  Neumann 
in  1899.  .      , 

Leisering  was  the  first  to  recognize  in  1858  the  disease  in  animals, 
but  greater  attention  was  paid  to  it  only  in  the  last  two  decades,  so 
that  at  present  quite  a  number  of  positive  cases  are  known.  Siedam- 
grotzkv  (1878),  Johne  (1879),  Nocard  (1880),  Frohner  (1885),  Wolff 
(1892),  de  Jong  (1903),  have  carefully  studied  the  disease,  likewise 
Hutyra  and  Marek,  whose  case  was  not  published  in  detail. 

Occurrence.  Leukemia  occurs  most  frequently  among  dogs, 
more  rarely  horses,  cattle,  hogs  and  cats  are  affected,  whereas 
nothing  is  known  of  leukemia  in  sheep  and  goats.  Some  of 
the  cases  recorded  in  literature  very  probably  do  not  belong 
here,  but  to  pseudo-leukemia  or  to  tuberculosis. 

Somnier  reported  46  cases  up  to  1889,  of  which  22  occurred  in  dogs,  10  in 
horses,  7  in  cattle,  5  in  hogs  and  2  in  cats.  Among  the  horses  of  the  Prussian 
army  2-4  cases  occur  annually. 

Etiology.  The  leukemia  of  mammals  is  probably  of  a 
toxic-infectious  origin,  although  nothing  positive  is  known  rela- 
tive to  this  at  the  present  time.  The  course  of  the  disease 
would  correspond  with  this  view,  as  well  as  its  localization 
in  the  various  organs,  but  to  date  it  has  been  impossible  to 
produce  the  disease  artificially  in  mammals  by  feeding  af- 
fected organs  (Xocard),  or  by  subcutaneous  or  intravenous 
inoculation  of  emulsions  from  organs  (Hosier,  Bollinger,  Cadiot, 
Roger,   Gilbert,  Marek).     The  bacteriological  examination  of 


870  Leukemia  of  Mammals. 

the  blood  of  an  infected  dog  was  also  imsuceessfnl  (Stockmann). 
On  the  other  hand  the  infections  nature  of  chicken  leukemia 
(see  p.  877)  should  be  considered  as  proven,  and  in  addition 
several  observations  are  known  in  human  medicine,  which  in- 
dicate the  transmissibility  of  leukemia  to  healthy  man  (Eller- 
mann  &  Bang). 

Lowit  claims  to  have  found  protozoa  (Haemonioeba  leukaemiae)  in  the  white 
blood  corpuscles  of  man  affected  with  myelogenous  leukemia,  with  which  he  suc- 
ceeded in  producing  a  marked  leucocytosis  in  animals,  but  without  an  affection  of 
the  blood-forming  organs.  Protozoa  (H.  leukaemiae  vivax)  were  demonstrable  in 
the  blood-forming  organs  of  lymphatic  leukemia.  Other  authors  have  not  substan- 
tiated this  finding  and  consider  the  bodies  observed  by  Lowit  as  fragments  of  cells. 
Pawlowsky  found  bacilli  in  leukemic  blood,  with  which  he  failed,  however,  to  pro- 
duce the  disease.  Likewise  negative  were  the  attempts  at  inoculation  of  Ferni, 
Delbet  and  Lucet. 

Pathogenesis.  Ehrlich's  thorough  hematological  examina- 
tions have  thrown  some  light  on  the  development  of  the  disease. 
According  to  these,  the  hyperplasia  of  the  lymphadenoid  tissues 
develops  in  some  cases  under  the  influence  of  a  still  unknown 
cause,  whereby  the  blood  becomes  flooded  with  the  lymphocytes 
which  are  formed  in  much  greater  numbers  (Leukaemia  hanph- 
atica),  whereas  the  number  of  true  leucocytes  remains  un- 
changed. The  hyperplasia  of  the  lymphadenoid  tissue  affects 
not  alone  the  lymph  glands,  but  also  the  spleen,  the  bone  marrow, 
the  intestinal  wall,  and  usually  also  other  organs  (liver,  lungs, 
kidneys,  glands,  etc.),  which  under  normal  conditions  contain 
only  microscopically  small  lymph  follicles.  Exceptionally  how- 
ever the  hyperplasia  of  the  lymphadenoid  tissues  occurs  only 
in  a  few,  or  even  only  in  a  single  organ  (for  instance  in  the 
bone  marrow). 

In  other  cases  of  leukemia  the  causative  factor  effects  a 
proliferation  of  the  myeloid  tissue,  when  the  leucocytes  migrate 
from  the  blood  stream  in  grea't  numbers,  at  the  same  time  how- 
ever young  unripe  leucocytes  as  well  as  numerous  ripe  leucocytes 
migrate  from  the  leucocyte-forming  bone  marrow,  and  flood 
the  blood  (Leukaemia  myelogenes  [s.  myeloides]).  Besides  the 
bone  marrow,  other  blood  forming  organs  also  become  affected, 
more  particularly  a  hyperplasia  of  the  spleen,  lymph  glands, 
liver,  and  the  development  of  areas  of  tissue-like  bone  marrow 
results  in  these  organs. 

This  classification  of  the  forms  of  leukemia  by  Ehrlich  ap- 
pears, considering  the  morphology  of  the  white  blood  cor- 
puscles, much  more  appropriate  than  the  designation  of 
leukemia  in  accordance  with  the  blood-forming  organs,  Avhich 
are  found  alone  or  most  strikingly  affected  on  macroscopical 
examination,  as  on  one  hand  all  blood-forming  organs  are  in 
most  cases  more  or  less  affected  in  both  forms  of  leukemia, 
while  on  the  other  hand  the  lymphatic  and  the  myelogenic 
leukemia  probably  represent  even  etiologically  two  different 
diseases.  As  the  Avhite  blood  corpuscles  formed  in  the  spleen 
do   not   appear   to   have   any  part  in   the   leukemic   cases   of 


PatliDyenesis,  Aiiattmiicul   Changes.  371 

wliicli    have    been    observed,   a    differentiation    of    '*  Lciikaeinia 
lienalis"  does  not  appear  jnstilied. 

In  view  of  tiie  i'aet  that  in  the  desij^nation  of  the  forms 
ol'  k'ukemia  by  veterinary  authors,  the  niaeroseopical  changes 
of  the  blood-forniini»-  organs  were  ahuost  exclusively  taken  into 
consideration,  it  cannot  be  decided  how  f recjuently  the  two  forms 
of  leukemia  occur  in  aninuds.  In  the  cases  observed  by  A\'olff, 
de  Jong,  Nocard,  and  Ilutyra  &  Marek,  the  examination  of  the 
blood  reveals  the  lymphatic  nature  of  leukemia.  In  all  prol)a- 
bility  the  lymphatic  form  of  leukemia  occurs  in  aninuds  much 
nuire  fre(iuen1ly  than  the  myelogenic  form. 

Anatomical  Changes.  In  botli  forms  of  leukemia  the  i)ath- 
oloi;i<'al  changes  visible  to  the  naked  eye  greatly  resemble  each 
other. 

The  si)leen  appears  considerably  enlarged,  and  excep- 
tioiudly  its  surface  is  nodulated,  its  tissue  is  mostly  dense,  but 
at  the  same  time  somewhat  friable,  sometimes,  on  the  contrary, 
very  soft  (in  dogs  and  sometimes  also  in  hogs).  The  cut  surface 
ai)})ears  usually  ])ale  brownish-red  resend)ling  the  color  of  rasp- 
l)erry  jelly,  somewhat  dry,  and  with  a  dull  luster,  it  is  not  in- 
frequently permeated  by  bluish-white,  hard  or  soft,  hemp-seed, 
pea,  or  up  to  Avalnut-sized  areas  (enlarged  follicles),  and  also 
by  dark  red  hemorrhages.  Sometimes  the  connective  tissue 
trabeculae  form  a  conspicuous  network,  and  at  the  same  time 
the  capsule  is  thickened. 

The  spleen  may  at  times  reach  enormous  dimensions.  Its  weight  may  some- 
times in  horses  reach  46  kilograms  (Cunningham),  in  hogs  3.7  kilograms  (Hel- 
linger),  in  dogs  1.7  kilogram  (Siedamgrotsky).  in  cattle  up  to  six  times  its  normal 
size  (Mauri).  In  one  case  of  Zell  the  spleen  had  a  diameter  of  5^0  centimeters. 
The  cases,  however,  in  which  the  spleen  is  so  enormously  enlarged  were  probably 
in  most  instances  of  pseudo-leukemic  origin. 

The  lymph  glands  are  very  frequently  enlarged.  The 
glands  may  attain  a  size  from  a  hazelnut  to  a  walnut  and 
coalesce  with  the  neighboring  glands,  forming  large  nodular 
bodies.  They  are  either  denser  or  on  the  contrary  softer  than 
normal,  their  cut  surface  is  unifonnly  white  or  grayish-white, 
in  exceptional  cases  however  they  are  permeated  by  red  points, 
and  a  cream-like  fluid  may  be  scraped  off. 

The  bone  marrow  appears  either  grayish-red,  of  jelly-like 
transparency,  softened  and  entirely  filling  the  marrow  cavity, 
or  pale  gray  and  in  this  case  almost  of  a  ])us-like  consistency. 
The  marrow  tissue  is  changed  to  a  lymphadenoid  tissue,  which 
is  very  rich  in  white  blood  corpuscles.  Sometimes  the  bone 
tissue  also  becomes  rarified  and  then  the  spaces  appear  filled 
with  numerous  leucocytes. 

In  about  half  the  cases  the  liver  is  found  to  be  enlarged, 
somewhat  harder,  and  on  its  grayish-brown  or  grayish-red  cut 
surface  pale  gray  points  and  a  similarly  colored  network,  or 
hTuphoma-like  nodules  appear  sometimes  between  the  lobules. 


g72  Leukemia  of  Mammals. 

The  kidneys  are  also  considerably  enlarged  on  account  of  a 
diffuse  infiltration  with  white  blood  corpuscles  and  on  account 
of  the  presence  of  larger  or  smaller  lymphomas.  In  the  intes- 
tinal wall,  especially  in  the  posterior  part  of  the  small  intestines, 
various  sized  l}anphomas  are  found,  w^hich  protrude  into  the 
lumen  of  the  intestines,  and  may  contract  the  same  considerably, 
in  one  of  Olt's  cases  a  chylusthrombosis  developed  in  a  dog. 
On  the  serous  membranes  and  in  the  lungs  nodules  consisting 
of  lymphadenoid  tissue  may  sometimes  be  found  and  the  inter- 
lobular connective  tissue  of  the  lungs  may  contain  extensive 
areas  of  infiltration.  In  the  heart,  the  peri-  and  endocardium 
of  which  may  be  permeated  by  wdiite  areas  of  infiltration  or 
small  lymph  nodules,  a  great  quantity  of  very  soft  blood 
coagulum  maj^  be  present.  The  blood  shows  changes  as  de- 
scribed below.  Similar  cellular  infiltrations  may  frequently  be 
found  also  in  other  organs,  thus  on  the  cerebral  meninges,  in 
the  uterine  walls,  in  the  various  glands,  as  well  as  in  the  con- 
nective tissue  of  any  other  of  the  organs.  Hemorrhages  are 
not  infrequently  present  in  some  of  the  organs. 

Symptoms.  Leukemia  always  develops  insidiously.  Rapid 
tiring  is  observed,  especially  during  work,  the  animal  perspires 
easily  and  shows  in  general  the  symptoms  of  pulmonary 
emphysema.  Soon  indications  of  languor  and  depression  ap- 
pear also  during  rest,  the  appetite  becomes  capricious  and  later 
entirely  depressed,  while  thirst  is  not  infrequently  increased. 
The  pale  discoloration  of  the  mucous  membrane  becomes  more 
and  more  conspicuous,  so  that  the  mucous  membranes  finally 
take  on  a  porcelain  white  color.  The  heart 's  action  is  accelerated 
and  throbbing,  the  heart  sounds  being  sometimes  obliterated  by 
secondary  sounds,  the  pulse  accelerated  and  small.  Gradually 
emaciation  becomes  perceptible ;  edematous  swellings  appear  on 
different  parts  of  the  l)ody.  The  hair  becomes  lusterless  and 
scanty. 

In  most  cases  a  chronic  swelling  of  the  Ijmpli  glands  ap- 
pears symmetrically  on  both  sides  of  the  body.  Enlargements 
which  vary  in  size,  dense,  roundish,  not  painful,  are  found  in 
the  sul)maxillary  space  and  in  the  vicinity  of  the  pharynx,  on 
the  neck,  along  the  jugular  groove,  on  the  chest,  in  the  axillary 
region,  and  in  both  inguinal  regions,  as  well  as  in  all  places 
where  hauph  glands  occur.  The  skin  covering  them  is  normal 
and  easily  raised.  Because  of  the  enormous  enlargement  of 
'the  Ij^npii  glands  locomotion  is  interfered  with,  either  from 
purely  mechanical  causes  or  by  compression  of  the  neighboring 
nerve  trunks.  In  infection  of  the  internal  lymph  glands  func- 
tional disturbances  of  some  of  the  organs  may  result.  Thus 
the  compression  of  the  bronchi  or  of  the  vagus  nerve  may 
cause  difficulty  in  respiration,  roaring,  and  even  attacks  of 
asphyxiation.  At  first  this  may  appear  only  during  work,  later 
however  also  during  rest.     The  compression  of  larger  blood 


Symptoms. 


873 


vessels,  especially  uf  tlie  veins  causes  edematous  swellings  and 
indications  of  heart  weakness.  The  affection  of  the  mesenteric 
and  other  lym])li  crlands  of  the  abdominal  cavity  may  result  in 
ascites  or  a'chylus-tlirombosis,  when  the  enlarged  lymph  glands 
may  in  large  animals  he  palpated  through  the  rectum,  in  small 
animals  through  the  ahdominal  wall.  Exceptionally  the  thyroid 
or  the  thymus  glands  may  also  appear  enlarged. _ 

The  enlargement  of  the  s])l('en  uiay  he  ascertained  in  horses 
hy  rectal  exploratit)n,  in  snuill  animals  by  palpation  of  the 
aixlomen.  The  consideraldy  eidarged  spleen  of  the  ruminants 
l)ro(luces  a  dull  sound  running  parallel  with  the  posterior  border 
of  the  lungs,  between  the  lungs  and  the  rumeu.  Exceptioiuilly 
the  left  side  of  tlie  abdomen  may  be  distended  downward  and 
outward  by  the  enormously  enlarged  and  heavy  spleen. 

The  sensitiveness  of  the  bones  to  pressure,  which  might 
be  considered  as  an  indication  of  a  simultaneous  affection  of 


Fig.  155.  Lj/mphatic  leukemia  in  an  old  bitch,  a  enlarged  parotid  gland  ;  &,  c,  d.  e 
enlarged  prescapuiar,  inferior  eervieai,  precrural,  and  poplietal  lynipli  glands;  /dis- 
tension of  the  al)dominal  wall  by 'the  enlarged  liver;  </ distension  of  tiie  al)doniinal 
wail  bv  the  enlarged  spleen;  h  enlarged  mammary  gland. 

the  l)one  marrow,  was  only  reported  by  Wolft",  who  observed 
in  a  calf  sensitiveness  in  the  region  of  the  lower  ribs  and  at- 
tributed the  same  to  leukemic  liyi)erplasia  of  the  bone  marrow. 
The  disturbances  in  locomotion,  which  sometimes  appear  in  the 
course  of  leukemia,  may  also  depend  to  a  certain  degree  on 
the  painfulness  of  the  bones. 

The  enlargement  of  the  liver  may  be  recognized  in  small 
animals  from  the  increased  area  of  dull  sounds  over  the  liver 
region  in  the  anterior  half  of  l)oth  costal  arches  and  still  more 
certainly  by  palpation  of  the  epigastrium.     In  ruminants  the 


374  Leukemia  of  ]\Ianimals. 

dullness  over  the  liver  increases  backwards  and  downwards 
to  a  level  with  the  point  of  the  shoulder ;  in  case  of  very  great 
enlargement,  the  posterior  upper  border  of  the  liver  may  be 
felt  in  the  anterior  angle  of  the  right  flank.  In  horses  the 
dullness  over  the  liver  appears  first  in  the  region  of  the  last 
intercostal  space  on  the  right  side.  The  recognition  of  a  possi- 
ble enlargement  of  the  mammary  or  salivary  glands  causes  no 
difficulty. 

The  blood  appears  pale  red,  sometimes  chocolate  brown, 
stains  less  intensively,  coagulates  slowly,  causing  on  the  upper 
surface  of  the  coagulum  a  grayash-white  layer  or  an  adliering 
gravish-white  deposit  consisting  of  white  blood  corpuscles. 
The  blood  of  leukemic  horses  separates  on  standing  into  three 
layers,  a  lower  violet-colored  consisting  of  red  blood  cells,  an 
upper  formed  by  somewhat  transparent  yellowish  fibrine,  and 
a  middle  grayish-white  consisting  of  white  blood  corpuscles, 
the  layers  may  appear  of  different  heights  in  proportion  to 
the  number  of  white  blood  corpuscles.  The  blood  of  other 
leukemic  animals  separates  on  coagulating  into  two  layers,  of 
which  the  lower,  violet-colored,  is  formed  by  red  blood  cor- 
puscles, the  upper  grayish-white,  milk-like  being  formed  by 
fibrin  and  white  blood  corpuscles. 

An  increase  of  white  blood  corpuscles  may  always  be  shown. 
While  normal  blood  contains  at  most  4  to  6  white  blood  cor- 
puscles in  a  field,  they  are  seen  in  leukemic  blood  in  much 
greater  numbers,  sometimes  nearly  as  many  or  even  as  many 
as  the  number  of  red  blood  corpuscles.  On  counting,  the 
number  of  white  blood  corpuscles  is  found  considerably  in- 
creased, as  compared  with  the  normal  (8,000-12,000)  and  the 
mmierical  relation  between  the  white  and  red  blood  corpuscles 
(in  normal  conditions  1:400-800)  becomes  much  less,  as  low  as 
1:5  (Berndt)  and  may  be  even  less  (in  man  the  relation  of 
2:1  has  even  been  observed  [Sticker]).  A  diminution  of  red 
blood  corpuscles  may  also  always  be  demonstrated,  and  their 
number  per  cubic  millimeter  of  blood  may  diminish  from  7.5 
millions  to  two  millions  (Nocard). 

The  establishment  of  the  morphological  condition  of  the 
white  blood  corpuscles  in  stained  preparations  is  of  especial 
value  (see  p.  865).  In  lymphatic  leukemia  lymphocytes  are 
found  to  be  increased  (Wolff,  de  Jong,  Marek),  while  the 
number  of  true  leucocytes  remains  normal  or  comparatively  so. 

The  lymphocytes  appear  uniform  in  size  or  slightly  and  sometimes  even 
considerably  larger  than  the  red  blood  corpuscles;  their  large  roundish  nucleus 
is  stained  less  with  basic  dyes  (methylene  blue,  methyl  green)  than  the  proto- 
plasm surrounding  the  nucleus  in  the  shape  of  a  ring;  in  some  large  examples, 
however,  both  are  sometimes  stained  uniformly  pale   (Plate  X,  Fig.  1-a,  b). 

In  the  myelogenic  (myeloid)  leukemia,  on  the  other  hand, 
the  number  of  l^anphocytes  remains  unchanged,  and  the 
leucocytes  are  considerably  increased;  there  also  appear  in  the 
blood  unripe,  mononuclear  forms,   which  possess   granulated 


SyiiiptoDis,  ('i)iirsc',   Diagnosis.  875 

protoi)lasin,  altlioiigli  tliore  exists  as  yet  no  positive  observa- 
tions in  regard  to  their  oeeiirrence  in  leukemia  of  mannnals. 
The  entire  nnii'onnity  of  white  blood  cori)useles  of  domestic 
mammals  with  those  of  man  permits  the  supposition  that  the 
unripe  forms  of  leucocytes  occur  also  in  the  myelogenic  leukenua 
of  domestic  animals.  Accordingly  besides  the  oonsiderably  in- 
creased number  of  normal  cells  in  the  blood  there  should  be 
found  neutrophiles,  a  few  acidophiles  and  prol)ably  also 
basophilic  polynuelear  leucocytes,  also  mononuclear  neutrophilic 
leucocytes  (marrow  cells,  myelocytes)  in  varying  numbers  and 
sizes,  also  mononuclear  acidophilic  leucocytes  (Plate  X,  P'ig.  2). 

The  red  blood  corpuscles  in  lymphatic  leukemia  show,  as 
a  rule,  no  changes  in  form,  while  in  myelogenic  leukemia 
])oikilocytosis  is  frequent,  and  they  are  frequently  nucleated 
(Plate  X,  Fig.  2).  A  dhnimition  of  the  hemoglobin  contents 
in  the  blood  can  always  be  demonstrated. 

In  some  cases  the  temperature  shows  only  a  slight  rise, 
or  it  may  rise  to  39-40^  C. ;  on  the  other  hand,  towards  the 
termination  of  the  disease,  a  subnormal  temperature  is  not 
infre<iuently  ol)served. 

Frohner  found  in  the  eye  of  an  affected  horse,  near  the  inner  border  of 
the  })apilla,  a  lentil-sized,  triangular,  sharply  circumscribed  white  spot  (Retinitis 
leukaeniica  ?) 

Towards  the  termination  of  the  disease  hemorrhages  occur 
not  infrecpiently,  especially  on  the  mucous  membranes  (gums, 
conjunctivae,  intestines,  etc.),  further  on  the  skin  and  in  the 
muscles,  sometimes  even  in  the  brain.  At  the  same  time 
parenchymatous  hemorrhages  are  very  stubborn. 

Course.  Leukemia  is  usually  a  chronic  affection  and  ex- 
tends over  several  months  and  even  years.  An  acute  leukemia 
develops  only  exceptionally,  principally  in  young  animals  which 
may  succumb  to  the  disease  in  a  relatively  short  time,  some- 
times in  a  few  weeks  (X'^ocard  observed  in  one  case  a  termina- 
tion of  the  disease  in  less  than  one  week).  At  the  same  time 
chronic  cases  sometimes  are  arrested  for  a  varying  space^  of 
time,  or  an  apparent  improvement  may  even  occur.  By  im- 
proper keeping  or  by  using  the  animals  for  work  the  course 
is  always  influenced  unfavorably.  Frequently  however  the 
animals' are  destroyed  before  the  occurrence  of  natural  death; 
only  rarely  do  they  die  from  complete  exhaustion  or  from 
internal  hemorrhage,  and  still  more  rarely  the  fatal  termina- 
tion results  unexpectedly  or  without  apparent  cause  (Siedam- 
grotzky). 

Diagnosis.  The  affection  of  the  blood-forming  organs,  and 
the  considerable  increase  of  the  white  blood  corpuscles,  offer 
together  sufficient  indications  for  the  correct  recognition  of 
leukemia.     Without  a  knowledge  of  tlie  morphological  charac- 


87fi  Leukemia  of  Mammals. 

teristics  of  the  white  blood  corpuscles,  the  symptoms  described 
do  not  by  themselves  justify  the  diagnosis  of  a  leukemic  affec- 
tion, as  the  enlargement  of  the  blood-forming  organs  without 
a  simultaneous  increase  of  the  white  blood  corpuscles  may 
occur  in  pseudo-leukemia,  on  the  other  hand,  however,  an  in- 
crease of  polynuclear  leucocytes  without  an  affection  of  the 
blood-forming  organs  occurs  also  in  leucocytosis.  It  cannot 
however  be  denied  that  the  leucocytosis  which  develops  in  the 
course  of  infectious  diseases,  in  severe  simple  anemia,  in  various 
other  internal  affections,  and  during  pregnancy,  is  usually 
associated  with  a  slight  increase  of  the  white  blood  corpuscles ; 
but  in  some  of  the  leucocytoses,  as  Marek's  observations  proved, 
the  relation  between  white  and  red  blood  corpuscles  may  be- 
come as  close  (Marek  found  in  one  case  the  relation  1:18)  as 
in  the  severe  forms  of  leukemia.  On  the  other  hand  it  is  to 
be  considered  that  in  the  early  stages  of  leukemia  the  increase 
of  the  white  blood  corpuscles  need  not  necessarily  be  marked. 
For  the  determination  of  the  form  of  leukemia,  staining  of  the 
blood  corpuscles  is  necessary. 

Chronic  swelling  of  the  lymph  glands  may  also  be  caused 
by  glanders,  tuberculosis,  or  by  malignant  new-formations.  The 
symmetrical  arrangements  of  the  swellings  on  both  sides  of 
the  body  and  their  presence  in  all  places  wdiere  Ijinph  glands 
are  located,  further  also  the  involvement  of  the  other  blood- 
forming  organs,  usually  leaves  no  doubt  as  to  the  nature  of 
the  disease.  For  the  positive  exclusion  of  tuberculosis,  how- 
ever, the  examination  of  the  blood  corpuscles  is  indispensable, 
as  tuberculosis  may  in  some  cases  produce  similar  changes  in 
the  blood-forming  and  parenchymatous  organs,  for  instance, 
lymphatic  pneumonia  (Nocard),  or  a  pronounced  symmetric 
enlargement  of  all  the  lymph  glands  may  exceptionally  result 
from  tuberculous  infection  (observed  by  Anger  in  a  dog,  by 
Marek  in  a  cow). 

Prognosis.  Up  to  the  present  time  neither  in  man  nor  in 
animals  has  a  single  recovery  been  recorded  in  a  correctly 
diagnosed  case  of  leukemia.  Accordingly  the  prognosis  is  al- 
ways unfavorable. 

Treatment.  Treatment  appears  only  indicated  wdien  for 
special  reasons  it  is  desired  to  prolong  the  life  of  the  animals. 
In  such  cases  the  nutrition  should  consist  of  foods  rich  in 
proteids,  the  appetite  should  be  stimulated  by  tonics,  exertion 
should  be  avoided,  and  fresh  air  should  be  plentifully  supplied  to 
the  animals.  Of  medicinal  remedies,  iron,  quinine  (may  be  given 
combined  and  always  in  large,  full  doses),  further  arsenic 
(Fowler's  solution,  in  doses  increased  every  1  to  2  weeks,  is 
most  appropriate),  and  phosphorus;  they  must  however  be 
administered  systematically  and  for  a  long  time.  In  special 
cases  transfusion  of  blood  could  be  attempted,  as  it  is  supposed 


TrcaliiK'iit.  877 

to  have  now  and  tlien  prodiu'ed  a  lasting-  improvement  in 
leukemia  of  man.  In  hnman  medicine  relatively  the  best  results 
have  so  far  l)een  obtained  from  arsenic  and  with  the  Rontgen 
rays  or  witli  both  cond)ined. 

Literature.  Borndt,  A.  f.  Tk.,  1S«9.  XV.  .•?(»().  —  Bollinger,  Schw.  A.,  1871. 
XXIV.  L'Tl.'.  —  (adiot  &  Weil,  Eev.  yen.,  1905.  V.  571.  —  Ehrlich,  Lazarus  & 
Pinkiis,  Dio  Aniiiiiic,  Wien  1S9S.  —  (^iittlidi,  Pr.  Mt.,  1880/81.  19.  —  Jolnic,  S. 
B.,  1S79.  24.  —  (le  Jonjj,  V.  A.,  190.S.  ('I..\XIil.  511.  —  Lciscring,  S.  B.,  1858.  ^5; 
1861.  45;  1865.  29.  —  Lellmanii,  B.  t.  W.,  1904.  699.  —  Li3wit,  Kongr.  f.  innere 
Med.  in  Karlsbad.  1899.  —  Lucct,  J.  vet.,  1891.  570.  —  Nocanl,  l)c  la  Leiu^o- 
evtheniie  chez  les  aniniaux  dom.,  1881  (Lit.)  ;  A.  d'Alf.,  1882.  361.  —  Olt,  D.  t.  W., 
1899.  197.  —  Pr.  Mil.  Vb.,  1899-1908.  —  Sieilanigrotzky,  S.  B.,  1870.  21;  Vortr. 
f.  Tzte.,  1878.  H.  10  (Lit.).  —  Stockman,  J.  of  Couip.  Path.,  1S93.  65.  —  WolfiE, 
B.  t.  W.,  1892.  121.  —  Zell,  T.  R.,  1888/89.  49. 

(b)    Leukemia  of  Chickens. 

Leukemia  of  chickens  is  an  affection  of  the  blood-forming 
organs,  caused  by  an  infection,  and  is  associated  with  a  con- 
siderable increase  and  infiltration  of  large  mononuclear  leuco- 
cytes, atrophy  of  the  tissues  of  the  bone  marrow,  and  an  in- 
crease of  the  myeloid  tissue  in  the  liver.  The  circulating  blood 
frequently  shows  a  diminished  number  of  red  blood  corpuscles, 
and  also  a  variable  increase  of  white  blood  corpuscles. 

History.  Although  Moore  had  already  in  1896  described  "an 
infec'tiou.s  leukemia  of  chickens,"  these  cases  represented  undoubtedly 
a  bacterial,  acute  infectious  disease  with  a  simple  hyperleucocytosis, 
which  is  frequently  met  in  various  infectious  diseases  of  chickens.  The 
cases  described  by  Butterfield  (1905),  and  Yutaka  Kon  (1907),  are 
-more  likely  to  belong  to  leukemia,  although  the  blood  of  the  affected 
birds  was  not  examined.  Ellermann  &  Bang  (1908)  were  the  first 
to  recognize  and  study  the  disease  as  such.  Valuable  studies  relative 
to  this  disease  in  its  clinical  aspect  were  furnished  by  Hirschfeld 
&  Jacob  (1907),  also  by  Skiba  (1909). 

Occurrence.  The  disease  occurs  exclusively  among  chickens, 
and  among  these  in  an  enzootic  and  even  an  epizootic  form. 
The  disease  was  discovered  by  Ellermann  &  Bang  in  Denmark, 
and  it  has  also  been  observed  in  Germany  (Hirschfeld  S:  Jacoby, 
Eber). 

Etiology.  The  disease  is  produced  by  some  kind  of  an 
infectious  substance,  the  nature  of  which  is  still  unknown. 
Only  this  much  is  known  from  the  investigations  of  Ellermann 
&  Bang  that  the  cell-free  filtrate  from  organ-emulsions  may 
transmit  the  disease,  and  therefore  the  etiological  role  of  an 
ultra-visible  microorganism  does  not  appear  excluded.  Hirsch- 
feld &  Jacoby  however  up  to  the  present  always  obtained  nega- 
tive results  with  filtrates  through  Berkefeld  filters  of  organ 
emulsions  of  leukemic  chickens. 

The  virus  is  present  in  all  affected  organs,  the  spleen,  liver, 
bone  marrow,  etc.  The  infectious  properties  of  the  organs, 
however,  are  lost  in  a  few  days. 


878  Leukemia  of  Chickens. 

The  bodies  resembling  protozoa  seen  by  Yutalia  Kon  were  also  found  by 
Ellermann  «&  Bang,  and  these  also  observed  in  the  bone  marrow  round  bodies 
resembling  parasites;  the  authors,  however,  refrained  from  expressing  an  opinion 
as  to  the  nature  of  these  bodies.  Hirschfeld  &  Jacoby,  on  the  other  hand,  found 
peculiar  long  bacilli,  which  produced  a  temporary  anemia  with  lymphocytosis  in 
an  experiment  chicken;  still  they  do  not  yet  desire  to  consider  this  bacillus  as  the 
cause  of  the  disease. 

Pathogenicity.  The  disease  may  be  transmitted  to  chickens 
by  intravenons  or  intraperitoneal  inoculations  of  affected 
organs,  whereas  other  species  of  birds,  likewise  guinea  pigs 
and  ral3bits,  are  not  susceptible ;  subcutaneous  injection,  on  the 
other  hand,  is  negative  even  in  chickens.  After  an  incubation 
of  1  to  2  months  about  40%  of  the  inoculated  chickens  become 
affected,  and  then  about  one-half  of  the  birds  show  indications 
of  leukemia,  the  other  half  those  of  pseudo-leukemia. 

Pathogenesis.  The  irritation  of  the  virus  produces  a  great 
increase  in  the  production  of  white  ])lood  cells  in  the  capillaries 
of  the  bone  marrow,  liver  and  spleen,  whereby  in  these  places 
an  accumulation  of  white  blood  cells  results,  especially  of  large 
mononuclear  cells,  and  also  the  appearance  of  myelocytes.  The 
active  production  at  these  places  of  white  blood  cells  is  indicated 
by  extensive  mitosis.  The  tissue  of  the  bone  marrow  atrophies 
with  the  local  increase  of  the  white  blood  cells,  while  the  myeloid 
tissues  of  the  liver  on  the  contrary  increase.  Temporarily 
the  predominating  intravascular  process  remains  confined  to 
the  blood-forming  organs  without  flooding  the  blood  with  white 
blood  cells  (according  to  Ellermann  leukosis  aleukaemica, 
pseudo-leukemia).  In  about  one-half  of  the  cases,  however,  the 
circulating  blood  becomes  flooded  with  the  newly  formed  white 
blood  cells  (according  to  Ellermann  &  Bang,  Leukosis  leukae- 
mica),  probably  for  the  reason  that  there  are  no  agglutinines 
present  at  the  places  of  formation.  On  the  other  hand,  in  some 
cases  a  local  increase  of  cells  occurs  very  strikingly  in  the  tissue 
of  the  peritoneum  (according  to  Hansen,  so-called  multiple 
Sarkomatosis  of  the  peritoneum).  Hand  in  hand  with  the 
leukemic  process  an  anemia  also  develops,  either  as  the  result 
of  a  check  in  the  formation  of  red  blood  cells,  or  then,  owing 
to  an  increased  destruction  of  these  cells  under  the  action  of 
hemolytic  toxins. 

In  opposition  to  the  above-described  conception  of  Ellermann  &  Bang,  and 
Hirschfeld  &  Jacoby,  Skiba  maintains  on  the  ground  of  his  observations  in 
chickens  which  died  of  other  infectious  diseases,  that  on  one  hand  chicken  leukemia 
differs  from  the  similarly  named  affection  of  mammals,  and  that  on  the  other 
hand  it  probably  represents  a  disease  which  is  associated  only  with  a  marked  leuco- 
cytosis.  Chickens  are  supposed  to  have  in  general  a  great  tendency  to  respond 
with  a  marked  leucocytosis  to  infections,  or  to  other  harmful  influences  (insuffi- 
cient exercise,  improper  keeping).  The  principal  difference  between  leukemia  of 
chickens  and  that  of  mammals  is  supposed  to  consist  in  the  main,  in  that  in  chicken 
leiikemia  the  tissue  proper  of  the  blood  forming  organs  remains  unchanged. 
Schridde  maintains  further  that  a  disease  simulating  chicken  leukemia  may  also 
be  produced  by  intravenous  injections  of  organ  emulsions  of  healthy  chickens, 
which,  however,  was  not  substantiated  by  the  experiments  of  Hirschfeld  & 
Jacoby. 


Patlio^'enesis,  Aiiatimiical   Changes.  879 

Tlicrefoi-c  llic  \i('\vs  in  rci^ard  to  the  natui'c  of  cliickcii 
leukemia  still  tlillVr,  and  a  dceiilcd  i)o.sitioii  in  this  connection 
is  all  the  more  difficult,  as  the  morphologic  and  biological  re- 
lations of  the  Avhite  blood  cells  and  their  part  in  the  different 
diseases  of  birds  have  not  yet  ])een  iiivestigatecl  sufficient ly. 
The  (pialitative  changes  of  the  Avliite  ])lood  cells  demonstrated 
by  EUennann  •Jc  Bang,  llirschfeld  &  Jacoby,  namely,  the  ap- 
pearance of  abnormal  cells  in  great  numbers,  establish  very 
nearly  the  leulaMuic  nature  of  the  disease.  The  study  of  chicken 
leukemia  also  o])ens  a  prospect  for  the  determination  of  the 
nature  of  leukemia  of  mammals. 

Anatomical  Changes.  Most  striking  is  usually  the  enlarge- 
ment of  the  s])Ieen  and  liver,  also  the  grayish-red  discoloration 
of  the  bone  nuirrow.  However,  it  occurs  not  infrecjuently  that 
the  enlargement  is  insignificant,  and  the  color  of  the  bone 
marrow  does  not  always  deviate  noticeably  from  the  normal. 
XoAv  and  then  a  rupture  of  the  greatly  increased  spleen  or  liver, 
and  fatal  bleeding  in  the  abdominal  cavity  is  observed.  Other- 
wise fine  white  points  or  stripes  may  be  noticed  in  the  liver 
tissue,  even  with  the  naked  eye.  Histological  examination  re- 
veals a  considerable  increase  of  the  leucocytic,  and  a  diminu- 
tion of  the  erythroblastic  tissues  in  the  l)one  marrow,  further 
very  marked  perivascular  leucocytic  proliferation  in  the  liver, 
the  capillaries  of  which  appear  plugged  with  leucocytes,  while 
in  the  spleen  numerous  pale  leucocytes  are  present  and  strings 
may  be  noticed,  formed  by  capillaries  filled  with  leucocytes 
\vhicli  contain  small  nuclei.  In  all  of  these  organs  numerous 
cells  are  undergoing  mitosis.  Only  Eber  reports  an  enlarge- 
ment of  the  hTupli  glands  on  the  neck  and  in  the  mesentery, 
but  the  diagnosis  in  that  case  was  not  based  on  blood  examina- 
tion with  consideration  of  the  morphological  relations  of  the 
white  blood  corpuscles;  the  autopsy  findings  are  completed  by 
the  finding  of  anemia,  while  the  blood  proper  manifests  the 
changes  to  be  described  l)elow. 

Symptoms.  After  an  incubation  of  1  to  2  months  indica- 
tions of  anemia  become  noticeable,  inasmuch  as  the  comb  ap- 
pears pale,  its  turbidity  is  diminished  and  the  blood  obtained 
by  pricking  shows  a  pale  red  color.  In  stained  blood  specimens 
several  small  or  large,  round,  nucleated  and  mostly  polychroma- 
tophilic  red  blood  cells  are  noted  (normoblasts  and  megalo- 
blasts).  Simultaneously,  a  relatively  large  increase  of  hnnpho- 
cytes  may  also  be  observed.  At  the  same  time  the  number  of 
the  red  l)lood  corpuscles,  Avhich  under  normal  conditions,  accord- 
ing to  Ellermann  &  Bang,  amount  to  3,000,000,  according  to 
Skiba  however,  6,000,000  per  cubic  millimeter,  gradually  dimin- 
ishes to  1,100,000.  Likewise  a  diminution  of  the  hemoglobin 
content  is  noted,  inasmuch  as  the  normal  value  of  50-65  in 
vouug  chicks,  frequently  only  40-50°  (according  to  Sahli),  drops 


880  Leukemia   of   Chiekens. 

to  15".  During  the  entire  course  of  the  disease  there  exists  a 
hemorrhagic  diathesis,  as  a  result  of  which  numerous  and  fre- 
quently severe  hemorrhages  result  in  some  of  the  patients,  and 
the  wounds  inflicted  on  the  comb  for  drawing  blood  give  rise 
to  hemorrhages  which  are  hard  to  control  (Hirschfeld  &  Jacoby). 
In  this  stage  the  clinical  appearance  of  the  disease  corresponds 
to  that  of  pseudo-leukemia. 

As  already  mentioned  the  pronounced  leukemic  picture  of 
the  blood  appears  only  in  about  half  of  the  patients.  This  fre- 
quently develops  suddenly,  and  sometimes  the  birds  die  quickly, 
the  leukemic  changes  of  the  blood  being  then  recognized  only 
at  autopsy.  The  increase  of  white  blood  corpuscles  is  usually 
so  pronounced  that  instead  of  the  normal  number  of  about 
30,000,  100,000  to  600,000  white  blood  cells  may  be  counted  in 
the  diiferent  cases,  and  the  proportion  between  the  white  and 
red  blood  corpuscles  (1:100;  according  to  Skiba  1:250)  may 
fall  to  1 :2  or  1 :3.  At  the  same  time  the  percentage  of  the 
different  cells  has  changed  to  such  an  extent  that  the  large 
mononuclear  cells,  instead  of  the  normal  percentage  of  23,  are 
represented  in  a  percentage  of  60-94,  while  the  polynuclear 
leucocytes  and  the  smaller  lymphocytes  are  forced  into  the 
background,  and  at  the  same  time  the  granulated  polynuclear 
leucocytes  contain  spherical  granules  instead  of  the  usual  rod- 
shaped  eosinophilic  granules  (Hirschfeld  &  Jacoby).  In  con- 
trast to  the  normal  blood  round  nuclear  cells,  also  with  granules, 
are  seen  in  quite  large  numbers  which  may  be  considered  as 
myelocytes,  and  sometimes  their  granula  may  attain  the  size 
of  a  cell  nucleus. 

Course.  The  disease  usually  lasts  only  8  to  14  days,  some- 
times however  1  to  3  months,  and  unexpected  deaths  are  ap- 
parently not  exceptional.  Spontaneous  recoveries  are  very  rare 
(Ellermann  &  Bang  observed  such  recoveries  in  two,  Hirschfeld 
&  Jacoby  in  one  case). 

Diagnosis.  This  can  be  established  only  on  the  ground 
of  microscopical  examinations,  if  a  leukemic  condition  of  the 
blood  already  exists,  while  otherwise  the  disease  can  at  best 
only  be  indicated  by  determining  the  relative  increase  of  lympho- 
cytes by  the  infectious  character  of  the  disease,  and  still  more 
positively  by  the  autopsy  findings.  The  greatest  difficulty  may 
be  the  exclusion  of  simple  leucocytosis,  which  occurs  very  fre- 
quently in  chickens  and  which  may  at  times  be  very  severe. 
In  this  the  increase  of  the  white  blood  corpuscles  may  reach 
such  a  degree  that  the  relation  of  the  white  blood  corpuscles 
to  the  red  may  fall  even  to  1:26  (Skiba).  Leucocytosis  occurs 
especially  in  chronic  infectious  diseases  of  chickens,  most 
noticeably  in  tuberculosis,  and  may,  as  shown  by  Skiba,  pro- 
duce changes  even  in  the  blood-forming  organs  which  resemble 
those  of  leukemia.    A  careful  examination  of  the  morphological 


Diagnosis,     Ti-catinciit.  gg\ 

conditions  of  the  wliitc  l)loo(l  corpuscles  in  stained  specimens 
fre(niently  affords  snllicient  grounds  for  a  dinVreutial  diaii^nosis. 
A  relatively  uniform  increase  of  all  re})resentatives  of  white 
blood  corpuscles  and  the  absence  of  unrii)e  forms  of  cells  are 
met  with  in  simple  leucocytosis.  The  mononuclear  leucocytes 
however  ai)pear  to  gain  the  upper  hand  even  in  certain  cases 
of  leucocytosis,  Avliich  was  indicated  bv  the  observations  of 
Skiba. 

Treatment,  ^''ery  few  experiments  have  been  attempted  in 
this  respect.  Ellermann  &  Bang  observed  recovery  in  one  case 
after  treatment  with  arsenic;  it  cannot  however  be  decided 
whether  this  did  not  represent  an  accidental  spontaneous  re- 
covery. The  Rontgen  treatment  proved  unsatisfactory  in  an- 
other case. 

Literature.  Elter,  Leipz.  B.,  1907/08.  54.  —  Ellerniaini  &  Ban^,  Chi.  f. 
Bakt.,  ]lt()S.  XLV[.  (Orig.),  595  (Lit.);  Z.  f.  Hvfj-,  1^09.  LXIII.  231.  —  Hirsch- 
feld  &  Jat'obv,  Z.  f.  kl.  Mo.l.,  1909.  LXTX.  1  (Lit.).  —  Skilia,  D.  t.  W.,  1909. 
405   (Lit.). 

5.    Pseudo-Leukemia.    Pseudo-Leukaemia. 

{Ho(lf/kii/'s   Disease,   Aleukemic   Lympliadenia,    Suhlymphatic 

Leukemia   [Helli/];  Lymphadeuia   [Vi^choR•^^;  Pscjido- 

leukaemia  lymphatica  [Pi)tki(s].) 

By  pseudo-leukemia  is  understood  a  chronic  affection  in 
which  the  blood-forming  organs  show  the  same  changes  as  in 
"leukemia.  The  increase  of  white  blood  corpuscles  in  the  blood 
is  however  absent. 

Occurrence.  Up  to  the  present  cases  have  been  observed 
in  horses,  dogs,  cattle  and  in  a  cat  (de  Does).  The  disease 
occurs  more  frequently  than  leukemia  for  which  it  is  frequently 
mistaken.  Leukemia  of  chickens  is  in  a1)out  half  of  the  cases 
also  manifested  by  the  symptoms  of  pseudo-leukemia  (see  p. 
877). 

Etiology.  The  absence  of  an  increase  of  white  blood  cor- 
puscles constitutes  the  only  important  difference  between 
leukemia  and  pseudo-leukemia;  other^vise  the  anatomical 
changes,  as  well  as  the  clinical  s^inptoms  are  almost  identical. 
As  a  matter  of  fact  the  h^nphocytes  may  be  present  in  a  higher 
percentage  than  normally,  although  the  total  number  of  the 
white  blood  corpuscles  remains  comparatively  normal.  This 
phenomenon  occurs  in  pseudo-leukemia  of  man,  was  also  ob- 
served by  A.  Zimmermann  in  a  cow,  by  Jaeger  in  a  dog,  and 
by  Hirsciifeld  &  Jacoby  in  the  pseudo-leukemic  stage  of  chicken 
leukemia. 

Based  on  this  coi'respondence  the  view  is  greatly  supported, 
according  to  which  pseudo-leukemia  is  held  to  be  identical  in 

Vol.  1—56 


882 


Pseudo-Leukemia. 


its  nature  with  leukemia  and  depends  on  a  general  affection 
of  the  lymphatic  hematopoetic  tissue  (Rouvier,  Jaccoud,  Cohn- 
lieim,  Nocard,  Hirschfeld  &  Jacohy).  According-  to  this  view 
pseudo-leukemia  would  therefore  represent  only  a  form  of 
leukemia,  in  which  however  the  flooding  of  the  circulating  blood 
with  white  blood  corpuscles  is  absent,  as  agglutinines  are  possi- 
bly present  in  the  parts  producing  white  blood  corpuscles 
(Ellermann  &  Bang),  or  there  occurs  no  irruption  of  the 
proliferating  lymphoid  or  myeloid  tissue  into  the  blood  stream 
(Marchand,  Neumann).  In  addition  to  this  exceptional  transi- 
tory stages  of  pseudo-leukemia  were  observed  in  leukemia  of 
man,  whereas  in  chicken  leukemia,  as  ah'eady  mentioned,  about 
half  of  the  birds  manifest  simple  pseudo-leukemic  changes  in 
the  presence  of  the  same  anatomical  lesions  in  the  blood-forming 
organs  and  in  the  liver.  As  a  matter  of  fact  Pinkus  accepts 
pseudo-leukemia  as  identical  with  lymphatic  leukemia,  or  at  least 


Fig.  156.     Pseuc1o-1ei(l-emi(t :    a  enlarged  retropliai yiiiioal  gland:  h  enlarged  prescap- 
ular  lymph  gland  ;  c  enlarged  precrural  lyni|)h  gland. 

as  a  very  closely  related  alfection.  However  recently  pseudo- 
leukemias of  myeloid  types  were  also  noted  in  man,  and  the 
pseudo-leukemic  form  of  chicken  leukemia  very  likely  also  be- 
longs to  this  group. 

In  opposition  to  this,  other  authors,  even  at  the  present 
time,  are  supporting  the  view  of  the  iirst  recorder  of  pseudo- 
leukemia^ (Hodgkin),  according  to  which  both  diseases  would 
not  be  etiologically  identical.  In  this  they  seek  support  in  the 
fact  that  pseudo-leukemia  hardly  ever  passes  into  leucocytemia. 

At  the  present  time  various  diseases  are  comprised  under  the 
name  of  pseudo-lenkemia.     Exehiding  the  pseudo-leukemia  proper  which 


Elioloyy.     Syuipt'iiiis.  g83 

depends  on  a  hyperplasiu  of  the  lymphoid  and  myeloid  tissue,  the  in- 
flations graiudomata  -\vhieli  in  domestic  animals  are  usually  of  tuboi-- 
culous  origin  and  which  apparently  occur  frecpiently,  are  also  considered 
as  pseudo-leukemia.  Thus  Noeard  succeeded  in  demonstrating  tubercle 
bacilli  in  all  alfected  organs  of  the  eases  wliich  corresponded  to  pseudo- 
leukemia, and  accordingly  explained  also  the  cases  described  l)y  him 
formerly  as  lymphiidenua  to  be  tulu-rculous  in  nature.  The  same 
iinding  was  also  claimed  ])y  Brentano  &  Tangel  in  a  case  of  pseudo- 
leukemia in  man,  the  authoi-s  expressing  the  view  that  pseudo-leukemia 
is  probably  only  a  peculiar  form  of  tuberculosis.  These  processes,  how- 
ever, of  course,  do  not  belong  etiologically  to  pseudo-leukemia  proper, 
although  clinically  and  in  their  gi-oss  aiuitomy  they  bear  a  marked, 
resemblance  to  ])seudo-leukemia,  the  same  as  the  lymphosarconuitous 
swellings  of  the  glands  (Kundrat's  lymphosarcoma),  which  originate 
from  malignant  growths,  but  clinically  greatly  resemble  pseudo-leukemia. 

Symptoms.  Tiic  .symptoms  and  also  the  autopsy  findings 
simulate  greatly  those  of  leukemia,  while  the  course  is,  as  a 
rule,  somewhat  shoi-ter.  The  general  hyperplasia  of  the  lymph 
glands  and  tlie  indications  of  a  severe  anemia  strongly  suggest 
pseudo-leukemia,  but  the  nature  of  the  disease  can  be  cleared  up 
only  by  the  examination  of  the  blood.  Although  the  relatioii 
of  the  red  to  the  white  blood  corpuscles  is  not  found  to  be  greatly 
changed,  the  red  blood  corpuscles  may  sometimes  be  distorted 
and  smaller  (poikilocytosis) ;  at  the  same  time  their  number 
is  always  diminished,  while  the  hTnphocytes  are  always  present 
in  a  higher  percentage  than  in  normal  blood.  Sometimes  flat, 
roundish,  soft  eruptions  may  develop  on  the  skin,  over  which 
the  hair  falls  out  (Lienaux). 

Diagnosis.  From  the  standpoint  of  differential  diagnosis, 
leukemia,  tuberculosis,  glanders  and  malignant  growths  of  the 
lymph  glands  come  into  consideration. 

Prognosis.  Up  to  the  present  time  not  a  single  case  of 
recovery  has  been  recorded. 

Treatment.  Comparatively  the  best  results  were  o))tained 
in  man  from  a  systematic  administration  of  iron,  iodine  and 
arsenical  preparations.  On  suitalde  occasions  the  treatment 
with  Eontgen  rays  may  be  attempted. 

Literature.  Ca.leae,  J.  vet.,  11)07.  266.  —  de  Does,  Holl.  Z.,  1890.  158.— 
Dorst,  Z.  f.  Vk.,  1906.  437.  —  Ehrlich.  Lazarus  &  Pinkiis,  Die  Aiianiie.  Wien  1898. 
—  ^^(•Fa.lyean,  J.  of  Comp.  Path.,  1903.  379.  —  Frohner.  W.  f.  Tk.,  1885.  245.  — 
Haffner.  Z.  f.  Flhy^.,  1906.  XVL  418.  —  Hodgson,  J.  of  Comp.  Path.,  1905. 
382.  —  Jaeger,  B.  t.  W.,  1907.  563.  —  Lienaux,  Ann.,  1901.  478.  —  Lothes, 
B.  t.  W.,  1891.  9.  —  Lustig,  Ilann.,  Jhb.,  1879/80.  54.  —  Noeard,  De  la  Leuco- 
eythaniie,  1891  (Lit.)  ;  Bull.,  1885,  45.  —  Rottke,  B.  t.  W.,  1906.  712.  —  Siedani- 
grotzky,  S.  B.,  1876.  23.  —  Zimniermann,  Vet.,  1898.  473. 


'§84  Heiiioglobiiieuiia. 


6.    Hemoglobinemia.    Haemoglobinaemia. 

Hemoglobinemia  represents  an  affection  of  the  blood  in 
which  the  blood  plasma  contains  dissolved  blood-coloring  matter. 

The  paralytic  hemoglobinemia,  which  etiologically  as  well  as  from 
a  symptomatological  standpoint  represents  a  special  form  of  disease, 
will  he  treated  in  a  later  chapter. 

Etiology.  The  simple  hemoglobinemia  of  domestic  animals 
is  principally  caused  by  blood  parasites,  especially  by  piro- 
plasma  (see  p.  762),  more  rarely  by  trypanosomes  (see  p.  801). 
Besides  these,  although  much  more  rarely,  certain  chemical  sub- 
stances or  toxins  may  be  responsible  for  a  dissolution  of  the 
red  blood  corpuscles.  Of  the  known  chemical  substances, 
chlorate  of  potassium,  phenacetin,  creolin,  naphthol,  naph- 
thalin,  antifebrin,  and  various  acids  (by  insect  bites  formic 
acid  enters  into  the  body  [Albrecht] )  may  exceptionally  pro- 
duce hemoglobinemia  if  they  are  administered  in  large  quan- 
tities. (Siedamgrotzky  observed  the  disease  in  a  horse  which 
was  given  a  handful  of  naphthalin.)  The  disease  sometimes 
develops  also  in  the  course  of  acute  infectious  diseases  (in- 
fluenza of  horses,  distemper  of  dogs),  under  the  influence  of 
specific  infectious  substances,  or  more  often  as  the  result  of 
secondary  infections  (with  streptococci).  Szilagyi  observed 
numerous  cases  of  hemoglobinemia  in  horses,  with  intestinal 
hemorrhage,  after  the  ingestion  of  very  moldy  clover.  Hemo- 
globinemia sometimes  appears  also  in  connection  with  a  non- 
specific septicemia,  extensive  burning  of  the  skin  (Frohner, 
Plosz).  Whether  the  action  of  cold  or  the  cooling  of  the  bod}^ 
is  capable  of  producing  hemoglobinemia  in  domestic  animals 
remains  at  present  undecided.  Although  Saur,  also  Leech  ob- 
served the  affection  in  dogs,  and  Utz  in  a  hog,  occurring  after 
the  action  of  cold,  another  origin  of  the  disease  cannot  be 
positively  excluded  in  these  cases.  If  solution  of  the  blood 
corpuscles  resulted  from  the  action  of  the  cold  itself,  hemo- 
glol3inemia  would  appear  much  more  frequently  after  colds. 
In  the  paroxysmal  hemoglobinemia  of  man  hemolytic  substances 
were  found  in  the  blood  serum  of  the  patients,  Avhich,  when 
cold  are  anchored  to  the  blood  corpuscles  in  the  fashion  of  an 
amboceptor,  and  when  w^arm  are  supposed  to  produce  solution 
of  the  blood  corpuscles  with  the  aid  of  the  complement  (Moro  & 
Noda). 

Szoyka  observed  hemoglobinemia  in  two  dogs,  and  Marek  in  three 
horses,  and  in  enzootic  extension  in  sheep  also  without  being  able  to 
prove  a  hematozoal  origin  of  the  affections,  either  by  examination  of 
the  blood  or  through  injections  or  transfusions  of  the  blood  into  animals 
of  the  same  species. 


Etiology,  Patliofjeiiesis.  gg5 

Pathogenesis.  Tlio  development  of  the  disease  commences 
either  witli  the  breaking  down  of  red  blood  corpuscles,  or  with 
the  elimination  of  the  blood  coloring  matter  from  the  blood 
cells,  but  not  infrequently  with  both  ])rocesses  together;  the 
eliminated  hemoglobin  is  tlien  dissolved  in  the  blood  plasma 
and  deposited  mostly  in  the  spleen  and  in  the  bone  marrow. 
A  considerable  part  however  is  worked  up  by  the  liver  into 
bile  coloring  matter.  If  the  blood  plasma  becomes  suddenly 
flooded  with  l)lood  coloring  matter,  or  if  the  quantity  absorbed 
by  the  blood  plasma  exceeds  the  sixtieth  part  of  the  total  hemo- 
globin, a  part  of  the  coloring  matter,  as  found  by  the  experi- 
ments of  Ponfick,  is  eliminated  by  the  kidneys  (hemoglobinuria), 
producing  at  the  sanu^  time  a  degeneration,  or  even  an  in- 
flammation of  the  kidneys.  In  severe  hemoglol)inemia,  but  ac- 
cording to  AtTanasiew  only  in  hemoglobinemias  with  destruc- 
tion of  blood  corpuscles,  the  liver  forms  bile  pigments  in  large 
([uantities  from  the  blood  coloring  matter,  and  as  the  secretion 
of  the  fluid  constituents  of  the  bile  does  not  keep  up  with  it, 
the  thickened  bile  accumulates,  is  partly  absorbed,  and  thus 
the  possibility  is  afforded  for  the  development  of  icterus. 
Sometimes  other  organs  also  become  affected  under  the  influence 
of  the  blood  dissolving  substances. 

Anatomical  Changes.  The  blood  serum  appears  more  or 
less  reddisli  in  color;  in  severe  cases  the  blood  may  be  even 
darker  at  the  beginning,  in  the  further  course  however  it  is 
-lighter  in  color.  The  spleen  shows  an  acute  swelling  on  account 
of  the  taking  up  of  blood  pigments,  its  size  corresponds  with 
the  intensity  and  duration  of  the  disintegration  of  lilood  cor- 
puscles. The  spongy  bone  marrow  appears  more  or  less  red- 
dened, sometimes  of  a  dark  red  color.  In  severe  cases  a  general 
icterus  may  be  noted. 

Symptoms.  Without  a  blood  examination  mild  cases  of 
the  affection  may  pass  unrecognized.  In  severe  cases  depres- 
sion, icterus  and  hemoglobinuria  are  observed.  Fever  also 
appears,  as  a  rule,  and  is  brought  on  either  by  the  causative 
agent  of  the  disease,  or  by  the  febrile  action  of  products  from 
the  disintegrated  red  blood  corpuscles.  As  the  coagulation 
of  the  blood  increases  hemorrhages  occur  probably  as  the  re- 
sult of  a  simultaneous  destruction  of  white  blood  corpuscles 
in  the  mucous  membranes  and  also  in  the  other  organs.  The 
disintegration  of  blood  corpuscles,  as  Avell  as  the  substances 
causing  the  same,  may  further  ])roduce  difficulty  in  respiration, 
disturbance  of  consciousness,  also  convulsions,  weakness  and 
accelerated  pulse,  and  occasionally  nephritis  (renal  epithelial 
cells,  casts  in  the  urine).  The  blood  shows  the  same  changes 
as  in  acute  anemia  (see  p.  847),  provided  the  blood  serum 
contains  hemoglobin. 

Mild  cases  may  terminate  in  r<>covery,  wliereas  the  severe 


886  Heraoglobinemia, 

attacks  produce  death  in  a  few  days  or  later.  Tlie  animals 
which  remain  alive  not  infrequently  show  for  a  time  the  symp- 
toms of  simple  anemia. 

Diagnosis.  A  positive  recognition  of  the  disease  is  only 
possible  by  the  demonstration  of  hemoglobinnria,  or  by  the 
presence  of  dissolved  blood  coloring  matter  in  the  iDlood  serum 
drawn  with  great  care ;  a  severe  icterus  appearing  without  any 
apparent  organic  affection  should  he  considered  as  a  suspicious 
indication  of  the  disease.  An  attempt  should  always  be  made 
to  determine  the  cause  of  the  disease. 

The  paralytic  hemoglobinemia  is  differentiated  from  the 
other  forms  of  hemoglol)inemia  by  the  entirely  different  mode 
of  onset,  by  the  presence  of  the  paralytic  symptoms,  and  by 
the  changes  in  the  tendinous  reflexes. 

Treatment.  Besides  removal  of  the  cause  if  it  can  be  de- 
termined, and  relieving  the  threatening  s^anptoms,  the  treat- 
ment mentioned  in  anemia  appears  indicated  (see  p.  850). 

Literature.  Albrecht,  Monh.,  1892.  III.  241.  —  Dieterichs,  D.  m.  W.,  1903. 
293.  —  Marek,  Z.  f.  Tm.,  1904.  VIII.  285.  —  Moro  &  Noda,  Miineh.  m.  W.,  1909. 
545.  —  Siedanigrotzky,  S.  B.,  1892.  16.  —  Szilagyi,  A.  L.,  1907.  633.  —  Szovka, 
ibid.,  1903.   1.  —  rtz,  B.  Mt.,   1885.  4. 

7.    Paralytic  Hemoglobinemia.     Haemoglobinaemia  paralytica. 

{Azotiiria,  Haemoglohinemia   rheumatica    [Fruhiier] ;   Haemo- 
glohinuria  toxaemica  [Bol]i)iger] ;  Lumhago  [Dieckerlfoff].) 

Paralytic  hemoglobinemia  is  a  specific  acute  affection  of 
horses,  characterized  by  severe  disturbances  in  locomotion 
(mostly  lumbar  paralysis)  as  a  result  of  a  parenchymatous 
degeneration  of  certain  muscles,  and  by  the  presence  of  hemo- 
globin in  the  urine. 

History.  Considering  the  nature  of  the  etiological  factors  paralytic 
hemoglobinemia  of  horses  must  have  been  known  since  earliest  times, 
although  it  might  not  have  appeared  as  frequently  as  at  present.  Even 
in  the  '20 's  of  the  last  century,  Coulboux,  Chariot,  Prevot  and  Bouley 
jr.  described  a  disease  as  spinal  apoplexy  or  congestion  of  the  spinal 
cord,  which  etiologically  and  clinically  corresponds  with  paralj^tic 
hemoglobinemia,  and  which  did  not  appear  to  be  very  infre(iuent  at 
that  time.  Since  the  middle  of  the  last  century  the  reports  of  the 
disease  continue  to  increase,  especially  in  Germany.  In  former  times 
■'azoturia,"  "lumbago,"  "blackwater,"  "rheumatic  lumbar  paralysis," 
"spinal  meningitis,"  " Haemoglobinuria  paroxysmalis, "  etc.,  were  con- 
sidered as  different  diseases.  In  1852  however  Hofer  introduced  them 
in  literature  as  identical.  Since  then  until  the  most  recent  times,  a 
great  number  of  publications  have  been  prepared  on  the  subject,  which 
however  have  not  yet  completely  cleared  the  etiology  and  the  nature 


Etiolofjy.  837 

of  the  disease.  Studies  on  the  nature  of  the  disease  were  especially 
carried  out  by  Holliiifjcr  (1877),  Frohncr  (1884),  McP'advean  (1888), 
Lucet  (1889),  W.  Eher  (1892),  Dieckerhotl'  (1895),  Lignieres  (18!KS) 
Cadeae  (1899),  Hink  (1901),  and  Sehlegel  (1906).  Schlegel  at  first 
strictly  separated  tiie  affection  from  enzootic  spinal  meningitis 
(Meningomyelitis  haemorrhagica),  later  however  he  considered  them 
as  identical  ail'ections.  Fui-thermore  paral\tic  hemoglohinuria  has 
formerly  fre(|uently  been  confused  with  enzootic  spinal  meningitis. 
Johne  (1879)   described  the  disease  in  a  zebra. 

Etiology.  Tlio  observations  of  many  years  \\\)  to  the  present 
time  have  ])rove(l  beyond  a  doubt  that  the  development  of  the 
disease  is  favored  by  the  cooperation  of  certain  predisposing 
causes.  The  most  conspicuous  influence  is  the  method  of  keei)ing 
the  horses,  inasmuch  as  the  disease  usually  appears  after  a 
long  rest  with  rich  feeding  at  the  same  time.  Accordingly  it 
occurs  especially  after  holidays  of  several  days'  duration.  How- 
ever, exce])tions  are  not  at  all  rare,  as  occasionally  resting 
horses  may  become  affected  even  in  the  stables,  or  horses  that 
are  hitched  up  every  day  may  become  affected  during  work, 
and  again  poorly  nourished  or  even  starving  animals  may  be- 
come attacked  by  the  disease  (Hauptmann). 

Brun  observed  in  a  large  stable,  in  which  the  horses  were  not  -workeil  for 
sixteen  days  and  where  the  daily  exercising  was  impossible,  that  eight  cases 
occurred  inside  of  three  days,  while  among  the  horses  of  another  stable  in  which 
the  animals  were  exercised  every  day  only  one,  and  that  a  slight  case,  was  noted. 

The  influence  of  breed  is  sufficiently  proved  by  general 
observations,  in  that  horses  of  draft  breeds  become  affected 
most  frequently,  while  the  disease  appears  more  rarely  in  ani- 
mals of  the  finer  breeds.  Among  common  Hungarian  horses, 
as  well  as  in  the  more  hardened  horses  of  poor  men,  the  dis- 
ease seldom  occurs. 

According  to  the  tabulated  statistics  of  Adam,  among  63  affected  horses 
31C^  were  heavy  draft  animals,  .36%  improved  breeds  of  country  horses,  20% 
wagon  horses,  and  9%  belonged  to  higher  breeds.  Immediately  before  the  affec- 
tion five  horses  were  stabled  for  one  day,  21  horses  for  two  days,  11  horses  for 
H  days,  9  horses  for  4.3  ilays,  four  horses  for  5-8  days.  Out  of  .352  cases  observed 
by  Schindelka  &  Hiifling,  46%  belonged  to  heavy  draft,  19%  of  medium  weight 
animals,  and  35%    to  light  weight  breeds. 

Horses  usually  become  affected  betw^een  the  ages  of  five  and 
eight  years,  much  more  rarely  at  earlier  or  later  ages. 
(Razsovits  and  Hutyra  &  IVfarek  each  observed  the  disease  in 
a  foal  of  IVo  years  of  age;  according  to  Kleinpaul  even  sucking 
colts  are  supposed  to  be  susceptil)le?) 

Excessive  exertions  may  produce  the  disease  even  without 
a  previous  rest;  besides  cases  are  not  infrequent  in  which  the 
disease  develops  after  parturition  or  in  horses  which  liave 
struggled  considerably  during  painful  operations  (Bergstrand, 
Froimer,   Leipziger,   Dages,   Pr.   Mil.   Vb.).     Liko^^'iso   horses 


Paralytic  Henioglobinemia. 

may  become  affected  which  cross  their  foot  over  the  pole  or 
the  halter  rope  and  strain  their  muscles  (Hasse). 

The  arrangement  of  the  stable  is  also  supposed  to  have 
an  unfavorable  influence  to  a  certain  degree,  inasmuch  as  horses 
kept  in  poorly  ventilated,  warm,  damp  stables  are  affected  more 
frequently. 

The  influence  of  the  season  is  manifested  in  that  the  disease 
generally  occurs  more  frequently  during  cold  weather.  It  may 
be  attributed  to  this  condition*  that  cold  has  a  more  or  less 
important,  or  even  an  exclusive  etiological  significance  in  the 
development  of  the  disease.  However  in  this  respect  there 
are  numerous  exceptions.  Thus  of  the  91  cases  observed  dur- 
ing 19  years  at  the  clinic  of  Budapest,  42  occurred  in  the  first 
and  fourth,  49  in  the  second  and  third  quarters  of  the  year. 
According  to  the  statistical  data  of  the  Prussian  Army  in  the 
last  10  years  160  horses  became  affected  in  the  first  and  fourth 
quarter*  and  371  in  the  second  and  third  quarter;  in  the  second 
and  third  quarter,  that  is,  in  that  half  of  the  year  in  which 
there  is  less  opportunity  for  the  action  of  cold,  the  number 
of  the  affections  were  year  after  year  considerably  higher. 

Numerous  hypotheses  were  formed  for  the  explanation  of  the 
true  cause  and  nature  of  the  disease,  the  more  important  of  which 
only  will  he  mentioned.  Dieckerhoff  accepted  as  the  cause  an  auto- 
intoxication, claiming  that  the  toxic  substances  (meat  lactic  acid  and 
other  substances)  develop  from  the  proteids  that  are  not  utilized  during 
rest,  and  which  are  broken  up  under  the  influence  of  a  supposed  fer- 
ment. In  Egypt,  recently  Bollinger  also  considered  the  disease  as  an 
auto-intoxication.  According  to  this  author  a  certain  hemolytic  toxin 
is  supposed  to  develop  from  the  proteids  under  the  influence  of  muscular 
work  or  cold.  Eber  attributes  it  to  the  formation  of  a  toxigenic  sub- 
stance which  is  supposed  to  change  to  a  poison  during  muscular  func- 
tions. Hink  accuses  oxidation  and  decomposition  products,  which 
form  rapidly  during  exertion  of  the  muscles  previously  kept  out  of 
function  for  a  long  time;  he  thinks  that  under  the  cooperation  of 
vasometer  disturbances  there  results  under  a  simultaneous  attack  of 
cold  an  accumulation  of  lactic  acid  and  its  compounds  in  the  muscles, 
leading  to  a  congealing  of  the  muscle  substance,  paralysis  of  the  muscles, 
and  to  a  solution  of  the  muscle  coloring  matter.  According  to  Ohler 
the  disease  develops  as  a  result  of  an  excessive  and  rapid  breaking 
down  of  the  glycogen  in  the  muscles,  in  such  a  way  that  the  sugar 
formed  from  the  glycogen  produces  a  myositis  and  secondarily  a 
nephritis.  According  to  Siedamgrotzky  &  Hofmeister  the  red  blood 
corpuscles  are  supposed  to  be  dissolved  by  the  urea  and  by  the  extrac- 
tive substances  accompanying  it  which  are  formed  in  large  quantities 
by  the  muscle. 

MacFadyean  considers  an  excessive  production  of  red  blood  cor- 
puscles under  the  influence  of  rich  feeding  as  the  cause ;  the  profuse, 
ncAvly  formed  red  blood  corpuscles  are  then  supposed  to  break  down 
during  subsequent  work. 

The  greatest  acclaim  was  given  to  the  theory  of  cold.  Thus  Lueet 
attributed  it  to  an  acute  nephritis  brought  on  b^.  cold  and  to  subsequent 
uremic  or  other  intoxications.  A  great  numl)er  of  French  authors 
formerly  accepted  as  the  fundamental  cause  of  the  disease  a  hyperemia 


Etiology.  ggQ 

of  the  spinal  cord,  prodiu-od  by  cold  and  by  rich  feeding.  According 
to  the  hypothesis  of  P'nihner  the  nieta])olisni  of  the  muscles  is  supposed 
to  be  increased  to  such  an  extent  by  the  very  intense  irritation  of 
the  cold  on  the  sensitive  nerves  of  the  skin,  that  it  causes  the  con- 
li-actile  niu.scle  substance  to  break  down,  and  consequently  muscle  color- 
ing matter,  which  is  identical  witli  the  hemoglobin  passes  into  the  blood 
circulation,  and  is  eliminated  by  the  kidneys. 

Various  authors  assert  an  infectious  origin  of  paralytic  hemo- 
globinemia.  Thus  Cadiot  believes  in  the  possibility  of  an  infection 
through  the  intestinal  canal,  Avhile  Cadeac  considers  a  streptococcus 
infection  probable.  Lignieres  found  Gram-positive  streptococci  in  the 
sul)arachnoid  fluid  of  the  medulla,  sometimes  also  in  the  kidneys,  the 
inoculation  of  which  into  mice  produced  a  red  discoloration  of  the 
urine  and  increase  of  the  reflex  irritability;  a  horse  which  received 
300  cc.  of  the  culture  intravenously  could  no  longer  get  up  from  the 
sixth  day  on,  and  albumen  was  demonstrated  in  its  urine.  In  contrast 
to  this  Xowak  &  ITartel  also  found  the  streptococci,  but  could  produce 
no  disease  with  them;  experiments  carried  out  Avith  the  filtrates  of 
the  intestinal  contents  of  affected  animals  were  also  negative. 

Schlegel  accepts  as  the  cause  of  the  disease  the  streptococcus 
melanogenes  descri])ed  by  him,  and  identified  the  paralytic  hemo- 
globinemia  with  the  streptococcus  of  septicemia  which  is  "manifested 
by  a  paralytic  weakness  of  the  hind  parts  (enzootic  spinal  meningitis, 
see  Vol.  II). 

Hiityra  &  Marek  lielieve  it  best  to  hold  to  tlie  liypothesis 
of  an  anto-intoxication.  Accordino:  to  their  belief  thev  claim 
to  be  justified  in  assuming  that  during  the  function  of  pre- 
viously rested  muscles  or  in  muscles  which  have  worked  to 
excessive  exertion,  some  substance  is  formed  which  exerts  a 
toxic  action  and  which  produces  a  degeneration  of  the  muscle 
fibers  and  an  elimination  of  the  blood-coloring  matter  from 
the  blood  corpuscles.  This  process  occurs  either  while  the  blood 
passes  through  the  affected  muscles,  or  at  a  later  stage,  when 
the  blood  circulates  in  other  organs.  During  rest  and  rich 
feeding  the  suspected  toxin-forming  facultv  "of  the  muscles 
may  increase.  It  must  probably  be  attributed  to  the  last-named 
condition  that  heavy,  phlegmatic  horses,  which,  as  a  matter 
of  fact  relax  their  muscles  much  more  completely  during  rest 
than  horses  of  a  livelier  temperament,  and  voung  colts  become 
affected  more  frequently;  as  a  matter  of  "fact  colts  are  not 
used  at  all  for  severe  muscular  work.  By  the  sudden  action  of 
cold  the  influence  of  the  muscular  functions  could  evidentlv  be 
increased  up  to  a  certain  extent,  as  tlio  irritation  of  the  "cold 
stimulates  the  metabolism  of  the  muscles  (heat  regulation). 
Of  what  nature  however  the  suspected  poisonous  substance 
may  be  which  develops  during  the  muscular  functions  could 
only  be  determined  by  suitable  investigations  and  experiments; 
simple  theoretical  deliberations  do  not  lead  to  results. 

Dispensing  with  detailed  criticism  of  the  above  described  hypotheses, 
only  the  more  important  factors  in  favor  of  the  myogenic  auto- 
intoxication M-ill  be  brought  out.     The  disease  has,  up  to  the  present 


890  Paralytic  Hemoglobinemia. 

time,  been  observed  without  a  doubt  only  in  horses,  and  usually  after 
the  animals  had  been  kept  from  work  for  a  time,  at  the  same  time 
were  well  fed  and  subsequently  were  used  for  some  hard  muscular 
work,  which,  of  course,  may  occur  also  in  the  stable,  as  for  instance 
after  suddenly  rising  to  the  feet.  Although  sometimes  the  disease 
develops  also  without  cooperation  of  these  factors;  in  such  cases  an 
excessive  exertion  may  be  found  to  be  originally  connected  with  the 
development  of  the  disease.  At  the  same  time  it  has  frequently  been 
observed  that  in  horse  stables  in  which  the  disease  has  occurred 
regularly  it  may  be  prevented  by  systematic  exercising  of  the  animals 
or  by  a  considerable  reduction  in  the  quantity  of  nitrogenous  food 
(Benjamin,  Lavalard,  Brun).  The  fact  has  further  been  supported  by 
numerous  observations  that  without  exception  the  muscles  usually  be- 
come affected  and  the  changes  occur  chiefly  on  that  side  of  the  body, 
which  has  to  perform  the  greatest  muscular  exertion  in  the  execution 
of  the  work.  These  are  especially  the  muscles  of  the  hind  parts,  more 
rarely  those  of  the  anterior  extremities.  In  animals  which  are  lying 
down  the  muscles  of  the  back  may  be  involved. 

Against  the  importance  of  the  influence  of  cold  the  already  men- 
tioned observations  may  be  quoted,  according  to  which  the  disease 
occurs  in  continuous  warm  weather  more  frequently  than  in  cold  seasons 
(Pr.  Mil.  Vb.,  Hofling,  Marek).  Lassar  &  Nassaroff  succeeded  by  an 
excessive  cooling  of  the  body  (the  inner  temperature  of  the  animals 
falling  to  ]8°  C.)  only  in  producing  a  not  especially  severe  degeneration 
in  the  muscles,  and  more  markedly  in  the  parenchymatous  organs, 
which,  exclusive  of  actual  freezing  to  death,  could  not  occur  under 
natural  conditions.  On  the  other  hand  Dexler  failed  to  produce  the 
disease  by  strongly  cooling  the  hind  parts  of  a  horse. 

The  signs  of  a  nephritis  which  according  to  Lucet  develops  from 
cold  and  which  is  said  then  to  produce  the  hemoglobinemia,  are  fre- 
quently absent. 

Against  the  infectious  origin  of  the  disease  it  may  be  mentioned 
that  the  respective  authors  have  failed  up  to  the  present  time  in 
producing  the  disease  in  its  typical  form  artificially  in  horses,  and 
that  further  the  sudden  appearance  of  the  disease  and  its  characteristic 
clinical  picture  is  difficult  to  reconcile  with  a  theory  of  infection,  as 
is  also  the  not  infrequent  sequel  of  an  atrophy  confined  to  certain 
muscles,  which  after  a  time  again  disappears.  In  spite  of  the  position 
taken  by  Schlegel  on  this  question,  Hutyra  &  Marek  consider  their 
non-committed  standpoint  in  regard  to  the  infectious  origin  of  the 
disease  the  more  justified  since  paralytic  hemoglobinemia  was  originally 
separated  by  Schlegel  himself  from  infectious  spinal  meningitis,  and 
also  because  Zwick,  who  accurately  described  a  disease  which  appears 
to  be  identical  with  Schlegel 's  streptococcus  septicemia,  observed  no 
similarity  between  infectious  spinal  meningitis  and  paralytic  hemo- 
globinemia. It  therefore  remains  for  further  investigations  to  elucidate 
the  relationship  of  Schlegel 's  disease  to  paralytic  hemoglobinemia  and 
the  nature  of  the  last  mentioned  disease. 

Against  the  myogenic  origin  of  hemoglobinemia  it  may  be  said 
that  in  all  cases  investigated  by  Hutyra  &  Marek  the  hemoglobin  con- 
tent of  the  blood  was  found  to  be  somewhat  diminished  (on  Fleischl's 
apparatus  below  70°  against  the  normal  of  70-80°).  At  the  same  time 
they  never  succeeded  in  finding  an  increase  in  the  specific  gravity 
of  the  blood,  although  it  was  tested  very  accurately  with  the  pyknometer. 
On  the  other  hand  they  established  in  all  cases  a  diminution  of  red 


Etiology,    Anatomical  Changes.  891 

blood  corpuscles  (up  to  6,450,000-7,200,000,  against  the  normal  number 
of  7,500,000  to  8.000.000).  MacFadyean  and  Kiini^'  demonstrated  an 
increase  of  the  red  blood  corpnseh^s.  Sehintlclka  and  Iliiflinf?  found  fn*- 
(luently  and  Kiinif?  regularly,  a  very  marked  inerease  of  the  hemoglobin 
content  of  the  blood,  yet  these  findings  cannot  be  considered  as  con- 
clusive evidence  without  a  simultaneous  establishment  of  the  molecular 
concentration  of  the  blood  serum.  ]\Iention  should  not  be  omitted  of 
the  fact  that  Konig  found  a  comparatively  strong  inerease  of  the 
hemoglol>in  content  in  the  blood,  but  this  finding  may  also  have  another 
explanation,  as  tiie  increase  of  the  hemoglobin  content  persisted  for 
days  after  recovery,  and  for  a  long  time  after  the  disappearance  of 
the  hemoglobinuria.  The  experimental  findings  of  Wetzl  are  interesting 
in  this  relation.  According  to  these  on  one  hand  the  hemoglobin  con- 
tent of  the  blood  is  subject  to  great  variation,  and  on  the  other  hand 
a  considerable  loss  of  water  by  the  body  produces  a  very  significant 
increase  of  the  relative  percentage  of  blood  corpuscles  and  the  hemo- 
globin content,  on  account  of  the  thickening  of  the  blood.  In  paralytic 
hemoglobiuemia  there  are  ample  opportunities  for  a  decided  loss  of 
water  (profuse  perspiration,  omission  in  watering  the  animals  while 
lying  down).  The  fact  that  in  several  cases  examined  by  Schindelka 
and  Ilufling  the  dissolved  blood  coloring  matter  in  the  blood  serum  did 
not  always  correspond  with  the  higher  percentage  of  hemoglobin  in  the 
Idood  can  only  be  explained  in  this  manner.  On  the  other  hand  the  ex- 
periment of  Camus  &  Pagniez  in  dogs  (injecting  cold  distilled  water  into 
the.  muscles  of  the  thigh)  by  which  they  aimed  to  prove  that  the  hem- 
oglobin elinnnated  with  the  urine  is  muscle  coloring  matter,  cannot  be 
considered  as  conclusive  as  a  solution  of  red  blood  cells  around  the  point 
of  injection  appears  far  more  probable  under  the  influence  of  cold  dis- 
tilled water. 

Anatomical  Changes.  The  most  striking  changes  are  present 
in  the  muscles.  Especially  the  lumbar  muscles  and  those  of 
the  croup,  as  well  as  the  psoas  muscles,  to  a  slighter  degree  the 
muscles  of  the  hind  quarters,  sometimes  those  of  the  front  ex- 
tremities also,  and  other  muscles  appear  either  uniformly  gray 
or  yellowish  in  color,  hke  fish-meat,  or  as  if  boiled  and  moistened 
on  the  cut  surface.  They  tear  easily  or  they  may  he  firm,  hut 
they  sho\v  on  their  cut  surface,  between  the  healthy  hrownish- 
red"^  bundles  of  muscle  fibers,  light  gray  or  yello^yish  stripes, 
which  convey  to  the  basic  color  a  more  or  less  distinctly  recog- 
nizalde  grayish  tint.  The  degenerated  parts  sometimes  stand 
out  very  sharply  against  the  liealthy  tissue.  The  cross  striation 
of  the  contractile  substance  can  no  longer  be  recognized  under 
the  microscope,  the  sarcolemma  appears  to  be  filled  up  by  a 
mixture  of  fine  albuminous  granules,  fat  globules  and  coarse 
flakes  (degeneratio  parenclnnnatosa  et  adiposa,  sometimes  also 
Deg.  cerea).  Dexler  demonstrated  by  ^farclii's  method  the 
presence  of  fat  globules  arranged  in  longitudinal  rows. 

The  kidneys  are  also  affected  with  relative  frequency, 
showing  cloudy  swelling  or  even  severe  parenclninatous  or  fatty 
degeneration,  as  well  as  diffuse  necrosis  of  the  epithelia 
(Johne).  The  spleen  appears  swollen  in  areas,  more  rarely  the 
swelling  is  uniform.    The  muscle  of  the  heart  sometimes  shows 


892  Paralytic  Hemoglobinemia. 

the  same  changes  as  the  muscles  of  the  rmiip,  but  always  in 
a  lesser  degree,  and  probably  as  the  result  of  a  subsequent 
septic  infection.  (Dexler  found  in  the  lateral  and  posterior 
cornea  of  the  lumbar,  dorsal  and  sacral  sections  of  the  spinal 
cord,  perinuclear  chromatolysis  of  the  motor,  and  in  a  lesser 
degree  also  of  the  other  nerve  cells;  by  Marchi's  method  he  also 
demonstrated  degeneration  of  certain  nerve  sheets  of  the  lateral 
and  anterior  columns.)  The  bone  marrow,  especially  in  the 
femur  and  in  the  lumbar  vertebrae  is  hyperemic,  permeated  by 
small  hemorrhages,  sometimes  showing  a  blackish-brown  dis- 
coloration. 

The  blood  shows  no  changes  recognizable  by  the  naked  eye. 
The  bladder  contains  mostly  reddish  or  brownish-red  urine. 

Symptoms.  The  disease  sets  in  without  premonitory  signs, 
almost  invariably  with  disturbances  in  locomotion  of  the  hind 
parts.  After  a  certain  time,  sometimes  as  early  as  in  5  or  10 
minutes,  at  other  times  only  several  hours  after  the  animal 
has  been  taken  from  the  stable  and  used  for  work,  a  pronounced 
stiffness  is  noted  in  the  movement  of  the  posterior  extremities. 
There  is  staggering  of  the  hind  parts,  the  feet  are  raised  only 
slightly  from  the  ground,  the  horse  knuckles  at  the  pasterns, 
perspires  profusely,  and  attempts  to  go  on  in  spite  of  it  until 
it  finally  is  unable  to  stand  up  and  collapses  helplessly.  The 
disturbance  occasionally  progresses  so  rapidly  that  the  animal 
breaks  down  suddenly  without  the  rider  or  driver  even  noticing 
the  stiffness  of  the  gait.  It  is  only  rarely  that  the  horse  is  able 
to  rise  again  to  its  feet,  more  often  it  is  necessary  to  return 
it  to  the  stable  on  a  wagon.  In  the  rare  cases  in  which  the 
disease  develops  in  the  stable,  it  is  as  a  rule  observed  only  wdien 
the  animal  can  no  longer  rise  from  the  ground  in  spite  of  its 
attempts.  The  collapsed  horse  then  lies  flat  on  one  side,  mostly 
with  the  hind  extremities  stretched  somewhat  backwards,  at 
the  same  time  it  makes  repeated  attempts  to  rise;  with  the 
head  raised  it  succeeds  in  standing  on  its  front  legs,  but  soon 
drops  back  again  with  painful  groans.  Sometimes  it  succeeds 
in  half-way  rising  even  on  the  hind  legs  and  dragging  itself 
for  a  short  distance,  but  it  soon  falls  exhausted  and  usually 
with  the  hind  parts  first  (Fig.  157).  In  its  repeated  attempts 
to  rise  the  horse  strikes  its  head  and  feet  against  the  ground 
or  against  the  wall,  thereby  causing  injuries  to  these  parts.  The 
numerous  exertions,  and  the  anxiety  of  the  patient,  which  may 
be  seen  in  the  expression  of  its  face  and  eyes,  result  in  a  profuse 
perspiration. 

Sometimes  the  disturbances  remain  confined  to  only  one 
of  the  hind  extremities,  affecting  only  the  M.  quadriceps  fem. 
or  the  abductors,  at  other  times  they  appear  in  one  or  both 
front  extremities,  especially  in  the  triceps  brachii.  If  the  dis- 
turbances are  only  one-sided  and  not  very  extensive,  the  horse 
usually  does  not  collapse,  and  remains  perfectly  quiet  without 
perspiring. 


Symptoms. 


893 


The  muscles  of  the  paralyzed  parts  of  the  body  feel  at 
first,  and  sometimes  even  later,  very  dense,  almost  as  hard  as 
a  board;  they  are  however  not  sensitive  to  pressure.  At  the 
same  time  the  superficial  muscles  may  show  considerable  en- 
larirement.  In  the  further  course  of  the  disease  the  muscles 
usually  return  to  their  normal  consistency,  or  even  become 
softer.  The  sensitiveuess  of  the  skin,  as  far  as  examination, 
because  of  the  excitement  of  the  animal,  is  possible  is  not 
changed;  sometimes  it  appears  somewhat  reduced,  but  no  great 
importance  can  ])e  attri])uted  to  tliis  findino:,  as  the  skin  in  the 
region  of  the  croup  or  the  thigh  possesses  a  somewhat  slighter 
sensitiveness,    as    compared    with    other    parts    of    the    body. 


Fijr.  137.     Paralytic  hriiionluhinf'miii.      Theliui^.-  i..^.    on  tlie    second   day    of    the 
affeetion,  hut  iinnic(liat«*ly  fell  hack  to  the  position  shown  in  the  illustration. 


Spontaneous  indications  of  pain  are  however  not  infrequent. 
The  passive  resistance  of  the  muscles  is  at  first  increased,  later 
diminished.  Uexler  and  Marek  found  an  absence  of  tendinous 
reflexes  in  the  region  of  the  paralyzed  muscles.  As  the  M. 
quadriceps  cruris  is  also  involved,  the  patella  reflex  is,  as  a 
rule,  absent  either  on  one  or  both  sides.  Dexler  found  the 
faradic  irritability  normal  in  the  affected  muscles,  the  mechanic 
irritability  on  the  other  hand  was  absent  in  Marek 's  cases. 

In  mild  cases  as  well  as  in  the  early  stages  of  severe  affec- 
tions the  temperature  is  not  much  elevated;  but  owing  to  the 
great  restlessness  of  the  animal  a  rise  of  Vj  to  1^  C.  may  exist 
from  the  beginning.  In  the  later  course  of  severe  cases  a  con- 
siderai)ly  higlier  rise  in  temperature  may  be  present,  either 


894  Paralytic   Henlo^■lobinemia. 

resulting  from  an  infection  through  decubital  gangrene  or  from 
other  complications,  possibly  also  from  the  hemoglobinemia 
itself. 

The  heart's  action,  except  in  the  mild  cases,  is  from  the 
beginning  increased  in  proportion  to  the  restlessness  of  the 
animal  (50-60  beats  per  minute),  at  the  same  time  however 
it  is  strong.  After  the  development  of  complications  it  becomes 
more  accelerated  (80-100  per  minute),  correspondingly  the  pulse 
which  is  at  first  tense  and  full,  becomes  gradually  softer  and 
finally  thread-like. 

Frequently  the  passing  of  urine  is  retarded  so  that  a 
considerable  dilation  of  the  bladder  may  develop.  Excepting 
in  a  few,  mostly  very  mild  and  rapidly  passing  cases,  the 
urine  appears  to  be  more  or  less  intensely  dirty  reddish-broAvn 
or  beer-brown  to  ink-black  in  color;  and  although  it  clears  on 
filtration  it  retains  its  red  color.  The  specific  gravity  is  in- 
creased, but  the  reaction  is  mostly  alkaline,  more  rarely  acid; 
at  the  same  time  it  contains  more  or  less  albumen,  a  large 
amount  of  phosphates,  usually  also  uric  acid  salts,  and  less 
hippuric  acid.  The  sediment  with  its  pale  gray  or  yellowish 
color  stands  out  in  contrast  to  the  reddish-brown  to  blackish 
color  of  the  urine,  and  offers  a  certain  positive  means  of  proof 
that  the  abnormal  color  of  the  urine  originates  from  dissolved 
blood  coloring  matter.  The  sediment  of  the  urine  sometimes 
contains  hyaline  or  granular  casts,  possil)ly  also  renal 
epithelial  cells,  sometimes  white  and  red  blood  corpuscles  in 
sparing  numl)ers,  which  are  present  because  of  a  simultaneous 
inflammation  of  the  kidneys ;  hemoglobin  casts  are  also  frequently 
found.  (Tatray  observed  in  one  case  numerous  hemoglobin 
crystals.) 

For  demonstration  of  the  blood  coloring  matter  in  the  nrine  the  benzidine  test 
of  Sehlesinger,  or  the  guajac-oil  of  turpentine  test  of  Schumm,  is  best  adapted, 
while  the  sjiectral-analytic  method  or  Heller 's  test  is  considerably  less  suitable, 
because  of  its  sensitiveness  (Mayer),  when  it  is  desired  to  demonstrate  small 
quantities  of  blood  coloring  matter,  which,  however,  is  usually  not  the  ease  in 
hemoglobinemia.  The  spectral-analytic  method  can,  however,  not  be  omitted  for 
demonstrating  the  various  combinations  of  the  blood  coloring  matter,  especially 
the  oxy-  and  the  methemoglobins.  Two  absorption  bands  ai-e  indicative  of  oxy- 
hemoglobin, namely,  one  small  dark  band  lying  to  the  right  of  Frauenhofer  's  line 
D  (on  the  border  of  the  reil  and  yellow  color  of  the  sun  spectrum),  and  a  lighter 
and  somewhat  broader  band  lying  to  the  left  from  the  E-line ;  the  presence  of 
methemoglobin  is  indicated  by  a  band  to  the  left  of  the  D-liue  (in  the  field  of  the 
red  color).     Frequently,  however,  all  three  bands  may  be  seen  simultaneously. 

The  quantity  of  albumen  in  the  urine  (according  to  Lucet 
1-25:1000)  is  not  always  proportional  Avith  the  intensity  of  the 
red  color,  but  it  is  considerably  greater  in  a  simultaneous  af- 
fection of  the  kidne3^s.  The  quantity  of  urea  was  found  by 
Schindelka  and  Frohner  in  some  cases,  and  by  MacFadyean  al- 
ways to  be  diminished. 

Frequently  the  blood  coagulates  more  rapidly,  but  the 
coagulum  remains  loose  for  a  longer  time,  so  that  only  a  rela- 
tively small  quantity  of  serum  is  separated.  The  blood  serum 
appears  reddish  or  of  a  pronounced  red  color  at  the  onset,  and 


Symptoms,     Complications.     Course.  ^95 

in  somewhat  more  severe  cases,  even  later.  The  proportion 
of  blood  corpuscles  and  the  hemoi-iobin  content  of  the  blood 
are  subject  to  very  ^reat  variation,  as  the  diminished  water 
content  of  the  l)ody  is  manifested  in  varyins:  deijrees  from 
case  to  case.  The  observations  of  ^farek,^  wjiifh  were  made 
after  the  cessation  of  the  very  frequent  .general  perspiration 
and  reo:uh2r  waterinii',  showed  a  normal  specific  gravity  of  the 
blood  (1.052-1.0544),  a  slight  diminution  of  red  blood  corpuscles, 
and  as  a  rule  also  a  slight  reduction  of  the  hemoglo])in  content 
(under  70  of  Fleiscld's  or  (lowers'  scale).  In  contrast  to  this 
Schindelka,  ]  lolling  and  Konig  found  an  increase  of  one-half 
above  the  normal  in  the  quantity  of  hemoglolnn,  especially 
Konig  in  those  cases  in  whicli  the  percentage  of  the  blood 
corpuscles  appeared  quite  nonnal.  Strangely  enough  the 
qujintitv  of  hemoglobin,  although  gradually  diminishing,  re- 
mained increased  for  days,  even  after  the  disappearance  of  the 
sjnnptoms,  and  a  considerable  increase  of  red  blood  corpuscles 
is  frequently  also  present,  especially  in  severe  cases  (Konig 
found  in  one  case  21,328,000  blood  corpuscles),  probably  owing 
to  the  reduction  of  water  in  the  body  (see  p.  847). 

The  appetite  remains  good  at  the  onset  and  in  mild  cases 
to  the  end  of  the  disease.  Consciousness  appears  at  first  un- 
disturbed; the  animals  try  to  relieve  themselves  from  the  un- 
comfortable position,  and  make  repeated  efforts  to  rise  until 
completely  exhausted.  Later  however  they  lie  exhausted  on 
the  ground.  Sometimes  symptoms  indicative  of  uremia  may 
be  observed,  such  as  loss  of  consciousness  and  muscular  coii- 
H^ilsions. 

Complications  appear  very  frequently  in  severe  cases. 
Among  these  gangrene  of  the  skin  from  pressure  should  be  juen- 
tioned  in  the  first  place,  which  appears  on  the  prominent  parts 
of  the  body  after  lying  for  two  or  three  days  and  may  develop 
under  rapid  extension  into  severe  gangrene,  resulting  in  a 
general  infection.  Similar  complications  may  develop  from 
deep  tears  or  bruises  of  the  skin.  In  other  cases  the  continuous 
lying_  on  one  side  may  cause  a  hypostatic  h^-peremia  or  later 
even  inflammation  of  the  lungs.  Now  and  then  uremia  develops, 
which  manifests  itself  especially  by  deep  coma  and  convulsions. 
When  collapsing  the  animals  may  also  fracture  bones,  especially 
in  the  pelvis  or  thigh. 

Course.  The  disease  is  characterized  by  a  very  variable 
course.  First  of  all  there  are  cases  where  only  a  certain  stiff- 
ness in  locomotion  is  noted,  which  disappears  within  a  few 
hours,  or  at  the  most  after  one-half  to  one  day.  In  the  great 
majority  of  cases  however  pronounced  s^nnptoms  of  paralysis 
appear,  which  persist  for  2  or  3  days,  sometimes  even  for  a 
week,  and  then  change  either  into  a  rapid  or  slower  return  to 
the  normal  condition,  or  on  the  contrarv  mav  lead  to  death  under 


896  Paralytic  IIenioslol)ineinia, 

gradual  aggravation  of  the  general  condition.  Finally  in  rare 
cases  there  exists  only  a  stiffness  and  weakness  of  the  hind 
parts,  as  Avell  as  hemoglobinuria,  for  3  to  5  days,  and  complete 
paralysis  does  not  develop  until  later,  as  a  result  of  which 
the  animals  collapse,  and  soon  die  (according  to  Utz  there  is 
a  subacute  form  of  the  disease  in  contra-distinction  to  the  above 
acute  form). 

In  severe  cases  death  may  ensue  on  the  third  or  fourth, 
exceptionally  even  on  the  first  day,  mostly  however  the  animals 
do  not  die  until  towards  the  end  of  the  first  week  or  at  the 
beginning  of  the  second.  The  immediate  cause  of  the  fatal 
termination  is  probably  most  frequently  a  general  septic  infec- 
tion with  its  consequences,  more  rarely  hypostatic  pneumonia 
or  uremia. 

In  the  favorable  cases  the  improvement  makes  either  rapid 
progress,  so  that  the  gait  of  the  animal  becomes  normal  within 
a  few  days,  or  on  the  contrary  a  weakness  of  the  hind  parts 
persists  for  several  weeks,  although  it  gradually  subsides. 
Sometimes  the  weakness  or  the  paralysis  of  one  extremity  may 
remain  for  months,  even  for  1  to  2  years,  exceptionally  even 
permanently,  and  meanwhile  lead  to  a  rapidly  progressing 
atrophy  of  some  of  the  muscles  (the  extensor  quadriceps  of  the 
leg,  the  abductor  of  the  thigh  or  the  rump). 

Eepeated  attacks  also  occur,  either  at  shorter  or  at  longer 
intervals,  sometimes  even  after  several  weeks  (Kronburger 
observed  a  horse  become  affected  three  times  within  one  week). 

Diagnosis.  The  disease  can  be  diagnosed  with  certainty 
only  by  the  presence  of  its  two  cardinal  symptoms,  namely,  the 
peculiar  muscular  affection  and  the  hemoglobinuria.  None  of 
these  symptoms  however  suffice  in  themselves  as  a  firmer  con- 
sistency of  the  muscles  and  their  functional  disturbances  may 
be  observed  also  in  muscular  rheumatism,  but  in  this  affection 
the  tendon  reflexes  are  normal.  Hemoglobin  may  be  present 
in  the  urine  also  in  acute  infectious  diseases  or  intoxications, 
but  in  these  pronounced  symptoms  of  paralysis  and  reduction 
of  the  reflex  irritability  are  absent. 

A  traumatic  injury  of  the  spinal  cord  or  spinal  meningitis 
can  easily  be  excluded  by  the  history  of  the  case,  in  some  cases 
by  the  evident  sensitiveness  of  the  vertebral  column,  by  the 
complete  insensibility  of  the  paralyzed  part  of  the  body,  by 
the  disturbances  of  the  functions  of  bladder  and  rectum,  and 
by  the  action  of  the  patellar  reflex,  which  in  contusions  of  the 
sacral  cord  is  normal,  in  the  presence  of  a  lesion  anteriorly 
to  the  lumbar  cord  appears  to  be  normal  or  increased,  while 
after  injuries  of  the  middle  lumbar  cord  on  the  other  hand 
it  is  not  present.  Moreover,  in  hemoglobinemia  there  also 
exists  in  most  instances  a  hemoglobinuria  which  is  absent  in 
contusions  of  the  spinal  cord. — From  the  enzootic  spinal 
meningitis  (infectious  spinal  meningitis,  Schlegel)  the  paralytic 


Diagnosis,    Prognosis.  ggy 

hemoglobiiiemia  is  distinguished  by  the  history,  the  hard  con- 
sistency and  enhirgenient  of  tlie  affected  muscles,  and  by  the 
hemoglobinuria,  while  in  enzootic  spinal  meningitis,  hematuria 
may  also  appear  frequently.  Sometimes  a  compression  of  the 
spinal  cord  (melanoma,  exostosis)  may  also  give  rise  to  mistakes 
in  cases  in  which  they  i)roduce  a  sudden  paralysis.  They  may 
be  excluded  in  the  same  manner  as  contusions  of  the  spinal  cord. 
In  unilateral  paralysis  a  paralysis  of  the  peripheric  nerves  must 
also  be  excluded  on  the  ground  of  local  examinations  and  with 
consideration  of  the  presence  of  hemoglobinuria. 

Fractures  of  the  bones  (pelvis  and  femur),  as  well  as 
tearing  of  the  Achilles  tendon  may  result  in  clinical  manifesta- 
tions similar  to  paralytic  hemoglobinemia.  In  such  cases  local 
examination  would  reveal  the  true  cause;  in  a  severe  paralysis 
due  to  hemoglobinemia  the  urine  almost  invariably  contains 
blood  coloring  matter,  however  as  traumatic  influences  may 
simultaneously  produce  a  hemorrhage  in  the  urinary  passages, 
the  examination  of  the  sediment  of  tlie  urine  determines  in 
doubtful  cases  whether  hemoglolnnuria  or  hematuria  is  present. 
Swellings  and  a  lirmer  consistence  of  the  muscles  of  the  croup, 
with  absence  of  the  patellar  reflexes,  have  in  such  cases  little 
significance,  as  enlargements  of  muscles  are  also  observed  in 
fractures  of  bones  or  tearing  of  muscles,  with  extensive  hemor- 
rhagic infiltration,  and  at  such  times  the  contractility  of  the 
muscle  or  percussion  of  the  patellar  ligament  may  disappear. 

The  thrombosis  of  the  posterior  aorta  and  its  branches 
differs  in  that  the  animals  are  after  a  certain  time  again  capable 
of  standing  up  and  walking  normally;  after  more  strenuous 
exercise  however  they  again  collapse.  At  the  same  time  the 
presence  of  a  thrombus  or  the  absence  of  pulsation  may  be 
established  by  rectal  examination  of  the  iliac  or  of  the  fenioral 
arteries. 

Colicky  affections  can  only  be  excluded  by  a  somewhat 
careful  examination. 

Prognosis.  The  prognosis  appears  unfavorable  in  propor- 
tion to  the  completeness  of  the  lumbar  paralysis,  the  number 
of  muscles  showing  functional  disturl)ances,  and  to  the  pro- 
nounced character  of  the  hemoglobinuria.  If  the  animals  can- 
not rise  in  spite  of  apparent  health,  or  if  they  are  not  capable 
of  standing  up  by  themselves  or  in  slings  even  for  a  short 
time,  further  if  they  remain  lying  for  longer  than  three  days, 
the  urine  containing  at  the  same  time  elements  indicating  "an 
affection  of  the  kidneys,  finally  if  high  fever  is  present,  there 
is  only  very  slight  chance  for  recovery,  especially  if  extensive 
decubital  gangrene  becomes  associated  Avith  the  disease.  A 
very  accelerated  and  weak  pulse  has  an  unfavorable  significance, 
according  to  Konig,  also  the  marked  increase  of  red  blood 
corpuscles  at  the  onset  of  the  affection. 

On  the  other  hand  there  is  always  hope  for  an  early  re- 

Vol.  1^57 


898  Paralytic  Hemoglobin  emia. 

covery  in  the  presence  of  an  incomplete  and  transitory  paralysis, 
if  at  the  same  time  the  nrine  is  pale  red  in  color  and  the  pulse 
strong;  also  in  those  cases  in  which  the  marked  disturbances 
in  locomotion  rapidly  diminish.  In  the  prognosis  however  the 
possibility  should  be  taken  into  consideration  that  sequels  to 
the  disease  may  develop,  which  diminish  the  value  of  the  animal 
for  a  long  time,  or  permanently.  According  to  Thomassen  and 
Thomson  the  paralysis  of  the  muscles  disappears  in  most  cases 
inside  of  three  months,  not  infrequently  however  only  after 
5  to  6  months.  Marek  observed  a  case  in  which  a  paralysis 
of  the  quadriceps,  with  a  pronounced  atrophy  of  the  muscles, 
persisted  for  seven  months,  in  another  case  even  for  11  months; 
after  that  however  it  rapidly  improved  and  disappeared  to- 
gether with  the  atrophy  in  the  ninth  and  twelfth  months. 

The  statistical  data  relative  to  the  mortality  vary  greatly,  as  the  severity  of 
the  affection  in  the  various  localities  and  at  different  seasons  may  show  marked 
fluctuation.  At  the  Budapest  clinic  in  the  years  between  1890  and  1909,  45  =z:  45% 
died  out  of  100  affected  animals;  the  mortality,  however,  fluctuated  considerably 
in  the  different  years.  According  to  Friedberger  &  Frohner  the  mortality  at  the 
Munich  clinic  amounts  to  20%,  at  the  Stuttgart  40%,  while  Bouley  estimates  it  at 
60%,  Stockfleth  at  50%,  and  Bay,  based  on  368  cases,  at  70%.  Among  the 
horses  of  the  Prussian  army  the  mortality  varied  in  the  different  years  between 
26%,  and  46%,  and  usually  amounts  to  32-36%o. 

Treatment.  First  of  all  care  should  be  taken  that  the 
animal  be  saved  from  all  excitement,  and  especially  from  ex- 
cessive muscular  exertion.  Accordingly  horses  which  have 
broken  down  at  a  distance  from  their  stables  should  be  carried 
to  shelter  in  wagons;  further  it  appears  advantageous  to  allow 
the  animal  to  lie  down  for  a  half  or  a  whole  day  on  richly  lieddcd 
ground,  and  to  turn  it  over  at  3  to  4  hourly  intervals  if  they 
show  no  inclination  to  rise  by  themselves.  Besides  they  should 
be  prevented  from  injuring  themselves  by  continuous  watching. 
After  the  lapse  of  the  mentioned  time  an  attempt  should  always 
be  made  to  make  the  animals  stand  up,  which  in  many  cases 
may  be  accomplished  with  the  aid  of  a  girth  placed  under  the 
rump,  at  the  best  however  by  the  use  of  pulleys.  It  is  a 
favorable  sign  if  the  animal  bears  more  or  less  upon  the  feet. 
Frequently  standing  in  the  slings  even  for  a  short  time  is  of 
great  benefit.  If  in  proper  supports  the  animal  places  no 
weight  on  the  extremities  it  should  not  be  forced  to  stand,  as 
it  may  asphyxiate ;  but  attempts  to  get  the  animal  to  stand  on 
its  feet  should  later  be  repeated  from  time  to  time,  about 
twice  dail5% 

Spontaneous  passing  of  feces  should  be  favored  by  in- 
fusions of  water,  the  passing  of  urine  by  moderate  pressure 
with  the  hand  in  the  rectum.  If  this  procedure  does  not  lead 
to  results  subcutaneous  injections  of  eserin  (0.08-0.10  gm.), 
pilocarpin  (0.20-0.30  gm.),  or  arekolin  (0.06-0.08  gm.),  or  the 
administration  of  salines  should  be  undertaken,  and  the  bladder 
should  be  emptied  with  a  catheter  if  possible  every  six  hours. 
Flour  and  bran  gruels,  green  feed  and  good  fresh  hay  are  best 


Troatiiieiii,     l'r<'\  eiilinn.  899 

ada})tod  for  food.    It  i.s  best  to  offer  the  animal  diiiikiii.u  water 
as  frequently  as  it  is  desired. 

Rubbings  repeated  two  or  three  times  a  (hiy  and  w  ra])]tin.ii: 
the  paralyzed  part  of  the  body  with  moist  cloths  may  also 
be  advantageous,  while  it  is  better  to  omit  counter  irritants, 
as  they  may  contribute  to  produce  an  aggravation  of  the  con- 
dition by  causing  restlessness.  The  frequently  recommended 
bleeding  was  found  ineffective  by  various  authors.  If  heart 
weakness  is  present,  stimulants  (alcohol,  l)lack  coffee,  camphor 
[20-30  gni.  subcutaneously],  caffeine  [2-5  gm.  subcutaneously]), 
may  be  used  to  some  advantage.  If  gangrene  of  the  skin  from 
pressure  develops  it  may  be  treated  with  drying  and  disinfect- 
ing washes  (alum  and  acetate  of  lead  water  [1  :2:r)0],  Goulard's 
extract),  or  with  similarly  acting  dusting  powders  (charcoal 
])Owder  containing  corrosive  sublimate,  iodoform,  dermatol, 
xeroform,  etc.). 

To  increase  the  alkalinity  of  the  blood,  which  is  supposed  to  be 
considerably  reduced,  Dieckerhoff  recommended  the  administration  of 
alkalies  in  great  (|uantities.  He  gave  on  the  first  day  150-300  gm.  of 
bicarbonate  of  sodium,  and  300-500  gm.  of  sodium  sulphate,  in  three 
doses,  and  on  the  following  days  50-200  gm.  of  sodium  biearlionate.  The 
result  was  said  to  be  satisfactory,  but  Hutyra  and  ]\Iarek  failed  to  ob- 
serve any  particular  results.  Hink  and  Humann  observed  good  results 
from  the  use  of  sugar  (^^-1  lb.  per  os  repeated  several  times),  while 
Braund  produced  recovery  in  95%  out  of  50  cases  with  iodide  of  potas- 
sium (15-25  gm.  in  250  gm.  of  water  on  the  first,  and  if  necessary  10 
gm.  additional  on  the  following  day),  and  subcutaneous  injections  of 
eserin.  Atoxyl  on  the  other  hand  was  not  effective  (Rudolph).  Finally 
the  results  of  the  veterinarians  agree  in  that  Lumbagin  lacks  any  thera- 
peutic value  whatever. 

After  improvement  has  commenced,  the  rubbing  should 
be  diligently  continued,  and  later  the  animal  may  be  exercised 
quietly,  then  used  at  first  for  light,  and  finally  for  the  ordinary 
work. 

Prevention.  The  disease  may  be  prevented  with  the  greatest 
certainty  by  exercising  the  horses  daily  and  reducing  the  grain 
food.  In  consideration  of  this,  the  horses  should  be  exercised 
for  a  short  time,  and  fed  less  even  on  days  of  rest  and  in  bad 
weather.  Sanitation  and  sufficient  ventilation  of  the  stable  are 
also  of  importance. 

In  a  large  stable  of  horses  in  -which  year  after  year  cases  of  henioKloliiiieniia 
appeared,  new  cases  were  avoided  after  tlie  animals  were  only  led  out  of  doors 
after  stable  rest,  if  covered  with  blankets  ( Johne).  Similar  observations  were  made 
by  Ben.iamin  and  Lavalard  after  a  considerable  reduction  of  grain  fooil.  l)y  Brnn 
from  systematic  exercising  the  animals  by  trotting  on  days  of  rest.  Ohler  orders 
washing  the  croup  with  cold  water  in  the  stable,  after  which  it  should  be  rubbed 
dry.  shortly  previous  to  the  use  of  the  horses;  with  this  procedure  he  succeeded 
in  preventing  the  appearance  of  the  disease. 

Literature.  Beniamin,  Bull.,  1907.  240.  —  Bollinger,  D.  Z.  f.  Tm..  1S77. 
ITI.   lo.T;   W.  f.  Tk.,  1885.  439.  —  Brun,  Bull.,  1007.  2.37.  —  Cadeac.  J.  vet.,   1S97. 


900  Paralytic  Hemoglobinemia. 

465;  Path,  int.,  1899.  VI.  100.  — Cadiot,  Bull.,  1907.  243.  —  Camus  &  Pagniez, 
Ann.,  1902.  621.  —  Dages,  Bull.,  1901.  168.  —  Dieckerhoff,  B.  t.  W.,  1895.  1; 
1896.  37;  Spez.  Path.,  1904.  II.  524.  —  Eber,  Monh.,  1892.  III.  207;  A.  f.  Tk., 
1898.  XXIV.  262.  —  McFadyean,  Vet.  Jhb.,  1888.  71.  —  Frohner,  A.  f.  Tk.,  1884. 
X.  296  (complete  lit.).  —  Haase,  B.  t.  W.,  1897.  484.  —  Hauptmann,  T.  Z.,  1898. 
582.  —  Hink,  D.  t.  W.,  1901.  106.  —  Hofer,  5.  Vj.,  1852.  II.  151.  —  Hofling, 
T.  Z.,  1905.  373.  —  Humann,  W.  f.  Tk,  1907.  546.  —  Johne,  S.  B.,  1879.  94.  — 
Kleinpaul,  B.  t.  W.,  1904.  369.  —  Konig,  Monh.,  1909.  XXI.  1.  —  Lavalard, 
Bull.,  1907.  240.  —  Leipziger,  Z.  f.  Vk.,  1900.  389.  —  Lignieres,  Bull.,   1898.   744. 

—  Lucet,  Eec,  1889.  96;  1899.  209.  —  Nowak  &  Hartel,  Vet.  Jhb.,  1901.  82.  — 
Ohler,  Munch,  t.  W.,  1909.  829.  —  Pr.  Mil.  Vb.,  1899-1908.  —  Eazsovits,  Vet., 
1894.  559.  —  Schlegel,  B.  t.  W.,  1906.  463;  Die  inf.  Euckenmarksentziindung  oder 
schwarze  Harnwinde,  1907   (Lit.).  —  Siedamgrotzky  &  Hofmeister,  S.  B.,  1878.  115. 

—  Thomassen,  Monh.,  1902.  XII.  305.  —  Thomson,  Am.  v.  Eev.,  1905.  309.  — 
"Wetzl,  Klinische  Blutuntersuchungen,  Diss.  Budapest,  1908   (Hungarian). 


Paralytic  Hemoglobinemia  of  Cattle.  There  are  a  few  piiblications 
from  which  it  appears  that  a  disease,  resembling  the  paralytic  hemo- 
globinemia of  horses  in  its  nature  and  symptomatology,  occurs  also  nov; 
and  then  in  cattle.  (Leech  is  supposed  to  have  observed  several  cases 
in  dogs  [D.  t.  W.,  1899,  88].)  As  formerly  all  forms  of  hemoglobinemia 
were  thrown  together,  and  as  a  conspicuous  weakness  of  the  hind  parts 
may  also  appear  in  other  very  frequent  forms  of  hemoglobinemia  (for 
instance  piroplasmosis),  a  positive  determination  of  the  cases  originat- 
ing in  former  times  is  not  possible.  According  to  the  present  stand  of 
knowledge  however,  it  appears  very  probable  that  the  observers  usually 
had  to  deal  with  affections  caused  by  piroplasma  or  by  certain  l)lood 
poisons,  but  not  with  cases  of  paralytic  hemoglobinemia.  A  symptom 
complex  which  permits  the  acceptance  of  paralytic  hemoglobinemia  has 
been  reported  by  Krug,  Hartle,  Saur,  Notz  and  Baer  &  Kurtz.  These 
cases  referred  to  affections  which  developed  in  work  oxen  either  after 
several  days  of  rest,  or  independently  of  it  and  also  in  other  cattle  sup- 
posedly after  colds.  The  disease  was  manifested  mostly  by  disturbances 
of  gait  in  the  hind  parts  or  in  weakness  and  stiffness  (Bauer  &  Kurtz), 
in  enlargement  and  swelling  of  the  muscles  of  the  croup  or  thigh, 
further  in  an  elimination  of  a  brownish-red  urine,  which  however  showed 
no  red  blood  corpuscles.  Notz  found  at  the  same  time  in  three  cases, 
in  an  otherwise  negative  post-mortem,  a  bluish-gray  discoloration,  swell- 
ing, and  softening  of  the  muscles  of  the  croup,  back,  shoulder  and  elbow. 

\ 

Literature.  Baer  &  Kurtz,  B.  t.  W.,  1901.  48.  —  Hartle,  W.  f.  Tk.,  1896. 
160.  —  Krug,  B.  t.  W.,  1893.  494.  —  Notz,  W.  f.  Tk.,  1900.  449. 


7.    Hemophilia.    Haemophilia. 

Hemophilia  is  a  peculiar,  as  a  rule  congenital  pathological 
condition,  which  manifests  itself  in  that,  even  after  very  in- 
significant injuries  or  blood  congestions,  profuse  hemorrhages 
appear  which  are  very  difficult  or  impossible  to  stop. 

Etiology.  Up  to  the  present  time  the  disease  has  been 
observed  almost  exclusively  in  horses,  and  especially  in  thor- 
oughbreds (Enghsh  thoroughbreds),  but  according  to  Zschokke 
an  affection  identical  with  hemophilia  has  not  yet  been  demon- 
strated in  animals.  The  cause  of  the  hemorrhagic  diathesis 
is  still  unknown ;  in  man  repeatedly  an  insufficient  development 


Hemophilia.  qqi 

of  the  vascular  svstom  was  found  (hypoplasia  cordis  et 
arteriaruni),  with  which  the  tendency  to  hemorrhages  is  sup- 
posed to  be  inherited.  In  opposition  to  this  Salili  pointed  out 
tlie  insulliciont  formation  of  thrombin  in  the  svalls  of  the  vessel. 
As  a  matter  of  fact  Morawitz  tS:  Lossen  found  a  deficiency  of 
thrombin  in  a  hereditary  bleeder,  probably  as  the  result  of 
a  change  of  the  chemical  constitution  of  the  cellular  elements 
in  the  blood,  which  are  to  produce  tlie  thrombokinasis.  In 
animals  inln-eeding  appears  also  to  have  an  influence  on  the 
development  of  a  hemorrhagic  diathesis  in  the  progeny. 

As  incidental  causes  of  the  hemorrhages,  rapid  galloping, 
castration,  rope  pulling  and  other  ijijuries  of  the  skin  or  the 
mucous  membranes,  or  even  parturition  may  come  into  con- 
sideration (Stalin). 

Symptoms.  The  hemorrhage  is  usually  external,  sometimes 
however  it  may  be  into  a  body  cavity.  The  bleeding  resulting 
from  external  wounds  is  usually  parenchymatous,  and  can  ])e 
stopped  by  the  ordinary  methods  only  with  diflficulty  after 
several  hours,  or  not  at  all,  so  that  the  animal  may  even  bleed 
to  death.  Frequently  the  loss  of  blood  is  so  greaf  that  it  may 
result  in  acute  anemia  from  which  the  animals  recuperate  only 
after  several  weeks.  (Meyer  observed  in  one  case  a  diminution 
in  the  number  of  red  blood  corpuscles  to  3,000,000  in  one  cmm. 
))lood.)  In  other  cases  the  bleeding  may  cease  after  a  time, 
but  may  appear  again  later,  and  after  frequent  recurrences  may 
])roduce  death.  In  man  hemorrhages  are  also  frequent  into 
the  joint  cavities  and  give  rise  to  painful  swellings  of  the  joints. 

Diagnosis.  Before  establishing  the  diagnosis  of  hemophilia 
all  diseases  which  according  to  experience  may  cause  hemor- 
rhages must  be  excluded  (acute  infectious  diseases,  affection  of 
the  heart,  aneurysms,  kidney  disease,  new-formations). 

Treatment.  After  the  appearance  of  the  hemorrhage  the 
customary  hemostatic  remedies  should  be  applied,  likewise  the 
borders  of  the  wound,  if  present,  should  be  united,  compression 
should  be_  applied  on  the  bleeding  place,  and  absolute  rest  of 
the  body  is  required.  If  the  hemorrhage  continues  in  spite  of 
these  measures  the  blood  must  be  coagulated  by  the  use  of 
concentrated  chloride  of  iron  solution,  fuming  nitric  acid,  or 
by  the  actual  cautery  on  the  bleeding  surface.  Internally  ergot 
preparations  may  be  administered.  xVccording  to  recent  ex- 
periences in  human  medicine  the  subcutaneous  injection  of  blood 
serum  from  other  species  might  also  be  utilized  to  advantage. 
A  resulting  anemia  should  also  be  given  appropriate  treatment 
(see  p.  848). 

Zschoklce   succeeded   in   preventing  the  recurrence  of  hemorrhages   in   a  horse 
in  two  weeks  bv  the  administration  of  30  gni.  of  phosphoric  acid  daily. 

Literature.     Meier.  Z.  f.  Tm.,  1906.  X.   1.  —  Stahn,  Z.  f.  Vk.,  lOOG.  214.  — 
Villemiu,  Ann.,  1905.  154.  —  Zschokke,  O.  M.,  1904.  433. 


902  Animal  Parasites  in   the  Blood. 

8.    Animal  Parasites  in  the  Blood.    Haematozoa. 
(a)    Filaria  immitis. 

{Filaria  liaematica.) 

Occurrence.  The  blood  affection  caused  by  filaria  occurs 
in  China  and  in  Japan  very  frequently  among  dogs,  but  it  has 
also  been  observed  in  other  countries,  although  less  frequently, 
especially  in  East  India,  Tonkin,  Brazil  and  North  America. 
In  Europe  dogs  that  were  imported  from  Eastern  Asia,  or 
which  were  kept  there  for  a  time  became  affected  mainly,  but 
native  dogs  are  not  necessarily  spared  (Frolmer,  V.  Katz). 

Aecordiuff  to  Janson  about  50%  of  dogs  in  Japan  are  affected  with  filaria 
immitis,  but  about  75%  of  the  affected  animals  show  no  symptoms  of  disease 
whatsoever  for  a  long  time. 

Petropawlowsky  in  Charkow  found  120  vagrant  dogs  infected,  almost  with- 
out exception,  while  of  83  other  dogs  only  3  harbored  filaria  in  the  blood.  Galli- 
A^alerio  demonstrated  filariosis  haematica  in  18.5%  out  of  162  autopsies  on  dogs  in 
Milan. 

Etiology.  The  full  grown  filaria  immitis  is  a  long,  white 
worm,  of  about  2  millimeter  thickness.  The  male  is  12-18  cm. 
long,  its  posterior  extremity  shows  a  spiral  bending;  the  female 
is  20-.30  cm.  long  and  gives  birth  to  living  embryos. 

The  sexually  mature  filaria  live  especially  in  the  right  half 
of  the  heart,  more  rarely  in  the  pulmonary  arteries,  very  rarely 
in  the  vena-cava,  and  only  very  exceptionally  in  the  left  half 
of  the  heart  or  in  the  arteries  of  the  large  blood  circulation. 
They  are  found  at  these  places  in  varying  numbers,  sometimes 
up  to  several  hundred,  rolled  up  in  a  ball  which  is  difficult  to 
untangle,  in  which  the  females  give  birth  to  embryos  about  I4 
mm.  long  which  may  then  gain  entrance  to  the  circulating  blood 
in  very  large  numbers  (Rieck  estimated  them  in  one  case  up 
to  several  millions).  Not  infrequently  however  the  sexually 
mature  filaria  may  be  present  at  the  same  time  also  exclusively 
in  the  subcutis. 

The  mode  and  manner  of  the  natural  infection  is  not  yet 
known  with  certainty.  The  infection  is  probably  transmitted 
by  impure  swampy  water,  which  the  frequent  occurrence  of 
the  disease  in  marshy  localities  of  the  warmer  countries  seems 
to  substantiate  fully.  The  dogs  probably  take  the  larvae  of 
the  parasite  with  their  drinking  water.  These  then  reach  the 
heart  with  the  venous  blood  and  there  they  mature.  The 
embryos  may  leave  the  animal  with  some  of  its  blood  or  some- 
times with  the  excrement  and  the  secretions  of  the  air  passages 
(Janson),  principally  however  with  the  urine,  and  may  then 
reinfect  the  drinking  water.  The  artificial  transmission  of  the 
disease  by  inoculation  of  blood  containing  filaria  has  never  been 
successful  (Frohner).  According  to  Janson  and  Galep  & 
Pourquier  the  embryos  are  supposed  to  pass  sometimes  to  the 


Etiology,     ratliogenesis,  Anatouiical    Chaugeb.  903 

fetus  tliroui^'li  the  placental  vessels.    This  however  was  not  con- 
liriiied  by  l\osso  in  experiments  with  a  bitch. 

Acconling  to  Mansoii  tlio  embryos  of  tlio  filaria  sanguinis  honiinis,  a  worm 
resembling  tlie  filaria  of  tlogs,  are  taken  up  l)y  moscjuitoes  (culcx  nios(|uito)  with 
tiie  liiooti  of  affected  persons,  in  which  they  develop  to  larvae.  When  later  the 
mosquitoes  die  in  the  marshes,  after  depositing  their  eggs,  the  young  filaria  are 
set  free  from  their  bodies,  and  may  reach  the  stomach  of  new  victims  with  the 
water,  and  from  there  ^ain  the  blood  vessels  of  man.  A  similar  development  of 
the  filaria  immitis  would  also  be  expected,  but  Grassi  proved  that  the  majority 
of  the  embryos  of  the  filaria  sanguinis  hominis  die  in  the  intestinal  canal  of 
mosquitoes,  and  that  the  filaria  immitis  cannot  live  in  fleas  and  lice  of  dogs.  Grassi 
therefore  believes  that  the  embryos  reach  the  water  with  blood  from  occasional 
wounds,  and  j)robably  also  with  the  urine,  passing  into  the  healthy  animals  directly 
with  such  infected  water. 

Pathogenesis.  The  sexually  mature  filaria  appear  to  cause 
(listurl)anees,  especially  in  a  mechanical  way.  They  check  the 
blood  circulation  more  or  less,  dependini>-  on  their  numbers, 
either  in  the  heart  itself  or  in  the  blood  vessels,  with  which 
of  course  a  quite  considerable  thrombosis  produced  by  the 
parasite  usually  becomes  associated.  After  their  infesting  the 
lieart  cavities  the  filaria  produces  a  chronic  inflammation  of 
the  endocardium.  The  thrombi  which  develop  in  the  heart 
cavities  or  in  the  large  blood  vessels  may  again  give  rise  to 
the  dissemination  of  emboli.  The  formation  of  emboli  occurs 
mostly  in  the  branches  of  the  pulmonary  arteries,  and  may 
then  lead  to  necrosis  of  circumscribed  portions  of  the  lungs 
or  to  abscess  formation.  Particles  of  the  thrombi  are  excep- 
tionally conveyed  to  the  kidneys  or  into  the  brain. 

The  embryos  of  filaria  produce  first  of  all  anemia  with  a 
pronounced  leucocytosis,  the  severity  of  which  depends  on  the 
number.  These  changes  in  the  blood  are  probably  brought 
about  by  the  action  of  toxic  metabolic  products,  and  also  by 
the  utilization  of  the  constituents  of  the  blood.  The  purely 
mechanical  action  of  the  embryos  produces  on  the  other  hand 
at  most  only  insignificant  effects,  plugging  of  the  capillaries, 
and  occurs  most  frequently  in  the  capillaries  of  the  kidneys, 
more  rarely  in  the  other  organs  (lungs,  brain). 

Anatomical  Changes.  Sexually  mature  filaria  surrounded 
with  i\y\n  blood  coagulum  are  found  in  the  right  half  of  the 
heart  or  in  any  branch  of  the  pulmonary  arteries,  sometimes 
in  the  vena-cava,  and  exceptionally  also  in  the  left  half  of 
the  heart  (Hutyra  found  in  one  case  almost  the  entire  aorta 
filled  up  by  firm  masses  of  thrombi).  At  the  same  time  chronic 
endocarditis,  partial  hypertro])liy  and  dilation  of  the  heart, 
possibly  also  rupture  of  the  lieart,  with  s>inptoms  of  blood 
stasis  (hydrops,  cirrhosis  of  the  liver,  etc.)  may  frequently  be 
present.  The  lungs  sometimes  show  hemp-seed  to  pea-sized 
nodules,  each  containing  an  embryo  appearing  as  a  red  dot; 
besides  these  atelectasis,  splenization,  abscess  formation  or 
necrosis  may  be  found.     The  kidneys  may  manifest  a  paren- 


904  Animal  Parasites  in  the  Blood. 

clijTnatous,  or  not  infrequently  a  chronic  interstitial  inflamma- 
tion ;  they  may  also  contain  pnnctif orm  hemorrhages.  The  sub- 
cutaneous and  intermuscular  connective  tissue  may  reveal 
sexually  mature  filaria  free  or  encapsulated ;  in  these  parts  they 
may  be  present  even  when  the  heart  or  blood  vessels  do  not 
contain  full  grown  filaria  (v.  Eatz).  The  autopsy  finding  is 
further  completed  by  the  presence  of  anemia  and  of  the  em- 
biyos  in  the  blood.  If  accidentally  only  male  filaria,  or  only 
unimpregnated  females  are  present  in  the  affected  animal,  the 
blood  does  not  contain  filaria  embryos.  On  the  other  hand  some- 
times in  spite  of  the  presence  of  filaria  embryos  in  the  blood 
no  sexually  mature  filaria  can  be  demonstrated  (Frohner). 

Symptoms.  As  long  as  the  filaria  and  their  embryos  are 
present  in  the  blood  in  only  small  numbers,  their  joresence  is 
not  disclosed  by  disease  symptoms.  In  severe  cases  however, 
after  a  month  or  even  after  a  latent  stage  of  years,  more  rarely 
immediately  from  the  beginning,  s^anptoms  of  severe  anemia 
and  gradually  progressing  emaciation  develop;  sometimes  an 
abnormally  increased  appetite  is  also  observed.  Later  hemor- 
rhages appear  in  the  internal  organs,  in  the  lungs,  intestines 
and  in  the  kidneys. 

Besides  these  manifestations  which  are  of  general  import- 
ance, local  symptoms  may  appear  in  some  of  the  cases,  which 
are  produced  either  by  the  thrombi  developing  in  the  heart 
or  by  embolic  plugging  of  small  blood  vessels.  As  a  result  of 
these,  various  disturbances  of  the  heart  action  may  develop, 
which  may  even  lead  to  paralysis  of  the  heart,  hydropic  symp- 
toms, sometimes  venous  or  arterial  thrombosis,  further  epilep- 
tic convulsions,  cough  and  difficulty  in  respiration,  sjniptoms 
of  nephritis,  hematuria,  as  well  as  weakness  of  the  hind  parts 
which  may  increase  to  complete  paralysis.  Rheumatoid  pains 
were  also  observed  (Frohner).  The  blood  shows,  besides  indi- 
cations of  anemia,  also  a  pronounced  leucocytosis.  (Marek 
in  one  case  found  the  relation  between  white  and  red  blood 
corpuscles  to  be  1 :18.)  All  of  these  symptoms  develop  slowly,  and 
without  fever,  gradually  reach  a  high  degree,  and  the  disease 
extends  not  infrequently  over  several  years. 

Exceptionally  the  disease  maBifests  itself  only  in  epileptic  fits  (Megnin), 
■wliicli  may  lead  to  a  fatal  termination  (Earl)  or  death  ensues  as  the  result  of  a 
rupture  of  the  right  auricle   (Schneider,  Guittard). 

In  certain  cases  a  papular  erythema,  with  the  appearance  of  a  diffuse  red- 
dening of  the  skin,  and  numerous  small  and  hard  nodules  and  vesicles  develop,  -with 
which  severe  itching  is  associated.  Otitis  externa  also  occurs.  In  the  contents  of 
the  nodules  or  vesicles,  also  in  the  eczematous  or  otitic  products,  embryos  of  filaria 
may  be  demonstrated. 

Diagnosis.^  The  recognition  of  the  disease  is  usually  only 
possible  by  microscopic  demonstration  of  filaria  embryos  in 
the  blood.  A  drop  of  blood  placed  between  a  slide  and  a  cover 
glass   without  any  special  treatment,   reveals  even  on   slight 


Diagnosis,  Treatment.  905 

magnification,  fine,  worm-shaped  colorless  embryos,  which  exe- 
cute snake-like  or  circular  movements  between  the  blood  cor- 
puscles, (llutyra  c^'  Marck  failed  to  find  a  variation  in  the 
number  of  eml)ryos  durine:  the  hours  of  the  day  and  nijL^dit, 
although  it  is  claimed  by  Manson  and  Sonsino  that  filaria  ap- 
pear in  large  numbers  in  the  peripheral  vessels  only  during 
the  night.) 

Treatment.  This  promises  results  in  strongly  infected 
localities  only  in  so  far  as  some  chronic  cases  without  pro- 
nounced disturbances  in  nutrition  and  circulation,  may  be  ar- 
rested (Janson).  Good  nutrition,  avoiding  exertion  and  new 
infection,  as  well  as  the  administration  of  heart  tonics  or 
arsenical  preparations  come  into  consideration;  Dorn  recom- 
mends atoxvl,  which  produces  in  man  a  diminution  of  the  filaria 
embrvos.  If  a  skin  affection  results  this  requires  the  applica- 
tion of  antiparasitic  and  itch-preventing  remedies  (see  eczema 
or  scabies  in  Vol.  II). 

Literature.  Ca.leae,  J.,  vet.  1897.  .582.  —  Deffke,  Monh.,  1890.  I.  323  -• 
Fottiek,  Vet.,  1900.  245.  —  Frohner,  Monh.,  1892.  III.  494.  —  Grassi,  Cbl.  f. 
Bakt.,  1888.  IV.  61.5.  —  Janson,  A.  f.  Tk.,  1892.  XVIII.  63.  — Petropawlowsky, 
A.  f.  Vet.-Wiss.,  1904.  484.  —  v.  Katz,  Vet.,  1898.  395.  —  Eoger,  Bull.,  1906.  119. 
—  Rosso,  Mod.  Zooiatrio,  1897.  185. 


Filaria  Sanguinis  Equi.  In  former  times  repeated  reports  appeared 
relative  to  the  occurrence  of  filaria  embryos  in  the  blood  of  horses 
(AVedl  Sonsino,  Manzanti,  Lange).  The  classification  of  the  parasites 
found  was  never  satisfactory,  while  their  differentiation  from  trypano- 
somes  was  not  attempted.  Recently  however  Lingard  proved  by  long 
continued  experiments  that  filaria  embryos  do  pccur  in  the  blood  and 
mature  filaria  in  the  blood  vessels  of  horses. 

The  filaria  sanguinis  equi  is  a  thread-shaped,  thin,  whitish  worm,  the 
males  measuring  10-15  cm.,  the  females  about  three  times  that  length. 
The  caudal  extremitv  appears  rolled  up  and  supplied  with  two  uneven 
spicules  which  are  bordered  bv  a  papillae.  The  worm  is  ovoviviparous ; 
the  length  of  the  embrvos  amounts  to  160-220  m.  The  grown  specnnens 
live  in  "the  walls  of  the  large  arteries,  especially  in  the  anterior  or  pos- 
terior aorta,  while  the  eml)ryos  circulate  in  the  blood. 

The  worms  were  found  by  Lingard  in  India  especially  in  the  native 
horses  while  imported  animals  become  affected  only  after  long  stays  m 
the  country.  The  mode  and  manner  of  infection  is  not  yet  known ;  the 
transfusion  of  blood  containing  embryos  was  negative  in  two  cases.  The 
symptoms  of  the  disease  pro])al)ly  only  appear  after  a  long  period  ot 
latencv.  and  consist  of  rapid  fatigue,  edematous  swellings  of  the  lower 
parts  of  the  extremities  and  the  prepuce,  at  the  same  time  the  respu-a- 
tion  becomes  much  accelerated  and  small  hemorrhages  appear  on  the 
conjunctivae.  Sometimes  moderate  fever  is  observed.  The  heart  action 
is  stronger  and  more  frequent.  The  blood  reveals  embryos  witli  a  snaky 
and  circular  movement,  their  number  increases  in  the  afternoon  and 
reaches  its  maximum  in  the  evening.  The  embryos  are  especially 
numerous  during  the  hot  and  rainy  season,  but  now  and  then  they  may 
temporarily  disappear  entirely. 


908  Animal  Parasites  in  the  Blood. 

The  autopsy  reveals,  besides  the  already  mentioned  changes  in  the 
blood  vessels  and  in  the  blood,  numerous  mustard-seed  sized,  caseoua 
or  calcareous  nodules  in  the  lungs  and  also  in  the  liver,  and  in  theso 
are  found  embryos  of  the  filaria.  (Lingard,  Rev.  gen.,  1906,  VIII, 
179  [Ref.].) 


(b)  Other  Animal  Parasites  in  the  Blood. 

Bilharzia  crassa,  B.  indica,  B.  Bomfordi  ( Schistosomum  crassum 
s.  bovis,  Sch.  indicum,  Sch.  Bomfordi).  These  resemble  the  Schistoso- 
mum japonicum  of  man,  which  according  to  Tsuchiya  is  not  identical 
with  the  Bilharzia  haematobia  (Distomum  haematobium).  The  disease 
caused  by  them  (Bilharziosis),  occurs  frequently  in  Egypt,  India,  Japan, 
Mozambique,  Sudan,  Abyssinia,  Tunis,  Cape  Colony,  Cochin-China,  also 
on  the  Island  of  Martinique,  and  affects  cattle,  sheep,  horses  and  donkeys. 
In  Europe  the  disease  was  known  until  quite  recently  only  in  Italy  in 
cattle  and  sheep,  but  recently  a  case  was  observed  by  Marotel  in  a  cow 
in  the  vicinity  of  Lyons  in  France.  Grassi  &  Rovelli  in  Sicily  found 
75%  of  the  examined  sheep,  Bertolini  9%  of  the  cattle  of  Sardinia,  af- 
fected with  bilharziosis.  The  parasites  were  principally  found  in  animals 
between  two  and  four  years  of  age. 

Publications  on  bilharziosis  were  made  by  Sonsino  (1876),  Bomford  & 
Powell  (1886),  Grassi  &  Eovelli  (1888),  Eailliet  (1889),  Sanfelice  &  Loi  (1899), 
Montgomery  (1906),  Raja  &  Peju  (1907),  Marotel  (1908)  and  Bertolini  (1908). 
Montgomery,  Marotel  and  Bertolini  described  the  cause  of  the  disease  very 
accurately. 

The  infection  probably  results  from  drinking  stagnant  water,  which 
becomes  infected  with  the  eggs  through  intestinal  excrements  and 
through  the  urine  of  animals.  This  mode  of  infection  is  indicated  by 
the  fact  that  man,  who,  in  infected  localities  drinks  only  filtered  water, 
usually  does  not  become  affected. 

The  usual  location  of  the  bilharzia  is  the  portal  vein  with  its 
branches,  in  the  region  of  which  they  produce  manifestations  of  stenosis ; 
Montgomery  found  them  also  in  the  liver,  whereas  Bertolini  never  ob- 
served them  there.  The  worms  are  recognized,  on  placing  the  blood  in 
a  flat  dish,  as  thin,  white  bodies  about  14-I  cm.  long  bent  in  a  C-form. 
Not  infrequently  they  are  found  in  copulation,  when  the  females  are  held 
by  the  males  in  groove-shaped  depressions  of  their  bodies. 

The  spindle-shaped  eggs  which  are  supplied  at  one  end  with  spur- 
shaped  extensions,  circulate  in  the  blood  and  produce  inflammatory 
changes  or  hemorrhages  especially  in  the  walls  of  the  intestines,  also  in 
the  urinary  bladder.  In  cattle  changes  exceptionally  develop  in  the 
intestines  which  may  give  rise  to  confusion  with  rinderpest.  Small, 
wart-like  new-formations  develop  in  the  bladder,  rarely  in  the  rectum 
of  cattle. 

The  anatomical  changes  show  certain  variations  in  the  different 
localities  and  in  accordance  with  the  number  of  parasites.  Thus  Ber- 
tolini for  instance  found  only  hyperemia  of  the  small  intestines  and 
hemorrhages  in  the  rectum,  while  the  sections  of  the  large  intestines 
as  well  as  the  bladder  were  free  of  such  lesions.  At  the  same  time 
nodules  like  sand-granules  could  be  felt  in  the  mucous  membrane  of 
the  small  intestines,  which  contained  female  bilharzia  and  their  eggs ;  in 


Animal  Parasites  in   tlio  Blood.  907 

the  hemorrhagic  areas  of  the  rectal  mucous  membrane  eggs  of  hilharzia 
were  found  massed  together. 

The  symptoms  are  indicative  in  general  of  a  sul)eut;nirous  or  ehronie 
catarrh  of  the  nuieous  mcMiibrane  of  the  intestines  and  bladder,  in  which 
pei'iodieally  hemorrluigcs  may  be  observed,  according  to  I:5ertolini  in 
the  first  half  of  the  summer.  The  disturbances  of  health  are  always 
slighter  in  horses  than  in  ruminants. 

A  diagnosis  would  be  }>ossible  during  life  by  demonstrating  the 
eharacteri.stie  eggs  in  the  ui'ine,  feees,  or  by  the  water-like  new  foi-i na- 
tions in  the  rectum  which  might  be  present. 

Treatment  is  not    promising  of  i-esults. 

Literature.  Beitolini,  Klin.  Vet.,  190S.  1  (Lit.).  —  Marotel.  Bull.,  190S.  119. 
—  Moiit^oiiiciv.  J.  of  trop.  vet.  science,  19ur).  l.TS  (Lit.).  —  Eaja  Ac  T'eju,  J.  v^t., 
1907.  478. 

Haematozoon  Lewis.  Gruby  &  Delafond  found  worms,  among 
others  in  the  blood  of  dogs,  which  resembled  the  embryos  of  the  Fil.  im- 
mitis  with  relative  fre(|uency  even  in  countries  where  the  Fil.  immitis 
rarely  occurs  (the  mentioned  two  authors  in  Paris  in  evei-y  twentieth  to 
twenty-fifth,  Sonsino  in  Pisa,  Lewis  iu  Calcutta  in  every  third  dog).  They 
differ  from  the  Fil.  immitis  in  that  they  attach  their  head  ends  to  the 
cover  glass,  at  the  same  time  executing  livelj^  motions  with  the  other  parts 
of  the  body.  They  are  remarkably  resistant,  so  that  they  remain  alive 
for  10  days  outside  of  the  animal  body  at  a  temperature  of  15°  (\  They 
are  found  in  the  arterial  as  well  as  in  the  venous  blood,  and  sometimes 
in  such  quantities  that  a  drop  of  blood  may  contain  3-5  and  even  12-15 
specimens. 

Views  differ  in  regard  to  the  development  of  the  parasite.  Ac- 
cording to  Grassi  they  develop  from  larvae,  which  occur  quite  frequently 
in  fleas  (Pulex  serraticeps)  and  lice  (Haematopinus  piliferus)  of  dogs. 

Dogs  whose  blood  harbors  the  embryos  may  appear  entirely  healthy; 
Gruby  &  Delafond  observed  however  epileptic  fits  in  three  dogs.  The 
same  authors  have  further  ol)served  that  after  transfusion  of  defibrinated 
blood,  containing  the  embryos,  into  healthy  dogs  the  embryos  disappeai- 
from  the  blood  of  the  injected  animals  in  8-40  days ;  in  two  cases  however 
they  remained  alive  for  longer  than  three  years,  until  the  death  of  the 
dogs.  A  full  gi'own  worm  corresponding  with  the  embryo  is  still  un- 
known.    (Carougeau  &  Marotel,  Rev.  gen.,  1908.  T.  447  [Lit.].) 

Strongylus  Vasorum.  This  is  a  fine,  thread-shaped  worm  (the  male 
is  14-15,  the  female  18-21  mm.  long),  which  occurs  in  the  right  ventricle 
of  the  heart,  and  in  the  pulmonary  artery  and  in  its  branches.  In  the 
intima  of  the  vessel  wall  it  causes  the  fornuition  of  small  nodules  or 
elongated  cords,  and  in  the  small  vessels  thrombi.  The  eggs  laid  by  the 
female  remain  lodged  in  the  finer  blood  vessels,  and  lead,  like  the 
hatched  embryos,  to  the  formation  of  small,  up  to  pinhead  sized,  some- 
times quite  numerous  nodules.  According  to  Laulanie  the  embryos 
migrate  later  into  the  bronchi,  they  are  expelled  by  coughing,  and  are 
then  occasionally  taken  up  by  other  dogs. 

The  symptoms  of  the  disease  are  not  very  characteristic.  Symptoms 
of  anemia,  gradually  progressing  emaciation,  frequent  and  irregular  heart 
action,  possibly  hypertrophy  of  the  right  half  of  the  heart,  further  a 
painful  weak  and  dry  cough  are  observed  in  severe  cases,  but  the  disease 


908  Animal  Parasites  in  the  Blood. 

usually  remains  unrecognized.  If  it  is  suspected  the  small  embryos  may 
possibly  be  demonstrated  in  the  expectorations. 

Up  to  the  present  the  disease  has  been  observed  in  France  especially 
in  the  vicinity  of  Toulouse  (Baillet,  Lafosse,  Laulanie)  and  in  Italy 
(Bossi)  where  it  sometimes  appeared  in  an  enzootic  form  and  caused 
considerable  loss. 

According  to  Lafosse  it  is  possible  to  cure  ( ?)  the  disease  by  the 
internal  administration  of  oil  of  turpentine  (2-4  gm  daily  for  one  week) 
(Neumann,  Mai.  parasitaires,  1892.  621   [Lit.].) 

Strongylus  Subulatus  (Haematozoon  subulatum)  was  found  bv  Leisering 
(V.  A.,  186.5.  XXXTIT.  Ill;  S.  B.,  1864.  49)  in  the  venous  blood  of  the  corp. 
cavernosa  of  the  urethral  penis  and  the  glans,  while  in  another  dog  the  worms 
were  present  in  nodular-shaped  swellings  of  the  lungs,  the  thyroid  gland,  and  lymph 
glands. 

In  the  walls  of  the  large  arterial  branches  there  may  further  occur  the 
Spiroptera  sanguinolenta  (see  Vol.  II),  Filaria  Blini  and  P.  Evansi  (see  Inflam- 
mation of  the  Arterial  Wall). 


Diseases  of  the  Spleen 


The  diseases  of  the  spleen  in  animals  are  known  almost 
exclusively  from  the  results  of  post-mortem  examinations. 
This  is  due  to  the  fact  that  in  larger  animals  examination  is 
very  difficult  owing  to  the  unfavorable  anatomical  position  of 
the  spleen,  so  that  in  most  cases  only  marked  changes  in  form 
and  size  of  the  organ  can  be  determined;  furthermore  diseases 
of  the  spleen  usually  produce  only  ver^^  indefinite  disturbances 
in  function.  It  must,  however,  be  noted  that  in  veterinary 
medicine  a  careful  and  systematic  examination  of  the  spleen 
has  hitherto  not  received  much  attention. 

In  view  of  the  very  small  number  of  clinical  observations 
it  is  impossible  for  the  present  to  afford  a  satisfactory  descrip- 
tion of  the  s}Tnptoms. 

Acute  Enlargement  of  the  Spleen  (Tumor  lienis  acutus). 
This  occurs  very  frequently.  Owing  to  its  spongy  structure 
the  spleen  contains,  even  under  normal  conditions,  very  much 
blood,  the  quantity  of  which  may  vary  within  wide  limits  ac- 
cording to  different  influences.  Svoboda,  for  instance,  found 
the  spleens  of  healthy  sheep,  which  had  been  given  food  and 
water  just  before  being  killed,  enlarged  two  and  threefold,  and 
Lenkey  frequently  observed  an  enlargement  of  the  spleen  in 
food  animals  whose  central  nervous  system  was  destroyed  from 
brain  to  lumbar  cord  by  means  of  a  stick  forced  into  the  skull. 
In  fact  there  is  no  other  organ  which,  in  a  short  time,  increases 
so  much  in  size  through  variations  in  its  blood  contents,  while 
on  the  other  hand  the  smooth  muscular  fibers  and  elastic  ele- 
ments of  the  spleen  enable  it  to  contract  rapidly  when  the  influx 
ceases,  and  to  remove  its  surplus  of  blood. 

A  pathologically  increased  flow  of  blood  to  the  spleen  is 
sometimes  produced  by  contusions  or  wounds  of  the  splenic 
region,  and  is  also  likely  to  occur  in  the  initial  stages  of  in- 
flammatory processes  as  well  as  in  impediments  to  the  portal 

009 


910  Diseases  of  the  Spleen. 

circulation  or  to  the  splenic  vein  (as,  for  instance,  in  torsion). 
The  most  important  swelling  of  the  organ,  however,  is  that 
which  frequently  occurs  in  acute  infectious  diseases.  This  form 
of  acute  sjDlenic  enlargement  is  caused  partly  by  the  accumula- 
tion of  bacteria  in  the  pulp  of  the  spleen,  partly,  and  to  a 
greater  degree,  by  the  increase  in  the  number  of  lymph  cells 
and  the  deposition  of  leucocytes  containing  bacteria  as  well 
as  the  deposition  of  disintegrated  red  blood  cells  which  is 
quickly  followed  by  an  inflammatory  process  associated  with 
swelling  and  increase  of  the  cells  and  swelling  of  the  connective 
tissue  framework.     (Splenitis  hyperplastica  acuta.) 

The  most  striking  pathogenic  effect  of  bacteria  and  their 
toxins  is  observed  in  anthrax.  In  this  affection  the  spleen 
may  be  enlarged  as  much  as  5  to  10  times  the  normal  size  and 
the  swelling  may  increase  so  rapidly  that  the  capsule,  being 
subjected  to  severe  tension,  sometimes  tears.  In  other  diseases 
the  swelling  is  usually  less  in  degree  and  it  is  probably  least 
intense  in  such  cases  in  which  only  bacterial  toxins  circulate 
in  the  blood.  A  marked  splenic  enlargement  is  met  with  in 
swine  erysipelas,  in  acute  glanders,  and  in  acute  tuberculosis 
(partly  due  to  the  formation  of  nodules),  in  pyemia,  hemo- 
globinemia,  in  the  acute  infectious  anemia  of  horses,  while  the 
various  forms  of  hemorrhagic  septicemia  as  well  as  croupous 
pneumonia  are  accompanied  only  by  slight  swelling,  and  this 
is  entirely  absent  in  purpura  hemorrhagica  or  in  tetanus. 

In  living  animals,  except  in  ruminants  and  in  fat  hogs  and 
dogs,  acute  swelling  of  the  spleen  may  as  a  rule  be  diagnosed : 
in  horses  by  rectal  exploration ;  in  smaller  animals  by  abdominal 
palpation.  The  spleen  is  found  to  be  enlarged,  soft  or  more 
or  less  tense  to  the  touch.  A  considerable  swelling  may  be 
recognized  by  dullness  on  the  left  side,  which  is  in  horses  parallel 
to  the  costal  arch,  in  dogs  and  hogs  in  the  direction  of  the 
last  two  intercostal  spaces  passing  downward  from  the  costal 
arch  and  wdiich  is  3  or  4  fingers  wide.  In  ruminants  the  swelling 
is  usually  unnoticed  because  the  spleen,  covered  by  the  lung,  does 
not  protrude  beyond  the  posterior  border  of  the  lung  even  if  de- 
cidedly enlarged.  Nevertheless  in  severe  cases  careful  per- 
cussion may  show  a  dullness  at  the  border  between  lung  and 
rumen  as  was  recently  observed  by  Szathmary  in  a  buffalo 
affected  with  anthrax. 

Literature.  Jaweiii,  A'.  A.,  1900.  CLXI,  461.  —  Lenkey,  Husszemle,  1907.  65. 
—  Szathmary,  A.  L.,  1909.  .52-5. 

Purulent  Inflammation  of  the  Spleen.  (Splenitis  aposte- 
matosa.)  This  occurs  after  the  extension  of  a  similar  inflam- 
mation from,  neighboring  organs  or  after  the  lodgement  of 
infected  emboli  (as,  e.  g.,  in  strangles,  etc.).  In  a  case  reported 
by  Arndt  the  embolus  in  the  spleen  came  from  a  suppurating 
inflammatory  focus  which  had  been  produced  by  a  rusty  needle 


Purulent  Inllaiiiiuation.  Oil 


in  tlie  hard  palate).  The  suppurative  foci  may  be  isolated  or 
numerous,  and  in  case  of  metastasis  several  abscesses  are 
usually  formed.  In  exceptional  cases  gastrus  larvae  may  pro- 
duce extensive  suppuration  in  the  spleens  of  young  horses 
(Kovats).  Traumatic  influences  usually  lead  to  the  formation 
of  onlv  one  abscess,  but  the  entire  organ  may  become  subject 
to  the 'suppurative  destruction.  Whih'  an  injury  m  the  splenic 
region  may  be  the  immediate  cause  of  such  an  inflammation  it 
is  far  more  frequentlv  produced  by  foreign  bodies  which  may 
get  into  the  organ  from  tlie  flrst  stomachs  of  ruminants  and, 
exceptionallv,  from  stomach  and  intestine  in  other  animals. 
The  spleen  'mav  l)e  enlarged  to  4  or  5  times  its  normal  size. 
According  to  Notz  sucking  calves  often  develop  a  purulent 
hemorrhagic  inflanmiation  of  the  spleen  when  they  are  stepped 
on  bv  their  mothers. 

The  sjmiptoms  of  traumatic  purulent  inflammation  ot  tlie 
spleen  are  verv  vague.     xVside  from  the  sensitiveness  and  en- 
largement of  the  organ  which  may  be  demonstrable,  the  clinical 
picture  is  composed  more  of  general  disturl)ances  an  explana- 
tion of  which  is  possible  onlv  by  reliable  historical  data  to  a 
certain  degree.     There  are  cases  in  which  a  large  abscess  is 
found  in  the  spleen  on  autopsv  of  animals  which  presented 
no  sign  of  disease  during  life.     Mol)ius,  for  instance,  found  an 
abscess   containing  3   liters   of  pus   in   the   spleen   of   a  well- 
nourished  cow,  and  Kiihnau  reported  a  similar  case,     in  other 
cases  onlv  digestive  disturbances  and  colicky  symptoms,  show- 
ing little' that  is  characteristic,  are  observed  and  are  followed 
bv  a  gradual  or  rapid  emaciation    (Knoll,  Zimmermann;  de 
Meestre  ordered  the  animal  to  be  killed  in  one  case  because 
he   suspected  lung  plague).     Fleischer  observed,  m  purulent 
inflammation   of   the   spleen   in   cattle,   convulsive   movements 
which  recurred  periodicallv.     If  the  disease  develops   rather 
rapidlv  there  exists  a  violent  fever  which  may  be  continuous 
or  remittent.     Imminger  is  inclined  to  consider  a  continuous 
temperature  of  40-41°  C,  which  does  not  yield  to  antipyretic 
remedies,  as  characteristic  of  purulent  splenic  inflammation 
In  this  he  surelv  goes  much  too  far,  for  in  the  presence  ot 
such  s^miptoms  'the  nature  of  the  disease  can  be  recognized 
only  then  when  at  the  same  time  swelling  and  perhaps  tender- 
ness of  the  spleen  mav  likewise  be  ascertained  by  percussion 
and  palpation  (van  den  Eeckhout  found  m  a  colt  an  area  ot 
dullness,  five  fingers  wide,  below  the  left  costal  arch,  the  an- 
terior border  of  which  passed  in  front  and  below,  obhquely 
to   the  fifth  rib  and  then  turned  vertically  downwards ;   the 
enlarged  spleen  weighed  9V.  kg.).     Sometimes  a  large  splenic 
abscess  mav  be  felt  from  the  rectum  and  then  it  will  be  possible 
to   determine  fluctuation.     Finally,  purulent  inflammation   ot 
the  spleen  mav  give  rise  to  the  development  of  peritonitis  or 
pleurisv  which  will  also  occur  after  rupture  of  the  abscess  in 
which  case  it  becomes  purulent  (Frohner,  Author  s  case). 


912  Diseases  of  the  Spleen. 

In  an  uncomplicated  purulent  inflammation  of  the  spleen, 
surgical  interference  is  to  be  considered,  internal  treatment 
affording  no  promise  whatever  of  results. 

Degive  extirpated  the  sjjleen  of  a  dog,  which  was  adherent  to  the  omentiinij 
without  any  harm  to  the  animal. 

Literature.  Arndt,  B.  t.  W.,  1889.  243.  —  Degive,  Ann.,  1888.  10.  —  van  den 
Eeckhout,  Ann.,  1906.  619.  —  Faustle,  W.  f.  Tk.,  1908.  362.  —  Fleischer,  B.  t.  W., 
1906.  922.  —  Frohner,  Monh.,  1907.  XVIII.  144.  —  Gmeiner,  Monh.,  1896.  XVII. 
510.  —  Imminger,  W.  f.  Tk.,  1892.  229.  —  Kovats,  Vet.,  1895.  360.  —  de  Meestre, 
Ann.,  1887.  354.  —  Mobius,  S.  B.,  1888.  71.  —  Notz,  W.  f.  Vk.,  1891.  280.  — 
Eichter,  Z.  f.  Vk.,  1906.  390.  —  Zimmermann,  B.  t.  W.,  1894.  358. 

Hemorrhage  of  the  Spleen.  (Haemorrhagia  lienis.)  Hemor- 
rhages into  the  spleen  are  not  infrequent,  but  can  hardly  be 
diagnosed  clinically.  (Rupp  observed  obstinate  constipation  in 
a  dog  with  a  large  splenic  hematoma.)  The  cause  of  the  hemor- 
rhage may  lie  in  active  or  passive  hyperemia,  or  in  acute  splenic 
enlargement.  Berg  and  other  Danish  veterinarians  quite  fre- 
quently observed  diffuse  splenic  hemorrhage  in  cattle  which 
suddenly  became  ill  and  died  soon,  so  that  anthrax  w^as  often 
suspected.  Hemorrhage  in  the  spleen  not  infrequently  occurs 
after  contusion  of  the  splenic  region,  but  is  rare  after  the 
lodgement  of  non-infected  emboli.  The  hemorrhage  may  cause 
the  spleen  to  burst. 

Literature.  Berg,  Maanedsskr.,  1905.  XVI.  441.  —  Bodou,  Vet..  1899.  432. 
—  Querrini,  Monh.,  1908.  XX.  90.  —  Eiipp,  B.  t.  W.,  1906.  44.  —  AVitt,  B.  t.  W. 
1908.  625. 

Rupture  of  the  Spleen.  (Ruptura  lienis.)  A  healthy  spleen 
only  very  rarely  tears  from  direct  injury,  but  in  rapidly  in- 
creasing acute  swelling  this  may  occur  without  any  traumatic 
effect,  and  internal  fatal  hemorrhages  from  such  a  cause  are 
by  no  means  rare;  they  are  observed  in  anthrax  with  relative 
frequency.  Sometimes  here  also  a  traumatic  accident  that  may 
be  slight  in  itself,  such  as  falling  down,  rapid  motion,  cough, 
etc.,  may  form  the  immediate  cause  of  the  rupture,  but  in  other 
instances  no  external  cause  can  be  determined.  Witt,  who  often 
observed  sudden  death,  and  hemorrhage  into  the  abdominal 
cavity  in  cattle  with  ruptured  spleen,  took  the  disease  to  be 
malaria,  as  he  had  found  w^hite  corpuscles,  similar  to  parasites, 
in  the  blood  cells.  In  a  case  of  Darvas'  the  rupture  of  the 
spleen  was  due  to  the  bursting  of  an  echinococcus. 

Rupture  of  the  spleen  produces  in  general  only  symptoms 
of  internal  fatal  hemorrhage,  the  cause  of  which  can  at  best 
be  suspected  on  account  of  the  simultaneous  colicky  sjmiptoms, 
the  accumulation  of  fluid  in  the  abdominal  cavity,  and  still 
more  on  account  of  a  splenic  tumor  that  may  be  detected. 
(Drewien  found  on  rectal  exploration  in  a  horse  a  large  swell- 
ing in  the  left  side  of  the  abdomen.)  (Literature  under  Hemor- 
rhage of  the  Spleen.) 

Torsion  of  the  Spleen.     (Torsio  lienis.)     Torsion  of  the 


Rupture,  Torsion,  Clirouic  Enlargement.  9]^3, 

spleen  around  the  splenic  ligament  occurs  not  infrequently  in 
liogs  (Glage)  and  is  observed  occasionally  also  in  dogs  (Boston, 
Jolme,  Author's  case).  If  the  spleen  has  become  heavier  be- 
cause of  enlargement  or  swelling,  and  if  the  ligament  has  be- 
come atroi)liic  (Glage),  the  organ  may  rotate  on  the  ligamentum 
gastro-lienale  during  a  forced  motion  of  the  body  or  yielding 
to  the  pressure  of  other  organs.  When  the  rotation  has  taken 
place,  the  veins  passing  through  the  ligament  are  compressed 
so  that  the  return  flow  of  the  venous  i)lood  is  impeded  and  a 
splenic  tumor  is  produced  which  increases  rapidly  and  enor- 
mously. Sinmltaneously  stasis  takes  place  in  the  gastric  veins 
opening  into  the  splenic  vein,  which  leads  to  a  venous  hyperemia 
of  the  stomach ;  this  is,  however,  usually  not  intense.  ^  Torsion 
may  lead  to  necrosis  of  the  spleen. 

The  affection  is  characterized  by  marked  splenic  enlarge- 
ment and  sometimes  also  by  symptoms  of  gastric  catarrh.  Al- 
though a  great  swelling  of  the  spleen,  together  with  a  rather 
soft  consistency  of  the  organ  may  suggest  torsion,  this  cannot 
be  definitely  recognized  by  clinical  methods. 

Literature.  Glage,  Z.  f.  Flhyg.,  1898.  YIII.  4.  —  Zietschmann,  S.  B.,  1903. 
257. 

Chronic  Enlargement  of  the  Spleen.  (Tumor  lienis  chroni- 
cus.)  strictly  speaking,  this  always  develops  in  consequence 
of  venous  stasis,  which  by  the  copious  effusion  of  nutritive  ma- 
terial stimulates  an  increase  in  the  connective  tissue  elements 
of  the  frame  substance.  As  more  frequent  causes  may  be 
"enumerated :  Thrombosis  of  the  splenic  vein,  chronic  interstitial 
hepatitis,  thrombosis  or  compression  of  the  Vv.  portae  by  a 
swelling,  by  atrophy  of  the  connective  tissue  or  by  a  hematoma 
of  the  liver,  sometimes  also  organic  heart  lesions. 

In  the  diagnosis  of  chronic  tumor  of  the  spleen  the  symp- 
toms described  for  acute  swelling  are  deciding,  but  with  the 
difference  that  here  the  consistency  of  the  spleen  is  firmer. 

Chronic  swelling  of  the  spleen  may  include  the  following 
pathplogical  conditions  of  the  organ: 

Splenitis  chronica  indurativa,  which  develops,  according  to  KHt, 
through  the  persistent  influence  of  toxic  infectious  agents  (for  instance 
in  the  clironie  erysipelas  of  hogs). 

The  leukemic  splenic  tumor  can  usually  be  clinically  diagnosed 
with  certainty.  The  nature  of  the  enlargement  is  indicated  by  the 
characteristic  hlood  changes;  greater  difficulties  are  encountered  in 
the  correct  recognition  of  a  pseudoleukemic  splenic  tumor. 

Simple  hyperplasia  of  the  spleen  (Hyperplasia  lienis)  is  occa- 
sionally found  on  autopsy.  The  spleen  is  usually  remarkably  large 
(in  the  case  of  Bourret  and  Druille  the  spleen  of  a  horse  weighed 
21  kg. ;  in  that  of  Duschanek,  39 ;  in  that  of  Koch  the  spleen  of  a  cow 
weighed  18.5  kg.).  During  life  gradual  and  progressive  emaciation 
and  respiratory  difficulty  was  observed. 

Vol.  1 — 58 


914  Diseases  of  the  Spleen. 

Literature.  Bourret  &  Druille,  Eec,  1887.  300.  —  Duschanek,  T.  Z.,  1894. 
353.  —  Kappel,  Z.  f.  Flhyg.,  1904.  XIV,  53.  —  Koch,  B.  t.  W.,  1893.  127. 

New  Form::uons  in  the  Spleen.  The  most  frequent  of  these 
are  melaiio-sarcomas  which  occur  particularly  in  white  horses 
(Deste)  either  in  the  form  of  fairly  large  metastatic  growths 
which  may  become  as  large  as  a  child's  head,  or  in  the  form 
of  diffuse*  infiltrations,  and  at  times  they  become  the  cause  of 
considerable  enlargement  of  the  spleen.  Barrier  observed  in 
one  horse  first  an  enlargement  of  the  circumference  of  the 
abdomen,  the  desire  to  eat  being  good  and  the  ability  to  work 
satisfactory.  Not  until  about  three  weeks  before  death  did  the 
animal  begin  to  lose  weight;  the  appetite  was  disturbed,  the 
weakness  increased  progressively,  the  walk  became  staggering 
and  at  times  colicky  sjmiptoms  appeared.  On  rectal  examina- 
tion a  large  swelling  was  found  in  the  left  half  of  the  abdominal 
cavity. 

Of  similar  clinical  significance  is  the  enlargement  of  the 
spleen  in  amyloid  degeneration,  in  metastatic  carcinoma  or  in 
the  presence  of  large  tubercles  (especially  in  cattle  and  hogs, 
sometimes  also  in  horses)  or  of  echinococcus  cysts.  Direct  ex- 
amination can  at  most  show  the  splenic  enlargement  which 
may  occasionally  cause  respiratory  distress  (Barrier),  the 
cause  of  the  enlargement  must  be  determined  from  other  patho- 
logical signs.  Laendler  succeeded  on  rectal  examination  in  a 
heifer  in  palpating  the  very  knobby  posterior  border  of  the 
spleen  which  was  increased  about  5  times  in  volume  through  the 
presence  of  echinococcus. 

Necrosis  of  the  Spleen.  This  was  found  by  Zietschmann 
and  Poetsch  (S.  B.  1903,  259)  in  an  apparently  healthy  heifer 
which  had  been  killed  for  meat.  As  the  cause  of  the  necrosis 
a  complete  thrombosis  of  the  splenic  vein  may  probably  be 
held  responsible. 

Atrophy  of  the  Spleen.  Mayer  (Z.  f.  Flhyg.  1909,  XIX, 
251)  found  in  a  sow  which  had  been  killed  for  meat  a  far  ad- 
vanced senile  atrophy  of  the  spleen  which  was  only  6  cm."  long 
and  4.5  cm.  wdde. 


Diseases  of  Metabolism. 

1.    Obesity.    Obesitas. 

Fettsucht. 

By  obesity  is  understood  an  excessive  deposit  of  fat  which 
interferes  in  some  way  or  other  with  the  ability  of  the  animals 
to  work.  If  the  increase  of  the  fat  dejjosit  occurs  while  nutri- 
tion and  muscular  activity  are  normal,  it  is  called  obesity  in 
a  limited  sense  of  the  word,  in  contrast  to  the  alimentary  obesity 
(fattening),  which  is  the  result  of  generous  feeding  or  of  in- 
activity. 

Etiology.  The  cause  of  alimentary  obesity  lies  in  a  dis- 
projjortion  between  the  intake  and  the  utilization  of  nutritive 
units.  This  condition  very  frequently  prevails  if  the  animals 
-receive  more  food  than  the}'  need  in  order  to  maintain  tlieir 
bodily  functions.  It  also  occurs  frequently  enough  that  the 
intake  of  caloric  units  does  not  exceed  the  average  amount,  but 
that  through  insufficient  activity  the  muscles  of  the  body  use 
up  too  small  an  amount  of  energy^-units.  Finally,  both  factors 
frequently  combine  in  producing  obesity. 

A  generous  deposit  of  fat  is  promoted  above  all  by  the 
fattening  of  animals  intended  for  food,  but  although  strictly 
speaking  a  pathological  condition,  this  does  not  usually  form 
an  object  for  therapeutic  measures.  Obesity  is  further  fre- 
quent in  breeding  animals,  especially  in  the  males,  which  are, 
as  a  rule,  not  only  fed  generously,  but  are  moreover  spared 
all  work,  and  are  even  not  rarely  prevented  from  taking  the 
most  necessary  exercise.  The  same  is  true  of  pet  and  house 
dogs.  In  general,  however,  favoring  factors  are  of  essential 
importance.  Above  all  a  vigorous  appetite  comes  into  consider- 
ation, which  apparently  varies  individually  within  wide  limits. 
Then  the  nature  of  the  food  is  important,  food-stuffs  which  are 
rich  in  fat  and  carbohydrates  producing  a  considerable  fat  de- 
posit. On  the  other  hand  the  deposit  of  fat  is  promoted  by 
all  conditions  which  persistently  diminish  muscular  activity. 
In  this  respect  the  phlegmatic  temperament  which  may  be  in- 

915 


916  Obesity. 

lierited  is.  very  important.  Animals  also  become  phlegmatic 
after  castration  (Liitlije)  and  then  tend  to  put  on  fat.  The 
same  is  true  for  older  animals.  By  diminishing  muscular  ac- 
tivity anemia  may  favor  the  deposit  of  fat  if  it  is  not  due  to 
an  organic  lesion  or  to  deficient  feeding.  It  has  for  this  reason 
become  customary  in  many  districts  to  promote  the  fattening 
of  the  animals  by  periodical  venesection.  The  diminution  of 
nmscular  activity  finally  becomes  a  favoring  factor  in  producing 
obesity  in  many  broken-winded  horses. 

In  all  these  cases  the  obesity  develops  in  consequence  of  an 
absolute  or  relative  hyperalimentation.  As  to  whether  aside  from 
this  there  also  exists  in  animals  a  true  constitutional  obesity  we 
do  not  possess  any  observations  based  upon  examinations  of  the 
metabolism.  This  form  of  obesity  might  be  expected  to  arise 
from  a  slowing  of  metabolism  because  in  such  individuals  the 
weight  unit  protoplasm  would  transform  less  potential  energy 
into  living  force,  primarily  into  heat  (v.  Noorden).  As  a  matter 
of  fact,  v.  Bergmann  recently  actually  demonstrated  the  slow- 
ing of  metabolism  in  persons  affected  with  obesity.  This  diminu- 
tion of  the  oxidizing  function  of  the  protoplasm  may,  according 
to  V.  Noorden,  have  its  cause  in  a  peculiar  constitution  of  the 
protoplasm  itself  or  it  may  be  the  consequence  of  abnormal 
internal  secretions,  especially  those  of  the  thyroid  gland  which 
exerts  a  stimulating  action  upon  oxidation,  while  its  function 
is  regulated  in  its  turn  by  other  organs  (pancreas,  sexual  glands, 
hypophysis,  adrenals),  v.  Noorden  thus  explains  constitutional 
obesity  as  a  thyreogenic  obesity. 

Anatomical  Changes.  The  fat  is  present  in  very  large  pro- 
portion, especially  in  the  subcutaneous  connective  tissue  whence 
it  may  enter  between  the  muscles  and  even  between  the  muscle 
fibers,  also  between  the  mediastinal  folds,  under  the  visceral 
layer  of  the  pericardium  and  possibly  in  the  heart  muscle,  in 
the  omentum,  the  colon,  in  the  region  of  the  kidneys,  etc.  In 
severe  cases  individual  fibers  of  the  muscles  which  are  per- 
meated with  fat,  for  instance  in  the  heart  muscle,  take  on  a 
yellowish  color  owing  to  fatty  degeneration.  Of  the  internal 
organs  it  is  particularly  the  liver  in  which  there  is  a  great  ac- 
cumulation of  fat. 

Symptoms.  Obesity  shows  itself  most  strikingly  in  a 
peculiar  alteration  in  the  shape  of  the  body  by  which  the  out- 
lines of  the  body  are  rounded  out  and  the  skin  forms  thick, 
but  soft  and  elastic  folds.  This  change  is  most  decided  on  the 
trunk,  especially  on  the  abdomen,  then  on  the  thighs,  the 
shoulders  and  on  the  throat.  The  enlargv^d  belly  sometimes 
has  an  appearance  as  though  the  abdominal  walls  were  forced 
apart  by  fluid  or  a  swelling,  but  the  actual  cause  can  easily 
be  determined  by  palpation  and  percussion  and  still  better  from 
the  other  signs  of  obesity.     The  skin  feels  soft  and  elastic; 


Symptoms,    Course  and  Prognosis.  917 

between  its  folds  a  superficial  inflammation  occurs  not  infre- 
quently. 

Another  symptom  is  lassitude  and  rapid  fatigue  on  motion 
which  causes  the  animals  to  become  dyspneic  and  to  perspire. 
Kespiration  is  frequent  and  superficial  even  at  rest,  be- 
cause the  diaphragm  is  forced  against  the  thoracic  cavity  and 
because  the  contraction  of  the  respiratory  muscles  is  impeded. 
This  may,  however,  be  partly  due  to  the  weakened  heart  action 
through  which  the  pulse  becomes  rapid  and  soft. 

Later  on  digestive  disturbances  occur  frequently  because 
the  motility  of  stomach  and  intestines  is  diminished  by  the 
masses  of  fat,  which  may  also  account  for  the  frequent  con- 
stipation. In  breeding  animals  the  ability  to  procreate  dimin- 
ishes proportionally  with  the  obesity  and  eventually  disappears 
entirely;  furthermore,  the  increased  weight  and  diminished 
muscle  force  renders  coition  difficult  or  impossible. 

Course  and  Prognosis.  With  care  and  moderate  feeding 
the  diseased  aninuUs  nuiy  be  kept  alive  for  a  long  time.  But, 
unless  the  causes  are  removed,  there  develops  a  gradually  in- 
creasing anemia  leading  to  an  aggravation  of  the  respiratory 
and  circulatory  disturbances,  and  finally  death  occurs  from 
heart  failure  or  asphyxiation.  Previous  to  the  fatal  termina- 
tion there  are  often  signs  of  blood  stasis,  such  as  cyanosis, 
dyspnea,  edematous  infiltrations,  etc. 

The  prognosis  is  favorable  insofar  as  a  timely  and  proper 
regulation  of  diet  will  in  most  cases  relieve  the  pathological 
condition. 

Treatment.  The  method  which  is  most  certain  to  be  suc- 
cessful consists  in  the  diminution  of  the  daily  food  ration  and 
in  systematic  exercise  of  the  animals.  In  order  to  prevent 
digesl:ive  disturbances  the  amount  of  the  food  should  be  re- 
duced gradually  down  to  a  daily  allowance  which  corresponds 
to  the  species  and  size  of  the  animal.  Especially  in  dogs 
care  should  be  taken  to  feed  them  only  at  certain  times,  once 
or  twice  daily.  It  is  of  course  necessary  to  pay  attention 
to  the  composition  of  the  food-stuffs  and  especially  the  allow- 
ance of  carbohydrates  and  fats  should  be  limited  as  much  as 
possible.  On  the  other  hand  the  limitation  of  the  amount  of 
drinking  water  has  only  the  effect  of  assuring  a  freer  motion 
of  the  animals  and  therefore  a  greater  expenditure  of  energy. 

It  is  advisable  to  attempt  the  systematic  administration 
of  Carlsbad  water  (in  dogs  i/>  to  1  tablespoonful  once  or  twice 
before  feeding),  although  in  most  cases  this  treatment  is  super- 
fluous. Of  excellent  service  are  the  thyroid  gland  preparations 
which  stimulate  a  considerable  oxidation  of  fat,  but  at  the 
same  time  cause  an  increased  disintegration  of  albumin,  so  that 
their  administration  must  be  supplemented  by  a  more  generous 
ratio    of   the   proteids.      The   various   preparations   that   may 


918  Diabetes  Insipidus. 

be  used  are  Tliyreoidinum  depuratum  (for  dogs  0.2-0.3  to  0.75 
gm.,  or  3  times  daily  1  dessertspoonful  of  the  1:1000  solution) ; 
Thyreoidinum  Poelil  (3  times  daily  0.3-0.6  gm.) ;  lodothyrin 
(0.1-0.2  gm.).  If  necessary  the  fresh  thyroid  gland  of  animals 
killed  for  food  may  be  employed.  If  anemia  is  present  this 
also  requires  appropriate  treatment. 

Literature.  v.Bergmann,  D.  m.  W.,  1909.  611.  —  Krehl,  Pathologische 
Physiol.,  1910.  430  (Lit.).  —  Liithje,  Arch.  f.  exp.  Path.  u.  Phmk.,  1903.  L.  169. 
—  V.  Noorden,  Arztekongr.  Budapest.  1909.  —  Zimniermaun,  Vet.,  1901.  657. 

2.    Diabetes  Insipidus. 

Diabetes  insipidus  is  a  functional  disturbance  of  the  kidne^^s 
which  causes  the  animal  permanently  to  require  large  amounts 
of  water  for  the  elimination  of  the  substances  that  are  secreted 
with  the  urine,  so  that  it  voids  large  amounts  of  watery  urine 
free  from  albumen  and  sugar  and  having  a  low  specific  gravity. 

According  to  this  definition  polyuria  (Lauterstall),  which  is  a 
transitory  condition,  is  not  to  be  classed  with  diabetes  insipidus ; 
excejit  after  excessive  water  drinking,  it  occurs  rather  frequently  in 
the  most  varying  diseases  in  which  copious  exudates  are  absorbed  in 
a  short  time  (pnenmonia,  pleurisy,  etc.),  then  in  certain  chronic  in- 
fections diseases  ( tuberculosis,  glanders)  and  in  certain  affections  of 
the  central  nervous  system  (tumors,  hemorrhages,  inflammations). 
That  form  of  polyuria  which  occurs  in  the  course  of  many  acute  or 
chronic  kidney  inflammations,  usually  together  with  alluiminuria  must 
also  be  considered  only  as  a  partial  symptom  of  the  diseases  named 
and  can  therefore  not  be  classed  with  diabetes  insipidus.  The  same 
is  true  for  the  transitory  polyuria  after  the  ingestion  of  irritating 
substances.  In  contrast  to  this  transitory  or  symptomatic  polyuria, 
diabetes  insipidus   occurs   as   an   independent   anomaly. 

French  medical  authors  differentiate  a  diabetes  insipidus  verus  and  a  diabetes 
azoturicus.  In  the  former  are  comprised  those  forms  in  which  witli  an  increased 
total  amount  of  urine  the  solid  constituents  are  not,  or  only  slijjhtly,  increased, 
while  in  diabetes  azoturicus  the  solid  constituents  are  secreted  in  amounts  far  above 
normal.  (If  the  amount  of  urine  is  normal  and  only  the  solids  are  increased,  the 
condition  is  designated  simply  as  azoturia.)  In  veterinary  medicine  exact  analytical 
examinations  in  this  direction  have  yet  to  be  made. 

Distribution.  As  an  independent  disease  in  the  meaning 
described  above  diabetes  insipidus  has  been  diagnosed  with  cer- 
tainty in  animals  only  comparatively  rarely  (Hayne,  Veitli, 
Moiroud,  Dammann,  Perrin,  Dieckerhoff,  Schindelka),  luit  from 
the  point  of  view  of  the  practician  those  far  more  frequent 
cases  may  be  added  to  it  which,  while  occurring  in  consequence 
of  improper  feeding,  take  a  chronic  course.  In  veterinary  medi- 
cine diabetes  insipidus  is  generally  understood  in  this  sense. 

Etiology.  The  disease  is  observed  most  frequently  in 
horses,  especially  if  these  are  fed  for  some  time  with  mouldy 
feed.  In  this  respect  oats  may  be  of  importance,  as  it  rapidly 
assumes  a  peculiar  mouldy  odor  when  it  is  stored  up  on  the 
ground  in  large   quantities   \vithout   being  turned  over   from 


Etiologj'.  919 

time  to  time.  The  feeding-  of  such  oats  soon  produces  polyuria 
which  may  pass  into  a  ])atliolo,i;ical  condition  simihir  to  dialx'tcs 
insipichis  if  the  spoiled  oats  is  continued  for  a  long  time.  In 
former  times  when  oats  was  often  transported  on  ships  on 
whicli  it  was  impossihle  to  turn  it  over  at  frequent  intervals 
the  disease  was  observed  more  frequentl\%  and  sometimes  in 
an  enzootic  form.  Today  it  occurs  far  less  often  because  the 
oats  is  usuall}"  shipped  in  bag's  (Dieckerhoff).  Other  mouldy 
kinds  of  feed  nmy  likewise  produce  a  similar  effect;  for  instance 
mouldy  hay,  peas,  vetches,  etc.,  l)ut  these  can  not  nearly  as  often 
be  brought  into  connection  witli  the  appearance  of  the  disease, 
perhaps  because  the  coarse  feed,  even  in  large  quantities,  can 
be  ventilated  more  easily  than  is  possible  with  oats.  More- 
over it  is  not  impossible  that  peculiarly  toxic  substances  are 
formed  in  mouldy  oats. 

Certain  plants  are  credited  with  the  ability  to  cause  diabetes.  As  such  are 
consiilcied  the  ilifferent  species  of  Adonis  and  Anemone,  and  above  all  the  Cynanchuni 
s.  Asclepias  vincetoxicuni,  the  latter  especially  since  Veith  succeeded  in  causing 
polyuria  in  sheep  by  feedinjj  it  to  them.  According  to  Roll  frozen  fodder  and  slop 
are  also  at  times  the  cause  of  diabetes. 

Aside  from  transitory  polyuria  true  diabetes  is  occasionally 
observed  as  a  complication  of  affections  of  the  central  nervous 
system,  but  such  cases  are  hardly  known  to  have  occurred  in 
animals. 

Other  etiological  factors  are :  The  continued  administration 
of  diuretics,  cold,  traumatic  accidents  to  the  liver  or  to  the 
vertebral  column;  some  authors  (Cagny,  Cagnat)  assume  an 
infection  as  the  cause  of  cases  which  occur  in  greater  numbers. 

Horses  which  are  used  for  heavy  work  and,  according  to 
Moiroud,  especially  stallions  appear  to  be  most  disposed  to 
diabetes  insipidus,  while  age  and  race  have  no  influence.  The 
disease  usually  occurs  more  frequently  in  summer  than  in 
colder  seasons. 

Tlio  nalnro  of  diabetes  insipidus  is  unknown.  This  iiinoh  is  cer- 
tain that  a  transitory  polyuria  can  be  produced  artificially  by  injuring: 
a  certain  spot  in  the  fourth  ventricle  near  the  Calamus  scriptorius 
(CI.  Bernard).  Later  it  was  ascertained  that  injuries  to  other  portions 
of  the  brain,  especially  the  vermiform  process  of  the  cerel)ellum,  as 
well  as  the  division  of  the  lumbar  cord,  or  of  the  splanchnic  nerve 
also  produces  similar  results.  These  experiments  permit  the  conclusion 
that  diabetes  insipidus  perhaps  also  originates  from  nervous  causes, 
and  according  to  this  view  the  effect  of  mouldy  fodder  would  have  to 
be  explained  thus,  that  sulistances  developed  in  it  produce  polyuria 
by  the  intermediation  of  the  nervous  system.  It  may  he  assmned 
that  through  disease  of  the  vasomotor  nerves  in  the  kidneys  a  constant 
arterial  hyperemia  is  maintained  in  consequence  of  which  the  amount 
of  urine  or  its  content  of  water  is  increased.  Against  this  view  stands 
the  demonstration  recently  afforded  1)y  E.  Meyer  and  F.  ]\Iiiller  tliat 
diabetes  insipidus  in  man  represents  in  fact  only  a  secretory  anomaly 
of  the  kidneys  througrh  which  the  organism  requires  very  great  amounts 


920  Diabetes  Insipidus* 

of  water  for  the  elimination  of  solid  urinary  constituents,  primarily 
of  urea  and  sodium  chloride,  or  the  kidneys  have  lost  the  faculty  to 
reabsorb  the  water  secreted  into  the  glomeruli. 

Anatomical  Changes.  The  autopsy  findings  are  sometimes 
entirely  negative;  in  other  cases  changes  are  fonnd  in  the 
central  nervous  system  (in  Holzmann's  case  the  spinal  cord 
of  a  dog  was  surrounded  in  almost  its  entire  length  by  myxoma- 
tous tissue  and  several  dural  sarcomas)  or  signs  of  an  earlier 
general  affection,  as  well  as  secondary  changes  in  the  organ. 
The  kidneys  are  either  entirely  normal  or  show  only  unim- 
portant changes  (cloudy  swelling,  hyperemia,  etc.). 

Symptoms.  After  feeding  mouldy  oats  or  other  spoiled 
fodder  the  symptoms  develop  in  a  short  time,  sometimes  within 
3  to  5  days.  In  other  cases  the  evolution  is  gradual  so  that 
the  disease  is  only  suspected  from  the  striking  emaciation 
and  debility. 

The  most  essential  and  important  symptom  consists  in  a 
decided  increase  in  the  amount  of  urine.  The  animals  secrete 
large  quantities  of  urine  at  brief  intervals,  the  total  amount 
in  24  hours  being  several  times  the  normal  daily  output,  so 
that  horses  may  pass  as  much  as  40  to  60  liters,  dogs  3  to  4  liters. 
The  urine  is  watery,  without  odor,  of  very  low  specific  gravity 
which  may  be  continuously  around  1.001-1.002.  Foreign  con- 
stituents, especially  albumen  and  sugar,  cannot  be  found  and 
microscopical  examination  in  this  direction  is  also  negative. 
While  the  urine  is  usually  voided  easily,  this  may  later  on  be- 
come somewhat  painful  because  of  catarrhal  swelling  of  the 
urethral  mucous  membrane. 

A  second  symptom,  which  is  never  absent,  is  a  considerably 
increased  thirst  (polydipsia)  which  causes  the  animals  to  drink 
surprising  amounts,  horses  as  much  as  100  liters  of  water,  dogs 
up  to  10  or  15  liters  per  day,  and  if  the  water  is  not  given 
them  in  sufficient  amounts,  they  will  drink  even  bad  and  ill- 
smelling  water,  as  well  as  their  own  urine.  The  amount  of 
urine  corresponds  to  the  amount  of  water  ingested  either  alone 
or  with  the  food,  or  it  exceeds  it  at  most  only  transitorily. 
(The  idea  that  the  skin  and  the  mucous  membranes  of  diabetics 
can  absorb  water  from  the  air  lacks  all  foundation.)  Com- 
parative researches  have  proved  that  with  an  equal  ingestion 
of  water  the  diabetic  organism  secretes  more  urine  than  the 
healthy. 

The  appetite  varies  greatly.  At  first  the  animals  take 
palatable  fodder  willingly,  but  later  they  refuse  even  this  or 
eat  only  a  little  from  time  to  time.  The  mucous  membranes 
and  the  skin  become  dry,  the  hair  dull  and  coarse.  Schindelka 
observed  in  a  dog  cataract,  abscess  formation  in  the  perianal 
glands  and  in  the  prostate.  Sooner  or  later  emaciation  com- 
mences and  may  increase  either  gradually  or  rapidly. 


Syiiii)toiiis.    Course,   Diagnosis.  921 

Course  and  Prognosis.  The  polyuria  which  develops  after 
the  iiigeslio)!  of  sjxjiled  fodder  usually  improves  soon  and  dis- 
appears if  tJie  fodder  is  changed  in  good  time.  But  the  longer 
tlie  injurious  factor  has  been  active  the  smaller  becomes  the 
prol)al)ility  of  complete  cure  and  the  longer  will  be  the  period 
of  convalescence.  In  the  neglected  cases  which  have  passed 
into  actual  dial)etes  the  condition  becomes  gradually  aggravated 
as  far  as  tlie  establishment  of  absolute  cachexia,  when  the  ani- 
mals perish  if  a  complication  has  not  caused  death  in  the  mean- 
while. The  disease  usually  extends  over  months,  in  rare  cases 
it  lasts  even  more  than  two  years  (Greve,  Dieckerhoff). 

If  the  diabetes  insipidus  appears  spontaneously  or  in  con- 
sequence of  a  nervous  affection  it  also  usually  takes  a  pro- 
longed course  with  fatal  termination. 

Diagnosis.  Simple  polyuria  is  differentiated  from  diabetes 
insipidus  by  its  transitory  character,  the  polyuria  of  diabetes 
persisting  in  spite  of  appropriate  regulation  of  diet,  and  being 
moreover  accompanied  by  emaciation  and  debility  of  the  ani- 
mals. Dia])etes  mellitus  is  differentiated  from  diabetes  insipidus 
by  the  increased  specific  gravity  and  the  sugar  content  of  the 
urine,  chronic  nephritis  by  the  existing  albuminuria. 

On  the  liasis  of  investigations  by  E.  Meyer  and  F.  Miiller  true 
dia1)etes  insipidus  is  diagnosed  by  determining  the  toleration  for  sodium 
eliloride.  This  is  done  as  follows :  The  daily  amount  of  urine  is  ascer- 
tained for  several  days  during  which  food  poor  in  albumen  and  sodium 
chloride  is  given.  Then  20  gm.  of  sodium  chloride  per  day  is  added 
to  the  same  kind  of  food  for  one  or  several  days.  If  the  amount  of 
urine  had  previously  been  diminished  and  noM'  shows  an  unduly  great 
increase,  the  ease  in  question  is  one  of  true  diabetes  insipidus,  since 
in  polyuria  the  ingestion  of  sodium  chloride  has  no  particular  in- 
fluence on  the  amount  of  urine  secreted.  An  exception  is  observed 
only  in  the  polyuria  of  indurative  nephritis  wliich,  however,  is  easily 
recognized  from  other  symptoms  (Liithje). 

Treatment.  If  the  disease  is  due  to  faulty  diet  a  change 
of  fodder  is  requisite,  in  which  the  spoiled  fodder  is  replaced 
by  feed  of  unobjectionable  character.  If  the  disease  has  existed 
not  more  than  a  few  weeks  and  the  strength  of  the  animal  is 
still  preserved  the  symptoms  may  be  removed  by  a  simple  regu- 
lation of  diet.  If  a  change  of  food  is  not  possible,  the  fodder 
at  hand  may  be  improved  materially  by  frequent  turning  over 
or  v'entilating  and  by  removing  the  badly  spoiled  portions.  It 
appears,  however,  even  more  appropriate  to  feed  small  por- 
tions of  the  spoiled  food  mixed  with  such  that  is  perfect.  It 
is  to  be  observed  that  a  regulation  of  diet  renders  good  service 
also  in  such  cases  in  which  the  disease  cannot  be  referred  to 
inappropriate  keeping  of  the  animals.  For  horses  the  best 
feed  is  good,  clean  and  dry  oats  and  palatable  hay,  but  in 
the  Avarm  seasons  green  feed  should  be  given.     According  to 


922  Diabetes  Mellitus. 

experiences  in  human  practice  tiie  food-stuffs  should  be  as 
free  as  possible  of  albumin  and  table  salt  because  the  elimina- 
tion of  the  latter  and  of  the  urea  requires  great  amounts  of 
water  in  this  disease.  In  true  diabetes  insipidus  a  limitation 
of  the  water  supply  does  not  appear  necessary,  but  it  should 
be  carried  out  in  those  cases  which  are  similar  to  diabetes  but 
must  be  classed  with  polyuria,  which  is  always  aggravated 
after  the  free  drinking  of  water  (Leblanc,  Cagnat).  In  horses, 
for  instance,  the  amount  of  drinking  water  should  be  reduced 
to  20  to  24  liters  per  day.  Finally,  the  animals  must  be  kept 
from  work  for  1  to  2  weeks  after  the  symptoms  of  the  disease 
have  disappeared. 

The  drug  treatment  of  diabetes  insipidus  promises  no 
results,  although  vasoconstricting  remedies  (Ergotin,  Ext. 
Hydrastis)  have  always  been  employed. 

Literature.  Almy,  Bull.,  1899.  215.  —  Cagnat,  A.  d'Alf.,  1884.  168.  — 
Dammann,  D.  t.  W.,  1898.  125.  —  Gcrhardt,  Der  Diabetes  iusip.,  Wien,  190G.  — 
Haase,  B.  t.  W.,  1898.  109.  —  Hertwig,  Mag.,  1859.  487.  —  Holzmann,  D.  Z. 
f.  Trn.,  1887.  XIIT.  197.  —  Meyer,  D.  A.  f.  kl.  M.  1905.  LXXXIII.  1.  —  Pr.  Mil. 
Vb.,  1899-1901;  1906.  —  Schindelka,  Monh.,  1893.  IV.  135.  —  Sehlampp,  D.  Z. 
f.  Tm.,  1884.  X.  133.  —  Siedamgrotzky,  S.  B.,  1878.  57;  A.  f.  Tk.,  1895.  XXL 
467.  —  Stockfleth,  Eep.,  1874.  60.  —  Veith,  Kep.,   1845.  261. 


3.    Diabetes  Mellitus. 

Diabetes  mellitus  is  a  chronic  disease  in  which  the  blood, 
owing  to  peculiar  changes  in  metabolism,  contains  an  excess 
of  grape  sugar  which  is  eliminated  unchanged  by  the  kidneys, 
so  that  the  urine  contains  sugar  either  permanently,  or  at  least 
temi3orarily. 

The  blood  of  healthy  animals  contains  about  0.1%  of  sujsar,  and 
this  proportion  is  maintained  with  only  slight  variations,  an  excess 
of  sugar  being  promptly  eliminated  by  the  kidneys.  By  means  of  special 
methods  it  is  always  possible  to  find  traces  of  grape  sugar  in  specially 
heated  large  amounts  of  urine,  particularly  in  cattle  and  sheep 
(physiological  glycosuria).  Certain  drugs  or  poisons  (morphine,  chloro- 
form, ether,  phloridzin,  chromic  acid,  adrenalin,  etc.),  also  certain  acci- 
dents to  the  organism  (shock  to  the  nervous  system  extensive  convul- 
sions, rabies,  acute  infectious  bulbar  paralysis,  etc.)  may  even  produce 
a  glycosuria  which  can  be  demonstrated  with  the  usual  methods.  It 
has  not  been  determined  whether  an  alimentary  glycosuria  (after  the 
absorption  of  very  large  amounts  of  sugar  in  the  intestine)  occurs 
in  otherwise  healthy  animals.  All  these  conditions  with  transitory 
elimination  of  sugar  (glycosuria,  mellituria)  cannot  be  called  diabetes 
mellitus  any  more  than  the  presence  of  milk  sugar  which  appears  in 
the  urine  of  nursing  animals  (lactosuria)  after  a  sudden  suppression 
of  the  milk  secretion,  with  particular  frequency  in  the  paresis  of 
parturition. 

History.  The  disease  has  long  been  known  in  human  medicine 
(Dobson  and  Pool  having  demonstrated  the  presence  of  grape  sugar 
in  human  urine  in  1775),  but  "was  observed  in  animals  in  onlv  com- 


Oec'unt'iRf,     Etiology.  923 

parativoly  i'cw  instances.  Tlio  reason  may  lie  in  tlie  fact  that  nrinary 
analysis  dici  not  receive  proper  attention  in  veterinary  medicine  until 
quite  recently.  Interesting  cases  of  (lial)etes  mellitus  have  ])een  de- 
scribed by  Thiernesse,  Kueff,  Leblanc,  Saint-("yr,  llaubner,  Ileiss, 
Dieckerhott',  Frohner,  Eber,  Schindelka,  Eichhorn,  Penberthy,  Lind- 
quist,  Lienaux,  Fettick,  Sendrail  &  Cuille,  Bohl,  Kriiger,  Preller,  Eisen- 
menger  and  others. 

Occurrence.  Dial)etes  mellitus  is,  as  a  rule,  very  rare  in 
doniestie  aiiiiiials,  do.i^s  l)eiii,ij:  most  fre(ineiitly  affected,  horses 
far  less  often  (according-  to  Froliner,  one  out  of  10,000  dogs 
is  diabetic;  according  to  Eber,  one  out  of  every  1,000).  Aside 
from  dogs  and  horses,  the  disease  has  been  observed  oidy  in 
cattle  (Darbas,  Girotti)  and  monkeys  (Leblanc),  which  does 
not,  however,  exclude  the  possibility  of  its  occurring  in  other 
animals. 

Etiology.  There  is  at  present  no  doubt  that  diabetes 
mellitus  is  etiologically  not  a  uniform  disease.  It  can  he  pro- 
duced by  certain  organic  affections  of  the  central  nervous  sys- 
tem, of  the  liver  or  pancreas,  and  occasionally  occurs  inde- 
pendently of  any  demonstrable  organic  disease.  Recent  investi- 
gations indicate  that  diabetes  mellitus  often  develops  on  ac- 
count of  a  pancreatic  anomaly,  especially  of  tlie  islands  of 
Langerhans,  which  may  be  demonstrated  only  with  the  micro- 
scope. 

The  influence  of  the  central  nervous  system  upon  the  sugar  cleavage 
-in  the  organism  was  shown  by  the  well  known  experiment  of  CI.  Bernard 
in  which  it  w^as  found  that  an  injury  to  a  certain  portion  of  the 
medulla  oblongata,  on  the  floor  of  the  fourth  ventricle  near  the  vagus 
root  ("sugar  puncture,"  "piqiire")  leads  to  a  transitory  glycosuria. 
Other  authors  found  later  that  the  same  takes  place  after  lesions  of 
other  portions  of  the  central  nervous  system  (cerebellar  worm,  cervical 
cord)  or  of  the  cervical  sympathetic.  The  central  nervous  system 
exerts  its  influence  exclusively  or  mainly  by  the  intermediation  of  the 
splanchnic  nerve,  at  least  the  "pi(jure"  does  not  produce  such  results 
after  the  nerve  is  divided.  The  glycosuria  occurs  here  evidently  by 
the  irritation  of  the  puncture,  causing  the  liver  to  discharge  its  glycoeren 
suddenly  so  that  the  blood  becomes  charged  with  grape  sugar.  This 
agrees  with  some  observations  in  diabetic  human  patients  in  whom 
these  portions  of  the  nervous  system,  the  abdominal  sympathetic,  and 
principally  the  solar  ganglion  or  the  coeliac  plexus  were  found  altered. 
All  these  experiences  indicate  that  certain  parts  of  the  central  nervous 
system  or  of  the  sympathetic  may  be  concerned  in  the  origin  of  diabetes 
mellitus    (neurogenic  diabetes). 

The  liver  is  an  essential  factor  in  the  formation  of  sugar,  because 
in  this  organ  the  grape  sugar  which  is  ingested  with  the  food  or  formed 
and  absorbed  during  the  digestion  of  carbohydrates  is  transformed 
into  glycogen,  and  thus  the  blood  is  kept  from  being  flooded  with 
grape  sugar  during  each  period  of  digestion.  For  this  reason  it  is 
possible,  in  case  the  function  of  the  liver  is  disturbed,  that  a  portion 
of  the  grape  sugar  wiiicli   was  absorbed  in  the  intestinal  canal  is  not 


924  Diabetes  Mellitus. 

changed  into  glycogen,  but  passes  into  the  general  circulation.  "While 
in  cases  of  diabetes  mellitus  lesions  in  the  liver  only  were  repeatedly 
observed  by  several  authors  in  human  as  well  as  in  veterinary  practice 
(Frohner,  Heiss,  Storch,  Penberthy,  Eber,  Fettick  and  others),  this 
does  not  justify  the  assumption  that  in  these  cases  the  diabetes  had 
actually  been  caused  by  the  hepatic  disease.  Aside  from  the  changes 
in  the  liver  there  may  be  slight  alterations  in  the  pancreas  (Herzog), 
and  on  the  other  hand  the  liver  disease  may  be  a  consequence  of  the 
diabetes.  Especially  the  fatty  liver  which  is  frequently  mentioned  by 
veterinarians  and  considered  by  some  as  the  cause  of  diabetes,  is  very 
probably  due,  as  is  fatty  infiltration  in  general,  to  the  deposit  of  fat 
from  other  parts  of  the  body,  without  interfering  with  the  functioning 
of  the  liver  cells.  The  diabetes  produced  in  dogs  by  extirpation  of 
the  pancreas  is  almost  invariably  followed  by  fatty  degeneration  of 
the  liver  (Naun.vn). 

Recently  the  experiments  of  v.  Mering  and  Minkowski  have  afforded 
the  proof  that  a  severe  diabetes  follows  the  complete  extirpation  of 
the  pancreas,  while  it  does  not  develop  if  at  least  one-fifth  of  the  gland 
is  left  or  has  been  transplanted  successfully  under  the  skin  before  the 
removal  of  the  gland.  If  the  entire  gland  has  not  been  excised,  only 
a  slight  diabetes  develops,  and  especially  after  a  generous  ingestion  of 
carbohydrates  a  glycosuria  l)ecomes  noticeable  but  disappears  again  on 
insufficient  diet. 

These  experiments  were  folloM-ed  by  a  long  series  of  control  in- 
vestigations and  were  responsil)le  for  a  great  many  contributions  to 
literature  putting  the  theory  of  diabetes  in  an  entirely  new  light.  The 
occurrence  of  the  disease  in  affections  of  the  pancreas  (pancreas- 
diabetes)  was  indeed  shown  to  take  place  by  older  observers  (Frerichs, 
Windle,  Hansemann),  but  the  theory  of  pancreatic  diabetes  received 
a  greater  vogue  only  since  more  attention  was  paid  to  the  behavior 
of  the  islands  of  Langerhans  in  the  pancreas,  to  whose  influence  upon 
the  carbohydrate  metabolism  Ebner  had  already  called  attention.  ]\Iany 
authors  (SsobeloAV,  Opie,  "Weichselbaum  &  Stangel,  Schmidt,  Herzog, 
Sauerbeck,  Halasz)  found  alterations  (simple  atrophy,  sclerosis,  colloidal 
degeneration,  disease  of  the  vessel- walls)  in  the  islands  of  Langerhans, 
even  in  those  cases  in  which  the  secreting  glandular  tissue  was  entirely 
intact.  The  participation  of  the  pancreas  in  the  causation  of  diabetes 
mellitus  in  domestic  animals  is  proved  by  cases  of  Lienaux,  Sendrall 
&  Cuille  and  of  Bohl,  in  which  a  considerable  atrophy  of  the  gland 
was  the  only  pathological  finding.  Eber  also  found  atrophy  in  one 
ease.  Fettick  observed  carcinomatous  degeneration  of  the  gland  in 
a  case  of  general  carcinomatosis,  while  Bohl  noted  diffuse  parenchyma- 
tous degeneration  in  a  dog,  Preller  chronic  inflammation  in  the  pancreas 
of  a  horse.  On  the  other  hand  diabetes  failed  to  develop  in  a  case 
of  atrophy  of  the  pancreas  in  a  dog  observed  by  Mliller.  It  is  to 
be  expected  that  diabetes  mellitus  will  be  brought  more  frequently  into 
relation  to  pancreatic  disease  when  this  gland  receives  greater  attention 
by  veterinary  authors.  In  man  changes  in  the  islands  of  Langerhans 
can  not  infrequently  be  determined  simply  by  microscopical  examina- 
tion. 

The  views  still  differ  as  to  whether  pancreatic  diabetes  represents  solely  the 
consequence  of  some  disease  of  the  islands  of  Langerhans,  or  whether  it  may 
develop,  on  the  contrary,  through  any  diffuse  alteration  of  the  pancreas. 

On  the  basis  of  his  experiments,  E.  Pfliiger  has  recently  assumed  that  the  anti- 
diabetic  action   of   the   pancreas,   which   regulates   the   cleavage   of   sugar,    is   influ- 


Etiology,   Predisposition,    Pathogenesis.  925 

enced  by  a  nerve  center  situated  in  the  walls  of  the  duodenum.  Even  in  earlier 
times  an  enterogenous  or  pancreato-enterogenous  origin  of  diabetes  mellitus  had 
been  assumed. 

It  appcai-s  tints  from  the  observations  and  experiments  eited  above 
that  a  regular  system  of  organs  is  concerned  in  the  regulation  of 
the  cleavage  of  sugar.  The  action  of  the  liver,  by  which  the  grape 
sugar,  both  that  absorbed  from  the  intestine  and  that  formed  in  the 
organism  from  albumin  and  fat,  is  retained  by  ])eing  transformed  into 
glycogen  and  yielded  up  again  according  to  need,  re(|uires  the  co- 
operation of  the  i)ancreas.  Tliis  probably  exerts  its  action  by  an  internal 
secretion,  and  substances  are  proba])ly  then  foi'nied  which,  immediately 
or  through  the  intermediation  of  the  nervous  system,  on  the  one  hand 
infltience  the  formation  of  glycogen  in  the  liver,  but  on  the  other 
hand  enable  the  body  cells,  and  primarily  the  muscle  fibers,  to  effect 
the  cleavage  of  the  grape  sugar  and  finally  to  oxidize  it.  Besides  these, 
however,  other  organs  probably  also  belong  to  the  system  which  regu- 
lates the  blood-sugar,  namely,  the  adrenals,  the  thyroid  gland  and  the 
hypophysis  cere])ri,  all  these  sugar-regulating  organs  b(>ing  in  com- 
munication through  the  nervous  system.  It  follows  that  a  prolonged 
functional  disturbance  in  any  one  link  of  this  system  might  give  rise 
to  diabetes  mellitus,  no  matter  whether  the  functional  disturbance 
originated  in  a  lesion  that  could  be  demonstrated  anatomically  or 
whether  it  developed  without  such  a  lesion. 

Predisposition.  In  the  ^reat  majority  of  cases  that  have 
so  far  l)een  reported,  the  disease  occurred  in  older  animals. 
Schmitt  observed  a  dog  aeqnire  it  after  swimining  across  a 
broad  river.     Heredity  also  appears  to  be  of  importance. 

Pathogenesis.  If  an  excess  of  grape  sugar  passes  from  the 
liver  into  the  blood,  or  if  the  cleavage  of  the  grape  sugar  is  in- 
complete a  hyperglycemia  follows  (Preller  found  O.d'21%  of 
sugar  in  the  blood  of  a  horse).  The  excess  of  the  grape  sugar 
is  then  eliminated  by  the  kidneys.  Since  the  organism  requires 
a  certain  amount  of  energy  for  the  maintenance  of  the  vital 
functions,  it  replaces  the  loss  occasioned  by  the  elimination  of 
the  sugar  in  such  a  manner  that  it  uses  up,  at  least  to  a  cer- 
tain degree,  the  sugar  wliich  is  formed  by  the  disintegration 
of  the  alimentary  and  of  the  organic  albumin  and  which  is  prob- 
ably more  readily  available,  at  the  same  time  breaking  up  its  own 
fat  in  a  greater  degree.  To  this  fact  are  due  the  gradually  in- 
creasing weakness  and  enunciation.  In  severe  cases  the  sugar 
formed  from  the  proteids  and  possiljly  from  the  fat  is  used  up 
in  always  smaller  amounts,  which  must  lead  to  an  increased 
combustion  of  fats  without  limiting  the  active  disintegration 
of  proteids.  All  these  factors  cause  not  only  exhaustion,  but 
also  an  accimiulation  of  oxidation-products  of  fats  (oxybutyric 
acid,  azeto-acetic  acid,  acetone  [Geelmuyden,  Schwarz,  Magnus, 
Levy] )  in  the  blood  and  thus  lead  to  an  acid  toxemia. 

The  diabetic  distur])ance  in  the  metabolism  easily  leads 
to  nutritional  disturbances  in  the  various  tissues,  especially  in 
the  lens  of  the  eye  and  in  the  renal  tissue.  The  insufficient 
tissue    nutrition    mav    further    facilitate    the    localization     of 


926  Diabetes  Mellitns. 

patliogenic  bacteria,  although  the  saturation  of  tlie  tissues  Avith 
sugar  is  here  an  important  factor. 

Anatomical  Changes.  The  autopsy  findings  differ  from 
case  to  case  and  may  indeed  be  entirely  negative  except  for 
secondary  changes.  In  the  central  nervous  system  hemorrhages, 
new-formations,  etc.,  are  sometimes  found  in  the  medulla  ob- 
longata or  in  its  immediate  neighborhood.  Fatt}^  liver  or  an 
increase  in  the  connective  tissue  of  the  liver  are  frequent  in 
dogs,  but  less  so  in  horses.  In  the  pancreas  there  is  at  times 
connective  tissue  proliferation,  atrophy  of  the  glandular  tissue 
or  calculus  formation.  There  are  finally,  as  a  rule,  evidences 
of  anemia  and  serous  infiltration. 

Symptoms.  The  clinical  picture  always  develops  insidi- 
ously. At  first  the  animals  show  a  degree  of  dullness  of  the 
sensorium,  and  fatigue;  they  perspire  and  easily  tire  whether 
at  work  or  at  exercise.  Simultaneously  a  gradual  emaciation 
becomes  manifest  in  spite  of  a  good  appetite,  and  often  in 
spite  of  the  greedy  eating  of  large  amounts  of  food. 

The  most  cliaracteristic  changes  are  found  in  the  urine. 
The  amount  is,  with  few  exceptions  (diabetes  decipiens),  at 
first  more  or  less  increased  and  may  rise  to  3  to  5  times  the 
normal  daily  output.  It  is  discharged  at  brief  intervals  and 
without  effort,  but  later  micturition  may  become  painful,  after 
a  catarrh  of  the  external  urinary  passages  or  an  eczema  around 
the  urethral  opening  has  developed.  The  urine  is  pale  in  color, 
being  almost  like  water  if  the  polyuria  is  marked ;  of  a  peculiar 
sweetish  odor,  or  somewhat  like  the  odor  of  fruit  or  chloroform ; 
it  is  always  acid  in  carnivora,  occasionally  so  in  herbivora, 
and  remains  unchanged  on  standing  for  a  relatively  long  time. 
The  specific  gravity  varies  between  1,040  and  1,060,  but  is  not 
rarely  much  lower  in  cases  in  which  only  small  amounts  of 
sugar  are  present  in  the  presence  of  polyuria.  The  greatest 
importance  must  be  attributed  to  the  content  in  grape  sugar 
which,  however,  may  vary  within  wide  limits,  not  only  in  different 
cases,  but  also  in  the  same  patient.  In  contrast  to  diabetes 
in  man,  where  the  sugar  content  is  usually  slight  in  the  initial 
stage  of  the  disease  and  only  later  increases  gradually,  in  dia- 
betic animals  which  usually  come  under  the  observation  of  the 
veterinarian  only  in  advanced  stages  of  the  disease,  large 
amounts  of  sugar  are  found  as  a  rule  (in  horses  3.75-7.33% ; 
in  dogs  4-10%).  The  sugar  content  is  also  decidedly  influenced 
by  the  amount,  and  even  more  by  the  nature  of  the  food.  The 
more  sugar  or  amylaceous  food  is  ingested  the  more  sugar  is 
eliminated  by  the  kidneys.  On  the  other  hand,  especially  in 
the  first  stage,  the  sugar  may  disappear  even  entirely  from  the 
urine  after  exclusive  feeding  with  nitrogenous  food-stuffs, 
during  the  abstention  from  food,  during  the  course  of  inter- 
current febrile  diseases,  after  strenuous  exertion.    Preller  found 


Symptoms.  927 

in  the  case  of  a  diabetic  liorse  that  the  urine  contained  more 
sngar  in  the  morning  than  in  the  evening  and  that  the  amount 
was  increased  after  psychic  excitement,  while  liard  work  did 
not  cause  a  diminution  in  the  amount  of  sugar  present.  Tiiere 
are  cases  where,  in  spite  of  uniform  feeding,  the  amount  of 
the  eliminated  sugar  does  not  remain  constant,  the  urine  l)eing 
temporarily  free  from  sugar  (diabetes  mellitus  intermittens) ; 
if  however  the  disease  is  far  advanced,  the  glycosuria  never 
ceases  entirely. 

For  the  practical  (lenioiistiatioii  of  fjrajie  suyar  tlie  feinioiitatioii  test  is  best 
adapted.  The  simplest  way  of  niakinj;  this  test  is  as  follows:  A  bit  of  yeast  as 
large  as  a  pea  is  added  to  a  test  tubefiil  of  urine  which  is  closed  with  a  |)erforated 
cork,  a  I'-shaped  thin  ij;lass  tube  being  inserted  in  the  perforation.  The  cork  is 
fitted  so  tliat  no  air  bubbles  remain  on  the  surface  of  tlie  urine.  The  test  tube  is 
then  inverted  and  j)erinitted  to  stand  at  room  temjierature,  or  better,  near  a  stove 
for  -i  hours.  If  grajii'  su<;ar  is  jiresent,  the  action  of  the  yeast  pro<luces  alcohol, 
and  also  carbonic  acid  which  collects  in  the  upper  portion,  of  the  test  tube  and 
forces  the  urine  downward.  In  order  to  make  quite  sure  if  is  well  to  ])repare  two 
control  test  tubes,  one  of  which  is  filled  with  normal  urine,  the  other  with  a  solution 
of  grape  sugar,  to  both  being  added  a  piece  of  yeast,  in  order  to  determine  whether 
the  yeast  itself  produces  carbonic  acid  and  whether  it  is  active.  If  the  fermenta- 
tion  test   is   positive,   grape   sugar   is   surely   present. 

For  a  quantitative  test  with  the  fermentation  reaction  graduated  glass  tul  es 
or  other  apparatus  nuirt  be  employed.  None  of  these  apparatus,  not  even  Lohn- 
steins  ^ai^■charimeter,  is  adapted  for  an  exact  quantitative  te^t,  Ijut  they  are  quite 
useable  for  practical  work,  especially  for  determining  variations  in  the  elimination 
of  the  sugar. 

Preller  found  the  reaction  with  aniline  dyes  sufficient  for  practical  purposes: 
10  cc.  of  urine  are  heated  in  a  test  tube  to  about  body  temperature;  on  adding 
a  small  amount  of  finely  ground  gentian  violet  or  methylene  blue,  diabetic  urine 
is  colored  blue  immediately  and  without  shaking. 

A  relatively  easy  test  is  that  of  Tronimer:  One  part  of  official  potassium  or 
sodium  hyilrate  is  added  to  three  parts  of  urine;  to  this  mixture  a  1UC(  solution 
of  Buli)hate  of  copper  is  added  drop  by  drop  and  shaken  uj)  until  a  trace  of  the 
precipitate  remains  on  shaking.  Tlie  upper  layer  of  the  mixture  is  then  heated 
slowly,  when  in  the  presence  of  sugar  a  yellow  or  red  finely  granular  ])recii)itate 
occurs,  even  before  the  liquid  commences  to  boil. — Porcher  found  a  modification 
of  Tronimer 's  test  useful:  in  this  the  reagent  (.Fehling's  solution)  and  the  urine 
are  boiled  in  separate  test  tubes  and  then  the  urine  is  poured  carefully  over  the 
reagent. 

In  human  urine  physicians  have  exceptionally  found  levulose,  pentose,  dex- 
trin and  inosite,  1  esides  the  grape  sugar.  There  may  also  be  found  acetone,  organic 
acids  (formic  acid,  oxybutyric  acid,  azetoacetic  acid)  and  albumen,  which  mostly 
appears  in  consequence  of  a  complicating  nephritis.  (In  the  urine  of  a  sick  horse 
the  authors  found  very  much  oxybutyric  acid  and  azetoacetic  acid;  the  same 
was  observed  by  Preller.) 

Another  constant  symptom  is  a  striking  increase  in  the 
sensation  of  thirst  (polydipsia),  and  an  abnormally  increased 
a])petite  (polyphagia)  is  frequently  observed.  The  mucous 
membranes  of  the  mouth  are  dry,  the  gums  at  times  loosened 
and  sensitive. 

The  lens  of  the  eye  often  becomes  opaque  (gray  cataract; 
cataracta  diabetica)  commencing  from  the  center,  usually  in 
both  eyes  and  leading  gradually  to  complete  blindness;  only 
in  isolated  cases  may  the  opacity  disapjjear  temporarily  if  the 
disease  is  not  loo  for  advanced  and  the  animals  are  fed  suitably. 
Sometimes  corneal  opacity  is  met  with,  possibly  together  with 
ulcerations  (TTeiss),  also  inflammation  of  the  iris,  hemorrhage 
beneath  the  retina  or  a  loosening  of  the  latter. 


928  Diabetes  Mellitas. 

Sometimes  the  respiratory  organs  become  affected  second- 
arily with  symptoms  of  laryngeal  or  bronchial  catarrh,  to  which 
may  later  on  be  added  pneumonia  or  even  gangrene  of  the  lungs. 
Kriiger  noted  a  sweetish  odor  of  the  exhaled  air.  In  the  ter- 
minal stage  there  appear  symptoms  of  cardiac  debility.  In 
dogs  an  enlargement  of  the  liver  may  be  detected.  Darras 
observed  in  a  diabetic  dog  necrosis  of  the  tip  of  the  tail,  Kriiger 
saw  in  a  horse  furunculosis,  but  Preller  found  phlegmosis  in 
the  subcutis,  which  however  healed  completely  in  contrast  to 
human  experience. 

Other  organic  diseases  which  may  have  a  causal  connection 
with  diabetes  are  discovered  only  rarely  during  the  lifetime  of 
the  animals.  In  this  respect  the  case  of  Preller 's  is  of  interest, 
in  which  it  was  possible  to  diagnose  the  disease  of  the  pancreas 
by  means  of  the  Cammidge  test  while  the  animal  was  alive. 

In  the  further  course  of  the  disease  the  debility  increases 
more  and  more ;  finally  apathy  and  stupor  appear ;  the  amount 
of  sugar  gradually  diminishes  and  sometimes  the  sugar  dis- 
appears entirely.  There  is  diarrhea,  and,  after  complete  ex- 
haustion of  the  patient,  death  occurs  with  symptoms  of  con- 
vulsions or  during  coma. 

By  coma  diabeticum  or  intoxieatio  diabetica  is  meant  in  linman 
medicine  a  peculiar  pathologic  condition  which  develops  toward  the 
end  of  diabetes  mellitus  and  is  usually  followed  immediately  by  death. 
The  respiratory  movements  suddenly  become  very  deep,  labored  and 
hastened;  at  the  same  time  or  a  little  later  the  patient  becomes  un- 
conscious, or  symptoms  of  collapse  appear,  or  great  restlessness  develops, 
followed  immediately  by  death  with  symptoms  of  heart  faihire.  In 
other  cases  the  patients  are  tormented  by  headache,  their  motions  are 
staggering  and  the  end  supervenes,  the  patients  being  in  a  stupor. 
The  exhaled  air  then  smells  strongly  of  azetone.  This  condition  is 
usually  referred  to  the  accumulation  of  organic  acids  ( oxybutyria  acid, 
azetoacetic  acid)  in  the  blood.  Frohner,  Eichhorn,  Lienaux  have  each 
observed  a  similar  condition  in  a  dog,  and  the  authors  themselves  met 
with  it  in  a  horse. 

Course.  Diabetes  mellitus  always  takes  a  chronic  course. 
In  the  cases  hitherto  observed  its  duration  varied  between  1 
and  12  months.  It  must  however  not  be  forgotten  that  the 
disease  was  always  recognized  only  in  a  far  advanced  stage. 
According  to  experiences  in  human  medicine  the  disease  may 
persist  for  years,  although  in  young  animals  its  duration  ap- 
pears to  be  short. 

Diagnosis.  If  the  urine  permanently  contains  considerable 
amounts  of  grape  sugar  the  diagnosis  of  diabetes  mellitus  ap- 
pears to  be  perfectly  certain.  The  disease  has  othenvise  no 
characteristic  symptoms  and  can  therefore  be  recognized  with 
certainty  only  by  means  of  regular  urinalyses.  Nevertheless 
there  are  a  number  of  symptoms  which  should  cause  the  affec- 
tion to  be  suspected  and  should  suggest  a  chemical  analysis 
of  the  urine;  such  are  particularly  the  increasing  emaciation, 


Diufiiiosis,    Projpiosis,    Treatiiieiit.  929 

t'lie  debility  in  spite  of  good  appetite,  then  the  increased  thirst, 
poljoiria,  and  the  simultaneous  occurrence  of  cataract.  In  the 
presence  of  polyuria  with  a  clear,  watery  urine  of  high  specilic 
gravity  the  existence  of  diabetes  mellitus  is  very  probable. 

Prognosis.  In  tlie  cases  that  were  observed  so  far  in  ani- 
mals the  disease  showed  a  gradual  progression,  at  most  with 
transitory  remissions,  and  always  ended  in  death.  Only  Walley 
reports  a  cured  case,  but  it  is  possible  that  either  this  was  a 
transitory  glycosuria  or  that  the  supposed  cure  was  in  fact  but 
an  intermission  of  the  disease.  The  more  sugar  the  urine 
contains,  the  sooner  the  fatal  termination  occurs.  If  the  sugar 
content  persists  unaltered  in  spite  of  exclusive  feeding  with 
proteids  and  fats,  the  ])rognosis  is  much  less  favorable  than 
if  this  diet  leads  to  a  diminution  in  the  amount  of  sugar,  or 
if  this  periodically  disappears  entirely  without  a  simultaneous 
loss  of  weight.  Complications  always  influence  the  course  un- 
favorably and  hasten  the  fatal  termination. 

Treatment.  This  consists  essentially  in  limiting  the  supply 
of  carbohydrates  and  in  feeding  with  food-stuffs  rich  in  fats 
and  proteids.  In  severe  cases  even  the  albumins  should  be 
diminished  to  such  a  degree  that  it  is  just  possible  to  maintain 
the  N-equilibrium.  The  limitation  of  albumins  appears  indi- 
cated for  the  reason  that  in  severe  cases  even  that  sugar  which 
is  formed  from  albuminous  substances  is  eliminated  unused.  In 
order  to  determine  the  degree  to  which  carbohydrates  and 
albumins  are  to  be  limited,  it  w^ould  be  necessary  to  test  the 
toleration,  that  is,  to  determine  the  amount  of  carbohydrates  and 
albumins  borne  without  any  sugar  being  eliminated  with  the 
urine.  Of  this  method,  which  is  quite  customary  in  human 
medicine,  no  advantage  has  as  yet  been  taken  in  veterinary 
practice. 

Carnivorous  animals  are,  in  lighter  cases,  nourished  most 
suitably  with  fat  meat,  eggs,  bran-bread,  or  with  oat  meal,  to 
which  a  generous  amount  of  fat  has  been  added ;  in  severe  cases 
the  amount  of  meat  must  also  be  limited  and  the  requirements 
of  the  organism  for  albumin  must  be  supplied  by  the  addition 
of  vegetable  albumins  ("Roborat,"  rice-albumin,  etc.).  If 
acetone  bodies  appear  in  the  urine  in  considerable  amounts,  it 
is  necessary,  according  to  experiences  in  human  medicine,  to 
limit  the  supply  of  albumin  and  especially  of  fat,  and  for  a 
time  to  return  to  the  carbohydrates  (oats,  bread,  milk,  possibly 
levulose).  In  herbivorous  animals  it  is  particularly  difficult 
to  carry  out  an  appropriate  dietary;  probal)ly  the  best  food- 
stuffs for  such  animals  are  oats,  good  hay,  bran  and  oil-cake. 
Preller  caused  a  decided  diminution  in  sugar  in  the  urine  of 
a  horse  by  replacing  the  accustomed  grain  feed  by  oats,  bran 
and  oil-cake,  but  simultaneously  a  deterioration  in  the  nutrition 
of  the  patient  was  observed.  AH  sick  animals  should  be  spared 
exertion. 

Vol.  1---59 


930  Rachitis. 

Of  drugs,  sodium  bicarbonate  deserves  mention  and  should 
be  given  regularly;  in  severe  acidosis  or  diabetic  coma  large 
amounts  are  to  be  administered  by  mouth,  or  hypodermically 
dissolved  in  physiological  salt  solution,  Carlsbad  water  or  salt, 
also  carbonate  of  ammonia  are  occasionally  of  use.  Opium 
preparations  in  large  doses  (to  dogs  up  to  0.5-1.0  gm.  per  day) 
have  been  recommended  as  they  are  capable  of  diminishing 
for  a  time  the  glycosuria.  No  results  worth  mentioning  have 
been  observed  to  follow  the  arsenic  treatment. 

Literature.  Bohl,  A.  f.  Vet.-Wiss.,  1906.  569  (Lit.).  —  Cadiot,  Etudes  de 
pathol.,  1899.  327  (Lit.).  —  Dammann,  Hann.,  Jhb.,  1876-77.  100.  —  Darbas,  Eev. 
vet.,  1890.  357.  —  Darras,  Bull.,  1906.  687.  —  Eber,  Monh.,  1898.  IX.  97.  —  Eich- 
horn,  S.  B.,  1891.  184.  —  Falta,  Z.  f.  kl.  M.,  1908.  LXVL  401.  —  Fettiek,  Vet.,  1899. 
277  (Lit.).  —  Frohner,  Monh.,  1892.  IIL  149.  —  Girotti,  N.  Ere,  1896.  69.  —  Herx- 
heimer,  V.  A.,  1906.  CLXXXIII.  228.  —  Kriiger,  Z.  f.  Vk.,  1907.  488.  —  Lienaux, 
Ann.,  1898.  190.  —  v.  Mering  &  Minkowski,  A.  f.  exp.  Path.  u.  Phmk.,  1890.  XXV. 
371.  —  Minkowski,  Ergebn.  d.  Path.,  1894.  I.  1.  Abt.,  69  (Lit.  on  pancreatic  dia- 
betes). —  Miiller,  Dresd.  B.,  1906.  162.  —  Naunyn,  Der  Diabetes  niell.,  1906.  — 
Penberthy,  J.  of  Comp.  Path.,  1894.  184.  —  Pfluge'r,  Pflugers  A.,  CIII.  1;  CXVIII. 
265.  —  Porcher,  Bull.,  1903.  409;  Eev.  gen.,  1905.  VI.  49.  —  Preller,  tJber  Diab. 
niellitus  beim  Pferde,  Diss.  Bern,  1908  (Lit.).  —  Prietsch,  S.  B.,  1902.  63.  — 
Sauerbeck,  Ergebn.  d.  Path.,  1902.  VIII.  2.  Abt.,  538-697  (complete  literature  on 
diab.  niell.  in  general).  —  Schindelka,  Monh.,  1893.  lA".  132.  —  Schmitt,  W.  f.  Tk., 
1863.  65.  —  Sendrail  &  Cuille,  Eev.  vet.,  1906.  229.  —  Wallev,  J.  of  Comp.  Path. 
1893.  70. 


4.  Diseases  of  Metabolism  which  Particularly  Affect  the  Osseous 

System. 

(a)     Rachitis.     Rickets.     Rhachitis. 

{GJlederkranliheii ;    Englische    Krankheit;    Zivergwachs    [Ger- 
man]; Rha  chit  ism  [French].) 

Rachitis  is  a  disease  of  young  animals  which  is  due  to  a 
disturbance  in  metabolism  and  is  characterized  by  the  per- 
sistence of  new-formed  bony  tissue  in  tlio  osteoid  condition, 
by  proliferation  of  the  cartilaginous  tissue,  and  by  an  irregular 
advance  of  the  lines  of  ossification,  the  result  being  manifold 
deformities  of  the  skeleton. 

Occurrence.  Whether  the  disease  occurs  in  all  parts  of 
the  globe  or,  as  is  the  case  in  man,  is  almost  exclusively  limited 
to  the  temperate  latitudes,  cannot  be  ascertained  by  any  in- 
formation in  veterinary  literature.  The  affection  is  frequent 
in  all  countries  of  the  temperate  zone. 

Almost  without  exception  the  young  animals  become  af- 
fected only  during  the  first  year  of  life  and  most  frequently 
when  only  a  few  months  old  or  after  being  weaned.  The  animals 
which  acquire  the  disease  most  often  are  young  pigs  and  dogs, 
lambs  and  kids,  much  more  rarely  calves  and  rabbits ;  the  dis- 
ease is  observed  quite  often  in  wild  carnivora  which  are  raised 
in  captivity,  also  in  monkeys;  of  fowls,  chickens  are  affected 


Occurrence,    Etiology.  931 

most  often,  less  so  pigeons  and  water  fowl  (Ziiin),  wlicii  they 
are  i/4  to  l'-^  year  old  or  even  younger.  (Ilanbold  observed  the 
disease  in  eiglit-weeks-oKl  geese  which  had  l)een  con  lined  for 
fattening.  Blooded  and  large  breeds  or  such  as  nuiture  early 
or  grow  rapitlly  are  in  general  more  apt  to  acquire  rickets  than 
breeds  of  animals  that  are  mostly  kept  out  doors  and  are 
hardened.  Among  hogs  the  disease  {ilTects  rehitively  frecpieiitly 
the  P]nglisli  breeds  and  their  crossings,  among  tlie  dogs  the 
Newfoundlands,  the  Danes  and  the  setters.  In  animals  living 
in  herds,  especially  in  pigs  and  landjs,  rachitis  usually  reaches 
an  enzootic  distribution  and  this  causes  a  very  decided  economic 
loss.  On  the  other  hand  the  disease  is  not  observed  in  wild- 
living  animals. 

Etiology.  In  the  production  of  rickets  in  domestic  animals 
the  deiicieiicy  in  lime  of  the  organism  is  undoubtedly  the  nu)st 
ini])ortant  factor.  This  may  be  concluded  above  all  from  the 
fact  that  the  disease  commences  most  frequently  in  the  bree<ls 
which  mature  early,  at  the  time  of  the  most  rapid  development 
or  after  the  nursing  period  is  over,  that  is  in  that  ])eriod  in 
which  there  is  most  likelihood  that  the  ingestion  of  lime  is 
insufficient  in  proportion  to  the  bony  growth.  Moreover 
numerous  incontrovertible  observations  directly  established  the 
relation  of  rickets  to  food  which  is  poor  in  lime.  Finally  a 
considerable  number  of  i)ositive  experimental  results  in  this 
direction  are  at  hand. 

A  deficiency  of  lime  in  the  organism  will  probably  occur 
niost  frequently  through  an  insufficient  calcium  content  in  the 
food.  In  nurslings  rachitis  develops,  comparatively  rarely, 
through  an  insufficient  calcium  content  of  the  mother  milk,  when 
the  mother  animals  are  nourished  with  food  poor  in  lime. 
(According  to  Dammann  healthy  young  sucking  animals  become 
ill  if  they  are  put  to  a  mother  animal  whose  young  is  affected 
by  rachitis.)  Moussu  observed  a  similar  symptom  complex  as 
that  seen  in  rachitis  of  young  pigs  in  sucking  land)s,  whose 
mothers  Avere  fed  generously  with  cut  carrots,  but  he  looks 
upon  it  as  an  asthenic  condition.  It  happens  very  rarely  that 
the  artificial  raising  of  young  animals  with  alien  milk  is  of 
importance  in  this  respect,  although  this  milk  may  become  in- 
jurious in  so  far  as  it  may  contain  less  lime  than  the  homo- 
geneous milk,  and  further  the  lime  salts  of  such  milk  may 
be  used  up  less  completely  (Uffelmann,  Briining)  because  the 
presence  of  alien  enzymes  may  lead  to  an  insufficient  assimila- 
tion of  the  milk. 

The  oaleium  rontpnt  of  milk  varies  very  eonsideralily  in  the  (lifTeient  aiiiinal 
species.  Cow's  milk  coiitaiiis  an  average  of  1.7  gm.  of  lime  ami  1.8  gni.  of  phos- 
phoric acid;  goat's  milk,  1.9  gm.  of  lime  and  3.0  gm.  of  pliosphoiic  aeiil ;  sheep's 
milk,  3.1  gm.  of  lime  and  3.0  gm.  of  phosphoric  acid;  mare's  milk,  1.2  gm.  of 
lime  and  1.2  gm.  of  phosphoric  acid;  and  hog's  milk,  4.3  gm.  of  lime  and  4.0 
gm.  of  phosphoric  acid  per  liter  (Stntzer,  Kellner),  -while  the  corresi>onding  vahies 
in  dog's  milk  are  3.01  gm.  and  4.11  gm.   (Wedeineyer). 


932  Rachitis. 

Concerning  the  assimilation  of  the  lime  salts  of  the  milk,  Ufifelmanu  found 
that  in  infants  78  per  cent  of  the  lime  of  the  mother's  milk  is  absorbed,  but  only 
25  per  cent  of  the  lime  of  cow's  milk.  In  calves  97  per  cent  of  the  lime  of  cow's 
milk  is  assimilated  according  to  Soxhlet.  Bruning  left  two  out  of  four  young 
dogs  of  the  same  litter  with  their  mother  and  fed  the  other  two  from  the  sixth  day 
on  with  cow's  milk,  one  of  them  receiving  the  milk  cooked,  the  other  raw.  The 
first  two  dogs  developed  quite  normally,  but  the  other  two  remained  back  in  their 
development;  their  belly  seemed  enlarged,  the  ends  of  the  costal  cartilages  thick- 
ened; the  dog  fed  with  raw  cow's  milk  was  also  feeble,  and  the  fontanelles  had 
remained  open.  Similar  results  were  obtained  in  dogs  fed  with  goat's  milk,  as  well 
as  in  rabbits,  guinea  pigs  and  kids  fed  with  alien  milk. 

An  opportunity  for  a  deficiency  in  lime  to  occur  in  tlie 
organism  is  afforded  more  especially  in  weaned  animals.  Ex- 
perience sliows  tliat  rachitis  develops  not  infrequently  in 
carnivora  if  they  are  put  on  an  exclusive  vegetable  diet,  and 
aside  from  the  small  calcium  content  of  vegetable  food,  the 
fact  is  here  of  importance  that  the  lime  salts  of  plants  are 
used  up  much  less  completely  than  those  of  animal  food  (Bunge, 
Bertram).  On  the  other  hand  a  strict  meat  diet  from  which 
the  bones  are  excluded  may  also  give  rise  to  the  development 
of  the  disease.  In  herbivora  the  principal  blame  attaches  to 
one-sided  feeding  with  non-nutritious  kitchen  refuse,  potatoes, 
mealy  food  substitutes  and  cow's  whey,  ground  meat,  barley 
and  bran,  which  are  known  to  have  a  low  calcium  content.  In 
colts  especially  the  exclusive  feeding  with  bran  causes  rickets 
(the  so-called  bran-disease)  while  in  pigs  exclusive  feeding  with 
potatoes,  barley  or  maize  is  a  factor.  Under  the  influence  of 
unfavorable  conditions  of  soil  and  weather  (see  brittle  bones) 
of  course  even  those  food  stuffs  which  ordinarily  contain  a 
sufficient  amount  of  lime  may  become  deficient  in  it.  The  vary- 
ing calcium  content  of  drinking  water,  and  a  relatively  low 
calcium  content  of  drinking  water  is  probably  of  importance 
only  in  combination  with  other  causes.  Nevertheless  an  ab- 
normally high  content  of  water  in  sulphuric  acid  may  become 
injurious  by  causing  the  formation  of  calcium  salts  which  are 
only  slightly  soluble. 

By  considering  the  calcium  content  of  the  food  on  the  one 
hand  and  the  calcium  requirements  of  the  growing  animals 
on  the  other,  which  vary  greatly  according  to  the  species  and 
breed,  it  is  always  possible  to  determine  whether  in  a  given 
case  a  deficiency  in  lime  could  occur  in  the  organism. 

Content  in  calcium  and  phosphoric  acid  in  the  most  important  foodstuffs, 

for  each  1,000  parts,  after  Stutzer:  Coarse  feed — Lucerne,  25.2  parts  of  lime  (6.5 
parts  of  phosphoric  acid)  ;  red  clover,  20.1  (5.6)  ;  bastard  clover  13.6  (4.1)  ;  espar- 
sette,  16.8  (4.6);  vetch,  16.3  (6.2);  peas,  15.6  (6.3);  lupine  hay,  8.8  (5.8); 
meadow  hay  of  good  quality,  9.5  (4.3);  of  poor  quality,  5.4  (2.3)';  second  crop 
("grummet"),  5.1  (4.1);  wheat  straw,  2.7  (2.0);  barley  straw,  3.3  (1.8);  oat 
straw,  4.3  (1.5);  cornstalks,  4.9  (3.0);  pea  straw,  15.9  (3.5);  vetch  straw,  15.6 
(2.7);  wheat  chaff,  1.7  (4.0);  oat  chaff,  4.0  (1.3);  barley  beards,  12.5  (2.4). 
Green  feed— J Aicerne,  8.5  (1.6);  red  clover,  4.5  (1.5);  bastard  clover,  2.9  (0.9); 
esparsette,  4.0  (1.1);  meadow  feed,  2.8  (1.2);  rich  grass,  2.6  (1.9);  green  corn, 
1.4  (1.0);  carrot  leaves,  1.5  (1.0).  Tubers  and  roofs— Potatoes,  0.3  (1.2);  beets, 
0.3  (0.6).  Grain— Oats,  1.0  (7.0);  barley,  0.1  (6.6);  corn,  0.3  (5.7).  Seeds  of 
leguvies—Soj  beans,  1.5  (12.1);  peas,  1.1  (10.0);  vetch,  2.2  (9.9).  Waste  from 
flour  7»n7?s— Wheat  bran,  1.5   (26.9);   oat  bran,  2.1    (34.4);   barley  bran,  1.9    (9.1); 


Etiology.  933 

barley  feed  flour,  0.7  (10.8).  Waste  from  .lutjar  factorica — Beet-chips,  1.1  (0.2); 
beet  treacle,  ;{.l  (0.5).  WuMe  from  oil  mills — Linseed  cake,  4.:{  (16.2);  rape  seed 
cake,  7.1  (l-'O.O)  ;  ^roimd-mit  cake,  1.6  (11.6).  Animal  food  sluff.s — Meat  (without 
bone),  0..'}  (4.2);  j,nuiind  meat  Hour,  3.6  (6.9).  Of  the  lime  contained  in  vegetable 
food  stutt's  at  most  one  half  is  made  use  of  (Keliner). 

Calcium  requirements  of  growing  animals.  According  to  ('.  Voit  the  calcium 
reijuirenient  in  growing  dogs  of  smaller  breeds,  weighing  1.5-2.8  kg.  is  0.128  gm. 
daily;  in  dogs  of  large  breeds  (weight  3.2-4..')  kg.)  0.769  gm.  daily;  in  pigs  1-240 
<iays  old  2.8  gm. ;  in  pigs  over  8  months  old  1.7  gm. ;  calves  require  in  the  second 
or  third  week  14.5  gm.  daily,  in  the  liftli  month  13.3  gm.  (Lehmann),  one-year  olds 
require  21  gm.  of  lime  (Keilner).  In  land)s  the  calcium  requirement  for  50  kg. 
body  weight  is,  according  to  Weiske,  as  follows :  In  the  first  month,  3.2  gm. ; 
at  5.5  mouths,  3.8  gm.;  at  8.5  months,  3.2  gm. ;  at  11.5  months,  2.7  gm.,  while 
in  the  16th  month  of  their  lives  they  require  only  0.6  gm.  of  lime. 

The  injurious  effect  of  food  which  is  deficient  in  lime  was 
proved  by  numerous  animal  experiments. 

Chossat  (1842),  Milne-Edwards  (1861),  Guerin  (1862),  RolofT  (1866),  E. 
A'oit  (1877),  Lehmann  (1877),  Baginsky  (1881),  and  recently  Miwa  &  Stoeltzner 
succeeded  in  producing  a  clinical  picture  which  was  in  its  symptoms  and  in  its 
gross  pathology  quite  similar  to  rachitis  in  j'oung  pigs  and  dogs  that  is  due  to 
food  containing  very  little  calcium.  In  these  e.xperiments  they  observed  swelling 
of  the  epiphyses,  softening  and  various  curvatures  of  the  bones,  while  other  authors, 
especially  Weiske  and  Wildt  (1873),  Tripier  (1874),  Piitz  (1875),  Delcourt  (1899) 
failed  to  cause  the  disease  in  this  manner.  The  cause  of  their  failure  may  lie  on 
the  one  hand  in  the  too  short  duration  of  the  experiments,  on  the  other,  and 
mainly,  it  was  probably  to  be  found  in  a  very  far-reaching  withdrawal  of  lime 
or  of  all  nutritive  salts.  Tt  must,  however,  be  admitted  that  in  most  of  the  positive 
results  cited  the  proof  of  the  rachitic  nature  in  the  anatomical  changes  was  not 
afforded  by  microscopical  examination ;  only  E.  Yoit  and  Baginsky  described  his- 
tological changes  which  corresponded  with  those  found  in  rickets.  Neither  Miwa 
&  Stoeltzner,  nor  Eeimer  &  Boye  were  able  to  demonstrate  such  tissue  changes  in 
their  experiment  animals  which  appeared  clinically  to  be  rachitic,  as  would  have 
agreed  with  those  found  in  true  rachitis.  (For  the  interpretation  of  their  results 
see  Pathogenesis.) 

Miwa  &  Stoeltzner  observed  in  a  dog  that  was  fed  with  fresh  horse  meat  and 
bacon,  and  received  distilled  water  to  drink,  a  waddling  walk  as  early  as  the  10th 
day,  and  a  moderate  epiphyseal  swelling  on  the  fore-feet  was  apparent  already  10 
days  later.  At  the  end  of  the  fourth  week  the  dog  disliked  to  move  about,  or 
crouched  down,  whining  after  taking  only  a  few  steps;  nor  was  he  able  to  climb 
upstairs.  The  swelling  of  the  epiphyses  gradually  increased,  on  the  distal  ends  of 
the  ribs  strongly  prominent  enlargements  became  noticeable,  which  were  arranged 
in  rosary  fashion,  while  the  long  bones  were  bent  outwards.  The  motor  disturb- 
ances did  not  continue  to  progress  from  the  seventh  week  on,  and  the  dog  was 
killed  at  the  end  of  the  eighth  week.  At  the  autopsy  the  authors  found  the  compact 
portion  of  the  bones  forming  a  network  of  wide-meshed  bone  lamellae  and  hollow 
spaces  of  different  sizes;  the  cambium  layer  of  the  periosteum  was  enlarged; 
periosteal  osteophytes  were  on  the  enchondral  zones  of  ossification  between  epiph- 
ysis and  diaphysis;  the  lines  of  ossification  were  rather  irregular;  the  layer  of 
proliferating  cartilage  extended;  the  columnae  of  cartilage  cells  in  irregular  arrange- 
ment and  the  cartilage  cells  themselves  enlarged.  The  preliminary  calcification  of 
cartilage  was,  however,  quite  normal,  as  was  also  the  bony  substance  which  con- 
tains no  lime,  and  which  surrounds  the  lime-containing  bony  lamellae  everjnivhere 
in  very  delicate  traceries.  In  contrast  to  this  autopsy  result  in  place  of  the 
normal  delicate  deposits  which  contain  no  lime,  there  were  found  in  true  rachitis 
thick  plates  of  tissue  entirely  without  lime  which  surround  on  all  sides  the  lime- 
containing  portions  or  which,  in  very  severe  cases,  rejilace  a  consideralde  portion 
of  the  bony  lamellae.  A  further  distinction  from  rachitis  was  found  in  the  normal 
zone  of  ossifying  cartilage.  Therefore  the  authors  exjdain  the  process  as  a  gen- 
eralized osteoporosis  with  rachitis-like  changes  in  the  periosteum  and  in  the  unealci- 
fied  proliferating  cartilage,  and  they  suggest  that  the  bony  changes  observed  after 
withdrawal  of  lime  by  other  authors  had  been  similar  to  theirs. 

In  the  experiments  of  Beimers  &  Boye  and  of  Getting  the  compact  bone 
substance  was  found  very  small,  the  spongiosa  with  extremely  wide  meshes;  the 
extension  of  the  proliferating  cartilage  was  only  slight,  a  proliferation  of  the  osteoid 
tissue  had  not  taken  place  at  all. 


934  Rachitis. 

As  a  further  cause  of  lime  deficiency  in  tlie  organism  an 
improper  chemical  composition  of  the  food-stuffs  may  be  men- 
tioned even  though  the  calcium  content  be  normal.  Above 
all  the  relation  between  the  amounts  of  lime  salts  and  of  phos- 
phoric acid  appears  to  be  of  importance  (Klimmer  &  Schmidt, 
Ingle).  The  intestinal  contents  being  alkaline,  it  may  perhaps 
be  supposed  that  in  such  a  case  a  mutual  precipitation  of  these 
salts  takes  place  in  the  intestinal  canal,  or  that  an  excess  of 
free  phosphoric  acid  is  formed  and,  owing  to  this,  a  prolifera- 
tion of  the  osteoid  tissue  (Piitz,  M.  B.  Schmidt,  Ingle).  On 
the  other  hand  an  abnormally  high  content  of  the  food  in 
potassium  salts  is  to  be  considered.  The  effect  of  food-stutfs 
rich  in  potassium  may  be  explained  thus,  that  the  chlorine  of 
the  HCl  of  the  stomach  is  bound  l)y  the  potassium  salts  and 
that  therefore  the  formation  of  hydrochloric  acid  is  reduced, 
wdiicli  would  again  lead  to  an  insufficient  solution  and  absorp- 
tion of  the  lime  salts  that  are  present  in  the  food  principally 
in  insoluble  form.  According  to  H.  Aron  and  Delcourt,  how- 
ever, the  potassium  salts  tend  to  impede  the  deposit  of  lime 
into  the  new-formed  bony  substance.  In  food-stuffs  which  con- 
tain much  sulphuric  acid  the  lime  salts  help  to  form  gypsum 
which  dissolves  with  difficulty,  and  they  are  therefore  absorl)ed 
less  readily  in  the  intestine.  With  this  assumption,  the  observa- 
tion of  Haubner  would  agree,  namely,  that  in  the  surroundings 
of  metal  factories  near  Freiberg  animals  acquired  rachitis  and 
osteomalacia,  because  the  smoke  contains  arsenic,  lead  and 
sulphurous  acid.  When  the  sulphurous  acid  Avas  collected  in 
condensators  both  diseases  ceased  to  occur. 

Digestive  disturbances  of  whatever  origin  are  also  capable 
of  producing  a  deficiency  of  lime  in  the  organism,  either  by  in- 
terfering with  the  formation  of  HGl  in  the  stomach  (Seemann, 
Zander)  or  with  the  intestinal  absorption ;  but  also,  and  possibly 
very  decidedly,  by  increasing  the  normal  elimination  of  the 
calcium  compounds  in  the  intestine,  a  possibility  that  must  be 
considered  especially  in  protracted  intestinal  catarrh. 

A  second  etiological  factor  of  rickets  is  found  in  intoxica- 
tion. Wegener  (1872)  wdio  produced  rachitis  in  animals  by 
long  continued  feeding  of  phosphoric  acid,  withdrawing  the  lime 
at  the  same  time,  attributed  to  phosphoric  acid  an  irritating 
action  upon  the  bone-forming  tissues.  A  similar  view  was 
expressed  later  by  Piitz  (1874).  But  Kassow^itz  (1878)  showed 
that  the  administration  of  slightly  enlarged  amounts  of  phos- 
phorus suffices  of  itself  to  produce  a  disease  similar  to  rachitis. 
On  the  basis  of  his  experiments  Kassowitz  assumed  the  action 
of  a  substance  circulating  in  the  blood  which  is  similar  to  phos- 
phorus. Lehnerdt  caused  similar  changes  with  strontium,  but 
held  them  to  be  different  from  rachitis  because,  in  contrast  to 
rachitis  the  new-formed  tissue  is  capable  of  taking  up  lime 
salts.  The  intoxication  theory  received  further  support  in  the 
results  of  experiments  undertaken  by  Ostertag  and  Zuntz  (1907) 


Ktiolo-y.  935 

conooniiiig  the  licking-  disease  of  cattle  (q.  v.),  according  to 
which  any  toxic  substance  present  in  meadow  ])lants  interferes 
with  tlie  hone-formation,  an  action  which  cannot  be  prevented 
by  the  addition  of  lime  salts  to  the  food.  Stoeltzner  considers 
it  probable  that  rachitis  develops  through  a  functional  insuili- 
ciency  of  an  organ  which  is  analogous  to  the  thyroid  gland. 

The  importance  of  infection  as  an  etiological  factor  was 
fre(puMitly  assumed,  but  only  through  the  investigations  of 
]\Iori)urgos  (IDOO,  11)02)  did  this  hy])othesis  gain  a  more  solid 
foundation.  These  results  are  supplemented  by  those  of  ^Foussu 
(1!)0.">),  and  also  Lienaux  (1907)  supposes  that  rickets  has  an 
infectious  origin. 

Tlio  oxjH'iiiiioiits  of  ]\Ioi)iuryos  were  iiiaile  on  wliite  rats  whic-li  liad  (leveloped 
osteomalacia  and  which  helonjjetl  to  a  bree<l  that  had  been  laised  in  liis  institution 
for  seven  years.  In  the  bones,  cord,  spleen  and  liver  of  the  affected  animals  he 
found  Gram  i>ositive  diploeocei,  the  cultures  of  which,  on  subcutaneous  injection 
into  healthy  rats  of  the  same  l)reed,  j)roihiced,  according^  to  the  age  of  the  animals, 
symptoms  of  typical  osteomalacia  or  of  rachitis.  In  adult  animals  the  ]>eriod  of 
inoculation  was  8  days,  but  often  weeks  and  occasionally  months,  while  young 
rats  inoculated  immediately  after  birth  did  not  become  ill  until  they  were  two  or 
three  months  old. 

It  must  be  mentioned  that  Plana  (1889)  already  described  an  infectious 
rabbit  rachitis  and  that  he  obtained  positive  results  in  young  rabbits,  after  inoc- 
ulation with  the  microorganism  which  he  had  isolated.  Later,  however,  he  dis- 
claimed the  correctness  of  his  observation  because  he  failed  later  on  to  find  the 
supposed  virus  in  the  afl'ected  bones  and  because  animals  kept  in  the  same  place 
abo  became  ill  without  being  inoculated. 

^Foussu  watched  a  little  pig  become  ill  which  was  kept  ami  fed  together  with 
one  suffering  from  snuffles;  another  pig  fell  ill  two  and  one-half  months  after 
being  put  in  the  stall  of  an  affected  pig,  which  had  not  been  cleaned  previously. 
By  subcutaneous  inoculation  of  the  bone  marrow  taken  from  pigs  in  the  initial 
stage  of  the  disease,  he  succeeded  in  producing  a  similar  disease  in  pigs,  goats 
and  later  in  rabbits.  Lienaux  also  saw  two  healthy  pigs  become  ill  three  and 
live  weeks  after  having  been  lirought  together  with  an  affected  pig  of  the  same  age. 

It  is  supposed  that  the  lime  salts  in  the  ready  formed 
bone  substance  undergo  solution  owing  to  an  excessive  forma- 
tion of  lactic  acid  in  the  intestinal  canal  (Heitzmann)  or  in 
the  intermediary  metabolism,  or  then  under  the  influence  of 
an  acid  that  develops  in  the  bony  substance  itself  and  exerts 
a  local  action  (Vierordt).  In  the  former  case  it  is  assumed 
that  the  alkalinity  of  the  blood  is  diminished  and  therefore  the 
calcium  of  the  bones  is  dissolved,  while  in  the  supposed  local 
acidulation  the  fixation  of  the  lime  salts,  which  circulate  in 
the  blood,  is  impeded  while  in  addition  to  this  the  already  formed 
bone  substance  is  decalcified. 

While  according  to  Heitzmann  animals  acquired  rachitis  or  osteomalacia 
after  feeding  with  excessive  amounts  of  lactic  acid,  Siedanigrotzky  and  Hofmeister 
found  only  an  increased  porosity  of  the  bones,  without  ra(dutic  changes,  in  young 
kids  which,  in  addition  to  the  acid,  received  an  appropriate  aniount  of  lime  salts 
with  their  food. 

Heitzmann 's  results  cannot  be  adnuttdl  as  proof,  because  he  limited  the 
supply  of  lime  and  because,  moreover,  other  authors  always  got  negative  results 
from  feeding  lactic  aci<l.  Nor  has  it  been  possible  to  demonstrate  the  jiresence 
of  considerab'p  amounts  of  lactic  acid  in  rachitic  bones.  In  fact,  Mrchow  found 
the  reaction  of  fresh  rachitic  bones  to  be  always  alkaline. 


936  Rachitis. 

Finally  an  insufficient  assimilation  of  lime  in  the  bones  is 
often  supposed  to  be  a  cause  of  rachitis,  the  osteoid  tissue 
being  incapable  of  making  use  of  the  lime  salts  carried  there 
in  the  circulation  and  of  retaining  those  that  have  been  de- 
posited. The  abnormal  condition  of  the  osteoid  tissue  is  be- 
lieved to  be  shown  by  the  fact  that  the  bone  substance  contains 
only  glutein  instead  of  ostein.  No  positive  proofs  have  as  yet 
been  afforded  for  the  correctness  of  this  hypothesis. 

Not  infrequently  the  influence  of  predisposing  factors  can 
be  shown.  It  is  commonly  known  that  an  absence  of  sunlight, 
but  preferably  confinement  in  damp  stables  or  in  similar  places 
(cellars,  dark,  damp  rooms)  promotes  the  development  of 
rachitis;  up  to  a  certain  degree  a  like  influence  may  possibly 
be  attributed  to  insufficient  ventilation  or  exercise  (Hansemann). 
The  possible  influence  of  digestive  disorders  has  already  been 
mentioned.  It  is  also  probable  that  there  are  individual  differ- 
ences in  predisposition.  The  state  of  nutrition  or  the  amount 
of  fat  deposited  in  the  tissue  may  insofar  be  of  importance 
as,  other  things  being  equal,  fat  animals  of  much  greater  l)ody 
weight  become  ill  much  sooner  and  also  more  severely. 

The  influence  of  predisposing  factors  may  perhaps  be  explained  thus  that 
they  affect  adversely  the  metabolism  in  the  organism  and  indirectly  the  calcium 
content  there  or  in  the  bones,  and  that  they  also  encourage  the  occurrence  of  an 
intoxication  or  infection.  It  is  also  probable  that  in  some  species  the  want  of 
earthy  ingesta  is  to  be  considered. 

Although  a  predisposing  role  has  often  been  attributed  to 
heredity  its  influence  is  probably  at  most  an  indirect  one.  If 
in  a  given  herd  the  disease  appears  more  frequently  and  in 
several  generations,  the  cause  must,  as  a  rule,  be  looked  for 
in  improper  conditions  of  maintenance,  also  in  close  inbreeding 
or  in  disease  of  the  mother  animals.  Under  such  circumstances 
weaker  and  less  resistant  individuals  are  l)orn  whose  metabolism 
is  easily  disturbed  by  insignificant  influences. 

For  the  present  it  still  appears  questionable  whether  Bhachitis 
foetalis  occurs  in  animals.  Marchi  made  the  observation  that  in  the 
Chiana  valley  in  Italy  the  cows  give,  in  damp  years,  birth  to  somewhat 
smaller  calves  Avhose  extremities  show  remarkal)le  curvatures,  the  liones 
being  twisted  and  short,  the  epiphyses  comparatively  long,  the  diaphyses 
long.  ^  Histological  examinations  were  not  made.  In  this  valley  the 
conditions  of  the  soil  are  unfavorable  and  the  feed  consists  principally 
of  sour  grass;  since  the  soil  has  been  cultivated  appropriately,  the 
disease  has  become  much  less  frequent.  Similar  observations  were 
reported  by  Sivieri,  Hansen,  and  before  them  by  Siedamgrotzky.  The 
cases  are  however  probably  instances  of  abnormal  development 
(Osteochondrodystrophia  foetalis)    (Zschokke,  Bourdelle  &  Dubois). 

Hardly  anything  is  known  in  animals  about  rachitis  which  com- 
mences soon  after  birth  (rachitis  congenita).  Only  Hansen  mentions 
a  few  cases  of  rachitis  in  colts  which  were  affected  when  about  one 
month  old.  However  they  were  all  sired  by  the  same  stallion  and 
came  from  mares  that  had  already  had  colts  with  congenital  rachitis. 


Etiology.  937 

lu  a  large  herd  of  cattle  in  which  many  of  the  cows  were  affected  with 
osteomalacia,  only  poorly  developed  calves  were  born  with  very  delicate 
bony  structures,  which  however  i)resented  no  rachitis  symptoms;  these 
symptoms  appeared  only  after  the  calves  were  weaned  and  when  they 
received  similar  food  as  the  cows  (authors'  observation). 

From  what  has  been  said  it  is  above  all  evident  tliat  the 
etiology  of  rachitis  cannot  by  any  means  be  said  to  be  com- 
])Ietely  explained.  This  nuieh  may  be  asserted  that  tlie  same 
factors  do  not  always  i)articipate  in  its  development  and  tliat 
therefore  the  disease  does  not  represent  an  affection  of  uni- 
form etiology.  There  is  no  doubt  that  in  domestic  animals 
the  most  frequent  cause  of  rachitis  lies  in  the  deficiency  of 
lime  in  the  organism  from  whatever  cause,  no  matter  wliether 
the  disease  is  sporadic  or  epizootic.  Whether  the  lime  deficiency 
causes  the  bony  changes  immediately  or  perhaps  only  creates 
a  foundation  on  which  the  rachitis  develops  through  the  inter- 
mediation of  a  resulting  disturbance  in  metabolism  cannot  for 
the  present  be  decided  definitely.  On  the  other  hand  a  toxic 
or  infectious  origin  cannot  be  denied  for  certain  cases,  especially 
for  those  with  excessive  proliferation  of  the  osteoid  tissue,  but 
the  investigations  which  have  been  undertaken  in  this  respect 
are  not  yet  sufficient  to  justify  a  definite  position  being  taken 
in  this  problem. 

Pathogenesis.  If  a  deficiency  in  calcium  occurs  in  the 
organism  the  calcification  of  the  developing  osteoid  tissue  re- 
mains insufficient  and  this  leads  to  a  lessened  firmness  of  the 
bones.  The  more  the  firmness  of  the  bones  diminishes,  the 
greater  is  the  mechanical  irritation  exerted  upon  the  bone- 
forming  tissues  by  the  motion  of  the  body  or  of  parts  of  the 
l)ody,  and  by  the  coincident  jolts  and  shocks.  In  consequence 
there  occurs  an  increased  new-formation  of  osteoid  tissue  with 
proliferation  of  the  epiphyseal  cartilage  and  bone  marrow 
tissue,  that  is,  a  process  similar  to  a  productive  inflammation. 
The  severity  of  the  mechanical  irritation  depends  not  only 
on  the  degree  of  lime  deficiency  Imt  also  on  the  ])ody  weight 
of  the  animal,  and  especially  upon  whether,  and  in  what  degree, 
the  animal  is  permitted  to  move  about  or  does  move  about  of 
its  own  accord.  As  a  consequence  of  the  lime  deficiency  in 
the  organism  there  occurs  a  partial  or  even  a  complete  cessa- 
tion in  the  ossification  of  osteoid  tissue,  through  which  the 
solidity  of  the  bones  becomes  less  and  less  in  spite  of  the  in- 
creased function  of  the  bone-forming  tissue.  It  is  as  a  further 
consequence  of  the  lime  deficiency,  that  we  may  consider  the 
abnormally  increased  absorption  of  bone  tissue  which  had  been 
formed  before  the  disease  (osteoporosis). 

Although  the  disturbances  in  the  bone  formation  occur  in 
various  parts  throughout  the  body,  they  reach  a  considerable 
degree  only  in  certain  parts  under  the  influence  of  the  con- 
stantlv  changing  mechanical  irritation. 


038  Rachitis. 

It  also  appears  thinkable  that,  according  to  the  degree 
of  lime  deficiency  and  to  the  external  influences,  either  the 
proliferating  process  or  then  the  osteoporosis  is  more  promi- 
nent, the  latter  being  indeed  sometimes  alone  present  (so-called 
juvenile  osteomalacia).  It  might  be  assumed  that  when  the 
affected  animals  are  prevented  from  motion,  or  when  the  ani- 
mals avoid  all  vigorous  motions,  because  the  bones  are  sensi- 
tive in  consequence  of  their  lessened  resistance,  the  process 
of  proliferation  is  far  less  intense  than  in  animals  in  Avhich 
the  mechanical  influences  can  manifest  themselves  fully.  It 
need  not  be  settled  in  this  connection  whether  the  proportions 
of  the  other  salts  contained  in  the  food  have  any  influence. 

These  considerations  may  perhaps  explain  why  some  authors  i)ro<luce(i  typical 
rachitis  by  withdrawal  of  lime,  while  with  similar  methods  of  experimentation 
others  could  only  cause  osteoporosis  and  marked  proliferation  of  the  epiphyseal 
cartilage,  and  still  others  only  osteoporotic  changes. 

If  the  rachitis  is  based  upon  an  intoxication  or  infpction, 
an  inflammatory  process  in  the  bone  tissue  will  probably  be 
primary  and  in  such  a  case  the  bone  salts  may  be  dissolved 
and  absorbed,  causing  the  bones  to  lose  their  firmness.  In 
the  further  course,  however,  similar  reparatory  processes  would 
occur  in  the  bones  as  take  place  in  lime  deficiency  under  the 
stimulation  of  the  mechanical  influences  mentioned. 

The  process  which  takes  place  in  the  bones  causes  in  tliem 
various  changes  in  form.  These  are  partly  due  to  the  prolifera- 
tion in  the  bones  and  are  therefore  developed  especially  in 
those  portions  of  the  body  in  which  the  bones  are  more  exposed 
to  mechanical  influences,  during  motion  or  during  the  chewing 
of  hard  food-stuffs,  or  in  rooting;  this  is  true  especially  for 
the  epiphyses  of  the  long  bones,  the  maxillary  or  face  bones, 
also  for  the  ribs  which  are  in  constant  motion  during  respira- 
tion. These  external  influences,  which  differ  according  to 
species  and  breed  and  according  to  the  care  of  the  animals, 
may  produce  the  most  varied  combinations  and  forms  in  the 
bony  changes,  and  especially  in  pigs  the  maxillary  or  face  bones 
are  often  strikingly  altered.  The  diminished  firmness  of  the 
bones  leads  on  the  one  hand  to  curvatures,  under  the  weight 
of  the  body  or  from  muscular  traction,  and  on  the  other  to 
fractures. 

The  diminished  firmness  of  the  liones  is  further  responsible 
for  dragging  upon  the  sensitive  nerves  in  the  periosteum  and 
in  the  bony  tissue  which  in  their  turn  cause  pain  in  the  bones 
on  motion.  The  proliferating  osteoid  tissue  may  even  compress 
certain  nerve  trunks  (e.  g.,  the  nervus  infraorbitalis  [Hintze]). 

A  high  degree  of  lime  deficiency  in  the  organism  may  of 
itself  cause  disturbances  in  metabolism  because  the  calcium 
is  necessary  for  the  binding  of  certain  metabolic  products.  In 
this  respect,  however,  a  diminution  of  the  other  food  salts  which 
is   often   coexistent   with  lime   deficiency   in   the   organism   is 


Pathoypiicsis,    Aiiatoiiiical   Cliaiities. 


1)3!) 


prol)a])ly  of  far  greater  iiifiuence.  This  (limimitioii  of  tlie  food 
salts  ill  genera]  may  ])erliai)s  be  held  resitonsihle  I'or  the  in- 
creased cerebral  irritability  which  is  a  i)roinineiit  symptom  in 
certain  cases.  If  an  intoxication  or  infection  is  the  cause  of 
the  disease,  the  presnnial)le  toxins  or  infections  substances  may 
cause  disturbances  in  metabolism. 

Anatomical  Changes.  The  ei)ipliyses  of  the  long  bones  are 
thickened,  club-slia])ed,  the  diaphyses  are  shortened  and  also 
thickened    (Fig.   158).     The   bony  tissue  is   porous   and   softer 


Fi''.  158.     Rdchiti 


Skeleton  of  a  setter. 


than  normal,  sometimes  so  much  so,  that  it  can  easily  be  cut 
with  the  knife.  Some  bones  show  l)ends  and  even  breaks  (see 
Symptoms).  On  the  cut  surface  of  the  bone,  which  has  been 
cut  lengthwise,  there  is  visible,  between  the  periosteum  and 
the  bone  tissue,  a  vascular,  soft,  spongy  layer  which  in  part 
remains  adherent  to  the  bony  substance  when  the  periosteum 
is  peeled  off.  This  osteoid  layer  is  especially  thick  at  the 
insertions  of  large  tendons  or  muscles,  and  at  these  jilaces 
exostoses  are  frequently  formed.  The  epiphyseal  cartilage  is 
not  separated  from  the  (lia])liysis  by  a  bluish-white  or  yellowish 
double  l)and  of  barely  a  few  mdlimeters  width,  but  there  de- 


940  Rachitis. 

velops  instead  a  spongy,  soft,  red  tissue,  certainly  more  than 
a  centimeter  wide,  which  passes  into  cartilage  and  bony  tissue 
without  any  sharp  border  or  in  irregular  streaks.  The  con- 
nection between  epiphysis  and  diaphysis  appears  loosened,  so 
that  they  can  often  be  separated  with  slight  exertion ;  this  may 
even  take  place  during  the  life  of  the  animal  and  then  the 
epiphysis  will  lie  laterally  to  the  diaphysis.  The  yellow  marrow 
of  the  long  bones  is  more  or  less  reddened  and  gelatinous  if 
the  animal  is  notably  emaciated.  The  spongy  bone  substance 
is  also  reddish  in  color  and  shows  a  rarification  of  the  cancellous 
portion.  The  joints  present,  not  infrequently,  signs  of  inflam- 
mation and  of  ulcerative  destruction  of  the  cartilages. 

The  flat  bones,  especially  the  upper  bones  of  the  skull  and 
the  pelvic  bones,  are  thickened,  sometimes  enormously  bulged 
out,  and  changed  to  a  lardaceous,  grayish-red  to  dark  red,  firm 
tissue,  which  can  be  cut  and  which  is  covered  only  in  spots  by 
a  flexible  and  porous  cortical  substance,  while  in  other  places 
it  passes  into  the  adjacent  soft  parts  and  contains  only 
isolated  bony  islands.  Owing  to  the  bulging  of  the  bones  the 
nares  and  the  maxillary  sinuses  are  small  or  even  obliterated, 
and  in  pigs  the  palate  furthermore  bulges  into  the  oral  cavity. 
Sometimes  the  proliferating  tissue  of  tlie  maxillary  bones  con- 
tains cysts  which  have  developed  from  hemorrhagic  foci 
(Hintze,  Willies).  The  teeth  are  placed  rather  deep  and  lie 
loose  in  the  proliferating  tissue,  without  any  alveolar  borders; 
their  enamel  surface  in  the  pig  is  uneven,  pitted,  honeycombed, 
or  in  exceptional  cases  the  enamel  layer  may  be  entirely  absent 
(Preuss).  Sometimes  the  skull  bones  are  soft  and  moderately 
thickened,  in  exceptional  cases  they  may  have  become  so  rarified 
that  in  spots  only  a  thin,  connective  tissue-like  membrane  (tlie 
single  or  the  double  periosteum)  remains  visible  (Craniotabes), 
and  in  such  cases  there  are  usually  also  signs  of  hydrocephalus 
internus  (Schiitz).  The  other  flat  bones,  especially  those  of 
the  pelvis,  may  also  be  bent  in  various  directions  and  present 
similar  changes  in  their  substance  as  those  in  the  skull  bones. 

The  mieroscoiiic  changes  in  the  long  bones  (Fig-  159)  may  be  summed 
up  as  follows:  Starting  from  the  periosteum  there  develops  a  cellular  and 
vascular  osteoid  tissue  containing  comparatively  large  osteoblasts  and  bone  cells 
in  varying  numbers.  In  the  diaphyseal  part  of  the  cartilage  the  cartilage  cells 
are  larger,  arranged  in  vravy  streaks,  and  similar  cartilage-islands  extend  toward 
the  marrow.  From  the  marrow  numerous  vessels,  with  thin  walls  and  surrounded  by 
cellular  tissue,  enter  deeply  into  the  cartilage  tissue,  opening  the  cartilage  cell  col- 
umns, often  in  an  oblique  direction.  Similar  vessels  may  proliferate  into  the  interior 
of  the  cartilage  tissue,  even  from  the  perichondrium  and  loosen  this  in  their  vicinity 
which  becomes  softened.  The  layer  of  calcification  between  bony  and  cartilaginous 
tissue  is  either  entirely  absent  or  there  are  only  isolated  foci  of  calcification ; 
instead  there  is  a  very  wide  layer  of  osteoid  tissue  which  is  similar  in  structure  to 
the  layer  starting  from  the  periosteum,  and  is  later  partly  changed  into  more  solid, 
bony  tissue. 

In  the  so-called  snufSes  or  maxillary  rachitis  of  pigs  a  transitional  zone  with 
smaller  decalcified  bony  laminae  is  joined  to  the  zone  of  normal  bony  tissue, 
upon  which  follows  a  tissue  similar  to  sarcoma,  consisting  basically  of  spindle  cells 
or  cells  of  various  shapes,  rich  in  protoplasm  and  containing  large  nuclei.  In 
this   proliferating  tissue  there  are   seen   numerous   osteoid  laminae  which   gradually 


Aiiatoiuioal  Changes. 


941 


become  more  slender  and  finally  represent  a  veritable  lattice  work  of  sjdinters. 
Finally  multinucleatetl  giant  cells  are  deposited  around  the  laminae  and  cause  their 
disappearance  by  lacunar  absorption   (Hintze). 

Ill  addition  to  the  changes  in  tlic  bones,  symptoms  of 
anemia,  ^astro-intestinal  catarrli,  or  catarrhal  affections  of  tlie 
res]nratoi-v  organs  are  often  observed;  in  tiie  latter  organs 
bronclio-pneumonia  is  frequent. 


I 


Fig.  159.  Rachitis.  Longitudinal  section  through  the  line  of  ossification  of  the  upper 
diaphyseal  end  of  the  femur,  a.  unchanged  hyaline  cartilage;  6.  cartilage  in  the 
tir^t  stages  of  proliferation  :  r,  zone  of  proliferated  cartilage  columns  •  (/.  columns  of 
proliferated  hypertrophic  cells;  e.  vascular  marrow  spaces:  /'  calcified  cartilage  tis- 
sue;  (/.  osteoid  tissue ;  /i.  remnants  of  cartilage  tissue  between  osteoid  tissue;  f.  tra- 
beculae  of  osteoid  tissue;  A".  Iraheeulae  of  osteoid  and  developed  (lime  containing) 
bone  tissue;  I.  vascular,  cellular-fibrous  marrow  spaces.  (Magnif.  50  X.  After 
Ziegler. ) 

Symptoms.  The  development  of  the  rachitic  manifesta- 
tions proper  is  sometimes  preceded  by  disturbances  in  nutri- 
tion. The  animals  seem  weak,  their  desire  to  eat  is  diminished, 
the  belly  somewhat  bloated,  and  at  the  same  time  obstinate 
diarrhea  makes  its  appearance.  Sometimes  there  may  be 
symptoms  of  pica  (licking  disease),  gnawing  the  walls  or  the 
wood  of  the  stable,  drinking  of  manure  water;  these  occur  not 
only  in  the  initial  stage,  but  also  in  the  further  course  of  the 
disease.    In  some  cases,  especially  in  colts,  the  second  dentition 


94:1'  Rachitis. 

is  retarded  and  irregular.  All  these  symptoms  may  be  un- 
noticed, so  that  attention  is  not  attracted  to  the  disease  until 
the  motor  disturbances  connnence.  The  aching  in  the  bones, 
which  occurs  before  the  changes  in  shape,  causes  the  animals  to 
step  about  restlessly,  while  at  the  same  time  they  move  gingerly 
and  their  walk  is  stiff  or  lame;  they  lie  much  on  the  ground 
and  dislike  to  rise.  Especially  pigs,  less  so  kids  and  lambs, 
and  at  times  other  animals  do  not  use  their  posterior  extremi- 
ties, or  indeed,  all  extremities,  at  all.  They  seem  paralyzed, 
and  on  being  forced  to  rise  they  crawl  about  squealing  aloud. 
(The  cases  of  paralysis  in  chicks,  which  Wilke  diagnosed  as 
poliomyelitis  anterior,  probably  had  a  similar  origin.)  Smaller 
animals  often  assume  a  kneeling  position  (Fig.  160).  These 
motor  disturbances  increase  with  the  progress  of  the  disease 
and  when  the  shape  of  the  bones  commences  to  be  altered. 


Fig.  160.     Rachitis     (of  pig).      Aside  from  the  motor  disturbances  the  pig  showed 

slight  snuffling. 

In  certain  cases  the  disease  becomes  apparent  through 
severe  nervous  disturbances,  as  was  pointed  out  by  Klimmer  & 
Schmidt  for  osteomalacia  and  as  the  authors  observed  fre- 
quently in  calves  and  pigs.  The  affected  animals  suddenly 
become  somnolent,  they  stagger  and  even  fall  down,  and  occa- 
sionally develop  generalized  tonic-clonic  muscular  convulsions, 
which  however  may  also  be  produced  by  external  influences. 
Such  attacks  either  terminate,  in  some  6  or  8  hours,  with  the 
death  of  the  animal  or  are  repeated  a  few  times  in  the  course 
of  some  days  or  weeks  before  death  results,  or  then  they  do 
not  appear  at  all,  but  the  typical  symptoms  of  the  disease  be- 
come evident  at  once. 

The  changes  in  form  are,  at  least  in  the  beginning,  most 
striking  in  the  long  bones  of  the  extremities.  The  epiphyses 
are  enlarged  and  it  looks  as  though  the  joints  themselves  were 


Syiii]>l""i^- 


1)43 


swollen,  l)iit  tlio  \v\\o  iialnro  of  the  swoHiiic,'  is  oaslly  asoortaincd 
on  palpation  (Fii;'.  lOl).  Similai-  ciilai-.i^oincnts  arc  to  he  seen 
on  the  sterno-costal  artienlations  where  the  Initton-shapecl 
cartilages  form  two  concave  lines  rnnninj;-  parallel  with  tlie 
sternnm  (rachitic  rosary).  These  bony  swelliniis  are,  especially 
at  the  l)eninnin,<i',  often  soiiK'what  sensitive  to  ])ressnre.  Cir- 
cnniscrihi'd  cxostotic  enlari^cnients  are  also  fre<pu'nt,  especially 
in  the  ribs  and  the  extremities  (Frohner  observed  a  ringbone 
develo])  in  rachitis). 

The  weight  of  the  l)ody  and  the  traction  of  the  mnseles 
causes  the  hones  to  bend  and  become  crooked.  These  distor- 
tions are  most  frequent  and  striking  on  the  extremities  which 


Fig.   161.     J'acliilis.     Setter.     The  skeleton  of  this  dog  is  .shown  in   Fig.  155 


assume  various  almormal  shapes,  such  as  " (lachshuad "  legs, 
knock-knee,  l)andy-leg,  legs  l)ent  backward,  legs  like  bear's  paws 
(Figs.  161  and  163).  The  thinner  bones,  especially  those  of 
the  metacarpus  and  the  metatarsus  are  sometimes  bent  double 
and  may  break  transversely  (Schiitz).  Lienaux  points  out  that 
the  Achilles  tendon  is  sometimes  torn  from  its  attachment,  and 
this  may  be  the  first  or  even  the  only  s^^nptom  of  the  disease. 
The  muscles  of  the  extremities  either  lose  their  tension  or 
some  of  them  become  contracted  and  thus  cause  much  pain. 

The  pressure  of  shoulders  and  ell)ows,  and  also  the  air 
]jressure  cause  the  middle  portions  of  the  ribs  to  be  bent  in- 
ward, giving  rise  on  both  sides  of  the  thorax  to  a  longitudinal 


944 


Kaeliitis. 


sliallow  groove  and  to  a  sliortening  of  the  transverse  diameter 
of  the  thorax.  The  inward  bend  of  the  ribs  causes  the  sternum 
to  recede  from  the  vertebral  cohnnn,  while  its  borders  are  ap- 
proximated, so  that  the  sternum  forms  an  acute  angle  or  pro- 
trudes (chickenbreast,  pectus  gallinaceum,  s.  carinatmn). 
When  the  animals  lie  down  much,  the  antero-posterior  diameter 
of  the  thorax  is  diminished  (Fig.  161),  because  its  anterior 
wall  which  rests  on  the  ground  is  forced  inward.  In  fowls 
the  sternum  shows  in  such  cases  a  single  and  often  a  double 
inw^ard  bend  (Ziirn).  The  limited  motility  of  the  thorax  is 
apt  to  cause  the  development  of  a  bronchial  catarrh  or  of 
catarrhal  pneumonia. 


Fis.  162.     Rachitis  in  a  lamb. 


In  the  pelvis  the  acetabulum  is  pressed  upward  and  inward 
by  the  heads  of  the  femurs,  w^hile  the  symphysis  is  forced  down- 
ward and  forward;  in  consequence  the  pelvis  is  narrow  trans- 
versely, as  is  already  indicated  by  the  position  of  the  hind 
feet  which  are  turned  inward. 

The  vertebral  column  presents  various  deformities  (hence 
the  name  rachitis,  viz.,  f5xts=vertebral  column).  It  is  curved 
either  laterally  (scoliosis),  or  upward  (kyphosis),  or  downward 
(lordosis).    In  most  cases  there  are  two  or  several  antagonistic 


Symiitoiiis. 


945 


curvatures,  for  instance  lordosis  in  addition  to  kyphosis,  or 
the  scoliotic  vertel)ral  column  is  bent  both  to  the  ri<^lit  and 
to  the  left  (Fi^s.  158  and  161). 

The  deformities  in  the  trunk  and  extremities  may  alter 
the  entire  body  conformation  (dwarfism)  and  naturally  in- 
fluence the  motions  of  the  animal,  which  is  clumsy,  uncertain, 
and  n.iay  reel  or  stagger  in  walking-  even  if  the  l)one8  arc  not 
l)ainful. 

The  skull  bones  either  sliow  certain  changes,  like  thicken- 
ing and  deformity  of  tlic  rami  of  the  inferior  maxilhiry,  on 
close  observation  onlv,  or  lliev  are  so  much  altered  that  their 


Fi".  163.     lidcliitis  in  a  calf. 


affection  forms  a  prominent  symptom  of  the  disease.  Some- 
times early,  more  often  later  the  respiration  becomes  sniffling 
and  difficult  with  occasional  attacks  of  asphyxiation,  and  as 
this  increases  the  facial  bones  bulge  out  more  and  more,  so 
that  the  head  may  in  the  course  of  6  to  8  weeks  become  enor- 
mously large.  The  bulging  of  the  bones  commences  mostly 
in  the  maxilla  and  gradually  involves  the  contiguous  bones 
and  tiie  inferior  maxilla.  The  vomer  protrudes  into  the  oral 
cavity  which  therefore  becomes  smaller,  so  that  the  ingestion 
of  food  is  rendered  difficult  and  even  impossible   (Fig.  164). 

Vol..! — 60 


946 


Rachitis. 


The  teeth  then  seem  shortened  and  sometimes  barelj'  stand 
out  from  the  gums ;  they  are  loose  and  may  fall  out ;  the  enamel 
is  perforated  in  places.  The  bones  of  the  skull  may  be  thick- 
ened in  parts,  or  they  may  be  thin  and  even  membranous; 
the  fontanelles,  especially  between  the  frontal  and  parietal 
bones,  often  remain  open  (Schiitz). 

The  form  of  rachitis  in  pigs  in  whicli  tlie  facial  bones  bulge  out  strongly,  has 
always  been  designated  as  snuffles  (French:  "  renifiement ' ').  With  it  were  classed 
other  diseases  characterized  by  a  sniffling  resjiiration,  especially  the  infectious  nasal 
inflammation  of  pigs  (Vol.  II).  Since,  however,  the  sniffling  respiration  is  only 
a  symptom  of  quite  heterogeneous  diseases,  and  has  all  too  often  given  rise  to 
misunderstanding,  the  name  snuffles  should  be  abandoned  altogether.  The  same  is 
true  for  the  so-called  bran  disease  of  horses,  which  also  represents  only  a  form  of 
rachitis  or  osteomalacia,  caused  by  the  exclusive  feeding  of  bran. 

Course  and  Prognosis.  After  the  appearance  of  clinical 
symptoms  rachitis  runs  a  chronic  course  lasting  for  months, 


Fig.  164.     Rachitic    bulging    of    the    maxillary    hones  and    protrusion    of    the    hard 
palate  into  the  mouth,  in  a  pig  with  rachitic  changes  in  the  other  l)ones. 

except  in  those  cases  in  which,  as  already  mentioned,  the  onset 
is  associated  with  severe  nervous  disturbances,  or  in  which 
death  is  hastened  by  complications.  If  the  conditions  are  un- 
favorable and  if  the  disease  is  not  treated,  it  gradually 
progresses  accompanied  by  increasing  emaciation  of  the  ani- 
mals whose  development  is  noticeably  retarded.  Spontaneous 
recoveries  are  not  infrequent  in  large  herds,  but  are  observed 
only  in  animals,  which  are  less  severely  affected,  or  in  nearly 
mature  animals  in  which,  of  course,  growth  is  less  rapid.  By 
proper  regulation  of  the  diet  and  by  prompt  treatment  many, 
even  severely  affected,  animals  are  cured,  or  the  bone  defornn- 
ties,  which  are  not  yet  considerable,  are  made  to  disappear. 
But  deformities  which  have  become  very  decided  persist,  the 
narrowing  of  the  pelvis  and  the  thorax  being  of  particular  im- 
portance.    Under  unfavorable  conditions,  or  if  the  disease  is 


Course    ami    Prognosis;,    Diagnosis.  947 

far  advanced  and  has  given  rise  to  emphatic  nutritional  dis- 
turbances, death  always  follows,  either  throu^li  exhaustion  or 
throu.nh  some  com])lication.  The  ultimate  iiealiiii;-  of  the  ])rocess 
is  not  rarely  jjrevented  l)y  ulcers  foi'iucfj  in  the  course  of  the 
disease  in   the  articular  cartilages. 

Diagnosis.  The  changes  which  occur  in  the  skeleton, 
especially  in  the  bones  of  the  extremities,  in  the  ribs  and  in 
the  bones  of  the  skull  are  so  characteristic  that  rachitis  can 
be  recognized  without  diHiculty,  especially  if  the  slow  develoj)- 
ment  and  the  early  age  of  the  animals  are  considered.  Pyo- 
septicemia  of  the  new-born  is  differentiated  by  its  acute  onset 
few  days  after  birth,  and  by  the  infiannnatory  s>nnptoms  which 
dominate  the  clinical  picture.  In  articular  rheumatism  also 
the  acute  inflammatory  character  of  the  disease  is  diagnostic; 
moreover,  the  swollen  joints  are  painful,  the  swelling  is  most 
intense  in  the  middle  portion  of  the  joints,  it  is  tense  and 
fluctuating.  In  muscular  rheumatism,  which  is  of  extremely 
rare  occurrence,  bony  swellings  or  deformities  are  absent. 
Tuberculosis  may  jn-odnce  similar  changes  in  calves  or  young 
pigs  as  they  are  observed  in  the  initial  stage  of  rachitis,  but 
in  this  affection  the  articular  ends  of  the  long  bones  remain 
unaltered  for  a  long  time  and  the  further  course  of  the  disease 
is  entirely  different.  In  all  the  diseases  just  mentioned  only 
one  or  few  joints  are  involved,  as  a  rule,  and  these  not  Avith 
almost  equal  intensity  as  is  the  case  in  rickets.  Xew-forma- 
tions  occur  only  in  some  bones,  while  in  rickets  the  entire  skele- 
ton is  diseased  more  or  less. 

Treatment.  Above  all  the  diet  should  he  regulated;  the 
animals  are  to  be  kept  in  moderately  warm  and  well-ventilated 
places,  or,  still  better,  in  the  open  air  when  the  weather  is 
favorable;  they  should  be  enabled  to  move  about  freely  and 
receive  food  that  is  rich  in  calcium.  Nurslings  are  properly 
left  with  their  dams  which  are  to  be  given  nutritious  food 
containing  much  calcium;  the  rachitic  nurslings  may  be  given 
milk  to  which  lime  water  has  been  added,  or  if  necessary  they 
are  put  to  a  healthy  nurse.  AVeaned  animals  and  the  dams 
of  nurslings  receive  food  containing  much  lime,  in  carnivora 
meat  with  the  addition  of  a  suthcient  amount  of  bones,  in  birds 
fish  (Merz),  in  herbivora  first  of  all  timothy  hay,  good  upland 
hay,  straw  of  leguminous  plants,  possibly  waste  of  oil  factories 
or  certain  leguminous  foods  being  best  adapted  to  their  needs 
(page  932) ).  Pasturing  or  green  feed  not  rarely  exert  a  favora- 
ble action,  but  often  the  disturbances  in  motion  are  increased 
at  first  when  animals  are  put  out  to  pasture,  if  they  were  not 
accustomed  to  move  about  freely.  The  treatment  of  gastric 
and  intestinal  catarrh,  which  may  be  present,  also  requires 
close  attention  in  order  to  insure  undisturbed  intestinal  assimi- 
lation. 

The  decided  lime-deficiency  in  the  organism  is  to  be  cor- 


948  Racliitis. 

rected  by  the  administration  of  lime  preparations,  and  liere,  of 
course,  the  lime  requirements  of  the  particular  species  and  the 
probable  lime  content  of  the  food  must  be  considered.    In  many 
cases  chalk  (calcium  carbonate),  which  is  cheap,  is  appropriate; 
colts  and  calves  may  be  given  10-20  gm. ;  lambs,  pigs  and  dogs 
2-10  gm.  daily  with  their  food,  perhaps  shaken  up  with  milk. 
In  order  to  prevent  digestive  disturbances  in  consequence  of 
the  HCl  being  bound  in  the  stomach  (an  occurrence  that  was 
not  observed,  however,  in  the  experiments  made  on  rams  by 
Yolhard),   Klimmer  &  Schmidt   suggest  to  replace  the  chalk 
partially  (1/3-1/2)  by  calcium  chlorate  (not  to  be  confounded 
with  chloride  of  lime!).    The  prepared  bone-meal  (phosphated 
food-lime;    food-bone-meal;    precipitated    calcium    phosphate) 
renders   excellent  service  in  doses   similar  to  those  of  chalk, 
and  should  be  administered  especially  in  those  cases  in  which 
the  administered  food  is  deficient  in  phosphates   (page  932). 
Feeding  experiments  made  in  this  direction  by  Kohler  showed 
that  almost  all  of  the  ingested  tri-calcium  phosphate  was  ab- 
sorbed, and  about  one-half  of  bone-ash  or  of  bone-meal  from 
which  the  gelatinous  portions  had  been  removed.    In  the  experi- 
ments of  Frese  in  dogs,  organic  calcium  compounds  were  not 
found   superior   in  their   effects  to  the  anorganic  lime.     The 
preparations  containing  lime,  respectively  phosphates,  should 
be  given  at  intervals  of  from  2  to  3  days  (Klimmer  &  Schmidt), 
or  alternately  at  different  feedings,  in  order  to  prevent  their 
precipitating  each  other  in  the  intestine.     If  phosphorus  is 
deficient  as  well  as  lime,  sodium  phosphate  may  be  given  alter- 
nately with  the  chalk.    In  human  medicine  phosphated  codliver 
oil  is  particularly  well  thought  of  as  a  remedy  (colts  and  calves 
0.02-0.05  gm.  of  phosphorus  in  30-100  gm.  of  codliver  oil  daily ; 
pigs   0.002-0.005:20-40   gm.;    dogs   0.001-0.002:5-15   gin.;    birds 
0.0005-0.001:2-5  gm.).     Hansen  &  Schabad  have  shown  experi- 
mentally that  the  remedy  produces  an  increased  retention  of 
the  lime  and  phosphorus  of  the  food  and  also  an  increased 
assimilation  of  the  lime  which  is  administered  separately.    Tim 
systematic  administration  of  salt   (rock  salt)   or  of  HCl  may 
enhance  the  favorable  action  of  the  medicinal  treatment  just 
described.     (Harms,  Klimmer  &  Schmidt.) 

In  a  far  advanced  stage  of  the  disease,  especially  when 
the  deformities  of  the  bones  are  very  marked,  it  appears  best 
to  slaughter  the  animals  early. 

Prevention.  The  disease  can  be  prevented  almost  with  cer- 
tainty when  the  animals  are  kept  and  fed  properly.  Care  should 
be  taken  that  the  animals  receive  sufficient  amounts  of  rock 
salt,  and  of  course  that  the  dams  are  suitably  fed.  In  localities 
where  the  disease  is  frequent  or  where  food-stuffs  poor  in 
lime  are  fed,  it  is  advisable  to  administer  systematically  chalk 
or  bone-meal  in  addition  to  the  food.  In  this  manner  it  has 
been  found  possible  to  eradicate  the  disease,  for  instance  in 


Prevention.  949 

swine  lierds  in  "wliicli  it  liad,  year  after  year,  taken  lar,i;o  toll. 
Colts  should  not  be  fed  with  bran  at  all,  or  only  in  small 
amounts.  Moreover,  the  youn<(  animals  should  be  protected  by 
cleanliness  and  proper  ventilation  of  their  stables  against  acute 
diseases  M-hieh  may  establish  a  predisposition  to  rickets,  and 
they  should  be  kei)t  as  much  as  possible  in  the  o]jen  where 
they  can  move  about  freely.  All  these  precautions  are  calle*! 
for  especially  in  pure-bred  or  high  grade  herds  in  which  the 
greater  or  lesser  degree  of  inbreeding  of  itself  reduces  the  re- 
sistance of  the  animals. 

Tf  thoro  is  a  suspicion  of  infoctious  or  toxic  rachitis,  the  isolation 
of  the  diseased  animals  and  the  disinfection  of  their  stahles,  as  well 
as  a  change  of  feeding,  is  indicated. 

Literature.     Allni  &  Xouberg,  riiysiol.  u.  Path.  d.  Mincralstoff-n-ophsels,  190G. 

—  Aroii,  PUii^rers,  A.,  CVI.  91.  —  Basset,  Rec,  1907.  107  (Lit.).  —  Bourdelle  & 
Dul)ois,  Rev.  vet.,  1907.  511.  —  Briimng,  Z.  f.  Tm.,  190(5.  X.  19S.  —  Fiese, 
Verwertbarkeit    il.    Nahniiifjskalkes,    etc.     Diss.    Gicssen.    1908.    —  Fiiilmer,    Moiih., 

1904.  XV.  211.  —  Hansen,  Maanedsskr.,  190.9.  XX.  55.3.  —  Hartenstein,  S.  B., 
IS94.  132.  —  HauboM,  ibid.,  190G.  77.  —  Hintze,  A.  f.  Tk.,  1909.  XXXV.  5.35 
(Lit.).   —   Kassowitz,   Jahrb.    f.   Kinderheilk.,    1882.    4.30.   —   Klininier   &   Schmidt, 

Monh.,  1900.  XVII.  481  (complete  Lit.).— Lienau-x,  Ann.,  1907.  9.3.— Loos,  W.  f.  Tk., 

1905.  421.  —  Marehi,  Clin,  vet.,  1889.  349.  —  Miwa  &  Stoltzner,  Beitr.  z.  path. 
Anat.,  1898.  XXIV.  578.  —  Morpurgo,  ibiil.,  1900.  XXVIIL  020;  Cbl.  f.  ally.  Path, 
u.  path.  Anat.,  1902.  XIIL  113.  —  Moussu,  Bidl.,  1903.  303;  Rec,  1908.  559.  — 
Ostertag  &  Zuntz,  Z.  f.  Infkrkh.,  1907.  II.  449.  —  Pfaundler,  M.  ni.  W.,  1903. 
1577.  —  Plana,  Clin.  vet.  1899.  307.  —  Pommer,  Unters.  iib.  Osteomal.  n.  Rhachitis, 
1885.  —  Preuss,  A.  f.  Tk.,  1909.  XXXV.  501.  —  Reimers  &  Bove,  D.  t.  W.,  1905. 
490  (review).  —  Rievel,  Ergebn.  d.  Path.,  190-5.  XL  2.  Abt.  597  (Lit.).  —  Rolofif, 
V.  A.,  1800,  XXXVII.  433;  A.  f.  Tk.,  1875.  I.  189.  —  Schmidt,  Ergebn.  d.  Path., 
1897.  IV.  531  (complete  Lit.).  —  Sivieri,  N.  Ere,  1902.  89.  —  Stoltzner,  Jahrb.  f. 
Kinderheilk.,  1899.  208;  Path.  u.  Ther.  d.  Rhachitis,  1904  (comjilete  Lit.).  —  Stutzer, 
Mentzel  &  Lengerkes,  Landw.  Kalender,  1900.  —  Vierordt,  Rhachitis  ii.  Osteomal., 
1890.   —   Yoit,   Z.   f.    Biol.,    1880.   XVI.    55.   —   Wedemaver,   B.    t.   W.,   1900.    703. 

—  Wegner,  Y.  A.,  1872.  LA^  11.  —  Wilke,  D.  t.  W.,  1909.  097.  —  Willies,  A.  f.  Tk., 
1908.  XXXIV.  023.  —  Zschokke,  Z.  f.  Tm.,  1899.  208. 

Barlow's  Disease.  Tn  a  young  dog,  which  during  life  had  shown 
signs  of  rickets,  rheiiniatoid  pains  and  de])ilit.v,  and  Mhich  had  often 
cried  out  in  pain,  Stoltzner  found  rosary-like  thickenings  of  the 
cartilaginous  ends  of  the  ribs,  a  large  subperiosteal  hematoma  of  the 
scapula,  a  considerable  swelling  of  the  proximal  epiphyseal  end  and 
of  the  adjoining  diaphyseal  portion  of  the  humerus,  with  a  large  double 
hematoma.  The  lower  two-thirds  of  the  radius  were  thickened  on 
account  of  a  su])periosteal  hematoma ;  where  the  swelling  was  largest, 
both  in  the  humerus  and  in  the  radius,  the  corticalis  was  entirel.v 
absent.  Histological  examination  showed  that  there  was  not  a  bone 
fracture,  but  that  the  cortical  portion,  and  in  places  the  spongy  portion 
also,  had  become  raritied ;  osteoid  tra])eculae  and  osteoblasts  were 
present  in  only  small  numbers,  the  epiphyseal  marrow  contained  fat 
cells  and  the  diaphysis  showed  a  spleen-like  structure.  Definite  rachitic 
changes  Mere  not  a.scertained. 

The  author  emphasizes  .iustly  the  great  similarity  of  the  clinical 
picture  with  Barlow's  Disease,  Avhich  occurs  in  children  together  with 
rickets  and  which  leads  to  hemorrhages  in  liones  and  elsewhere,  Init 
he  nevertheless  does  not  feel  justified  in  identifying  the  affection  with 
Barlow's  Di.sea.se.  (Schmorl,  Beitr.  z.  path.  Anat.,  XXXX,  215. — 
Stoltzner,  Y.  A.,  CLXXVII,  466.) 


050  Osteomalacia. 


(b)     Osteomalacia.    Brittleness  of  Bones. 

{Bone     softening;     Halisteresis     ostium,     Osteopsathyrosis; 
Cacliexie  osseuse  [French].) 

Osteomalacia  is  a  disease  arising  from  general  nutritional 
disturbances,  which  causes  an  increased  absorption  of  lime 
salts  from  the  bones  and  therefore  softening  and  manifold  de- 
formities ;  fractures  of  the  bones  are  not  infrequent. 

Occurrence.  Osteomalacia  affects  most  frequently  cattle, 
especially  milk  cows,  less  often  goats  and  swine,  and  still  more 
infrequently  horses  or  mules,  also  sheep  and  buffalo;  dogs 
and  birds  appear  to  acquire  the  disease  only  in  exceptional 
cases. 

The  disease  occurs  preferably  in  regions  with  unfavorable 
conditions  of  soil,  and  in  such  regions  it  assumes,  especially 
in  dry  years,  an  enzootic  distribution  and  causes  then  very 
emphatic  economic  losses. 

Osteomalacia  has  been  observed  in  various  parts  of  Belgium,  Germany,  France, 
Austria  (especially  in  Moravia  [Rudofsky]  ),  then  in  Hungaria,  and  here  more 
especially  in  the  regions  of  the  upper  Danube  as  well  as  in  certain  mountainous 
regions.  In  other  countries  in  Europe  it  has  also  made  its  appearance,  and 
further  in  many  countries  of  Asia,   Africa,  North  America  and  Australia. 

Quite  extensive  epizootics  of  the  disease  occurred  as  follows:  1778-1783  in 
the  province  of  Brandenburg;  181(5-1817  in  Baden;  1820-1822  in  Anhalt;  1828  in 
Switzerland;  1837  in  Krain;  1832-1838  in  Eheuish  Hesse;  1833-183-4  in  the  gov- 
ernment districts  of  Coblentz,  Trier  and  Aachen ;  1863-1866  in  Bohemia ;  1868- 
1869  in  the  grand  duchy  of  Weimar;  1893  in  Belgium  and  France;  1893-1894  in 
Baden,  the  Ehenish  countries,  etc.,  1895  in  the  district  of  Cologne,  in  the  region 
of  Chemnitz  and  Grossenhain;  1904-1905  probably  all  over  Germany,  certainly  in  the 
kingdom  of  Saxony  (Klimmer  &  Schmidt).  During  the  last-mentioned  period 
the  disease  was  epizootic  in  Moravia  (Rudofsky),  and  also  in  one  county  of  upper 
Hungary  on  the  Galician  borders.  In  the  years  1908-1909  many  canes  occurred  in 
several  parts  of  Hungary. 

Osteomalacia  (the  so-called  osteoporosis)  is  widely  distributed  in  Asia,  Africa 
and  Australia,  occurring  especially  in  Tcnking,  India,  Japan,  Madagascar,  Camerun 
(called  by  Ziemann  disease  of  the  maxillae  of  horses  and  mules),  the  Transvaal 
and  in  the  Cape  Colony;  in  these  regions  it  is  an  annually  recurring  enzootic 
affecting  the  horses,  nuiles  and  asses. 

In  America,  also,  enzootics  were  observed  among  horses  in  many  regions. 

Etiology.  As  in  rachitis,  so  in  brittleness  of  the  bones  of 
animals,  a  deficiency  of  lime  in  the  organism  is  undoubtedly  of 
the  highest  importance.  This  is  in  perfect  agreement  with 
the  constant  occurrence  of  the  disease  in  localities  with  un- 
favorable conditions  of  soil. 

In  these  regions  the  soil  is  usually  very  poor  in  mineral 
substances,  especially  in  phosphoric  acid  and  lime ;  the  subsoil 
consists  of  porous  bog-  or  peat-strata,  or  it  is  exposed  to  fre- 
quent floods.  If  in  addition  the  cultivation  is  primitive,  and 
particularly  if  the  deficiency  in  salts  is  not  corrected  artificially 
by  appropriate  fertilization,  the  food  plants  growing  op  such 
a  soil  are  likewise  deficient  in  mineral  substances.  This  may 
be  true  to  an  increased  degree  in  dry  years,  when  the  salts 


Etiology/  951 

contamed  in  the  superficial  strata  of  the  soil  cannot  l»o  dis- 
solved and  absorbed  suriicieritiy.  Food  ,ii:ro\vn  nndcr  such  con- 
ditions is  to  be  compared  in  regard  to  its  food  value  to  the 
sour  grasses  growing  in  very  wet,  boggy  and  swampy  regions, 
wliicli  are  not  only  ])oor  in  ])rot('ids  and  in  mineral  substances 
(Morgen),  but  are  moreovei'  diflicnlt  to  digest  and  easily  ])i-o- 
duce  gastric  (,'atanli  thi-ougk  irritating  substances  wjiicli  llicy 
contaiii. 

Tho.  .r-alciiiiii  content  of'  the  food  varies  within  wiilc  limits,  acconlinj^  to 
the  fomlitions  of  soil.  Cienniiin  lound,  for  instance,  in  J, 000  parts  of  hay,  of 
a  rejjion  in  which  osteomalacia  was  frequent,  only  2.97  j>arts  of  lime,  while  in 
another  liay  of  ;;ooi|  (jiiality  the  amount  of  lime  present  was  24.0.")  parts.  Both 
kinds  of  hay  contained  like  amounts  of  phosphoric  acid.  Karmrodt  found  <>.77 
parts  of  lime  and  2.25  parts  of  phosphoric  acid;  Morten  3.7  ami  G.7  parts  of 
lime  and  2  resp.  2.()  parts  of  phosphoric  acid;  Dircks  found  in  three  samides  of 
Xorwejjian  forest  liay  only  1.85,  2.79  and  2.78  parts  of  lime,  and  1.55,  1.4;{  ami 
1.29  i)arts  of  phos[thoric  acid  (Kellner).  (For  the  normal  percentage  of  lime  and 
phosphoric  acid   of  the   food-stuffs,  see  page  932.) 

A  deficiency  of  lime  in  the  organism  may,  however,  also 
occur  under  favorable  soil  and  meteorological  conditions,  when 
food-stuffs,  which  naturally  contain  only  small  amounts  of  lime, 
are  taken  largely  and  for  a  long  time;  such  food-stuffs  are 
carrots,  potatoes,  grains  and  their  waste  products,  grain-straw, 
slops,  molasses,  whey.  Usually  the  unfavorable  infiuence  of 
soil  or  meteorological  factors  and  of  food  poor  in  lime  become 
manifest  simultaneously  since  such  food-stuffs  are  fed  in  con- 
sideralde  amounts  in  j^lace  of  better  feed  when  the  latter  is 
not  availal)le  in  sufficient  quantities. 

In  regard  to  the  insufficient  absorption  of  lime  salts  to 
the  improper  chemical  composition  and,  perhaps,  to  the  diges- 
tive disturbances  which  may  act  as  causes  of  a  deficient  lime 
content  in  the  organism,  the  same  is  true  that  has  already  been 
said  in  the  chapter  on  rachitis  (see  p.  933).  Ilaubner  and  Roll 
have  observed  osteomalacia  especially  after  the  feeding  of  food 
that  had  been  exposed  to  the  smoke  from  smelters. 

Sometimes  the  deficiency  of  lime  in  the  drinking  water 
appears  to  be  of  importance,  at  least  Kasparek  saw  the  disease, 
which  had  become  stationary  on  an  estate,  disappear  after  the 
introduction  of  hard  drinking  water. 

Further  factors  in  dei)riving  the  organism  of  its  lime  are 
pregnancy  and  especially  lactation,  since  in  these  conditions 
very  consideralde  amounts  of  lime  are  withdrawn  from  the 
organism  (see  lime  content  of  the  milk,  ]),  931 ). 

With  the  exception  of  females  durin}^  prej^nancj-  and  lactation  the  lime  reijuire- 
ments  of  adult  animals  are  much  less  in  proportion  to  the  body  weiyht  than  in 
growing  animals,  although  in  these  also  the  lime  requirements  usually  dinunish 
rajtidly  toward  the  en<l  of  tlie  first  year  of  life  (see  iiage93l).  WJiile  a  calf 
from  '2-'.i  weeks  old  and  weighing  5()  kg.  neeiis  a  daily  supjdy  of  14.5  gni.  of 
calcium  and  of  13.8  gm.  of  phosphoric  acid  (Lehniann),  this  need  is  only  21 
and  19  gm.,  resjtectively,  in  a  calf  one  year  old  (Kellner).  The  calcium  re(|nire- 
ments  of  a  pregnant  cow  are  51  gm.  per  day  and  25  gm.  of  jihosphoric  acid  ( Bous- 
singault),  those  of  a  milk   cow  with   a  daily  milk  production   of  20   liters  are  200 


952  Osteomalacia. 

gm.  of  lime  and  100  gm.  of  phosphoric  acid  (Kellner),  those  of  a  vesting  ox  are 
76-78  gm.  and  36  gm.,  respectively  (Henneberg  &  Stohmann),  the  figures  in  the  two 
last  cases  being  calculated  to  1,000  kg.  body  weight.  A  ram  2  years  old  needs 
daily  only  0.57  gm.  of  lime  and  0.05  gm.  of  phosphoric  acid  for  his  50  kg.  of 
weight  (Weiske)  compared  to  a  need  of  3.2  gm.  and  2.3  gm.,  respectively,  in  a  lamb 
1  month  old. 

For  the  content  of  food-stuffs  in  lime  and  phosphoric  acid  see  chapter  on 
rachitis,  page  932.-. 

Tlie  etiological  importance  of  lime  deficiency  in  osteomalacia 
was  likewise  proved  by  some  animal  experiments,  and  the  same 
significance  must  be  attributed  to  the  numerous  observations 
according  to  which  the  disease  may  be  relieved  by  a  suitable 
supply  of  lime. 

Chossat  (1842)  and  later  Gelpke  (1891)  succeeded  in  producing  osteomalacia 
in  pigeons  by  feeding  them  exclusively  with  oats,  while  Forster  (1881)  obtained 
positive  results  in  dogs.  Koloff  (1S66)  in  a  goat  and  a  sheep.  Stilling  &  Mering 
(1889)  saw  in  a  bitch  which  had  been  fed  from  the  commencement  of  gestation 
with  food-stuffs  deficient  in  lime,  softness  of  vertebral  column  and  pelvis,  and 
microscopically  thick  layers  of  osteoid  tissue  upon  the  bone  trabeculae. 

Further  an  intoxication  was  assumed  as  causative  of  osteo- 
malacia, in  so  far  as  some  irritating  substance  circulating  in  the 
blood  was  supposed  to  produce  an  inflammatory  condition  in 
the  bones,  similarly  as  in  rachitis  (p.  933). 

The  infectious  origin  of  osteomalacia  is  finding  more  and 
more  adherents,  since  Morpurgo  and  Moussu  published  the  re- 
sults of  their  experiments  which  were  mentioned  above 
(p.  935),  and  even  Ijefore  them  some  authors  (Kehrer,  Ziirn) 
had  pointed  out  the  possibility  of  an  infection.  Moussu,  Lienaux, 
among  others,  even  assert  that  osteomalacia  always  arises  in 
consequence  of  an  infection,  at  most  a  predisposing  significance 
being  admitted  for  the  lime  deficiency  of  the  organism. 

Petrone  (1892)  assumed  that  Winogradsky 's  micrococcus  nitrificans  was  the 
virus  of  osteomalacia,  but  the  experiments  of  Tschistowitsch  (1893)  in  this  direc- 
tion had  a  negative  result.  Morpurgo  found  the  diplococci  mentioned  on  page  935. 
Pecaud  (1904)  in  Tonking  also  demonstrated  diplococci,  in  a  horse  affected  with 
osetomalacia  and  claims  to  have  produced  the  disease  with  the  blood  of  affected 
animals  in  a  horse  and  in  a  guinea  pig.  But  on  the  other  hand,  Moussu  and  Lienaux 
did  not  succeed  in  discovering  any  microorganism  whatever.  (Concerning  the  micro- 
organisms found  by  Plana  in  rabbits  aft'ected  with  osteomalacia,  see  page  935.) 

The  osteomalacia  (osteoporosis)  of  equides  which  is  met  Avith 
outside  of  Europe  was  considered  by  Theiler  (1907)  to  be  a  specific 
infectious  disease  in  spite  of  the  fact  that  the  inoculation  experiments 
of  Elliot  and  Robertson,  and  also  Theiler 's  own  blood  transfusion 
yielded  entirely  negative  results.  Theiler  assumed  that  the  micro- 
organism, which  is  perhaps  ultramicroscopic,  is  transmitted  by  insects. 
But  Ingle  showed  that  the  food-stuffs,  which  w^ere  supplied  to  the 
osteoporotic  animals,  were  deficient  in  lime  salts  and  contained  relatively 
much  phosphoric  acid,  and  he  concludes,  therefore,  that  the  cause 
of  osteoporosis  nnist  be  looked  for  in  food-stuffs  in  which  the  phosphoric 
acid  content  is  relatively  very  high  in  proportion  to  the  calcium  content. 
Ingle  refers  to  some  animal  experiments  of  Weiske 's  in  which,  after 
the  addition  of  sodium  phosphate  to  the  oats,  the  bones  of  the  experi- 


Etiology.  (j-;^ 

nu'nt  animals  :>ocame  thiniuT  and  fragile,  while  such  cliangos  did  not 
occur  if  at  Oic  same  time  calcium  carbonate  was  also  a(r(l<'d  to  the 
oats._  Finally  J^ane  saw  during  an  enzootic  the  disease  disajjpear  when 
the  food  was  made  richer  in  calcium  and  was  mixed  with  hone  meal. 
The  assertion  of  p]lliot,  according  to  which  the  extra-European 
osteoporosis  is  a  climatic  disease  which  occurs  principally  in  wet 
regions,  was  not  confirmed  by  exi)eriences  in  the  Transvaal. 

The  liypotliosis  that  the  bone  salts  suffer  solution  because 
of  the  al)sorption  of  lactic  acid  from  the  intestinal  canal 
(lleitzmann)  or  owing  to  the  accumulation  of  carbonic  acid  in 
the  blood  (Rindfleisch)  has  at  present  liardlv  anv  adherents 
(p.  ar)).  •         ^ 

Trophoneurotic  disturbances  were  attributed  a  causal  rela- 
tion to  osteomalacia  by  Fehling  (1890).  According-  to  tiiis 
autlior  an  increased  activity  of  the  ovaries  produces,  by  reflex 
action,  a  hyperemia  of  the  bones,  which  in  its  turn  ^vould  lend 
to  softening  of  the  bony  substance. 

The  liypothesis  is  based  upon  the  favorable  results  ol)taiTieil  in  -women  ill 
with  osteomalacia  by  extirpation  of  the  ovaries  and  also  upon  the  demonstration 
of  a  so-called  "physiological  osteomalacia"  in  pregnant  women  which  was  made 
by  Hanau  (1892).  This  author  repeatedly  found  newly  formed  osteoid  tissue  in 
the  bones  and  in  the  Haversian  canals  of  pregnant  and  lying-in  women  whose  bones 
were  otherwise  healthy.  But  it  must  be  noted  that  Liithje  failed  to  find  any 
changes  in  the^  phosphorus-  and  calcium-metabolism  in  castrated  female  animals, 
and  that  Gracsanyi  saw  recovery  occur  equally  in  six  affected  cows,  although  onlv 
two   of  them   were   castrated,  all  being  fed  alike. 

Honnicke  (1906)  is  inclined  to  assume  that  osteomalacia 
occurs  on  the  basis  of  a  thyroid  gland  affection  and  that  the 
disease  represents  a  form  of  hyperthyreosis.  (In  two  of  his 
cases  in  horses  the  thyroid  gland  was  much  enlarged.) 

In  a  rabbit  that  was  fed  with  normal  thyroiil  substance  during,  and  for  two 
months  after,  pregnancy,  Honnicke  found  a  decided  softening  of  the  pelvic  bones 
and  moderate  cachexia,  while  two  control  animals,  Avhich  were  also  pregnant, 
remained  well. 

Among  predisposing  causes  pregnancy  and  lactation  merit 
first  consideration  (see  p.  951),  while  racial  differences  are  of 
importance  only  in  so  far  as  the  calcium  requirements  of 
different  species  vary.  In  regions  where  osteomalacia  occurs 
enzootically,  recently  imported  animals  are  more  apt  to  acquire 
the  disease  than  the  native  ones. 

It  is  evident  from  these  considerations  that  there  are  many 
problems  still  to  be  solved  in  the  etiology  of  osteomalacia,  and 
that  osteomalacia  is  not  a  disease  with  a  uniform  etiology. 
Especially  the  experiences  in  European  countries  do  not  admit 
any  doubt  that  calcium  deficiency  of  the  organism  may  be  re- 
sponsible for  osteomalacia,  but  for  certain  cases  another  origin 
cannot  be  denied  (see  p.  937). 


954 


Osteomalacia. 


Pathog'enesis.  The  commencement  of  the  pathological 
process  in  the  bones  is  probably  similar  to  that  in  rachitis 
(see  p.  937),  whether  the  trouble  be  due  to  a  lime  deficiency 
of  the  organism  or  to  another  cause.  But  since  in  this  disease 
the  process  occurs  in  fully  developed  bones,  the  later  tissue 
changes  differ  more  or  less  from  those  in  rachitis.  In  osteo- 
malacia the  x)eculiar  proliferative  processes  are  absent  which 
are  noted  in  rachitis  at  the  borders  between  the  epiphyses  and 
the  diaphyses  of  the  long  bones,  and  on  the  other  hand  the 
decalcification  (osteoporosis)  predominates  over  the  new- 
formation  of  osteoid  tissue,  at  least  in  many  cases.  Still,  ex- 
ceptions are  observed  not  very  infrequently,  in  so  far  as  a 
decided  proliferative  process  may  set  in  under  the  influence 
of  certain  mechanical  factors  (see  p.  937)  and  of  other  agencies 


Fig.  165.  (Skeleton  of  the  cow  with  osteomalacia,  illustrated  in  Fig.  168.  Tiie  ribs 
are  bent  forward,  show  multiple  fractures,  and  callus  formation.  Both  ilia  are 
fractured,  the  fractured  ends  being  crowded  into  one  another.  Enormous  callus  for- 
mation, moderate  lordosis  of  tiie  luml)ar  vertebrae ;  callus  fonnation  at  the  base  of 
the  spinal  processes  of  the  anterior  dorsal  vertebrae. 


that  are  not  fully  known.    In  other  cases  the  new-formation  of 
osteoid  tissue  may  be  entirely  lacking. 

The  further  consequences  of  the  diminution  in  the  firmness 
of  the  bones  and  of  the  disturbances  in  the  metabolism  are 
the  same  as  in  rachitis  (see  p.  937),  except  that  in  osteomalacia 
the  bones  are  more  often  brittle  rather  than  pliable. 

Relations  of  Rachitis  to  Osteomalacia.  While  Virchow  and  others 
differentiated  rachitis  sharply  from  osteomalacia,  still  other  authors 
declared  both  diseases  to  be  closely  related,  or  identical.  Indeed  the 
pathogenesis  and  the  etiological  agencies  of  both  affections  agree  in 
many  points,  and  it  appears  as  though  the  anatomical  or  microscopical 
differences  were  dependent  solely  upon  the   difference  in  the  age  of 


Pallioyeiiesis,    Anatomical    Cliaiiyes. 


955 


the  affected  animals,  the  more  so,  as  both  diseases  may  occur  siinul- 
tanoously.  According  to  this  viewpoint  rachitis  and  osteomalacia  would 
form  i)rocesses  which  are  identical  anatomically,  but  which  mij^hl 
l)ossil)ly  be  chic  to  ditt'ereiit  causes.  But  since  many  points  are  still 
disputed  concerning  the  etiology  and  i)athogenesis  of  both  disease  forms, 
the  identitication  of  rachitis  and  osteomalacia  as  one  clinical  entity  of 
like  anatomy  and  etiology  does  not  appear  justified  for  the  present. 

The  relation  of  rachitis  an<i  ostooiiialacia  to  osteoporosis  in  ^'e..eral  (rarifica- 
tion  of  bony  substance  in  favor  of  the  marrow  spaces)  may  be  (lescril)e<l  as 
follows:  Both  in  rachitis  and  in  osteomalacia  osteoporosis  is  a  constant  symptom, 
and   it    is  either   eniphasizeil   \cry  sli^d\tly   compared   with   the   proliferative   process, 


Fi^.  166.  Pelvis  of  a  cow  icith  osteomalacia.  The  pubes  and  isciiiuni  are  bent, 
the  foramen  (ihtiiratum  being  distorted.  The  left  internal  angle  of  the  ilium  is 
lowered. 


dependent  upon  the  age  of  the  affected  animal,  on  the  cause  and  on  the  variable 
mechanical  influences,  or  on  the  contrary  it  predominates,  at  times  so  deciiiedly 
that  it  appears  to  exist  alone.  It  is  therefore  not  proper,  at  the  present  stage  of 
information,  to  classify  general  osteoporosis  (with  the  exception  of  senile  bony 
atrophy)  as  an  indepejident  affectiou  apart  from  rachitis  or  osteomalacia,  as  was 
recently  proposed  by  Miwa  &  Htoltzner,  Elliot,  Theiler  and  others. 

Anatomical  Changes.  In  well  marked  cases  of  the  disease 
the  inaiTow  spares  of  the  long  l)ones  are  dilated,  the  bony 
cortex  is  thin  and  spongy,  brittle,  or  then  so  soft  that  it  may 
be  cnt  with  a  knife.  In  very  severe  cases  the  cortical  portion 
of  the  long  bones  is  barely  a  few  millimeters  thick,  the  bone 


956 


Osteomalacia. 


marrow  much  reddened  and  studded  with  punctiform  hemor- 
rhages; if  cachexia  already  exists  the  bone  marrow  is  pale, 
gelatinous,  even  watery  (marrow-fluid).  The  flat  and  short 
bones  are  also  brittle  or  flexible;  owing  to  the  dilation  of 
the  marrow  spaces  the  spong}'  structure  of  these  bones  is  em- 
phasized and  may  contain  fair-sized  marrow  spaces.  The  sound 
of  the  bones  is  duller  than  that  of  normal  bones. 

In  osteomalacia  of  equides 
and  hogs  a  considerable  bulg- 
ing of  the  skull  bones  is  also 
often  observed.  It  is  less  fre- 
quent in  goats  and  dogs.  All 
skull  bones  appear  enlarged 
s;^^nmetrically  on  both  sides 
and  the  periosteum  is  easily 
pealed  off.  The  surface  of  the 
bones  is  reddened,  at  times 
discolored  dark-  or  blue-red 
and  contains  numerous  small 
holes  which  are  often  con- 
fluent ;  the  outer  lamella  of  the 
bones  is  soft  and  easily  cut. 
These  changes  are  particu- 
larly striking  in  the  superior 
maxilla  which  may  bulge  out 
so  much  that  the  molars  are 
imbedded  in  the  reddish, 
rather  fibrous  bone  mass  down 
to  their  masticating  surfaces. 
The  weight  of  the  macerated 
head  is  usually  much  dimin- 
ished (in  horses  400-1160  gni., 
as  compared  with  the  normal 
weight  of  4000  gm.  [Marcone])  ; 

'Fig.  1B7.  Osteomalacia.   Superior  max-  only  if  the  bulging  is  excessive 

ilia  of  a  i>oat  20  months  old.  (1.  periosteum  ir.     +1,^     ,^„„       ^  •    i  j. 

with  numerous  osteoblasts  in  the  deeper  1^  .  the     normal     Weight     maiU- 

layer;    ft.  trabeculae  becoming  gradually  tamed   after  maCCration.      The 

more  narrow;   o.  narrow  trabeculae   sur-  boue  CavitieS   are   Small   Or   CU- 

rounded  by  numerous  osteoblasts ;  (Z.  rem-  +•      i         i  tj.         ^     i  ^  x   v      v. 

nants  of  trabeculae  in  the  cellular-fibrous  lH^^ly   OOnteratecl. 
tissue;  e.  vascular  cellular-fibrous  tissue;  lu  COUSequeuce  of  atrOpllV 

f.  giant  cells,  partially  in  the  vicinity  of  p,,^    enffpnino-  nf  +1nr^  Iiait^t-  +ic 
remnants   of  trabeculae.      Magnif.    100.  SOiieUing   01   tUe    DOUy  tlS- 

After  Bassett.  sue  the   l)ones   are  subject  to 

all  sorts  of  deformities.  These 
are  most  striking  in  the  pelvis,  the  acetabula  of  which  appear 
pressed  inward,  while  the  ilia  are  much  bent  (Figs.  165  and 
166) ;  on  the  vertebral  column  scoliosis,  kyphosis  and  lordosis 
are  to  be  noted  and  the  depression  of  the  ribs  causes  the  thorax 
to  become  narrow  and  the  sterum  to  protrude.  The  pelvic 
bones,  and  still  more  the  long  bones  and  the  ribs  often  show 
recent  or  old  fractures,   callus   formation,  and  circumscribed 


Anatomical  Changes,    Syiuploiiis.  957 

bulging ;  in  other  cases  the  tendons  are  loosened  from  the  bones 
and  the  articular  cartilages  have  lost  in  substance. 

On  histological  examination  the  spaces  between  the  bony  trabeculae  and  Haver- 
sian canals  are  dilateil  and  bul}j;injj,  while  the  trabeculae  show  the  structure  of 
bony  tissues  almost  only  in  the  middle,  their  marginal  portions,  which  are  bordering 
on  the  narrow  sj)aces,  assunung  the  form  of  a  homogeneous  transparent  tissue 
or  of  a  cellular,  non-calcareous  tissue  which  may  be  finely  or  coarsely  granular 
(Fig.  1<)7).  The  liner  trabeculae  consist  in  places  exclusively  of  this  tissue.  The 
marrow  spaces  are  tilled  with  a  highly  vascular  tissue  which  is  at  first  embryonal 
and  fibrillary  and  later  contains  more  fat.  The  transformation  and  absorption  of 
the  bone  substance  proceeds  from  the  surroundings  of  these  vessels  in  which  multi- 
nuclear  giant  cells  appear   (so-called  osteoclasts). 

According  to  O.  Weber  the  s})ecific  gravity  of  osteomalacic  bones  is  low,  the 
fat  content  increased,  the  amount  of  inorganic  constituents  much  diminished;  the 
gelatinous  substances  are  also  dinniushed. — Keuscher  found  of  mineral  constituents 
only  32%%  instead  of  60  in  a  thigh  bone;  in  the  ribs  30%  instead  of  571/.;  jn 
the  vertebrae  and  the  pelvic  bones  26%  instead  of  57.  The  quantity  of  these  sub- 
stances is  therefore  reduced  to  one-half,  the  soft  tissue  increasing  in  like  proportion. 
Landois  found  in  the  bones  of  a  horse  with  osteomalacia  15.85%  of  fat;  12.59  of 
ossein;  47%  of  water,  and  22.57%  of  lime  salts,  a  percentage  that  was  quite  sim- 
ilar to  that  of  healthy  bones  Ilebrant  (!c  Mosselmann  found  the  mineral  constit- 
uents diminishe<l  on  an  average  by  10%,  the  ossein  by  8-9%  ;  the  water  was  in- 
creased by  3-4%,  the  fat  by  8-9%.  Ingle  showed  also  a  marked  diminution  of  the 
ash  constituents  of  the  l>ones. 

Finally  there  are  found  changes  suggesting  anemia  and 
cachexia,  principally  edematous  infiltration.  The  muscles  which 
are  attached  to  the  affected  bones  show  atrophy  and  fatty  de- 
generation ;  in  the  joints  and  tendon  sheaths  inflammatory 
changes  are  frequent,  as  are  also  ulcers  in  the  articular  carti- 
lages. 

Symptoms.  The  signs  which  are  characteristic  of  the  dis- 
ease are  preceded,  frequently  in  cattle,  less  so  in  the  other 
animals,  by  digestiye  disturbances  and  by  sjonptoms  of  licking 
disease.  Such  disturbances  are  observed  also  later  after  the 
changes  in  the  bones  have  become  manifest.  At  first  the  ani- 
mals simply  lick  the  manger,  the  iron  fastenings  and  the  walls, 
later  they  gnaw  them  and  swallow  portions  of  them.  They 
lick  and  gnaw  preferably  objects  which  contain  lime,  such  as 
mortar,  sand,  bits  of  stone  and  brick,  earthen  vessels,  etc.,  also 
woodwork,  the  latter  especially  if  it  is  rotten  or  covered  with 
soot.  Later  on  a  predilection  for  objects  which  have  a  dis- 
gusting smell  and  taste  becomes  more  and  more  marked ;  those 
portions  of  the  stable  which  are  soiled  with  feces  and  urine 
are  sought  out  and  eagerly  devoured,  and  all  sorts  of  foreign 
substances  are  swallowed.  At  first  the  patients  behave  in  this 
strange  manner  only  between  feeding  and  eat  the  fodder  which 
is  put  before  them  readily,  but  later  the  appetite  becomes 
gradually  worse,  the  animals  become  capricious,  eat  reluctantly, 
slowly,  and  steadily  smaller  amounts.  Still  later  they  refuse 
good  fodder  entirely  and  their  taste  is  perverted  to  such  a 
degree  that  they  may  prefer  urine  or  ichor  to  pure  water. 
Meanwhile  emaciation  becomes  manifest,  the  hair  loses  its  gloss 
and  becomes  rough,  the  skin  becomes  harsh  and  dry,  rumina- 


958 


Osteomalacia. 


tion  is  irregular  or  suppressed,  the  feces  are  tliin,  mushy  and 
foul  smelling. 

Klimmer  &  Schmidt  observed  the  nervous  disturbances 
described  in  the  chapter  on  rachitis  in  several  instances  in 
such  cattle  herds  in  which  osteomalacia  was  diagnosed  (p.  942). 

The  bone  disease  causes  pain  so  that  the  animals  lie  down, 
dislike  to  rise,  and  move  only  when  obliged  to.  On  standing 
they  arch  the  back  upward,  stand  with  their  feet  spread  apart, 
trip  restlessly  here  and  there,  lift  one  and  the  other  foot  and 
groan  while  discharging  urine  or  feces.  The  pains  are  often 
intermittent,  sometimes  paroxysmal  and  change,  similarly  to 


Fig.  168.     Osteomalacia  in  a  cow.     Emaciation;  lordosis  of  the  lumbar  vertebrae: 
the  sagittal  diameter  of  the  pelvis  is  diminished   (compare  Fig.  165). 


rheumatic  pains,  from  one  part  of  the  body  to  another,  becom- 
ing often  so  severe  that  horses,  for  instance,  roll  on  the  ground. 
The  animals  move  carefully,  their  walk  is  stiff  and  a  decided 
lameness  is  evident  in  one  or  the  other,  sometimes  in  all  four 
feet.  On  walking,  and  also  on  rising,  a  peculiar  cracking  sound 
is  perceptible,  probably  owing  to  the  loosening  of  the  articular 
capsules.  In  such  cases  the  bones,  still  more  the  joints,  the 
vertebral  column  and  the  pelvis  are  sensitive  to  pressure.  The 
lower  joints  of  the  feet,  also  the  tendon  sheaths  of  the  flexor 
tendons,  are  frequently  subject  to  inflammatory  processes  with 
sw^elling  of  the  respective  parts  of  the  body.  According  to 
Lienaux  the  Achilles  tendon  is  often  loosened  from  its  attach- 
ment. 

Meanwhile  the  solidity  of  the  bones  is  lessened  more  and 


Symptoms. 


959 


more  so  that  tliey  become  bent  or  fractured  on  sudden  motion, 
especially  on  rising  or  lying  down,  sometimes  even  for  appar- 
ently very  insignilieant  causes.  The  ribs  and  the  transverse 
processes  of  the  lumbar  vertebrae  can  at  times  be  (le])ressed 
easily  and  even  retain  linger  impressions.  In  goats  the  pliability 
of  the  skull  bones  may  reach  such  a  high  degree  that  the  an- 
terior portion  of  the  inferior  maxilla  may  l)e  bent  or  turiKM] 
in  an  angle  of  90°  (Richter).  Fractures  occur  most  frequently 
in  the  pelvic  bones  near  the  acetabulum,  in  the  ribs,  and  in 
the  proximal  long  bones  of  the  extremities,  also,  especially  in 
horses,  not  infre(iuently  in  the  vertebral  column.  Multiijlo 
fractures  or  Imlgings  are  observed  fairly  often  in  the  ribs  and 
on  the  jDelvis.     The  fractures   do   not  apix'ai-  to   cause  much 

Fip.  170. 


Fin-.     IfiO. 


Fig.  169.     Osteomalacia  in  a  cow,  whose  skeleton  is  illustrated  in  Fig.  165.  Asym- 
metry of  the  jielvis ;   bulging  of  the  left  hi|):  the  ])osterior  extremities  are  erossed. 

Fig.  170.     Osteomnlarin.     liulging  of  facial  bones  in  a  horse,   (.\fter  !Moussu.) 

pain,  but  tliey  further  diminish  the  power  of  motion  which 
has  already  been  reduced  by  the  spontaneous  pain,  because  they 
usually  either  heal  not  at  all  or  imperfectly. 

Deformities  occur  relatively  most  frequently  in  the  bones 
of  the  extremities,  the  ribs  and  the  vertebral  column.  In  the 
later  course  of  the  disease,  bulging  of  the  skull  bones  ("big 
head")  is  observed  exceptionally  in  cattle,  frequently  in  liorses, 


960  Osteomalacia. 

hogs  and  goats,  sometimes  also  in  dogs;  these  may  also  occur 
in  pelvic  bones.  The  head  appears  much  larger,  the  roof  of 
the  mouth  bulging  into  the  oral  cavity  which  therefore  becomes 
smaller,  or  it  becomes  impossible  to  close  the  mouth  so  that 
the  appearance  of  maxillary  paralysis  is  produced  (Figs.  IG-t 
and  170).  In  such  cases  there  is  blood  stasis  in  the  tongue, 
mastication  is  difficult  or  even  impossible.  The  bulging  of  the 
bones  causes  the  nasal  passages  to  become  narrow,  respiration 
becomes  difficult  and  accompanied  by  a  sniffling  or  snoring 
sound ;  even  attacks  of  asphyxia  may  occur.  The  bulging  bones 
are  elastic  and  easily  depressed. 

Moupsu  found  the  alkalinity  of  the  blood  diminished,  the  urinary  phosphates 
increased  five-fold ;  Haubner  &  Siedamgrotzky,  as  well  as  Marcone,  likewise  dem- 
onstrated a  considerable  increase  in  the  phosphorus  content  of  the  urine. 

The  emaciation  of  the  animals  gradually  increases.  The 
muscles  become  flabby  and  in  some  groups  of  muscles  there 
occur  at  times  fibrillary  tw^itchings.  With  the  severe  pain  in 
some  bones  there  is  associated  a  surprisingly  high  muscular 
tension  in  the  .  corresponding  region  ( Siedamgrotzky,  the  au- 
thors). The  temperature  is  usually  normal,  but  is  raised  to 
40°  C.  during  very  severe  pain,  and  also  in  case  of  extensive 
decubitus-gangrene.  The  secretion  of  milk  diminishes  steadily 
and  finally  ceases.  On  the  dry  skin  an  eczematous  eruption 
may  develop.  Finally  the  animals,  which  persistently  lie  pros- 
trate, become  totally  exhausted  and  perish. 

Course.  Osteomalacia  always  takes  a  very  chronic  course. 
Although  the  first  symptoms  usually  do  not  become  manifest 
and  the  disease  is  recognized  therefore  only  in  a  fairly  advanced 
stage,  several  months  usually  elapse  from  the  time  of  its  recog- 
nition to  that  of  complete  exhaustion.  Only  the  very  rare  cases 
with  severe  nervous  disturbances  usually  lead  to  death  in  a 
short  time.  At  times  the  disease  may  be  arrested  or  there 
may  be  improvement,  but  in  such  cases  relapses  may  occur. 
For  the  latter  gestation,  parturition  and  lactation  are  predis- 
posing factors  and  rapidly  progressive  aggravations  usually 
occur  during  such  times.  Sometimes  the  disease  has  been  latent 
for  some  time  and  becomes  manifest  only  through  such  an 
aggravation.  With  temporary  improvements  and  relapses  the 
disease  may  thus  extend  over  several  years. 

Diagnosis.  As  long  as  there  are  no  signs  of  bony  soften- 
ing, the  disease  cannot  be  recognized  positively  in  sporadic 
cases.  Licking  disease  may  occur  in  the  course  of  other  affec- 
tions, especially  in  gastric  catarrh,  while  pain  in  the  limbs  is 
observed  also  in  muscular  and  articular  rheumatism.  In  the 
presence  of  these  symptoms  the  suspicion  of  osteomalacia  is 
always  well  founded  if  the  fodder  is  poor  in  lime  salts.  The 
possibility  of  its  existence  must  also  be  considered  when  milch 


Diagnosis,    Prognosis,    Treatment.  QQ1 

COWS  become  ill  after  repeated  ])regnancies.  The  licking  disease 
which  occurs  in  the  course  of  gastric  catarrh  is  not  continuous; 
rheumatic  al^'ections,  especially  articular  rheumatism,  api)ear 
in  acute  attacks  with  febrile  symptoms,  and  alTect  usually  the 
higher  joints  of  the  feet,  while  callus  formation  is  absent,  es- 
pecially on  the  ribs. — ActinomjTOsis  of  the  facial  bones  is 
differentiated  by  being  mostly  unilateral  and  limited  in  extent, 
also  by  the  fact  that  the  other  parts  of  the  body  are  free  fi'om 
disease.  Kachitis  is  already  excluded  by  the  difTerent  age  of 
the  aniinals.  (According  to  Marcone  a  systematic  ((uantitative 
determination  of  the  urinary  phosphates  may  afford  diagnostic 
information,  but  must  be  made  with  reference  to  the  quality 
of  the  fodder.) 

In  regions  where  the  disease  is  enzootic  already  the  very 
first  symptoms  give  certain  indications  for  a  diagnosis,  but 
this  becomes  positive  only  when  softening  of  the  bones  can 
be  demonstrated. 

Prognosis.  As  long  as  extensive  deformities  or  fractures 
have  not  occurred,  the  animals  are  not  too  exhausted  and  an 
appropriate  regulation  of  their  hygienic  conditions  can  be 
carried  out,  the  symptoms  may  be  expected  to  retrogress,  but 
under  other  conditions  a  gradual  aggravation  of  the  trouble 
must  be  expected.  When  the  animals  can  no  longer  rise  or 
when  fractures  or  considerable  deformities  have  occurred,  im- 
provement cannot  be  obtained  by  any  treatment. 

According  to  Krabbe  281  out  of  ;?,24i)  sick  cows,  or  8.6%,  were  killed  in  Nor- 
way in  the  year  1877  as  incurable.  According  to  Bongartz,  the  frequency  of  cures 
is  20-25%,  while  Eudofsky  observed  about  16%  of  losses  during  an  epizootic  in 
Moravia  (1905). 

Treatment.  ^  The  removal  of  the  affected  animals  into  an- 
other region  with  favorable  conditions  of  soil  can  be  carried 
out  only  in  the  rarest  cases,  although  this  procedure  seems 
adapted  to  secure  healing  of  the  disease  in  cases  which  have 
not  progressed  too  far.  It  is  also  only  rarely  possible  to 
arrange  for  a  complete  change  in  feeding;  it  will  rather  be 
necessary  to  limit  endeavors  to  a  partial  change  of  feed,  in 
which  the  daily  amount  of  food-stuffs  which  in  spite  of  un- 
favorable conditions  of  soil  contain  com])aratively  much  lime, 
must  be  increased  considerably  (see  p.  933).  In  this  respect 
the  following  must  principally  be  considered :  Clover  hay,  good 
meadow  hay,  esparsette  hay,  bean-,  pea-,  lupine-,  buckwheat- 
straw,  perhaps  some  waste  from  oil  factories  (see  p.  933), 
especially  when  there  is  a  deficiency  in  phosphorus  in  the  feed. 
Green  feed  or  pasturing  on  good  pastures  also  influence  the 
course  of  the  disease  favorably,  as  has  been  observed  in 
the  extra-European  osteomalacia  of  equides  (Grandmougin, 
Sourrel).  Pasturing  has  the  disadvantage  that  the  motor  dis- 
turbances increase  at  first,  and  that  in  some  animals  they  only 

Vol.  1 — 61 


962  Osteomalacia. 

then  become  evident,  also  that  sometimes  an  increase  in  the 
frequency  of  fractures  is  observed.  The  supply  of  hard  drink- 
ing water  should  also  be  considered,  wherever  the  local  condi- 
tions permit  it. 

Lime  salts  should  always  be  added  to  the  food.  Among 
them  the  same  preparations  come  first  into  consideration  as 
are  used  in  rickets  (see  p.  947),  but  they  must  be  given  in 
sufficiently  larger  doses ;  for  instance,  for  large  animals,  accord- 
ing to  weight  and  employment,  and  to  the  probable  lime  con- 
tent of  the  food,  30-80  to  100-200  gm.;  for  smaller  ruminants 
and  hogs,  10-20  gm.  in  three  portions^  with  each  feeding.  If 
there  is  no  deficiency  in  phosphoric  acid,  chalk  is  efficient  and 
may  be  partially  (1/3-2/3)  replaced  by  calcium  chlorate,  which 
corresponds  to  about  two  parts  of  chalk,  or  hydrochloric  acid 
may  be  given  with  the  drinking  water  at  the  same  time.  In 
coexisting  phosphoric  acid  deficiency  "opened"  bone  meal  is 
indicated  and  is,  in  accordance  with  Klimmer  &  Schmidt,  given 
suitably  in  alternation  with  the  chalk,  thus  that  the  animals 
receive  for  2  or  3  days  a  calcium  preparation  and  during  the 
next  2  or  3  days  a  preparation  of  phosphoric  acid,  for  instance 
sodium  phosphate  (tablespoonful  3  times  daily).  The  other 
preparations  of  lime  (see  p.  948)  are  less  suitable.  The 
systematic  administration  of  HCl  or  of  NaCl  is  also  indicated 
in  such  cases  in  which  calcium  carbonate  is  not  given.  From 
phosphorus  (0.01-0.05  per  day  in  oil)  Klimmer  &  Schmidt  saw 
no  results.  If  symptoms  of  licking  disease  appear,  apomor- 
phine  hydrochlorate  (0.10-0.20  gm.  subcutaneously)  is  indicated 
according  to  Lenike,  who  claims  that  after  three  doses  the  licking 
disease  will  be  relieved  for  3  to  4  months  (Hafner  saw  no  im- 
provement follow  this  treatment).  In  cachectic  animals  Klimmer 
&  Schmidt  obtained  transitory  improvement  in  the  general 
condition  by  the  administration  of  pilocarpine  and  caffeine. 

The  suggestion  of  Rolotf  not  to  milk  the  affected  cows 
empty  and  to  exclude  them  from  breeding  during  the  duration 
of  the  disease,  deserves  consideration  if  the  economical  condi- 
tions permit  it.  Klimmer  &  Schmidt  believe  it  more  appropriate 
to  diminish  the  nitrogenous  food-stuffs  in  order  to  reduce  milk 
secretion,  or  to  permit  cows  in  advanced  pregnancy  to  stand 
dry  for  6  to  8  weeks.  Finally  the  extirpation  of  the  ovaries 
might  be  considered,  especially  if  a  proper  regulation  of  the 
diet  is  difficult,  yery  ill  animals  should  be  killed  as  soon  as 
possible. 

Prevention.  Experience  has  shown  that  the  disease  can 
be  prevented  by  proper  feeding,  especially  of  the  cows  during 
pregnancy  and  lactation,  and  by  suitable  cultivation  of  the  soil. 
Propli}' lactic  measures  merit  particular  consideration  in  regions 
where  osteomalacia  is  already  enzootic;  with  appropriate  fer- 
tilization, especially  after  the  use  of  fertilizers  which  contain 
phosphorus,  the  disease  usually  becomes  less  prevalent  in  such 


Licking  Disease.  963 

places.  (A  chemical  analysis  of  the  soil  is  always  advisahle 
for  the  purpose  of  improving  it  deliberately.)  If  the  feeding 
of  fodder  poor  in  lime  cannot  be  avoided,  the  animals  should 
systematically  receive  lime  preparations  in  the  amounts  indi- 
cated. 

If  there  is  a  suspicion  of  an  infectious  origin  of  the  trouble,  isolation 
of  the  diseased  animals  and  disinfection  of  the  stable  are  re(iuired. 

Literature.  Basset,  Rec,  1907.  167  (Lit.)-  —  Collard,  Bull.,  1893.  4.T1.  — 
Elliot  .T  of  Conip.  Path.,  1908.  206.  —  Grandniougin,  Eev.  gen.,  1905,  V.  .500. 
—  Hoennieke  U.  m.  W.,  1906.  116.  —  Iraiiiendorff,  Fortschr.  d.  ^  .-Hyg.,  190o. 
11  —  Ingle  J.  of  Conip.  Path.,  1907.  35.  —  Klininier  &  Schmidt,  Monh.,  1906. 
XVII.  481  (complete  Lit.).  —  Liithje,  A.  f.  exp.  Path.  u.  Phmk.,  1903.  L.  268.  — 
Marcone,  CI.  M.,  1903.  48L  —  Martin,  Rev.  gen.,  1905.  V.  499,  501.  —  Pecaud, 
Kev.  gen.,  1904.  III.  1.  —  Richter,  Z.  f.  Tm.,  1909.  XIL  394.  —  Rudofsky  O.  M 
1905.  193!  —  Schmidt,  Ergeb.  d.  Path.,  1897.  IV.  531  (complete  Lit.).  —  Sourrel, 
Rev.  gen.,  1906.  VII.  233.  —  Theiler,  Monh.,  1907.  XVIII.  193  (Lit.).  —  (See,  also, 
literature   on   rachitis. 


5.    Licking  Disease.    Allotriophagia. 

{Xaf/ekraukheif.    Lecksucht,  [German].) 

The  licking  disease  consists  in  a  morbid  tendency,  produced 
by  disturbances  in  metabolism,  to  lick,  gnaw  and  devour  various 
objects,  and  carries  in  its  train  chronic  digestive  and  nutritive 
disturbances  as  well  as  nervous  s^^nptoms. 

According  to  this  definition  the  morbid  perversions  of  taste  which 
are  often  observed  in  gastric  catarrh,  in  rabies  and  in  other  diseases 
are  not  classed  with  licking  disease. 

Occurrence.  Licking  disease  occurs  only  in  certain  regions 
and  affects  almost  exclusively  cattle,  more  particularly  cows 
and  weaned  calves  or  heifers.  In  the  affected  regions  the  dis- 
ease is  stationary  in  certain  premises,  but  occurs  enzootically 
after  failures  of  "crops,  causing  considerable  losses.^  The  symp- 
toms become  manifest  in  winter  and  their  intensity  is  the  higher, 
the  longer  the  winter  has  lasted.  The  disease  has  not  infre- 
quentlvbeen  observed  in  regions  in  which  osteomalacia  is  prev- 
alent (Roloff,  Roll,  Diem,  Brauer,  Hutyra  c^^  Marek). 

In  Germanv  the  following  parts  of  the  country  are  visited  by  the  disease: 
the  Saxonian  Erzgebirge,  the  Bavarian  Wald,  the  Western  Allgjiu,  the  Badish 
Black  Forest,  the  Swabian  Alp  (Ostertag  &  Zuntz).  More  recently  it  occurred 
with  {.articular  violence  on  the  Johannisburg  Heide  (in  Eastern  Prussia),  especially 
in  calves  and  heifers.  This  greater  prevalence  of  the  disease  coincided  in  time 
with  the  melioration  of  the  peat  fields. 

In  France  cases  of  the  affection  are  observed  distributed  fairly  evenly  throughout 
the  whole  country   (Moussu). 

Etiology.  Regarding  the  licking  disease,  which  occurred 
in  the  vicinity  of  Johannisburg,  the  investigations  of  Ostertag 
and  Zuntz  showed  that  the  causative  factor  is  a  food  poison, 


964  Licking  Disease. 

contained  in  peat  hay  and  which  is  not  known  exactly.  It  occurs 
in  greater  quantities  in  the  hay  of  meliorated  meadows  than  in 
other  meadow  hay,  is  entirely  absent  in  meadow  plants  before 
they  are  in  bloom,  also  in  the  hay  of  the  first  cut  before  bloom- 
ing time  and  in  the  clover  hay  of  meadows  which  are  otherwise 
dangerous.  The  second  crop  of  hay  is  less  dangerous  than  the 
first.  The  poisonous  substance  is  destroyed  entirely  or  par- 
tially by  steaming,  heating  to  80°  C.  and  during  the  preparation 
of  ''brown  hay."    It  has  no  harmful  effects  on  horses. 

The  presumable  poison  is  present  in  the  injurious  hay  in  com- 
paratively small  amounts  and  therefore  it  produces  gradually  increasing 
disturbances  of  metabolism  through  a  cumulative  action  and  only  after 
the  hay  has  been  fed  for  a  long  time.  These  disturbances  cause  a 
defective  formation  of  blood  and  bone  tissue  and  eventually  give  rise 
to  a  morbid  tendency  to  gnaw  and  to  lick.  The  elimination  of  Na,  Ca 
and  of  P  is  greater  than  the  intake. 

The  chemical  composition  of  Johannisburg  peat  meadow  hay  is 
insufficient  also  in  so  far  as  the  hay  is  poor  in  Na  and  Ca  salts  and 
rich  in  K  salts.  Although  the  quantity  of  the  ashes  was  found  in- 
sufficient, the  cause  of  the  disease  can,  according  to  Ostertag  and  Zuntz, 
not  lie  in  a  mineral  deficiency  of  the  fodder,  because  the  addition  of 
NaCl,  of  calcium-,  phosphorus-  and  iron-preparations  to  the  hay  did 
not  influence  the  toxic  action  and  because  this  could  be  destroyed  by 
heating. 

How  far  the  results  of  Ostertag  &  Zuntz  ma^^  be  applied 
to  licking  disease  occurring  in  other  places  cannot  be  determined 
at  present.  For  those  cases,  indeed,  in  which  licking  disease 
develops  in  connection  with  osteomalacia  or  simultaneously  with 
this  disease,  the  same  causes  are  probably  active.  It  appears 
that  particularly  the  deficiency  in  nutritive  salts  is  of  essential 
importance  in  this  respect. 

As  other  causes  of  the  disease  eoTitagion,  heredity,  imitation,  bad  care,  have 
been  mentioned. 

From  what  has  been  said  it  is  evident  that  a  close  relation 
exists  between  licking  disease  and  osteomalacia,  since  in  both 
diseases  certain  changes  in  the  bones  develop  under  the  influ- 
ence of  disturbances  of  metabolism.  The  most  important  dif- 
ference between  the  two  is  seemingly  that  licking  disease  occurs 
apparently  independently  and  leads  to  severe  cachexia  even 
before  manifest  softening  of  the  bones  has  developed.  But  since 
in  such  cases  the  bones  have  not  been  examined  microscopically, 
the  possibility  cannot  be  excluded  that  changes  corresponding 
to  osteomalacia  are  indeed  present,  only  not  in  such  a  degree 
that  the  softness  of  the  bones  could  be  determined  by  the  coarser 
methods  of  examination;  and  this  is  evident  from  the  observa- 
tions of  Ostertag  &  Zuntz.  It  is  thus  thinkable  that  licking 
disease  actually  owes  its  development  to  osteomalacia,  but  that 


Etiulugy,  Auatuinical  Changes,   Syniptoius.  y(35 

ill  its  course  the  debility  progresses  much  more  rapidly  than 
the  pathological  process  in  the  bones. 

Anatomical  Changes.  In  far  advanced  stages  of  the  dis- 
ease tliere  occur  severe  anemia  and  emaciation,  with  compicte 
atroi)hy  of  the  fatty  tissue,  muscular  atrophy  and  atrophy  of 
glandular  organs.  Ostertag  c^'  Zuntz  also  demonstrated  atroi)liy 
and  rarilication  of  the  compact  bon}'  tissue,  with  otherwise  nor- 
mal chemical  composition  of  the  bones,  also  a  brittleness  of  the 
ribs. 

Symptoms.  At  first  the  desire  to  eat  is  diminished,  rumina- 
tion is  slow,  defecation  arrested.  The  aberrations  in  taste  or 
the  peculiar  characteristic  phenomena  appear  only  after  these 
syni])toms,  increasing  gi-adually  and  assuming  the  form  which 
has  been  described  in  the  chajiter  on  osteomalacia  (page  957). 
Together  with  the  lessened  desire  to  eat,  emaciation,  timidity 
and  an  increased  sensibility  become  manifest  in  the  animals. 
Pregnant  cows  often  abort  during  the  disease.  The  symptoms 
l)ersist  for  2-4  months,  according  to  the  severity  of  the  disease, 
lead  gradually  to  cachexia  and  finally  the  animals  die  of  starva- 
tion. 

Course  and  Prognosis.  The  affection  always  takes  a 
chronic  course  and  extends  over  few  to  several  months,  some- 
times even  a  j^'ear  and  more,  during  which  time  temporary 
remissions  in  the  symptoms  may  take  place.  If  no  change  is 
made  in  the  hygienic  conditions,  fatal  termination  is  the  usual 
outcome,  but  otherwise  licking  disease  may  be  cured,  except  in 
very  severe  cases  with  marked  cachexia. 

Treatment.  A  positive  result  can  be  expected  only  from 
pasturing,  although  the  improvement  will  make  only  slow 
progress.  In  several  instances  a  favorable  influence  was 
observed  from  a  change  of  feed,  the  addition  of  linseed  or 
linseed  cake,  or  feeding  with  slops,  carrots,  molasses  (Klein- 
paul)  causing  the  symptoms  to  diminish.  On  the  other  hand, 
()stertag  &  Zuntz  found  the  admixture  of  highly  nutritious  food- 
stuffs or  of  nutritive  salts  to  the  injurious  hay  useless,  and  also 
apomorphine,  which,  however,  was  employed  by  some  veterina- 
rians (Hackl,  Eeindl,  Lemke)  with  lasting  success,  by  Klein- 
])aul  with  only  transitory  benefit.  The  remedy  was  given  hypo- 
dermically ;  to  adult  cattle  and  to  calves  in  doses  of  0.10-0.20  gm. 
daily  three  times,  for  three  days  (Kleinpaul;  to  horses  three 
times  daily  with  3-day  intervals  (Hillebrand).  (After  the 
injection  calves  must  be  put  in  a  closed  place  in  order  to  prevent 
their  injuring  themselves,  because  apomorphine  produces  in 
them  a  very  decided  excitement  [Kleinpaul]). 

If  the  disease  is  associated  with  osteomalacia,  the  treatment 
described  for  this  disease  is  indicated  (page  961). 


966  Wool    Eating. 

Prevention.  If  the  disease  has  developed  after  feedin^^  of 
peat  meadow  hay,  its  occurrence  may  be  prevented  permanently, 
according  to  Ostertag  &  Zuntz,  by  using  the  peat  meadows  for 
pasturage,  by  ''brown  hay"  in  place  of  the  ordinary  hay,  or  b}^ 
sowing  clover  on  the  peat  meadows.  On  the  other  hand,  the 
harm  is  only  diminished  if  the  hay  is  treated  with  scalding  water 
or  if  it  is  steamed ;  although  animals  may  be  carried  through  the 
winter  fairly  well  on  hay  treated  in  this  manner.  The  poisonous 
effect  of  the  hay  may  also  be  reduced  by  fertilizing  the  meadows 
with  sodium  nitrate.  A  further  preventive  measure  consists  in 
feeding  cattle  in  the  affected  regions  only  with  second  crop  hay, 
or  with  the  first  crop  which  has  been  cut  before  flowering.- — 
Brauer  and  Lippold  observed  favorable  effects  from  draining 
the  pastures. 

Literature.  Berndt,  P.  Vb.,  1902.  II.  30.  —  Brauer,  S.  B.,  1885.  63;  1890. 
80;  1893.  121.  —  Hillebrand,  W.  f.  Tk.,  1906.  367.  —  Kleinpaiil,  B.  t.  W.,  1903.  1.  — 
Leibenger,  W.  f.  Tk.,  1906.  .542.  —  Lenike,  D.  Z.  f.  Tni.,  1882.  VIII.  ]02.  — 
Lippold,  S.  B.,  1890.  80.  —  Ostertag  &  Zuntz,  Z.  f.  Infkr.,  1907.  II.  409.  —  Weigel, 
S.  B.,  1893.  121. 


6.    Wool  Eating. 

Occurrence.  Wool  eating  is  observed  in  the  finer  ])reeds  of 
sheep  only  during  wintering,  especially  toward  the  end  of  winter, 
and  causes  considerable  losses  in  wool,  sometimes  even  death 
owing  to  the  formation  of  hair  balls  in  the  stomach. 

Etiology.  Apparently  wool  eating  is  often  only  a  bad  habit 
which  is  possibly  formed  in  consequence  of  the  tedium  of  the 
young  animals  when  they  are  constantly  kept  in  the  stal^le, 
and  may  be  assumed  to  spread  by  imitation.  It  is,  however, 
very  probable  that  in  certain  cases  insufficient  feeding  or  an 
unsuitable  chemical  composition  of  the  fodder,  especially  a 
deficiency  in  nutritive  minerals  is  a  factor. 

Symptoms.  In  a  drove  of  sheep  a  few  lambs  begin,  usually 
already  in  early  winter,  but  mostly  not  until  later,  to  gnaw  the 
wool  of  their  mothers,  preferaljly  on  the  thighs,  on  the  abdomen 
and  the  tail,  that  is  principally  on  those  parts  of  the  body  which 
are  soiled  with  urine  or  feces.  More  and  more  of  the  lambs 
follow  the  example,  and  eventually  not  only  their  own  mothers, 
but  other  sheep  as  well  are  attacked,  the  lambs  gnawing  at  them 
together.  Among  yearlings  or  older  sheep  also,  one  or  at  most 
a  few  animals  begin  to  gnaw  the  wool  of  another  one,  but  pres- 
ently more  and  more  animals  acquire  this  vicious  habit.  At  first 
the  gnawing  sheep  attack  the  same  animal,  choosing  a  new 
victim  only  when  they  have  eaten  all  the  wool  off  the  first  one. 
In  this  manner  the  evil  assumes  a  constantly  increasing  exten- 
sion, until  finally  all  sheep  have  acquired  the  habit  and  the  wool 
eating  has  become  general  in  the  drove. 


!Syuiitti)iii.s,    Diagnosis;,    Treatment.  907 

Usually  the  animals  appear  to  be  in  good  health,  only  of  the 
lambs  a  few  perish,  exceptionally  many  (Moussu,  Richard), 
because  wool  balls  have  formed  in  a  compartment  of  the  stomach 
and  occlude  the  openings  of  some  of  the  compartments  or  the 
himen  of  the  intestine.  In  older  sheep  at  most  slight  nutritional 
disturbances  are  observed,  although  in  exceptional  cases  S5^np- 
toms  of  anemia  and  emaciation  nuiy  occur. 

Diagnosis.  The  fact  that  wool  eating  is  indulged  in  pref- 
eral)ly,  and  at  first  exclusively,  in  day  time  and  in  the  intervals 
between  feeding,  and  also  the  fact  tJuit  the  animals  gnaw  only 
the  wool  of  their  fellows,  never  their  own,  is  sufficient  to  dis- 
tinguish this  vice  from  other  diseases  which  are  accompanied 
with  itching  and  also  from  trembling  disease. 

Treatment.  The  habit  can  usually  be  removed  by  isolating 
the  wool  eaters  as  well  as  their  victims.  It  is  advisable,  even  in 
winter,  to  turn  the  animals  out  of  doors  for  a  certain  time 
during  the  day,  when  the  weather  conditions  permit  it;  more- 
over it  is  necessary  to  provide  proper  food  and  a  sufficient  min- 
eral content  of  the  food.  If  the  ewes  give  little  milk,  the  lambs 
should  receive  cow's  milk  to  make  up  the  deficiency.  Lemke 
obtained  excellent  results  from  the  subcutaneous  administration 
of  apomorphine  hydrochloride  (0.1-0.2  grn.,  a  dose  for  three 
days). 

Literature.  Korte,  Tierzueht,  1892.  218.  —  Lemke,  I).  Z.  f.  Tm.,  1882. 
VIII.  102. 


Feather  Eating  and  Feather  Pulhng  in  Birds.  This  vice  is  ob- 
served most  fre(iiieiitly  in  caged  birds,  especially  in  parrots  and  canaries, 
but  not  infrequently  also  iu  domestic  fowls,  especially  in  chickens. 

The  causes  of  feather  eating  are  probably  various.  Klee  considers 
as  the  most  frequent  cause  the  deficiency  in  certain  nutritive  substances 
iu  the  body,  which  is  due  to  one-sided  feeding  of  animals  which  are  at 
the  same  time  confined  permanently  in  narrow  quarters,  so  that  they 
have  no  opportunity  of  picking  up  insects  and  worms,  chalk  or  greens. 
(3ther  authors  take  feather  eating  to  be  mainly  a  ])ad  habit  originating 
in  play  or  in  tedium,  when  the  animals  have  but  little  opportunity 
to  move  about  in  the  open  air,  and  although  their  food  is  unobjec- 
tionable. Feather  eating  may  also  develop  in  consequence  of  itching 
skin  diseases  and  owing  to  the  itching  sensation  when  the  young  feathers 
break  through  during  moulting  (Klee).  In  this  manner  the  feather 
eating  which  occurs,  although  rarely,  in  well-kept  fowls  may  be  ex- 
plained. 

Symptoms.  In  feather  pulling  the  animals  pull  out  eitlier  their 
own  feathers  or  those  of  their  fellows.  Among  chickens  the  most 
beautiful  and  valual)le  laying  hens  often  first  acquire  this  bad  habit. 
At  first  only  occasionally  isolated  feathers  are  pulled  out,  but  later 
even  the  newly  growing  feathers  are  torn  out  so  that  the  body  becomes 
disfigured  by  the  bald  spots  which  are  produced. 


968  Gout. 

Feather  eating  differs  from  falling  out  of  feathers  in  various  skin 
diseases  or  in  nutritive  disturbances,  in  that  in  the  latter  feathers  are 
never  pulled  out. 

The  treatment  is  adjusted  to  the  cause.  In  most  cases  a  change 
of  food  and,  when  the  weather  permits,  the  opportunity  for  sufficient 
exercise  in  the  open  air  are  indicated.  Klee  and  others  saw  good 
results  from  the  administration  of  the  blood  of  slaughtered  animals, 
which  was  cooked  and  mixed  with  bran  or  curds.  In  addition  the 
animals  should  receive  green  feed  or  cooked  carrots,  also  chalk 
(powdered  egg-shells,  burned  shells,  bone  meal).  In  general  the 
principal  stress  should  be  laid  upon  as  much  variety  as  possible  in 
feeding.  Parrots,  which  are  freed  only  with  difficulty  from  the  vice 
may  be  given  sepia  or  bitter  chocolate.  If  there  is  itching,  daily 
sprinkling  with  water  or  with  a  5%  solution  of  thiol  may  be  effective. 

The  feather  eaters  should  be  kept  isolated  and  if  possible  in  a 
dark  place.  Sometimes  apomorphine  hydrochloride  is  useful,  injected 
subcutaneously  in  doses  of  0.0005-0.001  gm.  or  in  drinking  water 
0.05:100  (Friedberger  &  Frohner,  Klee).  Inunctions  with  remedies 
having  a  disagreeable  odor  or  taste  (tincture  of  aloes,  veratrum, 
asafetida,  gentian,  rancid  animal  oil,  carbolic  acid)  do  not  accomplish 
the  purpose  and  may  in  fact  be  injurious. 


7.     Gout. 

{Gicht,  [German]  ;  Goutte,  [French]  ;  Gotta  [Italian].) 

Gout  depends  upon  the  storage  and  deposition  of  urates 
in  the  tissues  of  the  internal  organs  (visceral  gout),  or  at  tlie 
same  time  also  in  the  joints  (arthritis  urica)  and  is  based  upon 
disturbances  in  metabolism. 

Occurrence.  Gout  is,  almost  without  exception,  observed 
only  in  birds,  in  which  it  is  of  rather  frequent  occurrence. 
Among  domestic  fowls  chickens  are,  according  to  Klee,  affected 
with  preference,  less  so  water  fowl,  and  most  rarely  pigeons. 
(Hartenstein  observed  visceral  gout  enzootically  in  a  large 
goose  establishment,  but  described  it  under  the  name  of  uremia.) 
Pheasants  are  affected  not  infrequently.  But  the  disease  is 
met  with  most  often  in  the  birds  of  prey  of  the  zoological  gar- 
dens, less  often  in  ostriches.  It  develops  only  rarely  in  birds 
kept  in  the  house,  and  birds  living  at  large  do  not  appear  to 
become  affected  at  all.  Among  mammals  only  a  few  cases  were 
observed  so  far  in  older  dogs  (Spinola,  Brnckmiiller),  although 
Vogt  claims  to  have  seen  a  gouty  affection  also  in  a  horse. 
Finally  the  disease  has  been  noted  in  reptiles  (alligator,  snakes) 
(Kitt).  Virchow  and  IVEendelsohn  recorded  deposits  of  guanin 
in  the  joints  in  two  hogs.  Pflug  found  a  guanin  deposit  in  a 
ham.  In  a  cow  which  during  life  had  shown  poor  appetite,  ineffi- 
cient nutrition  and  frequent  epistaxis,  Joest  demonstrated 
deposits  of  xanthin  in  the  spleen,  the  lymph  glands  and  the 
kidneys. 


Etiology,    Pathogenesis.  969 

Etiology.  AVitlioiil  a  doubt  gout  stands  in  close  relation  to 
tlie  diet,  since  it  develops  ]ireferably  on  generous  feeding  witli 
substances  containing  much  albumin,  especially  nucleoproteids. 
Such  substances  are  especially  the  thymus  glands,  the  liver, 
kidneys,  brain,  pancreas,  and  the  flesh  of  animals  in  general 
^vhich,  althougli  ])oor  in  nuck'i,  yet  contains  nnicli  hypoxantliin ; 
young  germinating  plants  also  contain  much  of  nucleoproteids 
(Kionka  and  Bannes  produced  typical  gout  in  birds  by  feed- 
ing tlieni  for  weeks  and  months  exclusively  on  horseflesh).  That 
certain  cliemical  snl)stances  liave  an  etiological  importance  is 
indicated  l)y  the  ex|)erience  tiiat  in  man  the  disease  may  occur 
in  connection  with  chronic  lead  poisoning,  and  v.  Kossa  pointed 
out  the  gout  producing  action,  upon  chickens,  of  chromic  acid, 
oxalic  acid,  carbolic  acid,  corrosive  sul)limate,  cane  sugar,  aloine 
and  acetone.  According  to  earlier  observations  smut  fungi 
(Ustilago  maidis)  also  are  said  to  be  capable  of  causing  gout 
in  birds.  Finally  the  disease  probably  develops  in  birds  in 
certain  cases  in  connection  with  disease  of  the  kidneys  or  ure- 
ters, for  Ebstein  and  others  succeeded  in  producing  gout  artifi- 
cially in  birds  by  ligating  the  ureters,  and  v.  Kossa  proved 
in  cases  of  toxic  gout  that  nephritis  must  be  considered  as  a 
cause  for  the  deposition  of  urates  in  the  tissues. 

Favoring  factors  are  want  of  exercise  or  confinement  of 
the  animals.  Of  birds,  especially  the  more  carefully  bred  and 
kept  large  breeds  are  inclined  to  the  disease  (cochin-china, 
brahma),  then  adult  and  especially  older  animals.  Male  animals 
are  affected  more  frequently  than  females.  Lastly  it  appears 
that  individual  peculiarities  are  of  essential  importance  for  the 
predisposition. 

Pathogenesis.  The  mode  of  development  of  gout  is  at 
present  not  entirely  cleared  up.  This  much  may  be  concluded 
from  investigations  or  animal  experiments  that  have  been  made 
that,  under  the  influence  of  the  enumerated  causative  factors, 
an  increased  production  of  uric  acid  occurs,  and  also  a  toxic 
nephritis,  the  latter  either  under  the  influence  of  the  eliminated 
toxins  or  also  in  consequence  of  the  excess  in  uric  acid.  The 
increased  formation  of  uric  acid,  together  mtli  the  inhibition 
(owing  to  the  existing  nephritis)  of  the  elimination  of  urates, 
lead  to  a  storing  of  urates  in  the  blood  (Benion,  Kionka,  v. 
Kossa)  and  under  certain  conditions  to  the  deposit  of  urates 
in  the  tissues.  According  to  Brugsch  &  Schittenhelm,  the  ulti- 
mate cause  of  gout  may,  however,  lie  in  a  deficient  transforma- 
tion of  the  purin  bases  which  are  formed  from  the  nucleo- 
proteids (first  of  all  of  the  hypoxantliin)  into  uric  acid,  and  in 
retarded  comlmstion  of  the  uric  acid,  owing  to  the  absence  of 
certain  ferments. 

Accorilinfj  to  El)stein  the  urates  which  are  eliminated  from  the  blood  produae 
necrotie  foci  in  the  tissues,  esjjpcially  in  ])la<'es  where  the  eircnlation  is  very  slow, 
and  are  only  later  deposited  in  the  necrotic  tissue  in  the  form  of  crystals.     Around 


970  Gout. 

these  foci  a  secondary  iuflammatory  reaction  occurs  with  emigration  of  white 
blood  cells.  Almagia  "found  that  cartilage  tissue  of  itself  decidedly  attracts  uric 
acid. 

In  disturbances  of  the  renal  function  from  other  causes,  or 
in  a  mechanical  impediment  to  the  flow  of  urine,  the  storage  and 
deposition  of  urates  occurs  even  without  a  previous  increase  in 
the  formation  of  uric  acid. 

The  source  of  the  uric  acid  are  the  albumins  of  the  body,  both  those  ingested 
with  the  food  and  those  that  have  disintegrated;  in  mammalians  the  nuclein  bases 
are  here  especially  concerned,  in  birds  all  albuminous  substances.  The  uric  acid 
content  of  the  blood  is  therefore  probably  increased  for  the  reason  that  the  animal 
ingests  an  excess  of  albuminous  substances.  The  fact  that  among  domestic  animals 
birds  which  even  normally  eliminate  very  much  uric  acid  are  affected  almost 
exclusively,  indicates  the  predisposing  influence  of  the  presence  of  uric  acid  in 
large  amounts.  Nothing  positive  is  known  about  the  cause  for  the  elimination 
of  the  urates  of  sodium  and  calcium  which  are  in  solution  in  the  blood.  The  fact 
that  the  serous  membranes  and  often  the  joints  of  the  extremities  are  usually 
affected,  might  in  part  stand  in  relation  to  their  being  constantly  subjected  to 
mechanical  irritation,  and  to  the  very  slow  blood  circulation  in  the  joints  as  well 
as  in  the  serous  cavities,  although  it  might  also  be  the  consequence  of  some  metabolic 
disturbance  of  these  parts  of  the  body. 

Anatomical  Changes.  In  visceral  gout,  which  is  by  far  the 
more  frequent  form,  the  serous  membranes  of  the  thorax  and  the 
abdominal  cavities,  especially  the  pleurae  or  the  peritoneum,  the 
membranes  of  the  air  sacs,  the  pericardium,  also  the  surface  of 
the  heart,  and  the  liver  are  covered  more  or  less  densely  with 
masses  that  are  dust-like  or  chalky,  and  mortar-like ;  the  kidne^'^s 
are  dotted  white  and  the  ureters  are  sometimes  filled  with  white 
plugs. 

Articular  gout,  which  is  much  less  frequent,  atfects  prefer- 
ably the  articulations  of  the  feet,  less  often  also  those  of  the 
wings,  leading  to  swelling  of  the  involved  joints,  in  and  around 
which  white  chalky  swellings  or  deposits  are  seen  wliicli  are 
like  peas  to  cherries  in  size.  Similar  foci  are  also  found  in  the 
adjoining  bone  tissue  and  bone  marrow,  in  the  articular  liga- 
ments and  tendons,  less  often  in  the  cartilages  of  the  larynx, 
in  the  vessel  walls  or  under  the  skin. 

In  the  chalky  masses  great  numbers  of  crystals  which  consist  of  sodium 
urate  are  seen  under  the  microscope,  especially  after  the  addition  of  some  acid. 
These  crystals  may  sometimes  be  demonstrated  also  in  organs  which  present  no 
microscopic   changes. 

Symptoms.  In  articular  gout  the  joints  that  are  affected 
most  frequently  are  the  metatarsal,  tarsal  and  phalangeal 
joints,  and  on  the  wings  the  elbow  joints.  There  is  at  first 
aching,  the  atfected  animals  moving  about  only  unwillingly  and 
going  lame;  tlie}^  remain  in  one  place  or  stand  on  one  foot  in 
order  to  ease  the  pain.  If  the  wings  are  affected  these  are  kept 
as  quiet  as  possible,  and  when  the  animals  are  disturbed  they 
flap  at  most  a  few  times  with  their  wings.  At  the  same  time  the 
joints  swell  (Fig.  171),  and  while  the  swellings  which  are  soft 
and  sensitive  are  at  first  not  sharply  circumscribed,  later  on 
isolated  nodes  (tophi  s.  Noduli  arthritici)  are  more  and  more 


Syiuptoiii> 


971 


sharply  demarcated  I'roiii  the  siuTOundiiig  tissue  and  form  hnii, 
not  very  painful,  tumors  which  are  closely  united  to  the  carti- 
lage, less  often  freely  movable  upon  it.  The  nodular  swellings 
are  as  a  rule  of  froni  hempseed  to  lentil  size  but  may,  in  excep- 
tional eases  and  in  the  larger  birds,  l)ecome  as  large  as  pigeon 
eggs.  The  development  of  such  thickenings  on  several  joints 
causes  very  striking  deformities.  The  toes  are  spread  apart  by 
lUKles  in  their  joints,  are  bent  toward  the  soles  and  tlius 
apparently  shortened. 

The  motility  of  the  affected  joints  becomes  limited  nunc 
and  more  and  may  develop  into  complete  ankylosis.  Sometimes 
sof  t  e  n  i  n  g  occurs 
later  in  some  joints, 
the  skin  over  the 
softened  places  be- 
coming thinner  and 
finally  necrotic; 
through  the  result- 
ing opening  a  soft, 
crumbly,  yellow- 
gray  substance,  like 
gypsum,  is  dis- 
charged. The  bor- 
ders of  the  ulcers 
which  form  in  this 
manner  are  irregu- 
,  lar  and  bleed  easily; 
their  base  is  formed 
by  cartilage  or  by 
exposed  bone  tissue, 
or  the  probe  may 
e  V  e  n  e  n  t  e  r  a  n 
opened  joint.    These  ulcers  may  form  in  succession  and  become 

confluent.  i   •       i      .      i 

Smaller  liard  nodes  are  sometimes  found  m  the  tentlons, 
skin  and  subcutis,  and  may  even  surround  the  base  of  the  quills. 
With  the  further  progress  of  the  disease  more  joints  are 
constantly  involved,  and  the  nutrition  of  the  animals  is  inter- 
fered with.  The  feather  coat  becomes  rough,  some  feathers 
fall  out,  the  comb  and  wattles  become  pale,  the  animals  are 
finally  hardly  able  to  move  from  place  to  place,  and  perish  of 
exhaustion  and  emaciation. 

In  dogs  nodular  thickenings  were  observed  on  the  lower  artienla- 
lions  of  tlfe  feet  and  on  the  lower  ends  of  the  ribs. 

Tn  the  supposed  gout  of  a  horse  Yoigt  noted  painful  swellings 
on  the  bones  of  the  extremities  near  the  joints,  and  lameness.  Various 
parts  of  the  extremities  were  affected  alternately,  giving  rise  to 
paroxysms.  The  appetite  was  diminished  and  the  urine  contained 
uric  acid  crystals.  The  disease  terminated  in  recovery  in  the  course 
of  a  year. 


^^3 


Fig.   171.     Articular  cjoiit  in  n  hm.  (After  Kioxka-) 


972  Gout. 

Visceral  gout  is,  in  its  ordinary  course,  manifested  by  sim- 
ilar nutritive  disturbances  as  the  articular  variety;  but  unless 
the  joints  are  likewise  affected,  the  actual  cause  of  the  disturb- 
ances cannot  be  recognized  during  life. 

Course  and  Prognosis.  The  course  of  gout  is  almost  with- 
out exception  chronic,  only  Hartenstein  observed  the  disease  in 
an  acute  form  in  geese.  In  most  cases  only  one  extremity  is 
affected  at  first,  and  other  joints  not  for  several  months,  usually 
the  corresponding  joints  on  the  other  side ;  in  the  meantime  the 
acute  signs  in  the  joint  that  was  first  atfected  have  diminished, 
and  the  general  condition  of  the  patient  has  improved.  The 
involvement  of  other  joints  is  usually  introduced  by  acute 
symptoms  which,  however,  later  go  down. 

The  prognosis  is  unfavorable,  since  complete  healing  is 
rarely  observed.  This  may  be  looked  for  at  most  in  domestic 
fowl  that  live  in  the  open;  in  birds  kept  in  captivity  the  disease 
progresses  steadily  and  leads  the  sooner  to  complete  exhaustion. 

Diagnosis.  For  the  positive  determination  of  gout  in  the 
living  animal  the  microscopical  or  chemical  demonstration  of 
uric  acid  or  of  urates  is  absolutely  necessary. 

For  the  microscopical  examination  the  material  to  be  examined  is  rubbed 
up  on  a  glass  slide  with  pure  or  slightly  acidulated  water,  after  which  the  crystals 
of  sodium  urate  are  recognized  as  very  fine  needles  which  form  sheafdike  groups 
or  radiating  balls.  The  chemical  test  for  uric  acid  is  properly  made  with  the 
Murexid-reaction.  The  secretion  is  mixed  in  a  porcelain  dish  with  a  few  drops 
of  concentrated  nitric  acid  and  is  warmed  slowly  until  the  mass  is  dried;  if  ammoniac 
is  added  to  the  onion  red  residue  after  this  has  become  cold,  it  assumes  a  ]nirple 
color,  while  the  addition  of  sodium  hydrate  produces  a  violet  coloration  which 
disappears  on  heating. 

Tuberculosis  of  fowls  or  the  chronic  forms  of  fowl  cholera 
may  cause  similar  changes  in  the  joints,  and  if  other  indications 
of  these  diseases  are  absent,  or  if  no  information  is  afforded 
by  outside  conditions,  the  exact  nature  of  the  disease  can  be 
determined  only  by  the  microscopical  or  chemical  examination 
of  the  secretion.  Purulent  arthritis  and  periarthritis,  and  also 
articular  rheumatism  are  differentiated,  at  least  in  a  part  of  the 
cases  by  a  more  chronic  course. 

Treatment.  The  diet  of  the  sick  animals  should  bo  n^g- 
ulated  in  such  a  manner  that  they  receive  only  limited  rations 
of  nitrogenous  substances,  especially  such  as  are  rich  in  purin 
bases  or  nucleoproteids.  Alkaline  salts  (sodium  bicarbonate, 
Carlsbad  salt,  etc.)  may  be  added  to  the  drinking  water.  The 
patients  should  be  enabled  to  exercise  freely,  especially  in 
pure  dry  air,  a  desideratum  which  is  usually  not  feasible  in 
captive  birds.  Experiments  in  birds  having  permitted  the 
conclusion  that  the  deposit  of  urates  is  prevented  when  piper- 
azine  is  present  in  the  blood,  this  remedy  might  be  tried  in  the 


Syniptciiis.  973 

.sick  animals  (cliickcns  0.5-1.0  gm.,  pig-eons  0.40-0.r)()  .i;in.  daily, 
hioktMi  nj)  in  frt'(}n(Mitly  repeated  doses  and  administered  for  4-0 
days).  Human  physicians  observed  in  acute  gout  analgesic 
effect  from  tincture  of  colcliicum,  and  this  remedy  might  also 
be  tried  in  the  articular  gout  of  l)irds  (2-5  drops). 

If  symi)toms  of  acute  inflammation  are  present,  the  affected 
joints  are  wrapped  in  salicylated  cotton,  which  may  previously 
be  dipped  in  alcohol  or  carbolic  acid.  Later  on  the  operative 
removal  of  the  well  circumscribed  nodes  may  be  attempted,  espe- 
cially of  those  in  the  skin  and  in  the  sul)cutaneous  connective 
tissue,  or  the  softened  nodes  may  be  opened  and  curetted,  after 
w  liicli  the  opened  joints  are  irrigated  with  a  weak  disinfectant 
solution. 

It  will  be  best  to  fatten  and  kill  animals,  which  are  intended 
for  the  table,  innnediately  on  the  appearance  of  even  moderately 
severe  symptoms. 

Literature.  Bamies,  vet.  Jhb.,  1901.  251.  —  Blaiiehard,  ihid.,  1891.  19(1.  — 
Frioilboi-Ker,  W.  f.  Tk.,  1S79.  38.  —  Hartenstein,  Vet.  Jhb.,  1899.  237.  —  Hebraiit 
\-  Antoiiie,  Ann.,  1909.  321.  —  Johne,  S.  B.,  1877.  89;  1879.  39;  1881.  66.  — 
Kionka,  A.  f.  exp.  Patli.  u.  Phmk.,  1900.  XLIV.  207.  —  Kitt,  Monh.,  1893.  IV. 
497.  —  Klee,  Getliiyelkrkh.,  1905.  51.  —  Kossa,  Kozl.,  1899.  III.  65;  1907.  VII. 
101.  —  Pfluji-.  Mag.,  1871.  197.  —  Siedamgrotzky,  S.  B.,  1872.  89.  —  Vogt,  D. 
t.    \V.,   1906.   357. 


9.     Scurvy.     Scorbutus. 

Scurvy  is  a  peculiar  form  of  the  hemorrhagic  diathesis 
wliich  is  manifested  by  bleeding  and  ulceration  of  the  gums,  also 
by  hemorrhages  in  the  most  various  organs  of  the  animals  and 
which,  in  severe  cases,  causes  debility. 

History.  In  former  times  all  diseases,  in  which  the  tendency  to 
hemorrhage  predominated  in  the  clinical  picture,  were  designated 
generally  as  scurvy,  lint  more  recently  the  large  group  of  hemorrhagic 
diatheses  was  divided  into  several  independent  clinical  pictures  and, 
in  addition  to  scurvy,  Barlow's  disease  (p.  949),  purpura,  petechial 
disease,  AVerlhof's  disease  and  hemophilia  are  differentiated.  It  is  not 
possible  to  draw  sharp  distinctions  between  these  diseases  and,  indeed, 
several  investigators  consider  scurvy,  Barlow's  disease  and  Morbus 
maculosus  Werlhofii  only  as  different  manifestations  of  the  same 
affection. 

Scurvy  in  man  has  become  known  especially  since  the  great  wars 
of  the  middle  ages  and  since  the  sailing  trips  around  the  world,  and 
at  that  time  it  caused  occasionally  great  losses.  When  the  hygienic 
conditions  imjjroved,  the  number  of  cases  diminished  steadily,  and 
at  present  only  sporadic  cases  are  met  with,  at  least  in  western  and 
central  Europe.  Veterinarians  also  paid  at  first  little  attention  to 
the  differences  between  the  various  representatives  of  the  hemorrhagic 
diathesis,  and  in  consequence  cases  of  purpura,  especially  in  cattle, 
hogs  and  dogs,  or  cases  of  ulcerative  stomatitis  in  lambs  have  often 
been  descril)ed  as  scurvy.  Some  clinical  descriptions  by  Spinola, 
Siedamgrotzky,  Pringle,   Arnous  and  others  suggest  that  scurvy  does 


974  Scurvy. 

occur  among  domestic  animals,  especially  dogs,  although  the  disease 
only  rarely  reaches  its  complete  development.  According  to  the  ob- 
servations of  Weber,  Schupp  and  Wolf,  the  scurvy  of  hogs  does  not 
really  correspond  with  the  actual  scurvy,  but  rather  with  purpura. 

Etiology.  In  the  occurrence  of  scurvy  in  liogs  the  benign 
urticaria  appears  to  be  of  essential  importance.  Weber  noted 
the  disease  in  about  5%  of  all  pigs,  from  3-6  months  old,  which 
he  examined,  almost  all  of  which  had  passed  through  an  attack 
of  benign  urticaria  about  four  weeks  previously,  probably  after 
an  infection  wdth  erysipelas  bacilli,  and  also  in  the  cases  of 
chronic  erysipelas  of  hogs  wdiich  have  been  described  by  Cor- 
nevin,  Hess  and  Eisenmann.  Predisposing  factors  are  excessive 
attempts  at  improving  the  species,  one-sided  feeding  especially 
with  spoiled  fodder,  bad  hygienic  conditions,  such  as  confine- 
ment in  damp,  badly  ventilated,  dirty  stables,  insufficient  exer- 
cise ;  a  severe  and  damp  climate  also  seems  to  be  of  importance. 

In  dogs  the  disease  develops  occasionally  after  continued 
feeding  with  spoiled  food-stuffs,  especially  spoiled  meat. 

It"  is  thus  probable  that  the  disease  of  domestic  animals 
described  as  scurvy  has  a  toxic-infectious  origin. 

Anatomical  Changes.  Punctiforra  or  striated,  or  then,  more 
extensive  hemorrhages  are  particularly  noticeable  in  the  skin, 
the  subcutaneous  and  even  the  intramuscular  connective  tissue, 
in  the  mucous  and  serous  membranes,  in  the  joints,  within  the 
skull,  etc.,  while  the  gums  show  destructive  ulceration.  The 
parenchymatous  organs  show  evidences  of  fatty  degeneration. 
The  spleen  is  often  much  enlarged  and  softened.  The  lymph 
nodes,  especially  of  the  mesentery,  are  sw^ollen  and  hyperemic. 
The  blood  is  not  infrequently  pale  red  and  thin  fluid. 

Symptoms.  In  hogs  the  disease  commences  in  some  cases 
with  the  signs  of  gradually  progressing  anemia  and  emaciation, 
the  animals  being  less  lively,  moving  reluctantly,  eating  but  little 
while  they  drink  much  water.  In  other  cases  the  trouble  begins, 
without  any  preliminary  symptoms,  Avitli  bleeding  (Weber).  In 
the  skin  there  appear  hemorrhagic  spots  which  may  be  as  large 
as  a  one-cent  piece  and  wdiich  become  more  and  more  numerous, 
so  that  at  the  height  of  the  disease  the  animals  look  as  though 
sprinkled  with  blood.  Extensive  hemorrhages  occur  in  the  skin 
and  subcutis  of  the  ear,  even  on  slight  external  causes  such  as 
taking  hold  of  the  ears  of  the  animals.  The  bristles  become 
loose  and  are  easily  torn  out,  the  root-ends  being  surrounded 
by  a  drop  of  blackish  blood  (bristle-red).  This  sjinptom  seems 
to  occur  less  frequently  or  not  at  all  in  the  improved  breeds  of 
pigs  wdth  fine  hair;  for  instance,  it  was  absent  in  the  cases 
observed  by  Weber  and  Schupp.  In  the  further  course  the 
bluish-red  hemorrhagic  spots  in  the  skin  may  change  into  nodes, 
vesicles  and  even  ulcers.  Simultaneously  with  the  changes  in 
the  skin  hemorrhages  occur  also  in  the  mucous  membranes, 


Syinptouis,    Diagnosis.    Piuiiiiosis.  975 

although  a  special  involvement  of  the  gums  cannot  be  ascer- 
tained The  gums  show  macular  reddening  and  swelling,  they 
))leed  easilv  and  linallv  ulcers  form  upon  them.  In  consequence 
the  teeth  [)econie  loosened,  tliey  fall  out  easily  and  a  carrion 
smell  comes  from  the  mouth  of  the  animals.  Weber  and  Schupp 
usuallv  noted  hemorrhages  also  in  other  mucous  membranes,  tor 
instance  in  the  orbital  cavitv,  the  eye  ball  being  forced  outward, 
epistaxis,  severe  dvspnea  due  to  hemorrhage  in  the  air  passages 
or  in  the  lungs,  also  bloody  discharges  from  the  intestines  and 
bloodv  urine.^  In  verv  severe  cases  the  joints  may  be  swollen. 

In  this  stage  of  the  disease  the  animals  are  languid,  those 
portions  of  the' skin  which  are  free  from  hemorrhages  are  pale, 
emaciation  and  del)ility  progress  rapidly  and  Imally  lead  to 
death.  Usually,  however,  the  animals  are  killed  earlier  or  die 
shortlv  after  the  appearance  of  the  first  manifest  symptoms, 
in  consequence  of  severe  hemorrhage  in  lungs  or  mtestmes. 

In  the  cases  of  scurvy  which  have  hitherto  been  observed 

in  dogs  the  disease  commenced  with  symptoms  of  anemia,  to 

which  the  changes  in  the  gums,  and  hemorrhages  were  added 

later  on.     The  "gums  are   discolored  bluish-red  m  the  region 

of  the  incisors,  "and  soon  afterward  around  the  molars ;  they 

become  swollen,  sensitive  and  bleed  easily  even  on  the  lightest 

touch  and  during  the  mastication  of  coarse  food  (kernels,  bones). 

Later   on   the   mucous   membrane   becomes   necrotic,    and 

graduallv  the  picture  of  ulcerative  stomatitis  (Vol.  II)  develops. 

Hemorrhages  occur  also  in  the  conjunctivae  and  in  the  skin, 

less  frequent  are  epistaxis,  intestinal  hemorrhages,  vomiting 

•  of  blood,  bloody  urine,  and  in  exceptional  cases  hemorrhages 

may  occur  in  the  anterior  chamber  of  the  eye  and  in  the  retina 

(Frohner).     Sometimes  isolated  joints  are  swollen.     Death  is 

due  either  to  exhaustion  or  to  severe  loss  of  blood,  or  then  to 

some  complication  (general  septic  infection,  pneumonia). 

Diagnosis.  Ulcerative  stomatitis  of  dogs  differs  from 
scurvv  in  its  strict  localization,  the  absence  of  hemorrhages, 
and  also  bv  the  fact  that  it  is  not  associated  with  cachectic  symp- 
toms until  after  the  disease  has  lasted  a  very  long  time.  In 
'Purpura  (Werlhof)  the  changes  in  the  gums  are  absent,  es- 
pecially the  loosening,  necrosis  and  ulcerative  destruction  of 
the  gums. 

Prognosis.  In  the  incipient  stage  of  the  disease  the  prog- 
nosis is  rather  favorable,  provided  the  harmful  influences  can 
be  removed.  If,  however,  the  s^^nptoms  of  ulcerous  stomatitis 
and  hemorrhages  have  developed  healing  can  no  longer  be 
expected. 

Treatment.     Scurvy  can  be  prevented  almost  certainly  by 
suitable  feeding  of  the'  animals  if  care  is  also  taken  to  insure 


976  Scurvy. 

fresh  air  and  sufficient  exercise  in  the  open.  In  the  treatment 
of  scorbutic  animals  the  best  possible  results  are  also  obtained 
by  appropriate  regulation  of  the  diet.  Hogs  are  best  fed  with 
grain  with  wiiich  acid  or  bitter  substances  may  be  mixed,  such 
as  acorns,  horse  chestnuts,  calamus  or  gential  root,  powdered 
oak  bark,  etc.;  for  dogs  good  fresh  meat,  bouillon  and  milk 
are  better  adapted.  In  severe  anemia  it  is  proper  to  administer 
preparations  of  iron  (p.  851)  and  bitter  remedies,  to  dogs  also 
wine  and  alcohol  as  well  as  the  customary  bitter  tinctures.  The 
disease  of  the  mouth  demands  local  treatment. 

The  sick  animals  should  be  isolated  and  their  stables  dis- 
infected. 

Literature.  Arnous,  Monh.,  1892.  III.  193.  —  Gundelac-h,  B.  t.  W.,  1907. 
490.  —  Hebrant,  Ann.,  1903.  597.  —  Biedamgrotzky,  S.  B.,  1878.  14.  —  Siedan.srotzky 
&  Hofmeister,  ibid.,  1878.  121.  —  Weber,  D.  t.  W.,  1909.  297.  —  Wolf,  Der  Skorbut 
d.  Schweines,  Diss.  Leipzig  1909   (Lit.). 


Diseases  of  the  Urinary  Organs 

vSectiox  T. 
DISEASES  OF  THE  KIDNEYS. 

1.    Albuminuria. 

Etiology.  Albuminuria  is  observed  principally  in  those 
diseases  of  the  kidneys  in  which  the  g-lomeruli  or  the  epithelial 
cells  are  affected;  affections  of  the  epithelia  of  the  tubuH 
uriniferi  may  also  lead  to  albuminuria  by  causing  the  serum 
albumin  of  the  surrounding  tissues  to  pass  into  the  lumen  of 
the  tubules.  Albuminuria  represents  therefore  an  almost  con- 
stant s:\inptom  of  inflammatory  and  degenerative  processes  in 
the  kidneys. 

In  like  manner  other  nutritional  disturbances  of  the 
glomerular  epithelia  may  cause  albuminuria;  disturbances  in 
the  circulation  of  the  blood  and  also  changes  in  the  composition 
of  the  blood  in  the  various  blood  diseases  act  in  this  manner. 

The  immediate  cause  of  the  albuminuria  Avhich  occurs  in 
connection  with  skin  diseases,  with  certain  diseases  of  the  ner- 
vous system  (cerebral  hemorrhage,  inflammation  of  the  spinal 
cord,  convulsions)  and  with  some  very  painful  affections,  has 
not  yet  been  determined  definitely.  Possibly  the  cause  lies  in 
disturbances  in  the  innervation  of  the  renafvessels  and  in  the 
nutritive  disturbances  in  the  epithelial  cells  which  occur  in 
consequence. 

The  glomeruli  retain  only  serum  albumen,  while  other  albuminous  substances, 
e.  g.,  egg  albumen  injected  directly  into  the  blood  or  hemoglobin  liberated  through 
the  destruction  of  red  blood  cells,  easily  pass  into   the  urine. 

Traces  of  albumen  are  sometimes  found  in  the  urine  of  healthy  individuals 
(physiological  albuminuria)  ;  in  man  especially  after  generous  meals,  severe  muscular 
exertion,  sexual  excitement,  copious  perspiration,  in  depressed  conditions  of  the 
mind  and  during  pregnancy.  Simader  examined  the  urine  of  several  hundred 
healthy  animals  by  Posner's  method,  and  found  that  minute  quantities  of  albumen 
form  a  normal  constituent  of  animal  urine,  and  that  even  a  fairlv  considerable 
quantity  of  urine,  up  to  0.01-0.03%  in  the  urine  of  dogs  and  hogs,  less  in  the  urine 
of  ruminants  and  very  rarely  in  that  of  horses  is  devoid  of  any  pathological 
significance.  The  albumen  which  occurs  under  normal  conditions' in  the  urine 
seems,  however,  to  be  mostly  nucleo-albunien  and  mucin.  Fettick  has  shown  that 
in  th»  dialyzed  urine  of  healthy  animals  acetic  acid  does  not  cause  cloudines::, 
Vol.  1—62  977 


978  Albuminuria. 

so  that  an  existing  precipitate  has  not  been  formed  by  serum  albumen,  but  by 
another  substance  which  is  as  yet  unknown.  Henn  also  doubts  the  occurrence 
of  serum  albumen  in  the  urine  of  healthy  animals. 

Except  in  the  true  or  renal  albuminuria,  albuminous  sub- 
stances also  occur  in  the  urine  when  blood  serum,  blood,  pus, 
etc.,  is  mixed  with  the  urine  somewhere  in  the  urinary  passages 
after  it  has  left  the  renal  tissue,  or  derived  from  the  genitals 
(vagina,  prostata).    This  constitutes  spurious  albuminuria. 

Diagnosis.  The  recognition  of  albuminuria  depends  upon 
the  chemical  demonstration  of  albuminous  substances  in  the 
urine ;  but  since  albuminuria  is  only  a  symptom  of  several  dis- 
eases, cHnical  examination  must  discover  also  the  underlying 
organic  disease. 

Demonstration  of  the  Albumens  which  are  Preformed  in  the  Blood.  (Serum 
albumen  and  serum  globulin.)  For  this  Heller's  ring-test  is  especially  adapted 
and  as  small  an  amount  as  U.U2'/r  of  albumen  can  easily  l)e  demonstrated  with  it 
(Hammarsten)  ;  it  is  made  as  follows:  A  small  amount  of  the  urine,  which  has 
previously  been  filtered,  is  carefully  poured  into  a  test  tube  containing  concentrated 
nitric  acid,  so  that  it  "over-lies''  the  acid.  At  the  point  of  contact  of  the  two 
liquids  a  sharply  defined  white  ring  forms,  the  depth  of  which  varies  according  to 
the   amount  of  albumen  present. 

For  the  boiling  test  a  few  cubic  centimeters  of  urine  are  heated  to  Ijoiling 
in  the  test  tube  and  are  then  acidulated  by  the  addition  of  5  to  10  drops  of 
concentrated  nitric  acid.  A  precipitate  which  has  been  produced  by  earthy  phos- 
phates or  carbonates  will  then  dissolve,  but  one  due  to  coagulateil  albumen  persists. 

The  acetic  acid-ferroeyanide  of  potassium  test  is  made  thus  that  up  to  about 
2%  of  acetic  acid  is  added  to  the  urine  and  then  a  o%  solution  of  ferroeyanide 
of  potassium,  the  latter  drop  by  drop  and  avoiding  an  excess.  If  albumen  is 
present  a  decided  turbidity  or  a  flocculent  precipitate  appears.  This  test  may  be 
made  like  Heller's  test,  a  mixture  containing  a  few  cubic  centimeters  of  dilute 
acetic  acid  and  a  few  drops  of  ferroeyanide  of  potassium  solution  being  made 
to  over-lie  the  urine. 

Spiegler's  test  seems  to  be  particularly  sensitive  and  is  said  to  be  exact 
for  a  minimum  of  1:350,000.  A  test  tube  is  filled  one-half  with  a  mixture  containing 
8  parts  of  mercuric  bichloride,  4  parts  of  tartaric  acid,  20  parts  of  glycerin  and 
.300  parts  of  water ;  the  urine  is  then  allowed  to  run  down  the  wall  of  the  test 
tube  drop  by  drop,  when  a  white  ring  is  formed  at  the  point  of  contact. 

In  the  salicylic  sulfonic  acid  test  of  Eoch  a  few  crystals  of  salicylic  sulfonic 
acid  are  added   to   a  few  cubic   centimeters   of  urine,  when   turbidity  results. 

The  Metaphosphoric  acid  test  after  Hindenlang  is  made  by  adding  an  aqueous 
solution  of  metaphosphoric  acid  to  the  urine;  the  result  is  opalescence  or  cloudiness. 

Esbach's  reagent,  prepared  by  Merck  in  tablet  form,  is  also  adapted  for 
practical  purposes. 

In  the  trichloracetic  acid  test  after  Eaabe  a  small  crystal  of  trichloracetic 
acid  is  added  to  a  cubic  centimeter  of  urine;  at  the  point  of  contact  a  sharply 
defined  turbid  zone  occurs. 

Henn  recommends  the  following  tests  for  albumen:  the  boiling  test,  the 
acetic  acid  ferroeyanide  of  potassium  test,  the  metaphosphoric  acid  test  (for  dog 
urine),  the  salicyl-sulfonic  acid  test  (for  horse  and  cattle  urine),  the  trichloracetic 
acid  test   (for  horse  and  cattle  urine),  Spiegler's  test   (for  cattle  urine). 

For  the  quantitative  determination  of  albumen  Esbach's  albuminometer  is 
adapted  for  the  requirements  of  practice.  Acidulated  urine  is  poured  in  to  the 
sign  U,  the  reagent  up  to  E  (1  part  of  picric  acid,  2  parts  of  citric  acid,  and 
100  parts  of  water)  ;  the  tube  is  closed  with  a  rubber  stopper  and  slowly  turned 
over  ^several  times  without  shaking;  after  standing  at  room  temperature  for  24 
hours,  the  precipitate  has  settled  and  may  be  read  off.  The  figure  indicates  the 
proportion  of  albumen  per  mille.  Urine  which  contains  very  much  albumen  must 
first  be  diluted  with  water  and  the  indicated  figure  must  then  be  multiplied  with 
the  figure  of  the  dilution. 

If  serum  albumen  has  been  demonstrated  in  the  urine  with 
the   customarv   chemical   tests,    it    remains   to   be    determined 


Diagnosis?,    Treat  moat.  979 

"wlietlier  tlio  albimion  is  derived  riom  tlio  kidnoys  (albnminnria 
vera)  or  from  tlie  urinary  passages  or  from  the  iiea)'d)y  genitalia 
(alltumiimria  spuria).  It'  tlie  urinary  sediment  contains  no 
organic  form  elements,  and  if  tlie  presence  of  dissolved  blood 
coloring  matter  may  be  excluded,  if  further  the  organic  sediment 
consists  exclusively  of  form  elements  wliicli  are  derived  from 
the  kidneys  it  can  only  l)e  a  question  of  renal  all)umimiria.  On 
the  other  hand,  in  the  presence  of  co])ious  organic  sediment  a 
small  (piantity  of  albumen  (less  than  1%)  speaks  against  renal 
albuminuria.  If  the  urine  contains,  in  addition  to  pus  cells, 
also  ei)itli(>lia  from  the  urinary  passages  or,  in  addition  to  red 
blood  cor])uscles,  comparatively  nnich  (several  per  cent  of) 
albumen,  the  indications  ])oint  not  only  to  a  spurious  albu- 
minuria, l)ut  it  may  be  inferred  that  the  urine  contains  albumen 
on  leaving  the  kidneys.  (In  the  presence  of  pus  cells,  at  least 
r)0,000  ])us  cells  in  a  cubic  centimeter  of  urine  correspond  to 
an  all)unien  content  of  1:1000   [Goldberg].) 

Significance  of  Albuminuria.  The  importance  of  albumin- 
uria lies  in  the  fact  that  a  portion  of  the  all)uminons  substances 
which  circulate  in  the  tissue  fluids  of  the  body  leave  it  unused, 
which  necessarily  leads  to  disturbances  in  nutrition.  Accord- 
ingly a  persistent  albuminuria  leads  of  itself  to  a  gradual  weak- 
ening of  the  organism.  In  a  given  case  the  amount  of  albumen 
present  and  the  duration  of  the  albuminuria  are  of  importance, 
aside  from  the  basic  disease. 

Treatment.  As  albuminuria  is  only  a  symptom  of  several 
different  diseases,  the  treatment  must  be  adapted  to  the  under- 
lying pathological  condition. 

Literature.  Fettick,  Z.  f.  Tin.,  1S99.  TJl.  :?29  (Lit.)-  —  Golflberg,  Cbl.  f. 
med.  Wissensch.,  1893.  36.  —  Henn,  Die  Albuiniiiurie,  etc.  Diss.  Giessen  1909  (Lit.). 
—  Eievel,  D.  t.   W.,   1901.   lol.  —  Senator,  Alhiiniinurie,   1882. 


2.     Hematuria. 

Etiology.  Blood  or  red  blood  corpuscles  may  become  mixed 
with  tlie  urine  either  in  the  kidneys  already  or  only  in  the 
urinary  passages,  and  they  may  also  get  into  the  urine  from 
the  contiguous  genital  organs.  Henuituria  presupposes  some 
disease  of  the  blood  vessels  in  the  kidneys  or  in  the  urinary  pas- 
sages, which  makes  it  possible  for  the  red  blood  cells  to  extrava- 
sate  by  diapedesis  or  by  rhexis.  Thus  renal  hemorrhage  may 
occur  in  consequence  of  certain  forms  of  acute,  less  often  of 
chronic  renal  inflammation,  after  injury  to  the  kidney,  in  severe 
blood  stasis,  after  rupture  of  the  renal  artery  if  this  sliows 
an  aneurismal  dilatation  (Liebetanz,  Voltz,  Ilackbarth),  also 
in  acute  infectious  diseases  (purpura,  anthrax,  swine  plague, 
hog  cholera,  etc.),  and  likewise  in  hemophilia  and  in  cachectic 


980  Hematuria. 

conditions  in  general.  Of  the  diseases  of  the  urinary  passages 
preferably  the  injuries  produced  by  calculi  or  by  parasites 
(Eustrongylus  gigas)  and  deep-seated  inflammations,  also  cer- 
tain new-formations,  e.  g.,  angiomata  (Schmidt)  or  papillomata 
may  give  rise  to  hemorrhages. 

Of  special  importance  is  the  so  called  hematuria  of  cattle  ("Weiderot  "= 
pasture-red)  which  is,  however,  a  hemoglobinuria  produced  by  piroplasnias  (p.  764) 
and  as  such  is  not  included  in  hematuria  proper. 

Symptoms.  The  urine  is  colored  more  or  less  red,  some- 
times contains  coagula  and,  in  contrast  to  urine  which  contains 
only  blood  coloring  matter  in  solution,  the  sediment  is  light 
or  dark  red  and  red  blood  corpuscles  may  be  found  in  it.  In 
all  forms  of  hematuria  the  urine  contains  as  a  rule  hemoglobin 
in  solution,  in  addition  to  red  blood  corpuscles,  owing  to  the 
destructive  action  of  the  urinary  constituents  upon  the  blood 
corpuscles.  There  usually  also  exist  signs  of  the  underlying 
disease,  and  after  severe  loss  of  blood  the  clinical  picture  of 
acute  or  chronic  anemia  develops. 

Diagnosis.  Hematuria  is  recognized  with  certainty  only 
by  the  demonstration  of  coagula,  of  blood-red  sediment  or  of 
red  blood  corpuscles  in  the  urine.  Except  in  the  paralytic 
hemogloljinemia  of  horses,  in  which  motor  disturbances  are 
noticeable  from  the  l)eginning,  jaundice  usually  occurs  in  hemo- 
globinuria. In  piroplasmosis  ticks  are  found  on  the  body  of 
the  animals  and  piroplasnias  may  be  seen  in  suitably  stained 
blood  specimens.  Epizootic  occurrence  of  the  cases  suggests 
piroplasmosis  as  the  most  probable  diagnosis. 

The  clinical  investigation  must  determine  whether  the 
blood  has  been  added  to  the  urine  in  the  kidneys,  the  urinary 
passages  or  outside  of  the  latter.  In  renal  hemorrhage  there 
are  usually  also  form  elements  (epithelial  cells,  casts)  which 
come  from  the  kidneys ;  by  means  of  palpation  it  may  be  possible 
to  demonstrate  some  anomaly  in  the  kidneys  and  the  red  l^lood 
cells  are  sometimes  disintegrated  (Gumprecht) ;  in  profuse 
hemorrhages  from  the  kidneys  or  from  the  renal  pelvis  the 
blood  coagulates  in  the  ureters  in  the  shape  of  thick  cylindrical 
formations  which  are  discharged  with  the  urine  (Ostermann. 
Author's  case).  In  hemorrhage  into  the  urinary  passages  the 
urine  frequently  contains  irregularly  shaped  coagula  and 
epithelial  cells  from  the  urinary  passages;  it  is  moreover  not 
infrequently  possible  to  demonstrate  a  disease  of  the  urinary 
passages  by  means  of  a  local  examination.  In  case  of  bleeding 
from  the  genitals  the  urine  removed  from  the  bladder  by  means 
of  a  catheter  contains  no  blood,  and  it  is  usually  possible  to 
show  an  abnormal  condition  of  the  genital  organs. 

Treatment.  The  mode  of  treatment  depends  upon  the 
underlying  condition.    In  copious  bleeding  liemostatic  remedies 


Treatiiienl.  QQl 

may  be  employed,  sueli  as  seeale  corniitum  and  its  preparations, 
siiprareniu  or  adrenalin  (of  tlic  0.1%  solntion  1-5  cc.  per  100 
k^ni.  of  body  wcii^iit,  intravenonsly  in  i)liysiol()oi('al  salt  solu- 
tion) ;  also  astringent  or  styptic  irrigation  of  the  ])ladd('r  with 
a  0.5%  solntion  of  tannin,  a  19^  solntion  of  alnm  or  a  0.01% 
solntion  of  snprarenin. 

Literature,     l.iclietanz.  Monh..  VMh.  XVIII.  454  (Lit.).  —  Schiiii.lt,  B.  t.  W., 

1  !'!>.'.  4'2(\. 


Haematuria  Vesicalis.  (Stallrot  der  Hinder,  Gorman;  TTomatnrio 
(•lir()iii(|in'  (Irs  lK)\ici(''s.  French.)  This  is  a  chronic  hcniatni-ia  of  catlle 
\\liich  occurs  in  l>adcn  (Hink,  Anacker)  and  elsewhere  in  Germany, 
also  in  certain  parts  of  France  and  Italy  (Moussu),  in  Belgium 
(Lienaux),  and  in  Hungary,  and  causes  in  some  regions  considerahle 
losses.  The  trou1)le  occurs  after  exclusive  dry  feeding  in  the  stable,  and 
more  particularly  in  older  cattle. 

As  causes  of  hematuria  have  been  suggested :  insufficient  feeding 
(Anacker),  1)acterial  infection  (Detroye),  coecidiosis  of  the  ])]add('r 
(Arnold),  filaria  or  distomata  (Lydtin),  the  action  of  irritating  poisons 
(Galtier),  and  Hink  considers  stasis  in  the  territory  of  the  posterior 
vena  cava  as  the  probable  cause.  The  latter  view  in  a  somewhat  modified 
form  has  recently  been  shared  by  Lienaux,  who  referred  the  develop- 
ment of  the  disease  to  the  periodical  compression  of  the  bladder  by 
the  rumen  when  it  is  filled  unduly  with  voluminous  food,  and  to  venous 
stasis  in  the  walls  of  the  bladder  produced  thereby.  The  circulatory 
distur})ances  produced  in  this  manner  would  then  result  in  similar 
dilatations  in  the  capillaries,  in  portions  of  the  bladder,  as  they  are 
found  in  teleangiectasia  maculosa  hepatis.  The  consequent  periodical 
hemorrhages  produce,  according  to  Lienaux,  a  secondary  proliferation 
of  the  connective  tissue  and  moreover  prepare  the  soil  for  secondary 
bacterial  infections  of  the  bladder.  On  the  other  hand,  Gotz  maintains 
the  view  that  certain  irritations  which  are  probal)ly  not  specific  but 
mechanical,  chemical,  mykotic  or  toxic,  cause  at  first  an  increased 
discharge  of  urine  which  is  associated  with  tenesmus,  in  conse(iuence 
of  which  the  epithelia  and  the  tissue  of  the  mucosa  are  caused  to 
proliferate,  while  the  capillaries  and  smaller  veins  are  permanently 
dilated.  In  this  manner  he  assumes  a  gradual  varicose  dilation  of 
the  ])lood  ves.sels  in  the  mucous  membrane  of  the  bladder,  and  from 
these  hemorrhages  into  the  tissue  of  the  mucous  membrane  and  into 
the  lumen  of  the  bladder.  For  this  reason  G()tz  believes  the  disease 
to  be  a  cvstitis  verrucosa. 


The  anatomical  chang'es  consist  at  first  only  in  the  occurrence 
of  dark  red  spots  in  1lir  iinicous  membrane  of  tiie  bladder;  in  a  more 
advanced  stage  red  or  brown,  sotnetimes  yellowish  or  gray  varicosities 
are  visil)le  as  large  as  hempseeds,  and  sometimes  between  these  cellular 
proliferations,  as  large  as  nuts  or  hen's  eggs  and  up  to  2  kgm.  in 
weiglit.  roundish  or  lobulated,  like  cauliflower  (Ilink's  round-cell 
sarcoma).  I^lcerous  destruction  of  the  vesical  mucosa  or  perforation 
of  the  bladder  wall  may  also  be  present  and  occasionally  unilati^-al 
or  bilateral  nej)hritis  or  hydronephrosis.     The  bladder  contains  bloody 


982  Uremia. 

urine  and  sometimes  coagulated  blood.     In  far  advanced  cases  there 
are  evidences  of  general  anemia. 

Symptoms.  The  urine  is  light  or  dark  red-brown  in  color;  it 
furnishes  a  copious  precipitate  or  red  blood  corpuscles  and  coagula, 
with  which  are  mingled  white  blood  cells,  bladder  epithelia,  and  rarely 
also  renal  epithelia  if  catarrh  of  the  bladder  or  nephritis  have  occurred 
secondarily.  The  formation  of  good-sized  coagula,  and  the  obstruction 
of  the  urethra  by  them,  fre<iuently  causes  temporary  retention,  more 
often  in  male  than  in  female  cattle.  The  general  condition  is  disturbed 
only  later  in  consequence  of  anemia  or  through  perforation  of  the 
bladder  which  occurs  occasionally,  likewise  more  frccjuently  in  male 
animals. 

The  course  is  always  chronic,  extending  over  weeks,  months  and 
even  years.  It  is  not  rare  to  observe  intermissions  of  variable  duration 
(especially  in  cows  far  advanced  in  pregnancy  the  condition  is  strikingly 
improved  after  parturition  [ Anacker] ) .  Permanent  cures  are  the 
exception;  usually  the  animals  must  be  killed. 

Treatment  consists  in  vigorous  feeding ;  if  possilile  the  food  should 
not  be  very  voluminous.  In  cows  irrigation  of  the  bladder  with 
astringent  and  styptic  solutions  may  be  considered. 

Literature.  Delacroix,  Ann.,  1905.  244.  —  Gotz,  Schio.  A.,  1906.  XLVIII.  1 
(Lit.).  —  Lienaux,  Ann.,  190.5.  185. 


3.    Uremia. 

Etiology.  In  tlie  course  of  severe,  acute  or  chronic  in- 
flammation of  the  kidney,  also  in  consequence  of  certain  dis- 
eases of  the  nrinary  passages  (obstruction  of  ureters,  arrest- 
ment of  a  nrinary  calculus  in  the  neck  of  the  bladder  or  in 
the  urethra,  bilateral  hydronephrosis,  paralysis  of  the  bladder, 
stenosis  of  the  nretlira,  etc.)  in  which  the  discharge  of  the 
urine  from  both  kidneys  is  impeded,  and  thereby  the  function 
of  the  kidneys  is  disturbed,  there  develops  a  peculiar. train  of 
s;^Tiiptoms  which  is  referable  particularly  to  an  involvement 
of  the  central  nervous  system  and  of  the  digestive  organs. 

The  nature  of  uremia  is  not  known  definitely.  It  is  generally 
assumed  that  it  develops  owing  to  the  retention,  in  the  blood,  of  ail 
or  most  of  the  solid  constituents  of  the  urine. 

For  a  long  time  sneh  a  pathogenic  action  was  attribnted  especially  to  urea, 
but  since  it  was  not  possible  to  produce  the  clinical  picture  of  uremia  artificially 
by  the  intravenous  injection  of  urea,  Frerichs  expressed  the  opinion  that  the 
retained  urea  is  transformed  by  the  action  of  a  su])posed  ferment  into  carbonate 
of  ammonia  and  that  the  intoxication  is  produced  immediately  by  this  substance. 
A^oit  on  the  other  hand  assumed  the  retention  of  all  N-containing  urinary  constituents, 
Landois  believed  that  the  extractives  (especially  creatinin)  and  salts  were  retained; 
according  to  the  last  named  author  the  respective  substances  exert  their  harmful 
action  immediately  upon  the  easily  irritated  cerebral  cortex. — Traube  attempted 
to  explain  the  occurrence  of  uremia  upon  a  purely  mechanical  basis  by  assuming 
that  in  kidney  disease  the  blood  pressure  is  increased  and  that  the  blood  is  diluted 
through  a  retention  of  water,  in  consequence  of  which  edema,  and  after  it  anemia 


Uremia.  983 

ilevelop  in  the  brain. — Boucliard  &  Lepine  found  that  the  normal  urine  has  toxic 
properties  which  are  considerably  diminished  in  uremia  because  toxic  substances 
which  are  ordinarily  eliminated  are  retained  in  the  blood. — According  to  Brown- 
Sequard  the  kidneys  are,  similar  to  other  organs,  believed  to  produce  certain 
substances,  by  the  agency  of  an  internal  secretion,  which  are  necessary  for  th« 
normal  maintenance  of  organic  functions;  the  absence  of  such  substances  would 
then  furnish  the  foundation  for  uremia. 

In  an  acute  form  uremia  is  not  observed  very  frequently 
in  animals,  but  chronic  uremia  is  by  no  means  rare,  especially 
in  dogs,  and  gives  rise  to  less  striking  disturbances,  which 
also  admit  of  a  different  explanation. 

Symptoms.  Acute  uremia  occurs  especially  as  a  sequel 
of  severe  acute,  and  sometimes  also  of  chronic  kidne}''  disease, 
also  in  consequence  of  complete  retention  of  urine  if  the  func- 
tion of  the  kidneys  lias  been  interfered  with  to  a  considerable 
degree  within  a  brief  space  of  time.  As  a  constant  symptom 
there  occurs  stupor,  sometimes  preceded  by  staggering  and 
vertigo  and  usually  increasing  to  somnolence  and  to  complete 
unconsciousness.  Sinndtaneously  the  animals  often  show 
trembling  or  even  clonic  contractions,  which  are  often  limited 
to  single  muscles  or  groups  of  muscles;  these  are  soon  followed 
by  general  epileptiform  convulsions  (Pflug  observed  opis- 
thotonus in  a  cow),  and  on  their  cessation  consciousness  does 
not  return,  but  the  animals  remain  prostrate  and  unconscious. 
There  are,  hoAvever,  isolated  cases  in  which  consciousness  is 
preserved  even  during  the  convulsive  attacks  (Lienaux),  and 
in  some  cases  symptoms  of  excitement  are  observed  between 
times. 

Respiration  is  sometimes  retarded  (owing  to  the  uncon- 
sciousness) and  sometimes  rendered  difficult  owing  to  the 
edema  of  the  lungs  which  develops;  occasionally  Cheyne-Stokes' 
respiration  is  observed.  The  temperature  may  at  first  be  con- 
siderably increased,  but  in  the  stage  of  stupor  it  falls  even 
below  normal.  Sometimes  strong  perspiration  is  observed  and 
the  skin  emanations  as  well  as  the  exhaled  air  disseminate  a 
urinous  odor  (especially  after  rupture  of  the  bladder). 

The  digestive  troubles  are  manifested  in  inappetence,  sup- 
pression of  rumination,  in  carnivora  also  in  vomiting,  and  in 
all  species  by  diarrhea.  (The  last  symptoms  are  attributed 
to  disintegration  products  of  urea  which  are  eliminated  through 
the  intestinal  mucosa  and  cause  inflammation.)  The  vomited 
material  sometimes  also  has  an  odor  of  urine. 

Acute  uremia  either  causes  death  in  a  short  time,  the  fatal 
termination  sometimes  occurring  after  the  first  convulsive  at- 
tack, or  it  is  postponed  for  several  days  during  which  the 
paroxysms  are  repeated  in  longer  or  shorter  periods.  In 
animals  acute  uremia  has  hitherto  always  had  a  fatal  termina- 
tion with  the  exception  of  a  case  of  the  authors,  in  a  horse 
with  retention  of  urine,  in  which  relief  of  the  retention  caused 
the  uremic  symptoms  to  disappear  after  a  short  time. 


984  Hyperemia    of   the  Kidneys. 

Chronic  uremia  develops  exclusively  in  chronic  diseases  of 
the  urinary  organs,  especially  in  dogs,  in  consequence  of  chronic 
indurative  nephritis,  as  also  in  incomplete  retention  of  urine. 
The  nervous  disturbances  consist  sometimes  in  a  certain  sensory 
dullness,  sometimes  in  periodical  epileptoid  attacks,  but  they 
are  often  absent.  The  respiration  is  sometimes  rendered  diffi- 
cult by  asthmatic  attacks  (Lienaux).  The  usual  phenomena 
of  chronic  uremia  consist  in  digestive  disturbances  which  occur 
without  demonstrable  cause  (s\Tnptoms  of  gastric  catarrh, 
vomiting,  diarrhea)  and  which  may  be  temporary  or  permanent. 
Pruritus  has  also  been  observed  occasionally. 

Chronic  uremia  usually  causes  death  sooner  or  later,  in 
most  cases  after  the  supervention  of  an  acute  uremic  attack. 

Treatment.  "With  the  exception  of  the  relief  of  the  urine 
retention,  which  is  usually  operative  and  which  sometimes 
removes  the  affection  entirely,  treatment  is  not  very  promising, 
especially  in  the  presence  of  severe  nephritis.  The  administra- 
tion of  diuretic  remedies,  and  diaphoresis  must  be  considered; 
in  convulsions  narcosis  or  subcutaneous  injections  of  morphine 
may  be  employed. 

Literature.  Albreeht,  W.  f.  Tk.,  1901.  25.  —  Bedel,  Bull.,  1897.  266.  — 
Grobon,  Rev.  vet.,  1906.  21.  —  Honigmann,  Ergebn.  d.  Path.,  1902.  VIII.  1.  Abt. 
549  (Lit.).  —  Lienaux,  Ann.,  1894.  65.  —  Otto,  S.  B.,  1905.  82.  —  Pflug,  Krankh. 
d.  uropoet.   Systems,   1876.  —  Senator,  Erkrankung  d.   Nieren,   1S96. 


4.    Hyperemia  of  the  Kidneys.    Hyperaemia  renum. 

Etiology.  Arterial  hyperemia  of  the  kidneys  develops  if 
irritating  chemical  substances  are  carried  to  them  with  the 
blood  and  are  then  eliminated.  Many  diuretic  remedies  (squills, 
turpentine,  especially  cantharides,  the  latter  even  on  cutaneous 
application)  exert  their  action  in  such  a  manner  that  they 
increase  the  arterial  blood  in  the  kidneys.  The  action  of  many 
meadow  plants  (Ranunculaceae)  becomes  manifest  in  a  similar 
manner,  and  especially  young  animals  frequently  show^  symp- 
toms of  renal  hyperemia  after  the  ingestion  of  such  plants. 
In  this  category  belongs  also  the  polyuria  (p.  919)  occurring 
in  horses  after  the  ingestion  of  spoiled,  musty  fodder.  Williams 
observed  polyuria  in  two  horses  after  drinking  a  small  quantity 
of  sea  water.  This  form  of  renal  hyperemia  also  occurs  often 
in  acute  infectious  diseases  in  which  it  is  produced  by  bacterial 
toxins  circulating  in  the  blood. 

Venous  hyperemia  usually  accompanies  diseases  of  the  cir- 
culatory and  respiratory  organs,  when  the  outflow  of  the  venous 
blood  from  the  kidneys  is  difficult.  This  is  most  frequently 
the  case  in  organic  heart  trouble  and  valvular  disease,  also 
in   pulmonary  emphysema,  in  chronic  interstitial  pneumonia. 


Anatuniical    Changes,    Symptoms.  985 

in  peritonitis  and  in  edema  of  the  thoracic  organs,  finally  in 
exceptional  cases,  owing  to  compression  or  thrombosis  of  the 
posterior  vena  cava. 

Anatomical  Changes.  The  arterial  hyperemia  is  manifested 
by  livid  redness  of  the  renal  substance,  in  which  the  congested 
glomeruli  often  stand  out  sharply  and  appear  as  dark  red  spots 
on  the  cut  surface  of  the  cortical  substance. 

In  venous  hyperemia  the  kidneys  are  dark  blue-red,  some- 
what enlarged  and  firm ;  the  tense  capsule  is  easily  peeled  off, 
whereupon  the  smooth  surface  of  the  cortical  layer,  which  is 
traversed  by  venous  plexuses  (Stellulae  Verheyenii)  becomes 
visible.  A  somewhat  prolonged  blood  stasis  leads  gradually  to 
an  increase  of  connective  tissue  which  causes  the  kidneys  to  be- 
come very  firm  (Induratio  cyanotica  renum),  but  later  their  vol- 
ume diminishes  with  the  atrophy  of  the  newly  formed  connective 
tissue,  the  surface  becomes  irregular,  and  the  renal  capsule 
adheres  in  places  to  the  substance  of  the  kidneys  (Atrophia 
cyanotica).  In  stasis-hyperemia  there  is  no  cellular  infiltration 
in  contrast  to  inflammatory  atrophy  of  the  kidneys,  but  red 
blood  corpuscles  lie  in  small  clumps  between  the  tortuous 
urinary  tubuli  (Kitt). 

Symptoms.  In  arterial  hyperemia  of  the  kidneys  an  in- 
creased amount  of  arterial  blood  flows  in  a  given  time  through 
the  kidneys,  in  consequence  the  quantity  of  urine  increases 
and  its  specific  gravity  becomes  lower.  Aside  from  polyuria 
(see  p.  918),  which  is  usually  accompanied  by  an  increased 
sensation  of  thirst,  a  certain  sensitiveness  in  the  region  of 
the  kidneys  and  a  stiff  gait  were  noted  in  many  cases. 

In  venous  hyperemia  of  the  kidneys  the  slowing  of  the 
blood  stream  results,  as  an  immediate  consequence,  in  a 
diminution  of  the  quantity  of  urine.  If  the  stasis  of  the  blood 
is  prolonged,  the  nutrition  of  the  epithelial  cells  suffers  and 
there  occurs  an  albuminuria  which  is  usually  only  slight ;  on 
microscopical  examination  red  blood  corpuscles  and  hyaline 
casts  may  sometimes  be  found  in  the  urine.  The  specific 
gravity  of  the  latter  is  increased  and  it  contains,  in  carnivora, 
large  quantities  of  acid  urates  which  form,  on  cooling,  a  reddish 
sediment  on  the  bottom  of  the  vessel  and  disappear  when  the 
urine  is  heated. 

Diagnosis.  For  the  determination  of  arterial  renal 
ln7)eremia  it  is  necessary  to  exclude  all  other  diseases  for 
which  polyuria  is  also  characteristic. — Diabetes  mellitus  is 
distinguished  by  its  high  specific  gravity  and  the  content  in 
grape  sugar,  chronic  indurative  nephritis  differs  by  the  amount 
of  albumen  present  in  the  urine  and  by  the  long  duration  of 
the  disease, — From  diabetes  insipidus  arterial  hyperemia  can 


986  Hyperemia    of    the   Kidneys. 

be   differentiated   almost    only   on   the   strength   of   its   acute 
course. 

Venous  hyperemia  differs  from  renal  inflammations  by  the 
fact  that  the  urine  contains  only  little  albumen  and  no  real 
form  elements,  and  also  by  the  existence  of  some  basic  disease 
which  has  produced  stasis  of  the  blood  in  the  kidneys. 

Treatment.  Arterial  hyperemia  disappears  in  a  short 
time  after  the  removal  of  its  cause,  especially  after  an  ap- 
propriate regulation  of  the  feeding.  The  administration  of 
irritating  remedies  should  be  avoided  as  much  a*s  possible, 
especially  in  acute  febrile  diseases. 

The  relief  of  blood  stasis  in  the  kidneys  is  possible  only 
by  suitable  treatment  of  the  underlying  disease,  and  it  is 
especially  those  remedies  which  raise  the  blood  pressure  that 
enter  into  consideration  (see  chapter  on  valvular  diseases). 

Literature.  Auguer,  Mag.,  1847.  95.  —  Dammann,  D.  t.  W.,  1898.  125.  — 
Friedberger,  Z.  f.  pr.  Vet.-Wiss.,  1874.  292.  —  Pflug,  Krankh.  d.  uropoet.  Systems, 
1876.  —  Williams,  A"et.  Journ.,  1901.  263.   (See  also  Lit.  on  Diabet.  insipidus.) 


Hemorrhagic  Infarct  of  the  Kidneys.  The  formation  of  infarcts 
in  the  kidneys  is  always  a  consequence  of  obstruction  of  the  arteries, 
by  emboli  carried  from  elsewhere  or  by  thrombi  which  form  at  the 
location  of  the  infarct.  Infarct  formation  is  frequent  after  obstruc- 
tion of  smaller  branches  of  the  renal  arteries  by  emboli,  especially  in 
\alvular  disease,  but  this  is  not  to  be  discussed  here  because  it  cannot 
be  diagnosed  clinically,  or  at  most  presents  the  clinical  picture  of 
chronic  indurative  nephritis  if  numerous  infarcts  have  formed  in 
succession.  Those  infarcts  need  also  not  be  considered  here  which 
develop  after  the  arrestment  of  pyogenic  bacteria  (see  the  chapter  on 
purulent  nephritis).  It  is  intended  to  discuss  here  only  the  hemorrhagic 
infarction  which  occurs  after  complete  occlusion  or  in  marked  stenosis 
of  the  renal  artery.  It  occurs  probably  only  in  the  horse  because 
thromlwsis  of  the  larger  blood  vessels  (usually  produced  by  larvae 
of  sclerostoma)  occurs  with  few  exceptions  only  in  this  animal.  It 
appears  to  be  not  infrequent,  although  it  is  usually  mistaken  for  other 
diseased  conditions  of  the  kidneys.  The  authors  have  observed  four 
cases  within  a  short  space  of  time  and  several  cases  are  reported  in 
literature  (Cadeac,  Lustig,  Ostermann),  which  permit  the  diagnosis 
of  a  similar  kidney  disease. 

The  cause  of  hemorrhagic  infarct  lies  in  the  occlusion  or  marked 
stenosis  of  one  of  the  renal  arteries,  which  causes  the  blood  pressure 
to  fall  in  that  kidney.  Arterial  blood  then  flows  into  the  kidney 
through  the  few  anastomoses  between  the  blood  vessels  of  the  kidney 
and  those  of  the  capsule  and  the  ureters ;  on  account  of  the  considerable 
size  of  the  region  which  is  excluded  from  the  circulation  the  blood 
remains  under  low  pressure  for  a  time  or  permanently.  The  great 
diminution  in  the  arterial  blood  pressure  causes  a  stasis  and  extravasa- 
tion of  the  blood.     (Compare  Vol.  II.) 

The  effect  of  an  occlusion  of  the  renal  arteries  was  elucidated  by  Littea  In 
animal  experiments.  If  the  vascular  obstruction  was  not  complete  or  if  it  rfas 
relieved   after    a    short    time,   the   circulatory    disturbances   retrogresf^ed ;    but    if  in 


Heiuuriliagic    Infarct    of    the    Kidneys.  987 

the  meantime  the  nutrition  of  the  renal  parenchyma  had  suffered,  a  new-formation 
of  connective  tissue  was   stimulated   in   places. 

The  thromliosis  is  probably  only  rarely  situated  in  the  renal  artery  proper, 
but  usually  in  the  abdominal  aorta  immediately  before  the  ori^dn  of  the  renal 
arteries  or  even  in  the  anterior  mesenteric  artery,  in  whiidi  case  the  throndjus 
projects  into  the  lumen  of  the  aorta.  Smh  a  thrombus  may  ])rotluce  an  occlusion 
(tr  stenosis  of  oiu^  or  the  other  renal  artery  thus  that  it  continues  as  far  as  its 
origin,  or  that  the  thrombus,  which  is  freely  movable  in  its  posterior  or  upper 
end,  happens  to  be  forced  against  the  opening  of  the  renal  artery  by  the  circulating 
I'lood. 

The  most  striking  syinptoni  is  a  profuse  renal  hemorrhage,  the 
l)k)od  extravasating  from  the  capillaries  entering  in  part  the  tuliuli 
urinit'ei-i  or  the  pelvis  of  the  kidneys  and  being  then  dischargiMl.  Tlie 
animals  usually  pass  light  or  dark  red  urine  at  short  intervals,  at 
limes  cylindrical  clots,  which  are  often  regular  casts  of  the  ureters, 
art'  mixtnl  with  it.  The  urine  contains  an  amount  of  albumen  corres- 
I)onding  to  the  (|uantity  of  blood  present,  red  blood  corpuscles  are 
foiuid  in  the  sediment,  sometimes  arranged  in  the  form  of  tube  easts, 
and  also  other  renal  form  elements.  On  rectal  exploration  the  en- 
largement of  the  one  (left)  kidney,  which  is  not  very  sensitive,  may 
be  ascertained. 

If  the  hemorrhage  continues  unchanged,  death  may  occur  in  the 
course  of  a  few  days  (authors'  case),  but  in  most  cases  such  attacks 
disappear  after  a  short  time,  although  they  nuiy  recur  several  times 
(the  authors  observed  such  repetitions  in  all  their  cases). 

The  treatment  must  be  limited  to  the  administration  of  remedies 
which  increase  the  blood  pressure,  to  intensive  feeding  and  possibly 
to  the  administration  of  iron. 


5.     Amyloid  Kidney.     Degeneratio  Amyloidea  Renum. 

Etiology.  Amyloid  degeneration  of  the  kidneys  occurs  far 
less  frequently  than  it  does  in  the  liver  (Vol.  II),  although 
it  develops  upon  a  similar  basis.  The  disease  may  be  limited 
to  the  kidneys,  but  occurs  more  often  simultaneously  with  a 
similar  aflfection  of  the  liver  and  spleen.  The  process  has 
been  observed  in  dogs  by  Rabe,  Eivolta,  Kitt,  Dorflinger;  in 
a  cat  by  Mathis ;  by  Rabe  not  very  rarely  in  horses  and  cattle. 

Anatomical  Changes.  In  well  marked  cases  the  kidneys 
are  enlarged,  firm  and  rigid,  anemic.  The  cut  surface  is  very 
pale  and  shows  a  waxy  or  lardaceous  luster  (for  the  amyloid 
reaction,  see  amyloid  of  the  liver). 

In  the  kidneys  it  is  usually  also  possible  to  find  proliferation  of  the  connective 
tissue  and  fatty  degeneration  of  the  epithelia.  Amyloid  kidney  can  only  occur 
in  association  with  chronic  nephritis,  and  in  this  case  small  punctate,  waxy,  some- 
what transparent  and  glistening  granules,  the  degenerated  glomeruli  are  noticeable 
on   the  cut   surface    (Dorflinger). 

Symptoms.  The  clinical  picture  of  amyloid  kidney  is 
known  only  slightly.  Rabe  observed  emaciation  and  debility 
of  the   hindquarter  in   his   cases,   also   symptoms   of  uremia, 


988  Amyloid    Kidney. 

especially  vomiting,  profound  stupor  and  lowered  temperature 
(down  to  35.9°  C).  In  tw^o  cases  lie  saw  edematous  infiltration 
of  all  four  extremities,  and  in  one  case  ascites  which,  however, 
was  probably  due  to  liver  disease. 

The  symptoms  have  great  similarity  with  those  of  chronic 
non-indurating  nephritis,  but  with  the  difference  that  the 
amount  of  urine  is  not  diminished  and  that  only  little  sediment 
is  formed  in  spite  of  the  large  amount  of  albumen  present. 

Diag^nosis.  The  disease  is  suspected  only  when  in  a 
chronic  organic  disease  or  in  poor  nutrition  and  anemia  the 
urine,  which  is  voided  in  approximately  normal  amount,  con- 
tains rather  much  albumen,  but  furnishes  only  little  organic 
sediment  w^ith  cells  that  give  the  amyloid  reaction,  or  hyaline 
casts.  The  probability  of  the  diagnosis  is  much  increased  if 
at  the  same  time  enlargement  and  firmer  consistency  of  liver 
and  spleen  are  found  to  be  present. 

Treatment.  Treatment  does  not  promise  particularly  good 
results.  In  suitable  cases  the  treatment  of  the  basic  condition 
may  be  supplemented  by  intensive  nutrition  and  by  the  ad- 
ministration of  iron  and  iodine. 

Literature.  Ball,  Arch.  f.  Vet.-Wiss.,  1905.  362.  —  Dorflinger,  Vet.,  1897. 
349.  —  Rabe,  Harni.  Jhl.,  1882-83.  86.  —  Ries,  Rec,  1903.  629. 


6.    Acute  Inflammation  of  the  Kidneys.    Nephritis  Acuta. 

Acute  nephritis  is  an  inflammatory  disease  of  the  kidneys 
which  is  manifested  either  by  nutritional  disturljances  of  the 
renal  epithelia  and  an  only  slight  involvement  of  the  interstitial 
tissue  (Nephritis  acuta  parenchymatosa),  or  which  in  addition 
to  changes  in  the  parenchyma  of  the  kidney  produces  very 
decided  inflammatory  changes  also  in  the  connective  tissue, 
without,  however,  causing  the  formation  of  a  purulent  exuda- 
tion (Nephritis  acuta  diffusa). 

The  clinical  data  concerning  nephritis  in  veterinary  medicine  are 
as  yet  rather  incomplete,  probably  partly  because  systematic  urinary 
analysis  does  not  yet  occupy  its  proper  place  in  veterinary  practice. 
In  contrast  to  the  many  various  forms  of  disease  which  have  been 
ascertained  by  post-mortem  examination  and  still  more  by  histological 
investigation  in  the  various  inflammatory  processes  in  the  kidneys, 
clinical  examination  is  able  to  differentiate  only  few  clinical  pictures 
with  the  methods  at  its  disposal. 

In  the  following  paragraphs  an  attempt  will  be  made  to  classify 
the  inflammations  of  the  kidneys  according  to  the  system  which  is 
generally  accepted  in  human  medicine,  on  the  basis  of  observations 
reported  in  literature  and  of  the  authors '  own  investigations.  This 
is  fully  justified  by  the  pathological  anatomy  of  nephritis  in  animals 
which  has  been  studied  carefully,  especially  by  Kitt. 


Occurrence,    Etiology.  989 

Bright  inchided  in  the  disease,  which  was  later  ealleil  after  him  "Morbus 
Brightii,"  ail  affections  of  the  kidneys  which  are  usually  associated  with  albuniinnria 
and  symptoms  of  dropsy.  Later  authors  extended  the  meaning  of  the  term 
"  Bright 's  Disease"  to  all  hematogenous,  nonpurulent  inflammations  of  the  kidneys. 
The  comprehension  of  all  renal  inflammations  under  this  one  common  name  does, 
however,  not  appear  to  he  apjtropriate  in  consideration  of  the  fact  that  these  inflam- 
mations represent  forms  of  disease  which  differ  materially,  not  only  clinically,  but 
even  more  in  their   anatomical  and   pathological  characteristics. 

Occurrence.  Acute  inflammation  of  the  kidney  is  a  very 
frequent  disease  of  animals  l)eeause  it  develops  mostly  from 
infectious  diseases  whicli  occur  very  often  in  domestic  animals 
(Semmer  found  nephritis  repeatedly  in  chickens). 

Etiology.  Acute  nephritis  may  occasionally  be  based  upon 
traumatic  influences  on  the  region  of  the  kidneys  or  upon  the 
kidneys  themselves;  as  such  are  designated  particularly  strain- 
ing, dull  force  (kicks,  blows)  upon  the  region  of  the  kidneys, 
being  run  over,  falling  down,  too  abrupt  stopping  during  sharp 
trotting  or  galloping,  etc.  In  other  cases  the  inflammation 
occurs  in  connection  with  cold  (on  crossing  a  cold  river  or 
on  transportation  in  open  railroad  cars).  The  manner  in  which 
traumatic  or  thermic  agencies  exert  their  pathogenic  action  is 
beyond  the  limitations  of  direct  observation;  but  the  possil)ility 
is  not  excluded  that  they  merely  reduce  the  resistance  of  the 
renal  tissue  to  the  actual  causes  of  inflammation  (infectious 
substances). 

Vegetal)le  and  mineral  poisons  are  capable  of  giving  rise 
to  an  inflammatory  process  if  they  are  introduced  in  consider- 
able quantities.  Such  substances  are  cantharides,  oil  of  tur- 
pentine, squills,  colchicum,  extract  of  felix  mas,  also  carbolic 
acid  and  preparations  of  coal  tar  in  general;  of  mineral  sub- 
stances phosphorus,  arsenic,  corrosive  sublimate  and  the 
mineral  acids.  Godbille  observed  acute  inflammation  of  the 
kidneys  occurring  in  cows  after  the  ingestion  of  acorns.  Many 
acid  substances  even  cause  inflammation  in  the  kidneys  when 
rubbed  on  the  skin,  for  instance,  oil  of  mustard,  styrax, 
cantharides,  etc.  A  similar  action  is  also  attributed  to  certain 
caterpillars  which,  after  being  swallowed  with  grass  or  leaves, 
are  said  to  irritate  the  kidneys  with  their  acrid  substances 
which  have  been  absorbed  in  the  intestine  (Cruzel).  Finally 
insects  (wasps,  bees,  Kolumbacs  gnats)  may  inoculate  sub- 
stances hj  their  stings  which  irritate  the  kidneys  and  thus 
produce  inflammation. 

In  by  far  the  most  cases  acute  nephritis  develops  un- 
doubtedly in  the  course  and  in  consequence  of  acute  infectious 
diseases.  The  bacteria  which  circulate  in  the  blood  may  become 
wedged  in  the  glomeruli  and  also  in  the  intertubular  blood 
vessels  and  may  injure  the  tissue  in  their  immediate  vicinity. 
But  they  may  also  leave  the  blood  vessels  and  be  eliminated 
with  the  urine  later.  In  this  manner  nephritis  occurs  in 
anthrax,  swine   erysipelas,  glanders,   hog  cholera,   and  swine 


990  Acute    Nephritis. 

plague,  and  in  septicemias  in  general.  However,  in  the  majority 
of  cases  the  bacterial  toxins  exert  an  immediate  pathogenic 
action  upon  the  kidneys.  In  passing  throngh  the  cellular  ele- 
ments of  the  kidneys  they  produce,  in  them  and  in  the  vessel 
walls,  degenerative  processes  and  subsequently  an  inflammation 
of  the  kidneys.  The  various  toxins  do  not,  apparently,  exert 
a  like  action  in  this  respect,  but  this  much  may  be  maintained 
in  general  that  the  development  of  nephritis  is  to  be  anticipated 
the  more  surely,  the  more  intense  the  infection  has  been.  This 
is  the  explanation  of  the  development  of  nephritis  in  those 
cases  in  which  no  bacteria  circulate  in  the  blood  and  in  which 
they  cannot  later  be  shown  in  the  renal  tissue,  but  where  other 
sjTiiptoms  of  intoxication,  especially  fever,  permit  the  suspicion 
that  toxins  are  present  in  the  blood;  this  is  especially  the 
case  in  influenza  of  horses,  purpura,  distemper,  tetanus,  foot- 
and-mouth  disease. 

In  similar  manner  every  extensive  inflammation  of  the 
gastro-intestinal  canal  and  of  the  peritoneum  may  give  rise 
to  a  nephritis.  As  a  matter  of  fact  every  extensive  organic 
inflammation  may,  under  certain  conditions,  also  supply  the 
impetus  for  the  development  of  nephritis.  Finally  infectious 
substances  and  their  toxins  are  of  etiological  importance  also 
in  that  form  of  nephritis  which  sometimes  develops  after  the 
ingestion  of  spoiled  food-stuffs. 

The  kidneys  are  likewise  irritated  by  hemoglobin  which 
happens  to  be  in  solution  in  the  blood  plasma,  a  fact  which 
explains  why  in  severe  cases  of  hemoglobinemia  also  a  de- 
generation or  an  extensive  necrosis  of  the  epithelial  cells 
(Johne)  develops,  or  even  a  true  nephritis.  In  such  cases, 
in  addition  to  the  blood  coloring  matter,  the  agencies  upon 
which  the  hemoglobinemia  is  based  or  certain  products  of  dis- 
integration are  probably  of  essential  importance.  It  is  evi- 
dently in  the  same  manner  that  nephritis  occurs  after  extensive 
burns  of  the  skin. 

The  nephritis  which  occurs  not  infrequently  accom- 
panying certain  skin  diseases  (eczema,  mange)  probably  owes 
its  origin  to  the  injurious  action  of  toxic  substances  which 
are  formed  in  the  inflamed  skin,  but  which  are  not  known 
exactly. 

Anatomical  Changes.  The  anatomical  changes  are  either 
easily  recognizalile  to  the  naked  eye  or  can  only  be  demon- 
strated by  microscopical  examination.  According  to  Kitt,  who 
was  the  first  to  attempt  a  systematic  classiflcation  of  inflam- 
mations of  the  kidneys  on  a  histological  basis,  the  following 
clinical  pictures  belong  to  the  group  of  acute  nephritis. 

Nephritis  Parenchymatosa  Acuta  (cloudy  swelling,  edematous, 
albuminous  degeneration  of  the  kidneys).  The  disease  is  essentially 
an   affection   of  ^  the   epithelia   of  glomeruli   and   tubuli  uriniferi,   it  is 


Anatomical    Changes.  991 

due  to  nutritive  disturbances  and  leads  to  cloudy  swelling  and  necrosis 
of  those  cells.  The  kidneys  are  enlarged  only  slightly  or  not  at  all. 
fairly  firm  or  slightly  softened,  their  capsule  is  easily  peeled  off,  the 
conli'guration  of  the  cut  surface  looks  washed  out,  while  tiie  glomeruli, 
overdistended  by  blood,  stand  out  clearly  in  the  form  of  red  dots; 
the  cortical  substance  is  grayish-red,  perhaps  traversed  by  grayish- 
yellow  spots  and  stripes;  the  medullary  substance  is  colored  intensely 
red;  the  tissue  is  sometimes  moist  with  serous  fluid,  and  turbid  fluid 
which  contains  uninjured  and  degenerated  epithelial  cells,  detritus, 
threads  of  fibrin,  and  perhaps  white  and  red  blood  corpuscles  may  be 
scraped  from  the  cut  surface.  In  many  cases  the  disease  is  most 
marked  in  the  glomeruli  (Glomerulonephritis)  ;  while  in  others  the 
tubuli  uriniferi  appear  to  l)e  involved  more  severely  (Tubulonephritis). 

Sometimes,  most  markedly  in  swine  erysipelas,  numerous  small 
hemorrhages  are  found  especially  in  the  cortical  substance  (N.  par. 
haemorrhagica). 

:\ricTOscopical  fin.liiigs:  The  blood  vessels  are  filled;  fibrinous  exudation, 
perhaps  slight  cellular  infiltration  between  the  tubuli  uriniferi  and  fibrinous  exuda- 
tion in  the  capsules  of  Bowman,  the  epithelial  cells  being  granular,  swollen,  ]>artlT 
degenerated  and  in  process  of  breaking  up;  the  tubuli  contain  hyaline  and  epithelial 
casts. 

Nephritis  Acuta  Diffusa.  The  kidneys  are  decidedly  enlarg(-d. 
soft  and  frial)le,  the  capsule  is  soft,  easily  peeled  off  from  the  moist 
and  glistening  surface,  the  cortical  substance  is  also  moist  throughout, 
very  broad;  the  gray  cut  surface  shows  numerous  yellow  spots  and 
streaks,  often  small  or  (especially  in  swine  plague)  large  hemorrhages, 
a  large  amount  of  a  thickish  fluid  may  be  scraped  off  from  the  cut 
surface   (large,  mottled  kidney). 

Microscopical  findings:  The  blood  vessels  are  distended;  interstitial  hemor- 
rhages; leucocytes  and  epithelial  casts  in  the  tubuli  uriniferi;  cellular  and  serous 
infiltration  of  the  connective  tissue;  degenerative  processes  in  the  epithelial  cells, 
exudation   in  the  capsules  of  Bowman. 

According  to  Cagny  and  Xocard  the  epithelial  cells  of  the  convoluted  and 
straight  tubuli  disintegrate  even  in  previously  healthy  kidneys  during  a  prolonged 
severe  attack  of  parenchymatous  or  even  fatty  degeneration  and  become  loosened 
on  the  walls  of  the  tubuli.  In  consequence  a  chylus  like  liquid  which  looks  like  pus 
is,  on  pressure  upon  the  kidneys,  discharged  from  the  tulnili  uriniferi;  it  contains 
numerous  epithelial  cells  and  free  fat  globules.  A  similar  liquid  is  found  also  in 
the  renal  pelvis  and  in  the  upper  portions  of  the  ureters. 

In  cases  of  severe  acute  nephritis  post-mortem  examina- 
tion usnally  reveals  also  dropsical  changes  in  the  body  cavities 
and  in  the  subcutaneous  connective  tissue. 

Symptoms.  Acute  parenchymatous  nephritis  is  the  most 
frequent  form  of  aento  renal  inflammation  and  preferably 
accompanies  febrile  acute  infectious  diseases  (febrile  albumin- 
uria). It  is  accompanied  by  moderate  albuminuria,  the  all)u- 
men  of  the  urine  usually  amounting  barely  to  1-2%.  The 
quantity  of  urine  is  either  normal — and  this  is  more  frequently 
the  case — or  it  is  somewhat  diminished,  mostly  in  consequence 
of  the  cardiac  weakness  produced  by  the  basic  disease;  only 
in  exceptional  cases  is  the  amount  of  urine  slightly  increased. 
The  urine  either  furnishes  no  organic  sediment  or  this  consists 
only  of  few  renal  epithelia,  sometimes  of  hyaline,  granular 
or  epithelial  casts,  also  occasional  red  or  white  blood  corpuscles. 


992  Acute    Nephritis. 

Parenchymatous  inflammation  alone  does  not  cause  any 
functional,  particularly  generalized,  disturbances. 

Acute  diffuse  nephritis  occurs  much  more  rarely  than  the 
preceding  form,  and  either  develops  as  such  from  the  start 
or  out  of  the  parenchymatous  inflammation. 

The  rapidly  increasing  inflammatory  infiltration  causes 
above  all  pain  in  the  kidneys.  The  animals  stand  with  feet 
spread  apart  or  bunched  below  the  belly,  they  arch  the  back 
and  dislike  to  move;  on  moving  they  drag  the  hind  legs  and 
show  in  general  a  certain  stiffness.  Pressure  upon  the  region 
of  the  kidneys  causes  the  animals  to  depress  the  back.  The 
sensitiveness  to  pressure  on  the  part  of  the  kidneys  may  be 
ascertained  in  large  animals  by  rectal  examination,  in  small 
animals  by  external  palpation.  Palpation  from  the  hollow 
in  the  right  flank  may  in  cattle  also  be  successful.  Horses 
often  show  symptoms  of  colic,  trip  back  and  forth,  look  around 
toward  the  abdomen,  at  times  they  lie  down  carefully  but  soon 
rise  again.  The^e  symptoms  are  not  constant  and  are  supple- 
mented by  depression,  general  debility,  inappetence  (in  dogs 
also  vomiting)  and  fever. 

In  a  portion  of  the  cases  there  is  also  pressiire  of  urine, 
and  in  stalhons  there  may  occur  incomplete  erections.  Some- 
times the  animals  void  only  little  urine,  in  spite  of  repeated 
efforts,  perhaps  only  a  few  drops.  This  so-called  strangury 
appears  especially  in  the  nephritis  produced  by  cantharides 
or  oil  of  turpentine.  The  diminished  quantity  of  urine  is  one 
of  the  most  striking  symptoms  and  in  some  cases  the  elimina- 
tion may  be  suppressed  entirely  for  several  (even  5  to  7)  days. 
( Funk,  Friedberger. ) 

The  appearance  of  oliguria  finds  a  sufficient  explanation  in  the  reduced  elim- 
ination of  water  in  the  kidneys,  owing  to  the  retarded  blood  flow  in  the  capillaries 
of  the  glomeruli,  also  in  the  compression  of  the  glomeruli  and  the  obstruction  of 
the  capillaries  by  numerous  desquamated  endothelia,  further  in  the  impeded  outflow 
of  any  secreted  urine  because  the  tubuli  uriniferi  are  obstructed  by  renal  epithelia 
and  casts  or  compressed  by  the  interstitial  infiltration. 

The  urine  is,  especially  at  first,  dark  in  color,  reddish 
or  even  brown-red,  cloudy  but  without  floccules;  the  specific 
gravity  is  increased.  The  urine  contains  variable  amounts, 
usually  one  or  several  per  cent,  of  albumen.  The  quantities 
of  the  other  nitrogenous  substances  (urea,  uric  acid)  are 
diminished,  also  that  of  NaCl  and  of  the  phosphates,  because 
of  the  involvement  of  the  epithelia  of  the  tubuli  uriniferi.  The 
sediment  is  copious  and  consists  of  crystalline  salts  (uric  acid, 
acid  sodium  urate,  calcium  oxalate  and  carbonate),  of  granular 
renal  epithelial  cells,  hyaline,  granular  or  epithelial  casts,  also 
not  rarely  (always  in  the  nephritis  produced  by  sharp  sub- 
stances) red  blood  corpuscles  and  leucocytes;  sometimes  it 
contains  even  bacteria.  (Thomassen  found  numerous  bacteria 
in  the  urine  of  calves  affected  with  septicemia  [see  p.  157].) 


Symptoms,  Course. 


993 


Tlie  icnal  epithelia  (Fig.  172)  are  larger  than  the  re<l  blood  corpuscles,  rouniletl 
or  (juadraugular,  coutaiuing  a  moderately  large  nucleus  around  which  the  protoplasm 
is  usually  granular  and  covered  with  fat  globules.  The  epithelial  cells  are  some- 
times united  into  elongatetl  cylindrical  shapes  (epithelial  casts;  Fig.  17:5.2).  The 
other  casts  are  either  quite  homogeneous  (hyaline  casts)  or  unevenly  granular 
(granular  casts),  perhaps  covered  with  fat  globules,  red  or  white  bloo<l  corpuscles, 
sometimes  with  small  crystals  (Fig.  173,  174).  In  the  urine  of  horses  the  calcium 
carbonate  granules  are  also  united  into  cylindrical  formations,  but  are  readily  dif- 
ferentiateil  because  they  disappear  with  the  tievelopment  of  gas  after  the  addition 
of  acids. 

Ill  severe  cases  edematous  swellings  sometimes  develop 
in  the  subcutaneous  connective  tissue,  on  the  lower  chest  and 
abdomen,  on  the  eyelids,  in  the  larynx,  on  the  extremities,  etc., 
and  sometimes  serous  effusion  may  be  demonstrated  in  tlie 
bodv  cavities. 

The  nutrition  of  the  animals  always  suffers  more  or  less; 
anemia  develops  after  a  comparatively  short  time  the  more 
so  as  the  appetite  is  dimin- 
ished, and  vomiting  occurs 
readily  in  carnivora.  In 
very  severe  cases  the  debil- 
ity increases  rapidlj^;  the 
pulse  is  more  and  more  ac- 
celerated and  feeble.  Fi- 
nally pulmonary  edema  or 
acute  uremia  (p.  983)  termi- 
nate the  case. 

Course.  Kecovery  from 
acute  parench^^natous  ne- 
phritis usually  occurs  in  a 
few  days  or  in  1  to  2  weeks, 
provided  the  basic  atfection 
itself  does  not  endanger  the 
life  of  the  animal ;  the  al- 
buminuria diminishes  rapidly  and  disappears  completely  with 
the  recovery  of  the  animal.  Only  rarely  the  disease  passes 
into  acute  diffuse  nephritis,  but  it  sometimes  probably  prepares 
the  soil  for  the  later  development  of  a  chronic  nephritis. 
Generally  acute  parenclnTiiatous  nephritis  in  itself  only  indi- 
cates the  intensity  of  an  infection  or  intoxication,  but  does 
not  in  itself  immediately  endanger  the  life  of  the  animal. 

On  the  other  hand  acute  diffuse  nephritis  lasts  1  to  2  weeks 
on  an  average,  and  ends  in  death,  possibly  in  recovery,  or 
gradually  passes  into  a  chronic  inflammation.  The  commencing 
improvement  is  indicated  by  the  increase  in  the  amount  of 
urine,  which  is  at  the  same  time  lighter  in  color;  its  specific 
gravity  becomes  lower  and  the  albuminuria  gradually  disap- 
pears. In  the  cases  with  fatal  termination  the  quantity  of 
urine  is  permanently  diminished,  it  contains  much  blood,  the 
appetite  is   lost  entirely,  the  temperature  persistently  high; 

Vol.  1 — 63 


Fig.  172.  Urinary  sediment  of  a  horse  with 
acute  diffufic  )iephi-itis.  a  renal  epithelia 
with  broken  up.  b  the  same  with  uninjured 
nuclei,  c  mononuclear  white  blood  corpuscles. 


994 


Acute    Nephritis. 


finally  the  animals  lie  down  constantly,  a  condition  of  stupor 
or  coma  develops  in  which  at  times  muscular  trembling  or 
eclamptoid  muscular  convulsions  are  observed,  tlie  body  is 
bathed  in  perspiration  and  death  finally  occurs  in  deep  coma 
or  with  convulsions. 

Diagnosis.    Nephritis  can  be  recognized  positively  only  on 
the  basis   of  urinary  analysis,  because   often  only  the  urine 
shows  a  deviation  from  the  normal,  while  pain  is  observed  also 
in  purulent  nephritis  or  in  pyelitis.     Of  importance  in  this  re- 
Fig.  174. 


Fis-.   173. 


Fig.  173.      Renal    co.s/.s-.      1    hyaline     cast,    granular;     2    Epithelial    cast;    3    blood 

corpuscle  cast. 
Fig.   174.     Renal  casts.     To  the   left  two  granular  casts,  to  the  right  a  cj'lindroid. 


spect  are  the  quantity  of  albumen  and  in  the  sediment  the 
presence  of  renal  epithelia,  casts,  red  and  white  blood  corpuscles. 
The  demonstration  of  the  form  elements  and  of  the  quantity 
of  albumen  is  of  particular  importance,  and  it  is  not  sufficient 
simply  to  ascertain  the  existence  of  albuminuria,  because  this 
may  exist  also  in  chronic  nephritis,  in  severe  passive  hyperemia 
of  the  kidneys  and  in  general  nutritive  disturbances,  and  be- 
cause it  affords  no  information  as  to  the  acute  or  chronic  nature 
of  the  nephritis. — Albumen  may  also  be  found  in  the  urine 
in  affections  of  the  urinary  passages,  even  in  affections  of  the 
immediately  contiguous  genital  organs  (prostate,  vagina),  but 


Diagnosis,  Prognosis.  995 

here  the  quantity  corresponds  to  that  of  the  pus  or  l)lood  which 
is  present  in  the  urine.  Further  the  presence  of  epithelial 
cells  from  the  pelvis  of  the  kidney,  from  the  bladder  or  urethra 
gives  information  on  the  localization  of  the  disease,  while  rectal 
exploration  may  often  make  it  possible  to  ascertain  immediately 
the  abnormal  condition  of  the  organ. — In  renal  hemorrhage 
(infarct,  injury,  rupture  of  the  renal  artery)  the  quantity  of 
the  urine  is  unchanged,  the  sediment  contains  almost  only 
red  and  a  few  white  blood  corpuscles,  the  blood  often  coagulates 
in  the  ureters  to  thick  cylindrical  shapes. 

An  exact  designation  of  the  various  forms  of  acute  nephritis 
is  often  possible  if  the  quantity  of  albumen,  the  quantity  and 
nature  of  the  renal  elements,  and  possibly  the  sensitiveness 
of  the  kidneys  to  pressure  are  considered.  Small  amounts  of 
urine  of  high  specific  gravity,  copious  organic  sediment,  a  high 
percentage  of  albumen,  sensitiveness  of  the  kidneys,  perhaps 
also  edematous  infiltrations  point  especially  to  acute  diffuse 
nephritis.  On  the  other  hand  the  slight  and  transitory  albumin- 
uria, which  is  of  frequent  occurrence  in  acute  infectious  dis- 
eases, and  the  presence  of  but  few  form  elements  as  a  rule 
permit  the  diagnosis  of  parenchymatous  degeneration  or  in- 
flammation of  the  kidneys. 

Prognosis.  Except  for  the  less  severe  parenchymatous  in- 
flammation there  are  only  few  data  available  on  the  course 
of  acute  nephritis  in  animals ;  but  this  much  seems  to  be  fairly 
certain  that  even  severe  cases  are  capable  of  complete  retro- 
gression (Trasbot).  During  the  course  of  the  inflammation  it 
is  impossible  to  make  a  definite  prognosis,  because  even  rela- 
tively slight  cases  may  later  become  aggravated  or  the  disease 
may  pass  over  into  the  chronic  form.  A  favoral)le  outcome  may 
be  expected  in  those  cases  of  febrile  diseases  in  which  the  urine 
contains  only  small  amounts  of  albumen  and  very  few  or  no 
organic  form  elements.  But  in  the  presence  of  decided  oliguria 
or  of  complete  anuria,  or  if  the  urine  contains  much  albumen 
and  many  red  and  white  blood  corpuscles,  the  prognosis  is  very 
unfavorable;  uremic  s^nnptoms  always  are  an  indication  of 
approaching  death. 

Treatment.  Of  particular  importance  is  the  regulation  of 
the  diet  in  so  far  as  the  animals  should  receive  easily  digested 
food-stuffs  which  contain  but  small  amounts  of  albumen  and 
of  salts,  and  which  are  neither  sharp  nor  irritating.  Herbi- 
vorous animals  will  therefore  receive,  if  possible,  fresh  green 
feed  or  good  hay,  tuberous  vegetables,  drinks  made  with  flour 
or  bran,  while  grains  should  not  be  permitted;  carnivorous 
animals  are  most  appropriately  put  on  an  exclusive  milk  diet, 
milk  may  be  given  even  to  large  animals  if  mixed  with  a  decoc- 
tion of  oats  or  linseed,  because  it  stimulates  diuresis.  It  is 
advisable  to  keep  the  animals  in  an  evenly  warm  place,  and 
well  covered. 


996  Acute    Nephritis. 

In  case  of  marked  oliguria  the  animals  must  be  made  to 
drink  as  much  as  possible,  especially  of  carbonated  water,  in 
order  to  facilitate  the  process  of  filtration  in  the  kidneys  and* 
to  prevent  the  obstruction  of  the  urinary  tubuli  by  desquamated 
epithelia  and  by  casts.  The  quantity  of  water  must,  however, 
be  limited  if  dropsical  symptoms  already  exist  (Kovesi  & 
Eoth-Schultz).  In  order  to  increase  the  elimination  of  water 
through  the  kidneys  mild  diuretic  remedies  may  be  employed, 
for  instance,  acetate  of  potassium  (of  Liq.  acet.  Potass.  50-100.0 
or  1.0-2.0  gm.  daily  3  to  4  times),  potassium  nitrate  (10-15.0 
or  0.2-0.5  gm.),  also  Diuretin  (for  dogs  0.1-1.0  gm.  given  to 
advantage  with  digitalis),  theozin,  theophyllin. 

For  promoting  the  elimination  of  the  products  of  metab- 
olism through  other  paths,  diaphoresis  is  particularly  ap- 
propriate, and  may  be  produced  in  small  animals  by  warm 
water-  or  steam-baths,  by  subcutaneous  injections  of  pilocarpine 
hydrochloride  (0.2-0.5  or  0.005-0.02  gm.)  or  of  arecoline  hydro- 
bromide  (0.06-0.08  gm.  for  horses).  In  addition  to  these,  laxa- 
tives are  indicated,  either  neutral  salts  or  better  "Vienna 
drench,"  or  castor  oil,  also  aloes  by  which  means  not  only  a 
portion  of  the  urine-forming  solid  substances  (urea  and  accord- 
ing to  Kovesi  &  Roth-Schultz  preferably  phosphates).  Uremic 
symptoms,  which  may  have  appeared  already,  are  to  be  counter- 
acted in  the  manner  discussed  farther  back  (p.  984). 

In  an  inflammation  of  the  kidneys  which  has  developed 
upon  an  infectious  basis,  especially  if  the  action  of  pyogenic 
bacteria  may  be  assumed,  an  attempt  may  be  made  to  prevent 
their  multiplication  by  the  administration  of  bactericidal 
remedies,  of  which  sodium  salicylate  (20-40.0  gm.  or  0.5-1.0  gm.), 
and  salol  (15-20.0  gm.  or  0.5-1.0  gm.)  are  appropriate. 

The  cardiac  action  must  always  be  watched  and  any  existing 
weakness  counteracted  with  digitalis,  camphor  or  other  heart 
remedies  (see  valvular  diseases). 

In  a  dog  with  artificially  produced  inflammation  of  the  kidneys  Pericone  pro- 
duced healing  by  decapsulating  the  kidney. 

Literature.  Albrecht,  W.  f.  Tk.,  1901.  145.  —  Friedberger,  Z.  f.  pr.  Vet.- 
Wiss.,  1874.  171.  —  Gebhardt,  W.  f.  Tk.,  1904.  709.  —  Godbille,  Eev.  gen.,  1906. 
YI  655.  _  Jacob,  B.  t.  W.,  1904.  398.  —  Kitt,  Monh.,  189.3.  IV.  433  (Lit.).  — 
Kovesi  &  Eoth-Schultz,  Orv.  H.,  1904.  92.  —  Pericone,  O.  M.,  1907.  49.  —  Pflug, 
Krankh.  d.  uropoet.  Systems,  1876.  —  Eoquet,  J.  vet.,  1909.  385.  —  Schmidt,  Die 
Cystitis  und  Nephritis  usw.     Diss.    Giesszen.     1909   (Lit.). 

7.  Chronic,  Non-Indurative  Nephritis.  Nephritis  Chronica  Non- 

Indurativa. 

{Chronic  parenchymatous  nephritis;  Nephritis  mixta   [Kitt] ; 
Nephritis  chronica  mixta  [Marcone].) 

Chronic  non-indurative  nephritis  is  a  diffuse  nephritis  with 
slow  course  in  which  considerable  degeneration  of  the  paren- 
chyma takes  place,  with  cellular  interstitial  infiltration,  edema, 


Etiology,  Anatomical   Changes.  997 

and  new-formation  of  connective  tissue,  while  atrophy  of  the 
new-formed  tissue  does  not  occur. 

The  difforcntiation  of  chronic  non-indurative  nephritis  from  the 
chronic  inflammation,  with  which  atropiiy  of  the  new-formed  tissue 
is  associated,  appears  justified  for  the  reason  that  these  two  forms 
of  renal  inflammation  differ  essentially  not  only  pathologically  but 
also  clinically,  and  because  the  chronic  indurative  nephritis  not  in- 
frcijuently  develops  from  the  commencement  as  such. 

Historical.  The  reports  in  veterinary  literature  concerning  chronic 
non-indurative  nephritis  are  very  scant  and  the  available  information 
on  this  form  of  inflammation  of  the  kidneys  is  less  complete  than  is 
the  case  in  other  forms.  Hable,  Verheyen,  Thomassen,  Zimmermann, 
Marcone,  Dell'Acqua,  Boudoire,  have  reported  cases  belonging  in  this 
category. 

Etiology.  In  certain  cases  the  chronic  nephritis  develops 
out  of  the  acute  form  and  is  therefore  caused  by  the  same 
injurious  influences  (see  p.  989).  Similar  causes  are  of  im- 
portance, however,  also  in  those  cases  in  which  the  chronic 
inflanunation  develops  as  such  from  the  start,  except  that  they 
exert  their  injurious  action  with  slighter  intensity  but  for  a 
longer  period.  Here  also  irritating  substances  must  therefore 
enter  into  consideration  in  the  first  place;  and  among  these 
especially  bacterial  toxins  which  are  formed  in  certain  pro- 
tracted infectious  diseases  (chronic  endometritis,  chronic  in- 
fectious bronchitis,  pneumonia,  pleurisy,  intestinal  ulcers, 
tuberculosis,  glanders),  and  which  are  eliminated  by  the  kidneys 
after  their  absorption  into  the  blood.  Chronic  nephritis  may 
also  develop  in  the  vicinity  of  purulent  foci  in  the  "kidneys 
(Kitt).  Finally  it  can  hardly  be  denied  that  repeated  taking 
cold  also  will  occasionally  lead  to  chronic  inflammation  of  the 
kidneys. 

Anatomical  Changes.  As  a  rule  the  kidneys  are  found  en- 
larged and  on  pealing  off  the  capsule,  the  internal  surface  of 
which  is  more  or  less  mottled,  small  shreds  of  renal  substance 
adhere  to  it.  Both  the  outer  and  the  cut  surfaces  of  the  kidney 
contain  red,  yellow  and  gray  spots,  and  likewise  occasional 
small  hemorrhagic  foci.  The  substance  of  the  kidney  is  moist, 
and  if  the  disease  has  lasted  for  some  time  it  is  firmer  than 
normal,  the  medullary  substance  is  poorly  defined,  wine-red, 
dirty  red  and  full  of  blood  and  fluid. 

Tender  the  microscope  the  same  chanpfes  may  be  ascertained  as  in  acute  diflfuse 
nephritis  (see  page  991),  but  with  this  difference  that  a  new-formation  of  nucleated 
connective  tissue  is  often  met  with  in  the  territory  of  the  cellular  infiltration. 

In  the  majority  of  cases  general  anemia  and  emaciation 
are  present,  also  serous  effusions  into  the  body  cavities  and 
the  subcutaneous  connective  tissue,  and  sometimes  hypertrophy 
of  the  heart  muscle. 


998  Chronic   Non-indurative   Nephritis. 

Symptoms.  If  the  chronic  disease  has  developed  from  the 
acute  form,  the  clinical  picture  of  acute  nephritis  gradually 
changes,  its  severe  manifestations  become  less  marked,  and 
finally  the  symptoms  of  chronic  non-indurative  nephritis  are 
established.  In  the  great  majority  of  cases,  however,  the 
chronic  nephritis  develops  from  the  start,  its  onset  is  insidious 
and  the  symptoms  of  the  disease  are  quite  uncertain  in  char- 
acter, so  that  a  suspicion  of  the  existence  of  the  disease  is 
aroused  only  in  a  farther  advanced  stage  of  the  process. 

In  working  animals  attention  is  first  attracted  to  the 
diminution  in  the  ability  to  work;  the  patients  are  easily 
fatigued,  out  of  sorts  and  languid,  although  on  careful  observa- 
tion these  symptoms  may  be  recognized  also  in  the  other 
animals.  As  the  disease  progresses  emaciation  becomes  evi- 
dent in  spite  of  the  fact  that  the  appetite  remains  good  or  is 
but  slightly  disturbed ;  at  the  same  time  the  mucous  membranes 
become  more  and  more  anemic.  In  some  of  the  cases  edematous 
swellings  form  on  the  lower  abdomen,  on  the  chest  and  about 
the  feet  or  the  thighs. 

Simultaneously  with  these  symptoms,  or  even  in  their 
absence,  a  diminution  in  the  amount  and  an  increase  in  the 
specific  gravity  of  the  urine  may  be  noticeable,  and  the  urine 
contains  relatively  much  albumen,  many  renal  elements  like 
hyaline,  granular  and  possibly  epithelial  casts,  fatty  renal 
epithelia  and  occasionally  few  red  blood  corpuscles. 

The  daily  amount,  the  specific  gravity  and  the  relative  quantity  of  albumen 
in  the  urine  show  great  variations  in  the  different  cases.  If  the  inflammation  or 
the  edema  retrogress  for  a  time,  the  specific  gravity  may  become  nearly  or  quite 
normal  and  the  quantity  of  the  urine  may  even  be  greater  than  normal.  If  the 
chronic  indurative  inflammation  approaches  the  stage  of  atrophy,  the  amount  of 
urine  also  increases,  and  in  this  case  permanently,  while  the  quantity  of  albumen 
at  the  same  time  becomes  relatively  lower.  (In  a  case  reported  by  A.  Zimmermann 
the  amount  of  urine  in  a  dog  varied  toward  the  end  of  the  disease  between  310  and 
110  cc,  the  specific  gravity  between  1010  and  1032,  and  the  urine  contained  albumen 
constantly   (0.05-0.1%),  white  blood  cells  and  also  amorphous   detritus.) 

Sometimes  the  sensitiveness  of  the  organ  is  increased  and 
it  is  enlarged,  but  as  a  rule  examinations  made  in  this  respect 
are  negative.  Many  animals  rise  with  difficulty  and  the  effort 
causes  pain  (Chouard). 

Occasionally  inflammation  of  the  serous  membranes  and  of 
the  lungs  supervenes  and  may  have  a  fatal  outcome.  In  the 
absence  of  such  complications  symptoms  of  heart  weakness 
occur  in  the  later  course  of  the  disease,  or  even  from  the  onset ; 
they  may  consist  in  pounding  heart  beat,  soft,  rapid  pulse, 
and  finally  the  animals  perish  with  signs  of  pulmonary  or 
laryngeal  edema  or  of  uremia. 

Course.  The  disease  always  runs  a  protracted  course  and 
usually  lasts  several  months.  The  clinical  picture  often  shows 
variations,  and  aggravations  are  observed  especially  after  over- 


Course,    Diagnosis.  999 

exertion  and  after  taking  cold.  In  other  cases  the  edema  which 
develops  in  a  certain  stag'e  of  the  disease  disappears,  the  ap- 
l)areiit  ini])r()veint'nt  heini*-  accompanied  by  an  increase  in  the 
(|uantity  of  urine  voided.  Eventually  the  clinical  picture  of 
chronic  indurative  nephritis  may  develop. 

Diagnosis.  Chronic  nephritis  can  be  reco.gnized  only  by 
means  of  urinary  analysis,  all  other  symptoms  i)ointin.ii,-  only 
to  general  nutritive  disturbances.  For  differential  diagnosis 
it  is  necessary  to  consider  the  change  in  the  amount  of  urine 
voided,  the  presence  of  albumen  in  considerable  (punitity,  and 
the  presence  of  epithelia  and  of  casts  from  the  tul)uli  uriniferi. 

Acute  diffuse  nephritis  differs  from  the  chronic  form  by 
its  more  rapid  evolution,  by  the  more  considerable  diminution 
in  the  amount  of  urine  voided,  and  especially  by  the  presence 
in  the  urine  of  numerous  red  blood  corpuscles.  It  nnist,  how- 
ever, not  be  forgotten  that  acute  exacerbations  may  occur  in 
the  course  of  chronic  nephritis,  which  sometimes  render  a 
diagnosis  extremely  difficult,  in  case  the  history  or,  after  the 
acute  symptoms  have  quieted  down,  the  further  course  of  tlie 
disease  do  not  afford  any  information  on  the  true  nature  of 
the  trouble. — Amyloid  kidney  is  very  easily  mistaken  for 
chronic  non-indurative  nephritis,  the  more  so  as  both  processes 
may  exist  simultaneouly  (see  p.  987). — In  venous  hyperemia 
of  the  kidneys  the  urine  has  a  higher  specific  gravity  and  con- 
tains at  most  traces  of  albumen  and  few  renal  elements. — 
In  atrophy  of  the  kidney  there  is  polyuria,  the  urine  is  light 
in  color,  watery,  the  specific  gravity  low,  the  percentage  of 
albumen  small  and  the  sediment  contains  only  few  renal  ele- 
ments; hypertrophy  of  the  heart  is  also  frequent. 

Prognosis.  The  course  varies  in  different  cases  in  so  far 
as  the  animals  may  be  kept  alive  for  years  under  favorable 
external  conditions,  while  severe  exertion  and  insufficient  nutri- 
tion render  the  course  more  rapid.  Other  things  being  equal,  the 
prognosis  becomes  more  unfavorable,  the  less  urine  is  voided, 
and  the  more  albumen  and  renal  elements  it  contains,  or  the 
more  prominent  the  cardiac  weakness  becomes. 

Treatment.  This  is  the  same  as  in  acute  nephritis.  First  of 
all  the  diet  must  be  regulated  in  such  a  manner  that  the 
patients,  which  are  to  be  saved  fron^  all  severe  exertion,  should 
receive  only  good  non-irritating  food  (in  carnivora  an  absolute 
milk  diet  is  here  also  most  effective  [see  p.  994] ). 

In  the  presence  of  oliguria  and  of  dropsy  cataphoresis 
and  especially  subcutaneous  injections  of  pilocarpine  repeated 
daily  for  weeks  may  have  a  good  effect.  Diuretic  remedies  are 
administered  in  order  to  increase  the  amount  of  urine  (page 
996),  and  in  cardiac  weakness  heart  remedies  (see  valvular  dis- 
eases) are  administered.    The  anemia  also  requires  appropriate 


1000  White    Spotted    Kidney. 

treatment  (see  page  850).  The  effectiveness  or  failure  of  the 
treatment  can  be  ascertained  from  the  quantity  of  albumen  in 
the  urine. 

Literature.  Dell'Acqua,  Clin,  vet.,  1906.  62.5.  —  Boudoire,  Kev.  gen.,  1906. 
VII.  657.  —  Kitt,  Monh.,  189:i  IV.  433  (Lit.).  —  Marcone,  Kev.  gen.,  1906.  A'll. 
34.5  (Lit.).  —  Thomassen,  Ann.,  1897.  9,  77.  —  Zimmermann,  Z.  f.  Tni.,  189S. 
II.  372. 


White  Spotted  Kidney.  (Nephritis  maculosa  alba.  Nephritis 
fibroplastiea.)  This  form  of  nephritis  occupies  a  position  between  the 
acute  and  the  chronic  inflammation  and  develops  usually  in  foci. 

It  is  frequently  found  in  calves  but  occurs  also  in  adult  cattle.  Blieck  observed 
the  disease  enzootically  almost  exclusively  in  fattened  calves.  In  the  abattoir  in 
Budapest  nephritis  maculosa  alba  was  found  during  the  years  1900-1902  in  2,323  out 
of  291,573  slaughtered  cattle  (0.8%),  but  in  only  20  out  of  343,012  calves  (0.006%). 

Etiology.  Nephritis  maculosa  alba  probably  results  from  a 
cryptogenetic  inflammation  (Kitt,  Kabitz),  which  appears  to  be  acquired 
most  fre(iuently  through  the  umbilicus.  The  disease  is  therefore 
probably  embolic  in  origin.  According  to  Rieck,  however,  the  trouble 
is  produced  by  the  secretion  of  toxins  which  originate  either  through 
the  influence  of  unknown  microorganisms  or  without  them.  Fattening 
of  calves  wdth  whole  milk  and  confinement  in  dark,  close  and  badly 
ventilated  quarters  favor  the  development  of  renal  inflammation. 

According  to  Vaerst  and  Guillebeau  the  white  spots  represent  foci  of  blastemas 
which  persisted  from  embryoii?!  life  and  disappear  eventually  without  leaving  any 
traces.  This  view  is  contradicted  by  the  undoubtedly  inflammatory  changes  found 
by  other  authors  and  also  by  the  findings  in  the  Budapest  abattoir. 

Anatomical  Changes.  Numerous  slightly  prominent  rounded  spots 
are  seen  on  the  kidney,  which  are  from  hemp  seed  to  a  one-cent  piece 
in  size,  smooth,  grayish-white  or  yellowish.  In  exceptional  cases  they 
are  confluent  so  that  normal  renal  tissue  may  be  discovered  in  only 
a  few  spots  (Nephritis  alba).  The  consistency  of  the  organ  is  some- 
times normal  or  somewhat  soft,  but  usually  rather  firm.  The  cut  surface 
also  appears  mottled,  light  gray  streaks  corresponding  to  the  spots  just 
mentioned,  and  standing  out  clearly  from  the  healthy  tissue  which  has 
a  browai-red  or  more  livid  red  color.  Sometimes  the  white  spots  are 
softened  in  the  center  or  show  purulent  disintegration   (Kitt). 

These  changes  may  retrogress  completely,  but  at  other  times  assume 
a  markedly  chronic  character. 

On  microscopical  examination  intense  cellular  infiltration  is  found,  sometimes 
also  fibrinous  exudation  between  the  tubules,  and  numerous  fibroblasts  or  a  consider- 
able increase  in  connective  tissue.  The  pathological  alterations  are  sometimes 
arranged  thus  that  the  cellular  infiltration  is  evident  only  at  the  borders  of  the 
islands,  while  the  center  of  the  islands  consists  of  fibrous  tissue  in  which  only  here 
and  there  portions  of  the  tubuli  are  visible.  The  tubuli  uriniferi  and  their  epithelia 
perish  apparently  only  secondarily  by  simple  atrophy. 

Blieck  differentiates  four  forms  of  spotted  kidney.  In  the  first  form  the 
trouble  is  limited  to  localised  white  foci  which  vary  in  size,  and  either  these  foci 
are  prominent  above  the  surface  of  the  kidney  or  the  latter  already  contains  cicatri- 
cial contractions.  The  second  form  is  distinguished  by  a  diffuse  inflammation  of  the 
renal  parenchyma  and  by  the  presence  of  white  spots,  the  kidneys  being  always 
enlarged.  In  the  third  form  hemorrhages  occur  in  and  around  the  white  foci,  and 
in  the  fourth  form  hemorrhages  alone  are  present. 


Symptoms.  1001 

Symptoms.  The  wliite  spotted  kidney  nsnally  causes  no  morbid 
syin])toiiis.  The  investigations  of  Blieck  sliowed  that  a  moderate 
albuminuria  (i/4-l%)  occurs  only  in  those  cases  in  which,  in  addition 
to  the  white  spots,  a  diffuse  disease  of  the  parenchyma  or  multiple 
hemorrhages  have  developed.  In  other  cases  only  nucleo-albumen  can 
l)e  demonstrated  in  the  urine.  The  sediment  consists  of  wliite  blood 
cells  which  are  soiiu'times  arranged  in  groups,  also  of  renal  epitlielia 
and  hyaline  or  granulai*  casts,  which  are  much  more  numerous  in 
ui-ine  thai  contains  albumen.  In  severe  cases  the  appetite  is  diminished, 
the  animals  are  languid  and  niay,  rarely,  suffer  from  diarrhea. 

Treatment  appears  indicated  only  when  the  disease  is  well  marked 
and  must  follow  the  same  principles  as  that  of  chronic  non-indurative 
nephritis. 

Literature.  Basset,  Rev.  gen.,  1903.  II.  .582.  —  Blieck,  A.  f.  Tk.,  1906.  XXXII. 
225  (Lit.).  —  Brusaferro,  Mod.  Zooiatro,  1903.  43(3.  —  Fallv,  Ann.,  1907.  463 
(Lit.).  —  Guillebeau,  A.  f.  Tk.,  1906.  XXXII.  574.  —  Kabitz,  Monli.,  1901.  XII. 
4.  —  Kitt,  Monh.,  1S93,  IV.  433;  Pathol.  Anat.,  1906.  II.  493.  —  Panisset,  Bull., 
1905.  472.  —  Yaerst,  A.  f.  Tk.,  1901.  XXYTl.  110. 


8.     Chronic  Indurative  Nephritis.    Nephritis  Chronica 

Indurativa. 

[Granulated  or  atrophied  kidney;  Nephritis  iuferstitialis  chrou- 
ica,  Atrophia  gramdosa  reiium.) 

Chronic  indurative  nephritis  is  a  kidney  disease  wliicb  is 
associated  with  atrophy  of  the  connective  tissue  and  takes  a 
very  protracted  course.  It  either  develops  from  acute  or  chronic 
non-indurative  nephritis  (secondary  atrophic  kidney)  or  occurs 
independently  and  slowdy  (primary  atrophic  kidney),  or  then  it 
follows  upon  certain  affections  of  the  urinary  passages  (uro- 
genic  atrophic  kidney).  It  ahvays  causes  a  destruction  of  tlie 
parenchyma. 

Occurrence.  Chronic  indurative  nephritis  occurs  in  cattle 
and  buffaloes  fairly  frequently.  Dogs  and  hogs  also  are  affected 
quite  often,  horses  rarely,  and  the  other  domestic  mammalians 
only  exceptionally.  Older  dogs  suffer  from  chronic  nepliritis 
comparatively  frequently;  but  as  personal  observations  of  the 
authors  show^,  the  disease  may  also  become  manifest  in  dogs 
that  are  only  a  few  weeks  old.  Horn  found  chronic  nephritis  in 
0.32%  of  7,000  slaughtered  sheep;  Semmer  observed  a  case  in 
a  cat.  In  birds  the  disease  may  possibly  develop  upon  a  gouty 
basis. 

Etiology.  The  disease  develops  out  of  the  chronic  non- 
indurative  nephritis  in  only  an  extremely  small  proportion  of 
cases.  This  is  indicated  not  only  by  the  fact  that  the  chronic 
non-indurative  inflammation  is  observed  far  less  often  than  the 
disease  under  discussion,  but  also  by  the  other  fact  that  this 


'10()2  Chronic    Indurative    Nephritis. 

latter  affection  not  infrequently  becomes  manifest  \yitliout  tlie 
severe  symptoms  of  the  non-indurative  inflammation  having 
been  observed ;  moreover,  atrophic  kidney  is  sometimes  discov- 
ered accidentally  in  animals  which  had  always  been  healthy. 

In  regard  to  the  primary  atrophic  kidney  there  is  much  to 
indicate  that  causes  primarily  similar  to  those  in  the  chronic  non- 
indurative  inflammation  are  active  (see  page  996),  but  Avith 
this  difference  that  they  manifest  their  injurious  influence  less 
intensely  but  for  a  longer  time.  There  is  also  a  possibility  that 
after  an  acute  nephritis  has  run  its  course,  a  slowly  progressive 
increase  of  the  renal  connective  tissue  commences.  This  would 
explain  those  cases  in  animals  where  the  symptoms  of  indur- 
ative nephritis  become  manifest  a  certain  time  after  recovery 
from  some  infectious  disease.  Frohner  observed  a  case  of 
chronic  nephritis  which  formed  a  sequel  of  paralytic  hemoglo- 
binemia.  Haase  found  a  sequel  of  swine  erysipelas  in  the  kid- 
neys of  hogs  to  have  taken  the  form  of  isolated  connective  tissue 
foci  containing  few  erysipelas  bacilli. 

In  carnivorous  animals  the  action  of  toxins  must  be  consid- 
ered which  develop  from  the  food-stuff's  rich  in  albumins,  during 
digestive  disturbances  or  in  chronic  skin  diseases  (eczema, 
mange)  ;  and  in  such  cases  confinement  in  dark  yards  is  said  to 
exert  a  predisposing  influence.  In  birds  the  fact  that  the  uric 
acid  is  formed  in  great  quantities  might  have  an  unfavor- 
able action,  as  is  made  strikingly  evident  in  gout.  Joest  found 
chronic  nephritis  in  a  cow  with  urinary  calculi  of  xanthin  and 
with  deposits  of  xanthin  in  the  kidneys. 

The  influence  of  chemical  poisons  may  be  concluded  from 
the  occurrence  of  the  disease  in  animals  which  have  eaten  sour 
plants  on  wet  pastures,  and  in  such  cases  chronic  liepatitis 
usually  develops  at  the  same  time  (Vol.  II).  Such  an  action  of 
chemical  poisons  is  proved  also  by  the  experiments  in  which  it 
was  possible  to  produce  a  chronic  nephritis  by  the  systematic 
administration  of  small  amounts  of  lead-  and  copper-salts  (El- 
lenberger  &  Hofmeister,  Heubel  &  Meyer,  Trasbot). 

A  primary  affection  of  the  arteries  only  rarely  is  respon- 
sible for  the  production  of  chronic  nephritis.  In  isolated  in- 
stances the  disease  was  observed  in  aortic  aneurism  (Cadf'ac, 
Marek)  or  in  degeneration  of  the  renal  artery  (Lustig),  and  m 
such  cases  the  arrestment  of  small  blood  clots  may  contriluite  in 
producing  the  chronic  inflammatory  process.  In  dogs  an  indu- 
rative nephritis  is  sometimes  found  simultaneously  with  valvu- 
lar troubles,  though  probably  not  as  a  consequence  of  the  lieart 
lesion  itself,  but  owing  to  the  same  cause  which  has  given  rise 
to  the  chronic  endocarditis.  On  the  other  hand,  repeated  em1)o- 
lisms  in  the  kidneys  may  also  cause  a  process  of  atrophy  (em- 
bolic atrophic  kidney). 

Mechanical  irritation  may  produce  chronic  interstitial 
nephritis  in  the  presence  of  urinary  calculi  or  of  worms  in  the 
renal  pelvis.     The  same  effect  may  probably  b*e  produced  also 


Etiology,   Anatomical   Changes.  1003 

.V   periodical  disturbances  in  the  outflow  of  urine,  and  this 
factor  probably  is  preferably  active  in  ruminants  and  hogs. 

The  chronic  nephritis  -n'hich  has  been  observed  frequently  in  buffaloes  in  Hun- 
gary (Schoppelt,  V^nios)  is  perhaps  caused  by  renal  gravel  or  by  periodical  inter- 
ference with  the  outllow  of  the  urine.  The  facts  that  the  affection  is  often  uni- 
lateral or  that  one  kidney  is  involved  far  more  extensively,  and  still  more  the 
atrophy  with  dilatation  of  the  calyces  which  is  observed  in  sections  of  tht;  kidney 
that  show  only  slight  morbid  changes,  are  certainly  in  favor  of  the  urogenic  origin 
of  the  process. 

Anatomical  Changes.  Indurative  nephritis  is  characterized 
principallv  bv  the  increase  of  the  connective  tissue  and  there- 
fore by  a  firmer  consistency  of  the  organ  (Nephritis  indurativa, 
Sclerosis  renum).  Later  on  the  kidney  becomes  smaller  and 
its  surface  uneven,  in  consequence  of  variable  depressions. 

On  histological  grounds  Kitt  distinguishes  the  following  forms: 

Nephritis  fibrosa  multiplex  s.  Sclerosis  maculata.  This  occurs 
in  cattle,  in  hogs  and  dogs  and  is  characterized  by  yellowish  or  gray- 
white  furrows  on  the  surface  of  the  kidney,  and  by  white  wedge-shaped 
foci  in  the  cortical  substance,  which  consist  of  fibrous  connective  tissue, 
round  cells,  and  isolated  urinary  tubules  with  disintegrating  epithelia. 
These  changes  are  probably  due  to  embolism  and  may  sometimes  develop 
out  of  nephritis  purulenta  disseminata.  Degen,  for  instance,  showed 
by  careful  examinations  that  purulent  nephritis  which  in  hogs  usually 
is  hematogenic,  generally  leaves  the  evidences  of  nephritis  fibrosa  multi- 
plex on  healing. 

Nephritis  fibrosa  diffusa  is  an  inflammation  which  is  about  evenly 
distributed  over  the  entire  kidney,  which  is  very  large,  firm  to  the  touch 
and,  in  the  calf,  sometimes  calcified.  White,  yellowish-white  and  yellow 
islands  alternate  and  any  remaining  healthy  tissue  is  only  indicated 
by  brown-red  streaks.  The  ground  substance  consists  of  fibrous  tissue 
which  is  poor  in  cells  and  in  which  few  urinary  tubules  are  imbedded ; 
the  latter  contain  only  occasional  normal  epithelial  cells  but  much 
granular  detritus.  The  glomeruli  and  the  vicinity  of  the  thick-walled 
capsules  show  cellular  infiltration. 

The  unequal  atrophv  of  the  proliferated  connective  tissue  causes 
shallow  depressions  on  the  surface  of  the  kidneys,  which  therefore 
appears  finely  or  coarselv  granular  (Nephritis  granulosa)  and  at  the 
same  time  the  kidney  becomes  smaller  (Atrophia  granulosa).  By  the 
contraction  of  the  connective  tissue  some  urinary  tubules  are  constricted 
in  places,  others  are  obstructed  by  masses  of  disintegrated  epithelia 
and  by  casts,  and  in  consequence  the  urine  is  dammed  vip  above  the 
constricted  or  obstructed  places,  leading  to  dilatation  of  the  tubules 
and  of  the  corresponding  capsules  of  Bowman,  which  then  are  gradually 
transformed  into  small  retention  cysts   (Nephritis  fibro-vesiculosa). 

Symptoms.  Chronic  indurative  nephritis  has  only  rarely 
been  observed  clinicallv,  and  it  is  therefore  as  yet  impossible  to 
describe  its  clinical  picture  exhaustively.  The  want  of  complete 
clinical  knowledge  is  particularly  great  in  the  indurative  nephri- 
tis of  ruminants  and  hogs.    The  urinalyses  made  by  Vamos  in 


1004  Chronic    Tndnrative  Nephritis. 

affected  buffaloes  permit  the  assumption  that  the  urine  is  fre- 
quently altered  in  the  course  of  the  disease  in  ruminants,  and 
evidently  also  in  other  animals,  although  the  animals  appear 
otherwise  healthy.  Other  observations  and  those  of  the  authors 
even  indicate  that  the  very  light  forms  do  not  noticeably  impair 
the  health  of  the  animals,  even  in  bilateral  disease,  and  do  not 
lead  to  alterations  in  the  urine.  In  the  great  majority  of  cases, 
however,  morbid  phenomena  are  observed  during  the  life  of  the 
animals. 

The  development  of  the  clinical  picture  proceeds  in  exactly 
the  same  manner  as  in  chronic  non-indurative  nephritis  (see 
page  997).  Nutritional  disturbances,  diminished  al)ility  to  work, 
listlessness,  rapid  fatigue,  languor,  diminished  appetite,  in  dogs 
recurring  vomiting  are  observed  frequently,  but  may  occasion- 
ally be  absent  for  a  long  time  and  even  to  the  end  of  the 
disease. 

The  most  constant  symptom  is  polyuria  in  which  the  ani- 
mals void  large  amounts  of  urine  at  frequent  intervals,  and 
house  dogs  often  discharge  their  urine  in  the  room  against  their 
custom.  The  daily  amount  of  urine  is  often  several  times  the 
normal  quantity,  although  great  variations  exist  in  this  respect. 
The  urine  is  watery  or  almost  as  clear  as  water,  sometimes  it  has 
a  greenish  tinge,  the  specific  gravity  is  very  low,  even  as  low 
as  1001.  Small  amounts  of  albumen  are  present,  but  may  disap- 
pear entirely  for  brief  periods.  On  standing,  very  little  or  no 
sediment  forms,  and  occasionaly  hyaline  casts  and  epithelial 
cells  from  the  urinary  tubules  may  be  found  in  it  (Fig.  175). 

Eegenbogen  observed  lipuria  in  two  cases  of  chronic  nephri- 
tis in  dogs  associated  wdtli  fatty  degeneration  of  the  renal 
epithelia ;  the  urine  looked  like  watery  milk  and  maintained  this 
appearance  even  on  standing  or  after  filtration;  it  contained 
%-l%  of  fat,  many  fat  globules  and  fatty  casts. 


Fig.   175.  Eenal  epithelia  in  the  urinary  sediment  of  a  dog  with  chronic  indurative 

nephritis. 

The  increased  quantity  of  urine  is  due  to  several  causes.  Tt  is  characteristic, 
especially  for  the  chronic  indurative  form  of  nephritis,  that  more  or  less  atrophied 
portions  of  the  kidneys  alternate  with  portions  that  are  more  or  less  unaffected 
and  may  be  quite  healthy;  the  latter  assume  the  function  of  the  diseased  portions, 
owing  to  the  power  of  accommodation  of  the  renal  tissue.  For  this  reason  the 
watery  amount  of  urine  does  not  diminish,  in  spite  of  the  destruction  of  a  portion 
of  the  renal  substance.  Since  in  the  affected  portions  many  arteries  have  become 
impassable,  the  remaining  patent  arteries  of  the  portions  of  the  kidney,  which  are 
still  capable  of  excreting,  dilate  and  this  is  the  more  likely  to  occur,  as  in  many 


Symptoms,    Course.  1005 

cases  a  hypertrophy  of  the  left  heart  develops.  Owing  to  the  lasting  hyperemia 
and  increased  circulation  the  functioning  portions  of  the  kidneys  actually  eliminate 
increased  amounts  of  a  dilute  urine.  On  account  of  the  raised  blood  pressure  in 
the  free  renal  arteries  the  urine  passes  much  more  rapidly  through  the  urinary 
tubules  and  therefore  a  much  smaller  proportion  of  its  water  content  is  reabsorbed 
by  the  blood  than  under  normal  conditions.  The  functioning  of  the  healthy  renal 
portions,  however,  replaces  that  of  the  diseased  parts  only  in  regard  to  the  elim- 
ination of  water  and  not  in  regard  to  the  elimination  of  most  of  the  solid  constit- 
uents. This,  together  with  the  arterial  hyperemia  in  the  excreting  portions,  is 
responsible  for  the  lowered  specific  gravity  of  the  urine  ami  also  affords  an  explana- 
tion why  uremic  symptoms  may  appear  in  this  form  of  nephritis. 

The  sensation  of  thirst  is  increased  in  proportion  to  the 
increased  elimination  of  urine. 

In  dogs  the  hypertrophy  of  the  heart  may  often  be  recog- 
nized by  the  fact  that  the  heartbeat  is  stronger,  the  cardiac 
dullness  enlarged  to  the  left  and  upward  and  the  aortic  sound 
accentuated;  the  pulse  is  strong  and  tense. 

The  causal  connection  between  the  cardiac  hypertrophy  and  the  chronic  inflam- 
mations of  the  kidneys,  especially  the  atrophic  kidney,  is  not  explained  satisfac- 
torily. According  to  Traube  the  hypertrophy  of  the  heart  is  due  to  the  occlusion 
of  numerous  renal  vessels,  but  it  may  be  objected  to  this  hypothesis  that  the 
enlargement  of  the  heart  may  occur  also  in  the  diffuse  non-indurative  chronic 
nephritis.  A  theory  which  was  recently  expressed  by  Senator  and  which  had,  in 
a  somewhat  similar  form  been  suggested  already  by  Bright,  appeared  more  accept- 
able. According  to  this  the  metabolic  products  are  retained  in  the  blood  in  atrophic 
kidney,  and  produce,  by  irritation,  an  increase  in  the  muscular  elements  of  the 
heart  and  at  the  same  time  an  increase  in  the  vascular  tone,  which  in  its  turn 
again  increases  the  work  of  the  heart. — Grawitz  and  Israel,  also  Lewinski,  pro- 
duced an  artificial  chronic  indurative  nephritis  in  dogs  and  rabbits  by  temporary 
ligation  of  the  renal  artery,  and  this  was  later  followed  by  a  hypertrophy  of  the 
heart. 

Palpation  sometimes  shows  enlargement,  more  frequently 
increased  consistency,  but  occasionally  a  diminution  and  irreg- 
ular contour  of  the  kidneys. 

The  respiration  becomes  sometimes,  especially  in  dogs, 
increasingly  difficult  in  the  further  course  of  the  disease  and 
ultimately  asthma  may  actually  develop  (Lienaux). 

When  the  disease  is  severe,  cardiac  weakness  eventually 
follows,  manifested  in  pounding  heart  beat  with  feeble  and 
rapid  pulse,  also  in  dropsical  effusions;  the  amount  of  urine 
is  then  diminished,  the  specific  gravity  increased.  At  this  stage 
emaciation  progresses  rapidly  and  finally  the  animals  die  of 
exhaustion,  of  pulmonary  or  laryngeal  edema,  possibly  of  in- 
testinal hemorrhage  or  hemorrhagic  enteritis.  (Thomas  ob- 
served epistaxis  in  a  cow.) 

The  s}Tnptoms  of  uremia  may  appear  in  every  stage  of 
the  disease.  They  usually  correspond  more  to  chronic  uremia 
(disturbed  appetite,  vomiting,  occasionally  diarrhea,  eventually 
epileptoid  or  asthmatic  attacks)  and  often  appear  in  repeated 
paroxysms.  Occasionally  an  acute  uremic  attack  closes  the 
scene. 

Course.  The  duration  of  the  disease  is  always  protracted. 
If  it  is  recognized  by  urinary  examination  after  the  appearance 


|[006  Chronic  Indurative   Nephritis. 

of  clinical  symptoms,  it  has  usually  already  existed  for  months 
and  then  is  apt  to  continue  for  months  or  even  years  longer 
during  which  time  frequent  variations  are  observed  in  the 
intensity  of  the  clinical  picture.  As  has  already  been  men- 
tioned, certain  forms  of  this  nephritis,  preferably  in  ruminants 
and  in  hogs,  run  their  course  from  beginning  to  end  without 
interfering  w^ith  the  general  health,  and  this  may  occasionally 
be  the  case  also  in  other  species. 

Diagnosis.  The  existence  of  a  chronic  indurative  nephritis 
may  be  assumed  properly  if  the  quantity  of  the  urine  is  in- 
creased, the  urine  watery,  the  specific  gravity  low  and  when 
the  urine  contains  only  small  amounts  of  albumen  and  at  most 
few  renal  elements.  These  findings  are  often  supplemented  by 
the  demonstration  of  cardiac  hypertrophy  and  by  s^^nptonls 
of  chronic  uremia.  The  poljTiria  of  active  renal  hyperemia 
differs  by  a  different  history  and  by  the  constant  absence  of 
albumen  in  the  urine.  Certain  difficulties  may  be  encountered 
at  most  in  the  exclusion  of  that  hyperemia  which  sometimes 
persists  for  a  considerable  time  after  acute  inflammations  of 
internal  organs  and  which,  on  account  of  the  simultaneous 
degeneration  of  the  kidneys  or  of  a  catarrh  of  the  urinary 
passages,  is  accompanied  by  slight  albuminuria.  In  such  cases 
the  condition  of  the  circulatory  organs  and  the  manual^  ex- 
amination of  the  kidneys  must  decide. — In  diabetes  insipidus 
the  urine  is  free  from  albumen,  in  diabetes  mellitus  it  contains 
sugar  and  its  specific  gravity  is  usually  high. — In  amyloid 
kidney  copious  albuminuria  is  usual.  Chronic  non-indurative 
nephritis  may  enter  into  the  problem  in  the  terminal  stage 
of  atrophic  kidney,  when  cardiac  weakness  is  already  present 
and  has  caused  the  development  of  edema,  while  the  specific 
gravity  of  the  urine  is  increased.  But  even  in  such  cases  the 
loreseiice  of  atrophy  of  the  kidney  may  be  decided  upon  on 
account  of  the  comparatively  low  content  in  albumen,  the  hyper- 
trophy of  the  heart  if  present,  and  on  account  of  the  fact 
that  the  specific  gravity  of  the  urine  does  not  correspond  to 
the  severe  sjTiiptoms  of  urinary  stasis. 

Prognosis.  In  clinically  well-marked  cases  the  disease  ends 
eventually  in  death,  which  is,  however,  in  many  cases  postponed 
for  years. 

Treatment.  A  regulation  of  the  diet  is  indicated  in  so  far 
as  the  animals  should  be  protected  from  all  severe  exertion 
and  receive  good,  non-irritating  food  (see  p.  995).  In  cardiac 
weakness  heart  remedies  should  be  employed  and  an  existing 
edema  may  be  counteracted  by  diuretic  remedies.  For  anernia 
the  systematic  administration  of  iron  and  of  bitter  remedies 
is  indicated  in  addition  to  good  nutrition. 


Treatment.    Purulent    Xephritis.  1007 

Literature.  Albrci-lit,  W.  f.  Tk.,  1901.  2o.  —  Ball,  J.  vet.,  190G.  193.  — 
Degen  Die  hiimatojiene  eiter.  Nephritis  d.  Schweines.  Diss  Giessen.  1907.  —  Frieil- 
bergcr,  D.  Z.  f.  Tm.,  1890.  XVI.  188,  —  Frohner,  Monh.,  1906.  XVII.  137.  — 
Ilaaso,  B.  t.  W.,  1908.  427.  —  Horn,  Beitr.  z.  Kenntn,  d.  chron.  Nierenerkrauk.  d. 
Schafes.  Diss.  Leipzig,  1908.  —  Joest,  Dresdn.  B.,  1907.  170.  —  Kitt,  Monh., 
1893.  IV.  433  (Lit.).  —  Lienaux,  Ann.,  1894.  6.5.  —  Marcone,  Kev.  gen.,  1906. 
VII.  345  (Lit.).  —  Regenbogen,  B.  t.  W.,  1908.  499.  —  Schoppelt,  Ung.  Vb., 
1901.  102.  —  Senator,  D.  m.  \\'.,  1903.  1.  —  A'limos,  B  t.  W.,  1905.  572. 

9.    Nephritis  Purulenta. 
{Purulent  NepJiritis.    Renal  Abscess.) 

Etiology.  Purnlont  nopliritis  develops  tliroiiftli  the  in- 
fluence of  pyoi^eiiie  bacteria  which  enter  the  kidneys  nsiially 
by  way  of  inetastasis.  The  principal  occasion  for  such  metas- 
tases is  afforded  in  purulent  diseases  of  other  or.o-ans  or  pyemia, 
especially  endometritis  i)uerperalis,  purulent  inflammation  of 
the  udders,  strang-les,  influenza  of  horses,  g'an.o-renous  pneu- 
monia, purulent  lung  diseases  (Horn  found  nephritis  to  have 
developed  upon  such  a  foundation  in  0.1%  of  slaughtered 
sheep),  also  phlegmonous  pharyngitis,  purulent  bronchial 
catarrh,  pyemia  due  to  uml)ilical  infection.  According  to  the 
experiments  of  Arenstein  an  embolic  purulent  nephritis  may 
develop  without  the  existence  of  purulent  processes  in  other 
organs,  for  instance,  owing  to  the  absorption  of  colon  bacteria 
from  the  intestine  in  severe  obstipation.  Degen,  wlio  found 
hematogenic  purulent  nephritis  in  about  0.5%  of  the  hogs 
slaughtered  in  the  Dresden  abattoir,  not  infrequently  found 
colon  bacteria  and  bacilli  of  the  enteritis  group  in  the  diseased 
portions  of  the  kidneys,  which  could  only  have  come  there 
from  the  intestines.  Nevertheless  he  never  succeeded  in  de- 
termining the  point  of  entrance  of  the  infectious  agents,  among 
which  a  new  variety  of  bacteria  which  he  had  discovered,  the 
Bacillus  polymorphus  suis,  was  found  frequently,  and  he  con- 
siders therefore  the  hematogenic  purulent  nephritis  of  hogs 
as  a  disease  arising  from  cryptogenetic  and  polybacterial  in- 
fection. Haase  finally  saw  occasionally  purulent  foci  as  sequels 
of  chronic  swine  erysipelas,  which  contained  few  erysipelas 
bacilli. 

Traumatic  agencies,  especially  contusions  of  the  region 
of  the  kidneys  only  in  exceptional  cases  give  an  impetus  for 
purulent  nephritis  by  preparing  the  soil  for  the  localization 
of  bacteria  which  happen  to  be  present  in  the  blood. 

Somewhat  more  frequently  a  urogenic  origin  may  be  recog- 
nized, inflammations  of  the  urinary  passages,  especially  those 
of  the  renal  pelvis  extending  into  the  kidnevs.  (Ostertag  saw 
in  lambs  repeatedly  a  purulent  nephritis  Avhich  had  been  con- 
tinued from  the  urinary  passages.)  Only  in  exceptional  cases 
do  bacteria  get  into  the  kidneys  from  their  vicinity  (in  the  case 
of  perirenal  abscess). 

Purulent  nephritis  is  particularly  frequent  in  cattle  and 
hogs. 


1008  Purulent    Nephritis. 

Anatomical  Changes.  If  the  inflammation  is  metastatic, 
both  kidneys  are  usually  involved,  in  other  forms  nsually  only 
one  and  this  may  be  affected  only  partially.  The  embolic 
purulent  foci  are  found  principally  in  the  cortex. 

According  to  Kitt  purulent  nephritis  occurs  in  the  following  forms : 

Nephritis  purulenta  (punctata,  disseminata).  The  substance  of 
the  kidneys  which  are  more  or  less  enlarged  contains  numerous  small 
whitish  or  yellowish  dots  and  stripes  which  are  surrounded  by  a 
narrow,  dark  red  areola  (hyperemia  and  hemorrhage)  and  from  which 
thickish  purulent  masses  may  be  lifted  with  the  knife.  The  tissue 
around  these  places  is  changed  in  variable  extension  similarly  as  in 
the  acute  diffuse  inflammation.  In  hogs,  less  often  in  calves  and  cattle, 
tough  white  bands  are  seen  between  the  purulent  foci. 

On  niicroscoiiical  examination  conglomerations  of  pns  cells  are  found  inside 
of  the  small  foci,  and  cellular  infiltration  containing  pyogenic  bacteria  is  noted  in 
the  surrounding  tissue.  The  epithelial  cells  show  fatty  degeneration  and  are  disin- 
tegrated, the  glomeruli  are  sometimes  surrounded  by  pus,  while  the  convoluted  capil- 
laries contain  numerous  leucocytes ;  in  the  urinary  tubules  casts  are  sometimes  found 
which  carry  leucocytes  and  red  blood  cells. 

The  hematogenic  purulent  nephritis  of  hogs  which  has  been 
studied  more  exactly  by  Degen  belongs  to  this  form.  It  commences 
mostly  in  the  cortical  substance  with  the  formation  of  dark  red  foci, 
of  from  hemp  seed  to  pea  size.  In  these  foci  a  central  yellowdsh-white 
spot  soon  becomes  visible  as  large  as  grits  or  up  to  l)irdshot  in  size. 
The  foci  eventually  become  tougher,  their  areola  paler,  the  yellowish 
color  of  the  center  passes  into  a  grayish-white  and  gray-white ;  sharply 
confined  and  slightly  depressed  cicatrices  appear  on  the  surface  of  the 
kidneys,  continuing  into  the  substance  of  the  kidney  in  the  form  of 
wedges  or  strips.    Abscesses  are  hardly  ever  formed. 

On  microscopical  examination  intense  hyperemia  and  partial  hemorrhagic  infil- 
tration is  visible  at  the  beginning;  this  soon  gives  way  to  a  purulent  infiltration 
which  proceeds  from  the  center,  while  the  renal  structure  is  obliterated  and  the 
parenchyma  partially  atrophied.  Still  later  fibroblasts  appear  in  the  purulent 
infiltrated  tissue,  young  granulation  tissue  is  formed  which,  in  the  cicatricial  stage 
of  the  disease  is  transformed  into  connective  tissue. 

Nephritis  apostematosa  (abscessus  renis).  In  this  form  small  pus 
foci  become  confluent  and  form  larger  abscesses  or  an  abscess  forms 
from  an  embolus ;  variable  portions  of  the  tissue  of  the  kidney  break 
down  or  the  entire  kidney  is  changed  into  a  sac  filled  with  pus  (pyone- 
phrosis). Larger  pus  foci  occur,  usually  numerously,  in  horses  by 
metastasis  of  stranges  and  in  calves  from  unknown  causes  (possibly 
by  umbilical  infection).  The  connective  tissue  is  increased  around 
older  abscesses  but  atrophies  later,  the  inflammation  of  the  surround- 
ing tissue  becoming  chronic. 

Symptoms.  The  clinical  picture  of  purulent  nephritis  is 
characterized  by  its  variability.  It  is  evident  that  the  symptoms 
will  be  different  when  the  nephritis  develops  as  a  local  affection 
and  when  it  occurs  as  a  part  of  general  sepsis  or  pyemia. 
Variations  also  occur  according  to  the  duration,  the  number 


Symptoms.  1009 

of  inflammatory  foci  and  in  the  involvement  of  adjoining:  tissue ; 
the  abscesses  may  or  may  not  be  in  commniiieatioii  with  the 
lumen  of  the  urinary  tubules  or  with  the  yjcivis  of  the  kidney; 
the  changes  may  be  unilateral  or  bilateral. 

If  the  inflammation  develops  rapidly  in  both  kidneys,  the 
same  objective  symptoms  become  apparent  as  in  acute  diffuse 
nephritis  (p.  992).  Especially  the  sensation  of  pain  in  the 
kidney  is  quite  marked;  in  horses  slight  attacks  of  colic  are 
observed  occasionally,  also  arching  of  the  rigid  back;  while 
walking  one  or  both  hind  feet  are  not  advanced  as  far  as  usual 
(Benjamin  observed  paralytic  weakness  of  one  posterior  ex- 
tremity in  a  horse  and  is  inclined  to  refer  it  to  a  compression 
of  the  plexus  lumbo-sacralis  by  the  inflamed  kidney).  In  very 
rare  cases  the  enlarged  kidney  or  the  purulent  perirenal  con- 
nective tissue  produces  a  painful  swelling  above  the  lumbar 
region. 

The  voiding  of  urine  is  often  disturbed  in  like  manner  as 
in  the  non-purulent  acute  nephritis.  But  the  amount  as  well 
as  the  physical  and  chemical  properties  of  the  urine  are  not 
altered  much,  if  only  few  abscesses  are  in  course  of  slow  evolu- 
tion, without  injuring  the  adjoining  renal  tissue  noticeably  and 
without  communicating  w^ith  the  renal  pelvis  or  the  urinary 
tubules.  In  other  cases,  especially  if  the  evolution  progresses 
more  rapidly,  the  urine  shows  the  same  or  similar  changes  as 
in  the  acute  diffuse  inflammation  (see  p.  992).  After  the  pus 
enters  the  urinary  tubules  or  the  renal  pelvis  the  urine  becomes 
cloudy,  milky  or  mixed  wdtli  floccules,  it  contains  pus  cells,  renal 
elements,  crystals  of  triple  phosphates,  and  free  ammonia. 
Exceptionally  the  sediment  contains  small  portions  of  kidney 
substance  (Leisering)  and  occasionally  hemorrhage  takes  place 
in  the  kidneys. 

If  the  hand  is  placed  below  the  transverse  processes  of 
the  lumbar  vertebrae  or  into  the  rectum  it  is  possible  to  de- 
termine pain,  unilateral  or  bilateral  enlargement  of  the  kidneys 
and,  in  the  presence  of  large  abscesses,  fluctuation  which  may 
be  limited  or  may  involve  the  entire  kidney. 

Edematous   infiltrations    are   observed   very   rarely. 

On  rapid  development  of  the  inflammatory  process  or  in 
septic  pyemic  infection  severe  general  symptoms  are  observed, 
in  other  cases  only  temporary  rises  in  temperature  and  grad- 
ually increasing  emaciation.  If  the  purulent  inflammation  is 
severe  and  affects  both  kidneys  uremia  may  also  follow. 

In  a  slower  evolution  of  the  purulent  process,  especially 
if  it  is  limited  to  one  kidney,  clinical  sjanptoms  seem  some- 
times to  be  entirely  absent.  The  same  is  true  for  the  hema- 
togenic purulent  nephritis  of  hogs  (Degen). 

Diagnosis.  Purulent  nephritis  can  be  recognized  Anth  cer- 
tainty only  then  when  objective  s^Tiiptoms  suggest  this  form 
of  nephritis,  when  pain,  fluctuation  of  the  kidney,  albuminuria 

Vol.  1—64 


J^OIO  Purulent    Nephritis. 

are  present,  or  when  the  sediment  contains  also  pus  in  addition 
to  renal  elements,  while  disease  of  the  urinary  passages  can 
be  excluded.  An  abscess  of  the  kidney  may  be  assumed  to 
exist  in  those  rare  cases  in  which  small  portions  of  renal 
tissue  are  found  in  the  sediment.  In  other  cases  the  disease 
can  only  be  suspected  with  more  or  less  probability. 

For  differential  diagnosis  are  to  be  considered  especmlly 
acute  and  chronic  non-purulent  nephritis,  catarrh  of  the  urinary 
passages,  purulent  catarrh  of  the  uterus,  vagina  and  prostate 
(seep.  994). 

Prognosis.  The  clinically  manifest  purulent  nephritis  ends 
sooner  or  later  in  death.  If  the  inflammation  is  not  very 
extensive,  and  especially  if  only  one  kidney  is  involved  the 
possibility  of  a  relative  recovery  is  not  excluded. 

Treatment.  In  case  of  unilateral  disease  the  extirpation 
of  the  affected  kidney  (nephrectomy)  is  to  be  considered;  the 
method  of  this  operation  in  animals  has  been  described  in 
detail  by  Parascandolo.  But  as  it  is  at  present  impossible 
in  animals  to  make  sure  whether  the  function  of  the  other 
kidney  is  undisturbed,  there  is  always  danger  that  after  the 
resection  of  the  one  kidney  the  animal  dies  of  uremia  Ijecause 
the  other  kidney  was  also  affected.  (Mlinnich  has  removed 
one  kidney  in  a  cow  without  the  desired  result;  Maksutow 
operated  on  a  horse  successfully).  Function  of  the  abscess 
rarely  gives  good  results. 

In  the  clinic  at  Budapest  experiments  were  made  with  the  cystoscope  which 
is  used  in  human  medicine.  It  appeared  that  in  dogs  the  catheterization  of  the 
ureters  was  impossible  on  account  of  the  anatomical  relations  of  the  ureteral  open- 
ings, while  it  was  carried  out  successfully  in  horses. 

If  operative  interference  is  not  resorted  to  and  other  treat- 
ment is  desired,  the  therapy  described  for  acute  diffuse  nephritis 
(see  p.  995)  may  be  adopted. 

Literature.  Benjamin,  Bull.,  1905.  131.  —  Cocu,  Eec,  1899.  232.  —  Colin, 
Bee  1900  20.  —  Degen,  Die  hjimatogene  eiterige  Nephritis  d.  8chweines.  Diss. 
Giessen.   1907    (Lit.).  —  Ellis,  Am.  v.   Eev.,   1901.   113.  —  Haase,  B.   t.  W.,   1908. 

497    Horn,  Beitr.   z.   Kenntn.   d.   chron.   Nierenerkr.   d.   Schafes.     Diss.   Leipzig. 

iqnS  —  Johne,  S.  B.,  1875.  30,  32.  —  Kitt,  Monh.,  1893.  IV.  433  (Lit.)  ;  Path. 
Anat  1906.  II.  487.  —  Leisering,  S.  B.,  1872.  21.  —  Morel,  Bull.,  1904.  931. 
—  Mlinnich,  W.  f.  Tk.,  1878.  17.  —  Parascandolo,  Monh.,  1903.  XIV.  228.  — 
Schmidt,  Ma'anedsskr.,  1899.  X.  179.  —  Biedamgrotzky,  S.  B.,  1875.  29;  1891.  18.  — 
Stiegler,  fS.  B.,  1904.  172. 

10.     Bacterial  Inflammation  of  the  Renal  Pelvis  and  of  the 
Kidneys.    Pyelonephritis  Bacterica. 

{Pyelonephritis  hacillosa  s.  diplitherica  s.  myotica  hovum.) 

Bacterial  pyelonephritis  is  an  inflammation  of  the  kidneys 
which  usually  runs  a  chronic  course  and  is  characterized  by 
small  softened  foci  in  the  cortical  portion,  diphtheritic  disin- 


Bacterial  Pyelonephritis.  '[{)M 

tegration  of  the  papillae,  involvement  of  the  renal  pelvis  and 
usually  also  of  the  lower  urinary  passages.  The  disease  is 
produced  by  various  bacteria,  among  them  the  Bacillus  s. 
Corynebacillus  renalis  (C.  pyelonephritidis)  bovis  and  occurs 
ahnost  exclusively  in  cattle. 

History.  Originally  bacterial  pyeloiicpliritis  was  inclnded  among 
the  common  purulent  nephrites  or  pyeloneph rites,  l)ut  was  separated, 
towjird  the  end  of  tlie  eighties  of  the  last  century,  from  the  other  inflam- 
mations of  the  kidneys  as  a  special  disease  form.  Siedamgrotzky  (1875) 
demonstrated  in  one  case  the  i)resence  of  bacteria  in  the  affected  por- 
tions of  the  kidneys,  while  Dainmann  (1877)  had  already  noted  the 
typical  arrangement  of  the  l)acteria  (which  he  called  micrococci)  in 
the  urinary  tubules.  Hess  (1888-1892),  Bang  (1889)  and  Schmidt 
(1890)  studied  the  disease  closely  and  called  attention  to  the  regular 
occurrence,  in  the  affected  kidneys,  of  the  Bacillus  renalis.  Avhiclf  was 
later  studied  at  greater  detail  by  Hoflich  (1891),  and  Enderlen  (1891). 
Valuable  investigations  were  made  also  bv  Lucet  (1892)  Mollereau  & 
Porcher  (1895),  Masselin  &  Porcher  (1895),  .Jensen  (1896),  Cadeac 
and  :\rorot  (1897),  Albrecht  (1900),  Lienaux  &  Zwaenopoel  (1902) 
and  Sommer  (1906),  while  Ernst  (1905)  particularly  studied  the  etiol- 
ogy and  pathogenesis  of  the  disease,  emphasizing  its  polvbaeterial 
origin  which  had  before  him  been  pointed  out  bv  Lucet,  Cadeac  and 
Kitt. 

Occurrence.  In  cattle  pyelonephritis  is  a  very  frequent 
disease,  co\ys  being-  particularly  affected,  often  shortlv  after 
calving,  while  calves  or  male  animals  (oxen,  steers)  acquire 
the  disease  much  less  often.  In  hogs  it  is  also  observed  in 
exceptional  cases  (Jensen,  Wyssmann)  and  Schmidt  has  seen 
it  in  a  colt. 

Etiology.  Pyelonephritis  is  a  polybacterial  disease  in  the 
causation  of  which  the  Bacillus  s.  Corynebacillus  renalis  is  con- 
cerned most  often,  while  other  bacilli"  also  take  part  in  the  in- 
fection which  are  capable  of  producing  suppuration  or  necrosis 
of  the  renal  tissue. 

The  Corynebacillus  renalis,  Ernst  (Bacillus  renalis  bovis 
[Bollinger,  Enderlen,  Hess],  B.  pyelonephritidis  bovum 
[Hoflich])  is  characterized  by  its  pleomorphic  occurrence,  it 
forms,  according  to  Ernst,  rods  2-3-4  ^  long,  0.5-0.6  f'  thick, 
which  are  often  united  to  short  thread-like  groups  and  are 
irregular  in  form;  sometimes  they  appear  as  slender  rods, 
slightly  larger  in  the  middle  and  at  the  ends,  where  thev  also 
take  the  stain  more  deeply,  sometimes  as  long  thread-like  for- 
mations which  are  wound  into  balls  and  nets. 

Staining  succeeds  with  the  customary  stains  as  well  as  bv  Gram's 
and  Weigert's  methods  and  shows  either  a  division  of  the"baci]larv 
bodies   into   fields   arranged    in    ladder-form,    or    then   a   homogeneous 


1012  Bacterial    Pyelonephritis. 

structure.  The  elongated  thread-forms  have  club-shaped  terminal 
enlargements  and  spherical  bud  formations,  also  bulgings,  excrescences 
and  often  actual  branching. 

Lienaiix  &  Zwaenopoel,  also  Hutyra  have  shown  that  this  bacillus  is  closely 
related  to,  if  not  identical  with  the  B.  pseudotuberculosis  ovis,  Preisz,  which  is 
active  in  several  other  diseases.  This  would  agree  with  Ernst's  claim  that  the 
B.  renalis  is  to  be  classed  in  the  group  of  the  Corynebacteria  to  which  the  B.  pseudo- 
tuberculosis ovis  belongs  also. 

Cultivation.  The  Corynebacillus  renalis  is  aerobic.  It  hardly 
grows  at  room  temperature,  but  kept  on  agar  at  the  temperature  of 
the  body  cultures  are  formed  which  are  fine,  whitish,  dry,  sandy  or 
moist  shining,  or  then  dry,  gray  and  scaly.  In  agar  shake  cultures 
two  zones  form,  one  about  2  mm,  the  other  12  mm  below  the  surface, 
where  the  oxygen  tension  is  most  favorable  for  growth.  On  blood 
serum  tender,  transparent  whitish-gray  dots  grow  which  glisten  like  dew 
drops;  in  bouillon  the  cultures  form  a  finely  granular  sediment.  Ernst 
has  shown  that  the  bacilli  grow  very  well  in  neutral  or  faintly  alkaline 
urine,  in  urine  agar  or  in  urine  bouillon,  and  that  in  concentrated  urine 
agar  a  deposit  of  crystals  forms  around  the  stab  which  consists  of  triple 
phosphates.  Acids  and  indol  are  not  produced.  Certain  cultural  differ- 
ences permit  the  assumption  that  there  exist  several  slightly  variable 
strains. 

Pathogenicity.  The  injection  of  a  pure  culture  under  the 
skin  of  mice  or  chickens  produces  no  results  (Enderlen,  Ernst, 
Masselin  &  Porclier),  while  in  rabbits  and  guinea  pigs  either 
a  transitory  swelling  or  an  abscess  develops  (Enderlen,  Kiinne- 
mann,  Ernst)  or  the  animals  are  not  affected  at  all  (Lucet, 
Masselin  &  Porclier).  The  same  is  observed  after  intraperi- 
toneal or  intrapulmonal  inoculation  of  the  culture  (Enderlen, 
Ernst).  An  intravenous  injection  produced  purulent-cheesy 
pneumonia  in  a  rabbit  (Ernst),  intraocular  inoculation  often 
a  passing  iritis  (Enderlen,  Kitt).  Intravenous  injection  pre- 
ceded by  ligation  of  a  ureter  was  followed  in  rabbits  by  a 
process  which  was  similar  to  pyelonephritis  (Enderlen).  In 
sheep  and  in  cattle  subcutaneous  injections  are  usually  without 
result  or  at  most  a  temporary  swelling  develops  at  the  point 
of  inoculation  (Ernst),  while  intravenous  injections  of  cultures 
either  remain  likewise  without  result  (Enderlen,  Hoflich, 
Kiinnemann)  or  Corynebacilli  are  eliminated  with  the  urine 
for  several  days  or  weeks  without  other  disturbances  (Hoflich, 
Ernst).  Intravesical  injections  in  cows  do  not  as  a  rule  cause 
any  trouble  (Hess,  Enderlen,  Hoflich,  Kiinnemann,  Ernst)  or 
they  may  exceptionally  be  followed  by  pyelonephritis  (Masselin 
&  Porclier  saw  this  in  one  case).  A  preliminary  or  simultaneous 
irritation  of,  or  injury  to  the  mucosa  of  the  bladder  enables 
the  bacilli  to  localize  in  the  bladder  (Lienaux  &  Zwaenopoel, 
Ernst),  and  according  to  Lienaux  and  Zwaenopoel  a  pyelone- 
phritis may  even  follow. 

Schmidt  claims  to  have  found  the  Corynebacillus  renalis 
also  in  a  colt  with  bacterial  pyelonephritis. 


Pathogenicity.  1013 

Of  otlicr  causes  of  pyelonephritis  pure  cultures  have  been 
found  of  the  bacillus  pyogenes  (in  cows  and  calves  [Ernst]), 
pyogenic  staphylococci  (Cadeac  &  Morot,  Ernst),  streptococci 
(Baillet  tS:  Seres,  Ernst),  bacillus  pyocyaneus  (Cadeac  &  Morot), 
bacillus  entoritidis  (Sonnnor),  bacilli  of  the  colon  group  (Jensen, 
Kitt).  Most  of  the  enumerated  bacteria  were  also  often  found 
together  with  the  corynebacillus  renalis,  or  several  kinds  of 
them  at  the  same  time,  so  that  a  mixed  infection  was  present 
(Kitt,  Ernst,  Zschokke,  Sommer).  In  two  cases  of  kidney 
tuberculosis  Ernst  found  similar  changes  as  in  pyelonephritis, 
although  the  tubercle  bacillus  was  alone  present. 

The  ability  of  the  bacteria  of  the  colon  group  to  caiise  pyelonephritis  after 
being  introduced  into  the  bla(l<ler  was  proved  experimentally  ]>y  Bchmidt  &  Aschoff, 
Savor,  V.  Wiinschheini.  On  the  other  hand  J.  Koch  produced  proofs  to  show  that 
saprophytic  staphylococci  are  also  ca[)able  of  giving  rise  to  a  typical  pyelonephritis 
in  rabbits  after  subcutaneous  or  intravenous  injection. 

There  exists  therefore  no  specific  virus  of  pyelonephritis  in  the 
domestic  animals.  Nevertheless,  in  consideration  of  what  has  been 
observed,  it  is  not  possible  to  agree  with  Ernst's  view,  according  to  which 
the  Corynebacillus  renalis  has  hardly  anything  to  do  with  the  genesis 
of  the  disease.  Earlier  observers  and  recently  also  Kiinnemann  found 
pure  culture  of  the  bacillus  in  question  in  the  diseased  kidneys,  and 
Ernst  himself  found  it  almost  pure  in  a  few  cases.  On  the  other  hand, 
certain  diseases  (Pseudotuberculosis  of  sheep,  ulcerating  lymphangitis, 
pustulous  dermatitis)  prove  that  the  bacteria  belonging  to  the  group  of 
the  Bac.  pseudotuberculosis  ovis  possess  pathogenic  properties  under 
certain  conditions. 

Although  it  is  not  determined  with  certainty  how  the 
natural  infection  is  produced,  it  is  at  least  very  probable  that 
the  virus  may  be  introduced  into  the  kidneys  or  into  the  urinary 
organs  in  general  in  various  ways.  The  general  experience 
that  the  disease  develops  most  frequently  in  cows,  a  certain 
time  after  parturition,  if  during  the  latter  the  birth  canal  had 
been  injured  or  the  placenta  had  been  retained  or  if  metritis 
developed,  makes  it  very  probable  that  the  virus  multiplies 
promptly  in  the  diseased  genital  organs  and  may  enter  the 
urinary  organs  if  opportunity  serves.  This  can  take  place 
the  more  easily  as  most  of  the  enumerated  pathogenic  germs 
are  ubiquitous  bacteria,  and  some  of  them  (for  instance  the 
bacteria  of  the  colon  group)  are  regular  inhabitants  of  the 
intestinal  canal.  • 

The  dissemination  of  the  virus  may  also  take  place  from 
other  organs  which  are  diseased  in  some  manner  owing  to  a 
bacterial  invasion.  In  a  case  described  by  Ernst  the  trouble 
developed  in  connection  w^ith  an  abscess  in  the  region  of  the 
xiphoid  cartilage,  while  in  a  case  in  a  young  steer  observed 
by  Hess  the  infection  had  probably  proceeded  from  a  para- 
urethral abscess.  In  newborn  animals  the  umbilicus  appears 
often  to  be  the  point  of  entrance  of  the  bacteria,  without  it 


1014  Bacterial    Pyelonephritis. 

being  necessary  that  the  nmbilicus  is  primarily  diseased.  The 
fact  tliat  male  or  young  animals  are  also  affected  without  other 
primary  diseases  has  led  Bang  to  suppose  that  the  virus  may 
possibly  be  introduced  by  way  of  the  digestive  tract.  Bollinger 
considers  also  a  cryptogenetic  infection  to  be  possible.  This  last 
hypothesis  receives  some  support  by  the  experiments  of  Ficker 
wliich  showed  that  bacteria  are  absorbed  by  the  uninjured 
intestinal  mucous  membrane  if  the  animals  are  subjected  to 
hunger  or  to  excessive  exertion. 

Concerning  the  mode  of  invasion  of  the  bacteria  into  the 
kidneys  the  views  differ.  Some  authors  insist  upon  a  urogenic, 
others  upon  a  hematogenic  origin  of  the  disease.  Aside  from 
Enderlen's  experiments  in  rabbits,  which  have  already  been 
mentioned  and  which  were  positive,  the  hematogenic  invasion 
of  the  bacteria  is  supported  by  some  observations  of  Ernst, 
in  which  the  kidneys  showed  typical  lesions  while  the  urinary 
passages  were  free  from  alterations  or  only  the  bladder  con- 
tained severe  inflammatory  lesions  while  the  pelvis  and  ureters 
were  normal.  Of  like  significance  is  the  observation  of  Scherzer 
where  in  a  case  of  pyelonephritis  the  valves  of  the  heart  con- 
tained deposits  in  which  the  Bac.  pyogenes,  which  was  present 
in  the  kidneys,  was  found  in  pure  culture.  The  above  men- 
tioned experiments  of  J.  Koch  afford  further  proofs  (p.  1013) 
and  also  those  of  Albarden,  Savor  and  Orth  which  demonstrated 
that  bacilli  of  the  colon  group  may  produce  the  picture  of 
pyelonephritis  by  being  eliminated  in  the  kidneys. 

On  the  other  hand  the  urogenic  origin  of  pyelonephritis 
cannot  be  denied  for  all  cases,  the  more  so  as,  according  to 
the  experiments  of  Schmidt  &  Aschoff,  Savor  and  v.  Wiinsch- 
lieim,  colon  bacilli  may  lead  to  the  development  of  pyelonephritis 
on  being  introduced  into  the  bladder. 

Evidently,  however,  the  urogenic  origin  is  rather  rare. 
It  is  always  necessary  to  consider  that  the  bacteria  may  enter 
the  blood  vessels  of  the  bladder  and  then  reach  the  kidneys 
by  the  blood  paths  after  the  bladder  has  become  affected  in 
consequence  of  an  artificial  or  a  natural  infection.  This  mode 
of  infection  may  be  thought  of,  especially  since  the  experiences 
of  human  physicians  in  catheterization  indicate  that  even  super- 
ficial epithelial  defects  in  the  mucous  membrane  of  the  l)ladder 
may  give  rise  to  an  absorption  of  bacteria  into  the  circulation. 

Favoring  circumstances  appear  to  be  important  factors 
for  the  origin  of  pyelonephritis.  Aside  from  the  frequent  con- 
nection of  the  disease  with  the  birth  act  or  with  inflammatory 
processes  in  the  female  genital  organs,  and  possibly  also  in  other 
organs,  a  functional  irritation  of  the  kidneys  may  have  a  pre- 
disposing effect,  even  after  normal  parturition,  and  still  more 
the  elimination  of  septic  substances  in  the  above  mentioned 
organic  diseases.  The  predisposing  influence  of  urinary  stasis 
also  deserves  mention,  whether  it  be  due  to  pressure  exerted 
by  the  pregnant  uterus,  especially  if  the  embryo  is  excessively 


Pathogenesis.  1 0 1  ."3 

largo,  or  by  the  full  rumen  or  through  some  disease  of  the 
urinary  organs.  The  influence  of  predisposing  factors  may 
indeed  be  so  important,  that  without  it  the  pyelonephritis 
would  not  have  developed  in  spite  of  the  bacterial  invasion 
of  the  kidneys. 

Pathogenesis.  In  the  ordinary  hematogenic  origin  of 
pyelone[)liritis  the  bacteria  are  arrested  in  the  capillaries  of 
some  glomernli  in  one,  more  frequently  in  both  kidneys,  and 
not  rarely  already  in  the  small  arteries;  they  then  produce 
a  local  inflannnation  of  the  related  portions  of  the  coi-tex,  or 
a  thrombosis.  A  considerable  portion  of  the  bacteria  is 
eliminated  and  is  compressed  into  cap-shaped  bunches  in  the 
capsules  of  Bowman,  and  partly  transported  with  the  urine. 
The  experiments  of  Orth  and  J.  Koch,  and  also  the  micro- 
scopical examinations  of  Ernst  have  shown  that  the  eliminated 
bacteria  accumulate  and  multiply  in  the  collecting  tul)ules  in 
the  lower  portions  of  the  medullary  portion,  whereupon  an 
inflannnatoiy  process  connnences  in  the  immediate  vicinity,  also 
in  the  mucous  membrane  of  the  papilla,  of  the  renal  pelvis 
and  in  the  ductus  papillaris.  In  certain  cases  the  deleterious 
action  of  the  microorganisms  which  are  wedged  in  the  renal 
capillaries  appears  to  become  manifest  only  after  their  elimina- 
tion in  the  collective  tubules. 

The  further  sequels  of  the  inflammation  differ  to  a  certain 
degree  with  the  nature  of  the  virus  and  according  to  the 
presence  or  absence  of  a  mixed  infection.  After  the  entrance 
of  the  corynebacillus  renalis  the  more  or  less  localized  inflam- 
mation results  in  necrosis  which  leads  to  the  formation  of  small 
softened  foci  in  the  kidney,  while  in  the  center  of  the  papilla 
a  sequestrum  is  formed,  surrounded  by  healthy  or  at  least  by 
not  degenerated  tissue  in  which  the  collective  tubules  break 
up  into  fibres.  Eventually  caseation  and  perhaps  calcareous 
incrustation  of  the  necrotic  tissue  takes  place  and  at  the 
periphery  the  inflammatory  process  either  progresses  or  the 
inflannnatory  focus  is  circumscril)ed  by  a  zone  of  demarcation. 
If  pyelonephritis  has  been  produced  by  other  microorganisms 
the  process  differs  only  in  so  far  as  the  inflamed  tissue  under- 
goes softening  and  suppuration.  The  same  is  to  be  observed 
in  mixed  infection  which  occurs  frequently.  In  the  surround- 
ings of  the  necrotic  foci  the  connective  tissue  proliferates  and 
then  atrophies  while  the  unaffected  portions  of  the  kidneys 
hypertrophy. 

Sooner  or  later  an  inflammation  of  the  descending  urinary 
passages  is  added  to  the  process  in  the  kidney.  Owing  to 
the  constant  contact  of  the  mucous  membrane  of  the  renal 
pelvis  with  the  bacteria  and  inflammatory  products  which  ac- 
cumulate in  the  corners  of  the  pelvis,  the  tips  of  the  originally 
affected  papilla  and  of  other  papillae,  as  well  as  the  mucous 


1016  Bacterial    Pyelonephritis. 

membrane  of  the  renal  pelvis  in  general  become  involved  in 
the  diphtheritic  and  suppurating  inflammatory  process.  Of 
the  peripheral  urinary  passages  the  bladder  is  most  endangered 
(and  also  the  urachus  if  this  is  not  yet  obliterated)  because  the 
urine  remains  there  for  a  longer  time.  Accordingly  a  very  severe 
inflammation  sometimes  develops  in  the  bladder.  The  affection 
of  the  descending  urinary  passages,  not  excepting  the  ureters, 
is  greatly  favored  by  the  urinary  stasis  which  necessarily 
occurs,  at  least  at  tiiiies  during  the  disease,  and  also  by  the 
constant  irritation  by  the  disintegration  products  of  the  urine. 
Under  these  conditions  the  germs  are  packed  into  the  collecting 
tubules  and,  after  the  destruction  of  the  pelvic  mucous  mem- 
brane, the  inflammatory  process  continues  directly  into  the 
renal  tissue.  In  this  manner  an  ascending  inflammation  of 
the  kidneys  is  added  to  the  original  process. 

In  the  urogenic  origin  of  the  disease,  which  is  undoubtedly 
infrequent,  the  inflammation  of  the  kidney  commences  with 
the  process  that  was  just  described,  after  the  inflammation  has 
existed  for  some  time  in  the  urinary  passages. 

It  appears  from  what  has  been  said  that  no  sharp  distinctions  can  be  drawn 
between  embolic  purulent  nephritis  and  bacterial  pyelonephritis. 

Anatomical  Changes.  In  well  developed  cases  both  kidneys 
or  only  one  are  enlarged  more  or  less,  1-4  kg.  in  weight  (in  a 
case  of  Cadeac's  the  kidney  weighed  6.5  kg.).  The  renal  capsule 
is  thickened,  adherent  to  the  cortex  in  many  places  and  in  varia- 
ble extension,  the  surface  of  the  kidney  is  multi-colored;  on 
a  red-brown  ground  yellowish-gray  islands  are  prominent,  and 
corresponding  with  them  striae  or  wider  wedge-shaped  liands 
of  similar  color  are  visible  on  the  cut  surface.  AVithin  these 
islands  and  within  the  brown  portions  of  the  kidneys  there 
appear  yellowish-gray,  turbid  small  foci  which  are  suppurating 
and  soft  or  friable  and  cheesy,  each  one  being  surrounded  by 
hemorrhagic  spots.  Hemorrhagic  infarcts  are  rare.  Later  the 
consistency  of  the  kidney  increases,  but  in  the  initial  stage 
the  tissue  shows  more  or  less  serous  infiltration. 

The  dilated  pelvis  of  the  kidney  contains  a  dirty-gray, 
grayish-yellow,  yellowish-brown  or  brownish  fluid  which  may 
be  bloody  discolored,  cloudy,  flocculent  and  peculiarly  milky 
and  which  contains  pus,  tissue  shreds,  blood  clots  and  granular 
calcareous  material.  The  mucous  membrane  is  much  swollen 
or  thickened,  in  recent  cases  studded  with  hemorrhagic  spots ; 
in  places  it  shows  ulcerous  destruction  or  dirty-gray  deposits. 
The  renal  papillae  are  covered  with  a  viscid  purulent  substance, 
they  are  reddened  and  terminate  in  dirty  discolored  tissue 
shreds  so  that  they  have  an  eroded  appearance.  Sometimes  the 
places  of  the  renal  papillae  are  occupied  by  hollow  spaces 
filled  with  purulent  masses  (Pyelonephritis  cavernosa)  or_  if 
the  process  progressed  by  multiple  lobar  extension,  the  entire 


Anatomical   Changes,    Syniptonis.  1017 

kidney   is    traiist'onncd    into    a   j)iis    sac   consistin^i;-   of   several 
('()ini)artments,  4-16  kg.  in  weight  (Pyonephrosis)   (Kitt). 

Tlie  ureter  is  clianged  into  a  tube  with  thick  walls,  up 
to  two  lingers  in  width,  the  mucosa  may  present  similar  changes 
as  that  of  the  renal  pelvis.  The  mncons  membrane  of  the 
bladder  also  sometimes  contains  hemorrhages  or  a  variable 
inflammation  which  may  even  be  diphtheritic. 

Tlie  iiiicroM-opical  examination  of  tho  affcctoil  kiihiov  jjives  the  followinff 
result,  acconlinj;  to  Ernst:  Cellular  infiltration  in  the  eortex,  in  places  assuniinjj  tho 
form  of  small  or  larjje  jnirnlejit  infarcts,  the  dilateil  urinary  tubules  are  filled  with 
anuclear  epithelia,  pus  cells  and  casts,  vascular  thrombosis  is  frequent;  in  a  more 
advanced  sta^je  connective  tissue  proliferation,  neci-otic  or  ])urulent  foci  esjiecially 
in  the  jiajiillae.  Masses  of  bacteria  are  found  in  the  small  softened  foci  in  the 
cortex,  in  the  capsules  of  Bowman  an<l  in  the  thrombi  of  the  l>lood  vessels,  while  the 
collectinja:  tubules  appear  as  though  filled  up  with  bacteria. 

The  fluiil  in  the  renal  pelvis  and  the  ureter  contains  much  tissue  detritus, 
numerous  pus  cells,  some  re<l  l)lood  corpuscles,  fibrin  threat  Is.  pavement  and  cylin- 
Iric  epithelia  and  crystals  of  trij)le  ])hosi)hates ;  there  are  also  found  masses  of 
B.  renalis,  alone  or  more  often  associated  with  other  bacteria. 

Symptoms.  It  is  impossible  to  indicate  a  definite  period 
of  incubation  because  the  exact  time  of  the  bacterial  invasion 
?annot  be  ascertained.  It  appears  from  the  observations  made 
up  to  the  present  that  pyelonephritis  may  become  manifest 
in  from  a  few  days  to  several  months  after  the  commencement 
af  the  primary  disease. 

In  the  more  frequent  chronic  form  the  clinical  symptoms 
are  diminished  appetite,  suppression  of  rumination,  emaciation, 
.staggering  gait,  the  urine  is  voided  fairly  easily.  Pressure 
upon  the  lumbar  region  sometimes  produces  manifestations? 
of  pain.  On  rectal  exploration  the  bladder  is  found  half  filled, 
sometimes  the  dilated  ureter  is  felt  above  the  pelvis,  below 
the  vertel)ral  column,  on  both  sides  or  only  one,  it  feels  like 
a  firm  rope  passing  to  the  kidneys  and  is  usually  thickened 
in  its  anterior  portion.  Palpation  of  the  kidneys  may  indicate 
normal  conditions  or  enlargement,  sometimes  fluctuation,  or 
sensitiveness  to  pressure  in  one  or  both  kidneys. 

It  is  more  frequent  to  find  increased  urination  associated 
with  painful  exertions.  Pressure  on  the  sacral  region  causes 
pain,  a  thick  purulent  vaginal  discharge  soils  the  pubic  region. 
Rectal  examination  gives  similar  results  as  in  the  preceding 
case,  but  on  inspection  catarrhal  reddening  or  swelling  of  the 
vaginal  mucosa  is  seen,  especially  around  the  urethral  opening, 
and  the  mucosa  may  be  covered  with  superficial  ulcers.  In 
male  animals  the  prepuce  may  be  inflamed  (Hess).  At  times 
colicky  symptoms  appear,  proliably  due  to  the  temporary 
occlusion  of  the  ureters  by  masses  of  exudate,  blood  clots  or 
sediment. 

The  urine  is  seldom  clear  and  even  then  contains  albumen, 
and  on  microscopical  examination  cellular  elements  and  the 
baciUary  chnn])s  described  above.  In  the  great  majority  of 
cases  the  urine  is  turbid,  muddy,  sometimes  bloody,  strongly 


1018  Bacterial    Pyelonephritis. 

alkaline  and  contains  as  much  as  2%  of  albumen,  and  also  free 
ammonia.  Under  the  microscope  there  appear  pus  cells,  red 
blood  corpuscles,  epithelial  cells,  crystals  of  triple  phosphates 
and  often  renal  elements.  By  Gram's  stain  and  even  in  un- 
stained specimens  of  fresh  urine  clumped  bacilli  or  other 
bacteria  are  seen  (Fig.  176). 

Toward  the  termination  of  the  disease  the  animals  are 
extremely  emaciated  and  unable  to  stand.  They  die  of  ex- 
haustion or  of  acute  uremia  unless  they  are  killed.  In  the 
rare  acute  form  symptoms  of  fever  (up  to  39.0°  to  40°  C.) 
and  rapid  pulse   are   observed.     The  local  manifestations   of 


CC— - 


d: 


Fig.   170.     Urinary  sediment  of  a  cow  vith  hacterial  pyelonephritis,     a  Clumps  of 

Coiynebacilliis  renalis.     h  Squamous  epitlielium  from  the  urinary  passages,     c  renal 

epithelium;  d  pus  cells;  e  red  blood  corpuscles.     (Magnif.  about  1000.) 

the  chronic  form  are  intensified  and  the  urinary  findings  are 
similar.  This  form  is  probably  due  to  a  septicemic  infection 
from  the  urinary  organs  or  to  a  severe  acute  nephritis,  it  may 
lead  to  death  within  two  weeks,  but  in  exceptional  cases  the 
sjinptoms  diminish  in  severity  and  the  disease  passes  into 
the  chronic  form. 

Recovery  of  a  well  defined  pyelonephritis  has  never  yet 
been  observed,  although  the  possibility  of  a  clinical  cure  is 
not  excluded  if  the  disease  is  unilateral. 

Diagnosis.  As  has  been  pointed  out  first  by  Schmidt,  the 
disease  may  be  recognized  positively  by  the  microscopic  demon- 


Diagnosis,    Treatment.  1019 

stration  of  the  Coryuebacilliis  renalis  wliicli  is  usually  present. 
Only  upon  this  basis  is  it  possible  to  dilTerentiate  the  affection 
from  the  other  forms  of  nephritis  or  from  inflammatory  affec- 
tions of  the  uterus,  vagina  and  bladder,  and  also  from  renal 
tuberculosis.  Mistakes  are  the  more  easily  possible  as  many 
of  these  diseases  also  frequently  occur  after  parturition  with- 
out simultaneous  nephritis.  If  no  symptoms  exist  pointini?  to 
these  affections,  and  if  some  weeks  after  a  delivery  which  was 
not  quite  normal,  the  urine  contains  pus,  there  exists  a  just 
suspicion  of  pyelonephritis  which  is  further  supported  by  the 
demonstration  of  a  thickened  ureter  and  enlargement  of  the 
corresponding  kidney. 

Treatment.  Since  all  efforts  at  treatment  have  hitherto 
proved  in  vain  it  is  advisable  to  slaughter  the  animals  as  soon 
as  possible.  In  the  beginning  of  the  disease  irrigation  of  the 
vagina  and  bladder  and  internal  disinfectants  like  salicylic 
acid,  Folia  uvae  ursi  (25-59  gm.)  may  be  tried. 

Literature.  Albreeht,  W.  f.  Tk.,  1900.  409.  —  Baillet  &  Seres,  Rev.  gen., 
1903.  I.  .504.  —  Bartels,  D.  t.  W.,  1879.  30.3.  —  Cadeac  &  Morot,  J.  vet.,  1897. 
65  —  Danimanii,  D.  Z.  f.  Tm.,  1877.  III.  26.3.  —  Enderlen,  D.  'Z  f.  Tm.,  1S91. 
XVII.  32.5  (Lit.).  —  Ernst,  Cbl.  f.  Bakt.,  190;j.  XXXIX.  549;  XL.  79  (Lit.).  — 
Friedberger,  Miincli.  Jhb.,  1899/90.  164.  —  Gillot,  Eec,  1888.  159.  —  Hess, 
Schw.  A..  18SS.  XXX.  269;  1891.  XXXIIL  157;  1892.  XXXIV.  70.  —  Hoflich, 
Monh.,  1S91.  IL  337  (Lit.).  —  Jensen,  Ergebn.  d.  Path.,  1895.  IL  389  (Lit.).  — 
Koch,  Z.  f.  Hyg.,  1907.  LVIII  287.  —  Kiinnemann,  A.  f.  Tk.,  1903.  XXIX.  128. 
—  Lienaux  &  Zwaeuopoel,  Ann.,  1902.  500.  —  Lucet,  J.  vet.,  1892.  220.  — 
Masselin  &  Porcher,  Eec,  1895.  657.  —  Mollereau  &  Poreher,  Bull.,  1895.  322. 
-^  Scherzer.  B.  t.  W^,  1903.  445.  —  Schmidt,  Maanedsskr.,  1890.  II.  149;  1899. 
X.  179.  —  Sommer,  B.  t.  W.,  1906.  400.  —  ^Vvssmann,  Schw.  A.,  1904.  XLVI.  287. 


11.    Inflammation  of  the  Renal  Pelvis.    Pyelitis. 

Etiology.  All  inflammation  of  the  mucous  membrane  of 
the  renal  pelvis  arises  usually  in  consequence  of  mechanical 
irritation,  particularly  in  the  presence  of  urinary  calculi  (in 
birds  also  when  uric  acid  crystals  are  present)  and  of  animal 
parasites  in  the  pelvis  of  the  kidneys,  also  in  stasis  of  the 
urine  in  which  fermentation  is  produced  l)y  bacteria.  Infectious 
and  poisonous  substances  which  leave  the  kidneys  with  the 
urine  may  also  exert  a  pathogenic  action  upon  the  mucous 
membrane  of  the  pelvis.  For  instance,  in  acute  infectious 
diseases  the  renal  pelvis  frequently  shows  catarrhal  involve- 
ment when  the  renal  tissue  is  also  affected ;  Dieckerhoff  even 
observed  a  diphtheritic  pyelitis  in  a  case  of  influenza.  Occa- 
sionally the  bacilli  of  tuberculosis  and  of  glanders  produce 
specific  changes  in  the  renal  pelvis.  Of  chemical  irritants, 
especially  cantharides,  oil  of  turpentine  and  the  severe  diuretic 
remedies  in  general  cause  pyelitis  if  they  are  administered 
for  a  considerable  time  or  in  large  amounts.  Prolonged  venous 
stasis  in  the  kidnevs  mav  also  give  rise  to  changes  in  the  mucous 


1020  Pyelitis. 

membrane  of  the  renal  pelvis  which  are  similar  to  chronic 
catarrh.  Finally  the  disease  occurs  in  conjunction  with  severe, 
especially  with  purnlent  nephritis,  and  also  Avith  ascending  in- 
flammation of  the  bladder  and  of  the  ureters. 

Anatomical  Changes.  Simple  catarrh  of  the  mucous  mem- 
brane of  the  pelvis  (Pyelitis  catarrhalis)  is  characterized  by 
increased  redness  and  swelling,  possibly  small  hemorrhages, 
in  chronic  cases  by  slate-gray  discoloration  and  thickening  of 
the  mucosa  which  is  covered  with  thick  mucus  or  pus  and  at 
times  with  a  granular  or  lumpy  deposit.  In  severe  inflamma- 
tion a  great  number  of  hemorrhagic  foci  are  found  in  the 
mucosa  and  much  blood  within  the  pelvis  (P.  Haemorrhagica) ; 
in  other  cases  there  is  ulcerous  destruction  of  the  mucosa 
(P.  ulcerosa)  or  this  is  covered  with  membranous  deposits 
(P.  membranacea  s.  diphtherica).  The  inflammatory  process 
may  be  associated  with  a  dilatation  of  the  renal  pelvis,  its  cavity 
being  filled  with  urine  (Hydronephrosis)  or  largely  with  pus 
(Pyonephrosis). 

Symptoms.  Usually  the  patients  show  sjanptoms  of  pain 
which  are  not,  however,  characteristic.  In  larger  animals  rectal 
exploration  sometimes  makes  it  possible  to  determine  sensitive- 
ness to  pressure  in  one  or  both  kidneys  and,  in  some  cases, 
a  dilatation  of  the  corresponding  renal  pelvis ;  in  smaller 
animals  pressure  through  the  abdominal  wall  elicits  evidences 
of  pain.  Some  animals  have  frequent  desire  to  urinate,  only 
a  small  amount  of  urine  being  voided  at  one  time,  in  other  cases 
micturition  is  normal. 

The  color  and  specific  gravity  of  the  urine  are  often  normal, 
but  the  urine  contains  much  mucus  and  more  or  less  pus.  The 
reaction  is  alkaline  in  herbivora,  acid  or  alkaline  in  carnivora, 
the  latter  especially  in  ammoniacal  fermentation.  In  any  case 
the  urine  contains  albumen  corresponding  in  quantity  to  that 
of  the  pus.  In  consequence  there  is  always  a  fairly  copious 
organic  sediment,  containing  pus  cells,  and  also  long-tailed, 
epithelial  cells  which  look  like  molars,  have  pointed  projections 
at  one  or  both  ends,  and  are  derived  from  the  deeper  epithelial 
layers  of  the  mucous  membrane  of  the  renal  pelvis ;  there  are 
also  pavement  epithelia.  At  times  the  sediment  contains  red 
blood  corpuscles,  small  blood  clots  and  mucous  shreds.  If 
urinary  calculi  are  present  in  the  renal  pelvis  the  urine  con- 
tains whitish  or  yellowish  sandy  granules,  if  parasites  are 
present  the  sediment  contains  eggs  of  worms. 

Since  inflammation  of  the  renal  pelvis  is  often  accompanied 
by  nephritis  or  by  catarrh  of  the  bladder,  the  clinical  picture 
mg,y  be  more  or  less  obscured  by  the  symptoms  of  these 
•diseases. 

Pyelitis  is  always  of  serious  significance,  because  it  is  the 


Syiiiptoins,    Diagnosis,    Trealiiicnf.  1021 

sequel  of  dauiiorons  ]n-iiiiai'y  diseases  (calculi,  parasites, 
nephritis)  or  leads  of  its  own  account  to  the  development  of 
nephritis. 

Diagnosis.  The  disease  can  be  recognized  only  by  means 
of  urinary  examination.  The  presence  of  pus  cells  and  of 
molar-shaped  epithelial  cells  is  particularly  significant,  but  is 
characteristic  only  then  when  a  catarrh  of  the  bladder  may 
be  excluded,  because  long-tailed,  molar-shaped  epithelia  may 
also  be  derived  from  the  deeper  layers  of  the  vesical  mucosa. 
The  pus  may  also  have  entered  the  urine  from  other  parts 
of  the  urinary  organs,  especially  from  the  kidneys,  fi'om  peri- 
renal abscesses,  from  the  bladder,  the  prostate,  etc. ;  and  it  is 
often  extremely  difficult  or  impossible  to  ascertain  its  origiji. 
It  is  finally  to  be  considered  that  in  the  presence  of  a  balanitis, 
of  a  uterine  or  a  vaginal  catarrh,  pus  may  be  mixed  with  the 
normal  urine. 

Treatment.  For  the  purpose  of  disinfecting  the  renal 
pelvis  the  following  remedies  may  be  administered  internally: 
Salicylic  acid  or  its  salts  (25-50  gm.  for  horses  and  cattle; 
2-10  gm.  for  sheep,  goats,  hogs;  0.1-2.0  gm.  for  carnivora  at 
each  dose) ;  according  to  Walther  these  preparations  may, 
however,  produce  albuminuria  and  even  nephritis  by  irritating 
the  urinary  passages  and  the  kidneys.  Salol  in  like  doses,  oil 
of  turpentine  (100-200  gm.,  or  5-25  gTn.,  or  0.05-2  gm.), 
urotropin  (5-10  gm.  for  large,  0.5-1.0  gin.  for  smaller  animals, 
3  times  daily  with  much  water  [Gmeiner]),  helmitol  (6-10  gm. 
for  large,  1-2  gm.  for  smaller  animals,  per  dose,  3  times  daily). 
Folia  uvae  ursi  (20-50  gm.  for  large,  1-15  gm.  for  smaller 
animals). 

12.     Kidney  Stone  Disease.     Nephrolithiasis. 

(Calculi  r 6)1  ales.) 

Occurrence.  Urinary  stones  are  in  domestic  animals  not 
infrequent  and  are  found  in  various  portions  of  the  urinary 
passages.  They  occur  primarily  almost  always  in  the  wider 
parts  of  the  urinary  apparatus,  either  in  the  renal  pelvis, 
l)0SvSibly  already  in  the  straight  urinary  tubes,  or  in  the  bladder, 
and  are  only  later  carried  with  the  urine  into  other  portions 
of  the  urinary  passages.  Stones  are  found  most  often  in  horses 
and  cattle  and  are  much  more  rare  in  the  other  mannnals  and 
in  fowls.  Their  frequency  is  said  to  increase  watli  the  age 
of  the  animals  (Moller).  Sometimes  the  trouble  occurs  simul- 
taneously in  many  animals  among  cattle,  sheep  and  hogs. 

Tn  the  years  1862-1897  urinary  calculi  were  found  in  the  Dresden  pathological 
Institute  in  12  out  of  3,301  dogs  '(0.3870,  in  1  out  of  450  cats  (0.229"^.  and  in 
11  out  of  2,100  horses   (0.5%). 


1022  Kidney  Stone  Disease. 

Etiology.  According  to  Klimmer  tlie  principal  condition 
for  the  .development  of  urinary  calculi  is  that  the  urine  con- 
tains an  excess  of  salts  or  that  slightly  soluble  or  insoluble  salts 
are  formed  in  it,  already  within  the  urinary  passages.  In  both 
cases  the  eliminated  salts  are  deposited  upon  any  foreign  body 
that  may  be  present  in  the  urinary  passages,  and  the  small 
stone  which  is  formed  in  this  manner  gradually  enlarges  by 
the  continued  deposit  of  salts.  It  is  a  question  whether  the 
presence  of  sticky  substances,  especiallj^  of  albuminous  or 
gelatinous  bodies  is  required  for  the  formation  of  stones.  The 
nucleus  on  which  the  eliminated  salts  are  deposited  is  usually 
furnished  by  some  element  derived  from  the  urinary  organs 
(epithelial  cells,  casts,  blood  clots,  pus-  and  fibrin  shreds, 
necrotic  tissue  shreds),  it  is  rarely  a  foreign  body  which  has 
entered  the  urinary  passages  from  the  outside  (straw,  gravel, 
etc.). 

The  amount  of  salts  present  in  the  urine  is  materially 
influenced  by  the  chemical  composition  of  the  food  and  of  the 
drinking  water,  and  therefore  in  a  way  also  by  the  conditions 
of  soil.  Drinking  water  which  contains  much  lime  or  many 
earthy  constituents  is  of  importance;  so  are  food-stuffs  that 
are  mixed  with  earthy  substances  or  which  are  rich  in  calcium. 
It  can  thus  be  explained  why  the  disease  is  more  frequent 
in  herbivora  in  regions  where  the  soil  is  calcareous  (Lang 
observed  on  one  estate  the  disease  excliisively  in  those  oxen 
which  had  lived,  at  least  for  a  time,  on  a  certain  farm).  Multiple 
cases  may  occur  independently  of  the  conditions  of  soil  after 
inappropriate  feeding.  Especially  feeding  with  very  large 
quantities  of  potatoes,  the  waste  of  sugar  beets,  beets,  and  slop 
may  be  followed  in  cattle  by  the  formation  of  silicate  con- 
cretions, and  a  food  rich  in  phosphorus  (bran,  grains)  may  give 
rise  to  phosphatic  calculi  (especially  in  sheep).  Theis  saw 
urinary  stones  in  two  mares  which  had  for  months  received 
prepared  bone  meal. 

Inflammatory  diseases  of  the  urinary  passages,  also  in 
complete  retention  of  urine,  from  whatever  cause,  may  lead 
to  the  formation  of  calculi  by  causing  the  formation  of  slightly 
soluble  or  insoluble  compounds,  owing  to  the  disintegration 
of  the  urine;  they  furnish  at  the  same  time  a  nucleus  for  the 
calculus.  In  this  direction  bacterial  diseases  are  particularly 
dangerous. 

The  attempt  has  been  made  repeatedly  to  produce'  urinary  ealeuli  artificially. 
Tu  Studensky's  experiments  salts  were  indeed  deposited  upon  foreign  bodies  that 
had  been  introduced  into  the  bladder,  but  actual  calculi  were  formed  only  when  the 
bladder  was  at  the  same  time  subject  to  catarrhal  affection.  Ebstein  and  Nicolaier 
oliserved  the  formation  of  stones  after  the  systematic  administration  of  oxamide. 
According  to  these  authors  this  substance  is  absorbed  in  the  intestines,  is  then  elim- 
inated in  the  kidneys  and,  on  coming  in  contact  with  the  mucosa  of  the  urinary  pas- 
sages it  causes  a  necrosis  of  the  epithelial  cells,  so  that  the  albuminous  substance  is 
supplied  which  is  said  to  be  required  for  the  formation  of  calculus.  Thomassen  also 
found  small  stones  in  the  renal  pelvis  of  a  small  dog  which  had  been  fed  with 
oxamide  for  two  weeks. 


Anatomical  Changes.  1023 

III  oalcuIatiiiK  the  time  of  development  of  the  calculi  their  size  and  chemical 
composition  must  be  considered,  and  also  the  external  conditions  (Klimmer).  Pflu^' 
says  that  phosphatic  concretions  grow  more  rapidly  than  the  other  calculi.  Kathke 
observed  in  cattle  in  the  space  of  three  weeks  the  formation  of  calculi  of  from  pin- 
heail-  to  bean-size. 

Anatomical  Changes.  Kidney  stones  are  sometimes  quite 
small,  covering'  the  mucous  membrane  of  the  renal  pelvis  in 
the  form  of  tine  or  coarse  grits,  and  are  there  mixed  with  the 
urine,  in  exceptional  cases  they  are  imbedded  in  the  renal 
tissue;  in  other  eases  they  are  good-sized  actual  stones  and 
may  fill  out  entire  calyces  and  even  the  whole  renal  pelvis. 
The  last  variety  of  stone  is  sometimes  round,  lying  free  in 
the  pelvis,  or  if  present  in  numbers,  they  are  polislied  smooth 
by  mutual  friction.  Larger  stones  show  irregular  coral  shapes 
with  knobbed  surfaces  from  having  adapted  their  shape  to 
the  form  of  the  cavity  in  which  they  formed.  Sometimes  each 
calyx  is  filled  by  one  stone,  in  other  cases  the  stones  are  con- 
nected by  their  extremities  which  point  toward  the  ureters 
or  they  may  fuse  together  to  good-sized  masses  after  atrophy 
of  the  calyces.  As  the  stones  grow,  the  renal  substance  grad- 
ually disappears  and  finally  large  stones  may  imitate  the  shape 
of  the  kidney,  and  are  found  surrounded  only  by  a  thick 
capsule. 

If  several  stones  are  present,  the  mucous  membrane  of 
the  renal  pelvis  is  always  inflamed,  perhaps  it  contains  hemor- 
rhagic spots  or  ulcers,  or  is  covered  with  diphtheritic  pseudo- 
membranes.  The  renal  tissue  usually  bears  the  signs  of  an 
acute  or  a  chronic  inflammation. 

The  urinary  calculi  of  herbivora  are  grayish-white,  brown  or  mottled  and  con- 
sist, according  to  examinations  made  by  Fiirstenberg,  largely  of  calcium  carbonate 
and  magnesium  carbonate  which  form  multicolored  layers  around  a  nucleus  consist- 
ing of  organic  substances,  rarely  of  calcium  oxalate.  In  cattle  and  sheep  the  stones 
are  smooth,  often  small,  yellowish  or  gray,  spherical  or  angular,  and  have  a  peculiar 
metallic  or  mother -of- ^iBad  luster,  which  evidently  is  due  to  the  very  fine  arrange- 
ment of  the  layers,  although  Fiirstenberg  believes  it  due  to  the  admixture  of  ferrous 
carbonate.  Bourmer  demonstrated  0.28%  of  iron  in  the  renal  stones  of  a  cow. 
Some  stones  do  not  show  layers  and  are  more  friable.  They  consist  of  a  small 
amount  of  organic  material,  of  calcium  carbonate  and  of  a  small  quantity  of  mag- 
nesia carbonate.  In  a  cow  which  had  probably  suffered  from  leukemia  or  pseudo- 
leukemia Joest  found  xanthin  stones  which  usually  are  formed  in  case  of  consider- 
able destruction  of  cellular  nuclei  and  which  had  already  been  found  by  Weiske 
in  a  ram  having  presumably  suffered  with  leukemia. 

The  calculi  of  carnivora  contain  ammoniacal  magnesia  phosphate  and  small 
quantities  of  calcium  phosphate  or  carbonate,  usually  also  uric  acid  and  its  salts. 
Cystin  calculi  are  much  less  frequent  and  are  always  small,  soft  and  of  a  greasy 
luster. 

Symptoms.  Renal  calculi  give  rise  to  a  clinical  picture 
which  is  as  a  whole  similar  to  that  of  pyelitis,  except  that 
the  evidences  of  pain  are  more  decided  and  are  rarely  al)sent. 
Xevertheless  cases  undoubtedly  occur  in  which  large  stones 
are  found  on  autopsy  and  perhaps  total  atrophy  of  one  kidney, 
and  in  which  the  animal  showed  no  signs  of  disease  during 
life.     The  walk  becomes  stiff,  the  region  of  the  kidneys  sensi- 


1024  Kidney  Stone  Disease. 

tive  to  pressure.  In  many  cases  the  animals  (horses,  cattle, 
sheep)  are  attacked  by  severe  colic,  either  suddenly  or  after 
violent  motions,  after  jumping,  etc.,  and  during  these  attacks 
repeated  attempts  are  made  to  urinate.  These  severe  colicky 
pains  are  observed  especially  when  the  ureter  is  occluded  by 
a  stone  which  has  passed  out  of  the  renal  pelvis,  because  both 
the  mechanical  irritation  of  the  ureteral  walls  and  the  stasis 
of  the  urine  cause  pain  until  the  stone  is  finally  discharged 
into  the  bladder.  During  the  attacks  it  may  be  totally  im- 
possible to  void  the  urine  if  both  ureters  are  occluded  (Barthe), 
or  if,  in  unilateral  obstruction  of  the  ureter,  the  function  of 
the  other  kidney  has  been  temporarily  suppressed  by  reflex 
action  (Morgagni).  A  prolongation  of  the  anuria  may  lead  to 
uremia.  This  ''renal  colic"  usually  recurs,  because  several 
small  stones  are  present  in  the  renal  pelvis  and  because  new 
ones  are  always  formed  which  from  time  to  time  pass  into  the 
ureter. 

The  urine  contains  pus  cells,  perhaps  epithelial  cells  from 
the  pelvis  of  the  kidney,  and  at  times  a  sandy  sediment  or 
small  stones.  It  is  not  rarely  bloody,  and  on  microscopical 
examination  fine  fibrinous  coagulates  are  found  in  addition  to 
red  blood  corpuscles.  In  cattle  and  sheep  grit-like  granules 
sometimes  adhere  to  the  hairs  around  the  opening  of  the 
sheath. 

The  nature  of  the  disease  may  at  times  be  discovered  by 
rectal  examination  or  by  palpation  through  the  abdominal 
walls,  that  is,  in  cases  in  which  the  presence  of  one  or  several 
stones  in  the  renal  pelvis  may  be  determined  in  addition  to 
the  increased  sensitiveness  of  the  kidneys  and  of  the  renal 
pelvis.  If  several  stones  are  present  a  slight  trembling  is  felt 
on  palpation  in  the  walls  of  the  renal  pelvis  which  is  produced 
by  the  rubbing  of  the  stones  against  each  other.  During  the 
colicky  attacks  the  stone,  wdiicli  is  wedged  in  the  ureter,  may 
sometimes  be  felt  as  a  swelling  of  pea  to  bean  size,  which  is 
very  sensitive  to  pressure. 

Course  and  Prognosis.  Kidney  stones  always  cause  pro- 
longed disease,  in  the  course  of  which  attacks  of  colic  and 
disturbances  in  micturition  alternate  in  long  periods.  The 
disease  develops  slowly  and  may  lead  to  gradual  exhaustion 
of  the  animal.  The  pyelitis  which  has  been  produced  by  the 
calculi  is  followed  by  acute  or  chronic  nephritis  or  the  renal 
tissue  is  destroyed  by  atrophy  so  that  the  elimination  of  the 
urine  is  necessarily  impaired,  especially  in  bilateral  disease. 
Occasionally  necrosis  develops  in  the  wall  of  the  ureter  around 
the  arrested  stone  and  this  leads  to  peritonitis  or  to  purulent 
inflammation  of  the  perirenal  connective  tissue.  Kidney  stones 
may  also  reach  the  bladder,  may  here  increase  in  size  and 
cause  catarrh  of  the  bladder,  or  they  may  later  on  be  forced 


Course  and  Prognosis.  1025 

into  the  urethra  where  they  produce  retention  of  urine  which 
may  lead  to  death  in  a  brief  time. 

Diagnosis.  A  sufficiently  positive  recognition  of  the  disease 
presupposes  the  demonstration  of  pyelitis,  or  sandy  or  gritty 
sediment  in  the  urine,  or  the  direct  discovery  of  stones  in 
the  renal  pelvis  by  means  of  palpation.  The  disease  may  be 
mistaken  for  other  colicky  diseases,  nephritis,  paranephritic 
abscess,  renal  tumor,  etc. 

Treatment.  If  there  is  a  suspicion  of  calculus  formation, 
the  diet  must  above  all  be  regulated  thus  that  the  animals 
ingest  with  their  food  or  drinking  water  as  small  amounts 
as  possible  of  salts.  In  herbivora  it  is  therefore  necessary 
to  withdraw  especially  bran  and  to  limit  grains;  carnivora 
should  receive  only  little  meat ;  in  addition,  good  soft  water 
must  be  supplied.  The  drinking  of  large  amounts  of  carbonated 
water  is  recommended  to  secure  the  solution  of  calculi  and 
prevent  their  formation.  In  renal  colic  subcutaneous  injections 
of  morphine  or  the  administration  of  chloral  hydrate  is  in- 
dicated. 

Lorge  and  Eubay  have  attempted  the  operative  removal 
of  kidney  stones  (nephrotomy)  with  satisfactory  results.  The 
resection  of  the  diseased  kidney  (nephrectomy)  may  also  be 
thought  of. 

Literature.  Albrecht,  W.  f.  Tk.,  1900.  1.  —  Ball,  J.  vet.,  1906.  19.3.  — 
Barthe,  Eev.  vet.,  1906.  289.  —  Bourmer,  Beitr.  z.  Nephrolithiasis  usw.  Diss.  Bern. 
1908  (Lit.).  —  Brun,  Bull.,  1902.  80.  —  Dammann,  D.  t.  W.,  1897.  435.  —  Freger, 
J.  vet,  1907.  326.  —  Hebrant,  Ann.,  1902.  578.  —  Imniinger,  W.  f.  Tk.,  1901. 
553.  —  Klimmer,  A.  f.  Tk.,  1899.  XXV.  336.  (complete  Lit.  to  1899).  —  Prietseh, 
S.  B.,  1901.  45.  —  Eabieanx,  Bull.,  1902.  310.  —  Eathke,  Pr.  Mt.,  1865-66.  129.  — 
Eubay,  Ann.,  1895.  413.  —  Theis,  Bull.,  1905.  255. 


13.    Renal  Dropsy.    Hydronephrosis. 

{Cystic  Kidney.) 

Occurrence.  Hydronephrosis  is  frequently  found  in  cattle, 
hogs  and  sheep  during  meat  inspection. 

Lucks  found  the  aflfection  in  43  (0.679f)  out  of  6,425  hogs  examined,  in 
female  pigs  almost  3  times  as  often  as  in  males;  in  29  animals  the  condition 
was  unilateral  (10  times  on  the  left  side,  19  times  on  the  right  side),  in  14  animals 
it  was  bilateral.  Horn  saw  hydronephrosis  in  0.21%  of  7,000  slaughtered  sheep, 
usually  unilateral,  and  due  to  kidney  stones  in  80%   of  the  cases. 

Etiology.  The  immediate  cause  of  hydronephrosis  is  sup- 
plied by  an  impediment  to  the  flow"  of  the  urine  from  one  or 
both  renal  pelvis,  in  consequence  of  which  the  urine,  which  is 
steadily  secreted,  is  dammed  up  behind  the  impediment  with 
a  constantly  increasing  pressure.  The  affected  urinary  passages 
gradually  become  dilated  and  the  medullary  substance  of  the 

Vol.  1—65 


]026  Hydronephrosis. 

kidneys  atrophies,  until  finally  even  the  cortex  becomes 
atrophic;  with  this  the  process  is  arrested  because  no  more 
urine  is  secreted.  If  the  impediipent  is  proximal  to  the  bladder, 
only  one  kidney  is  usually  affected;  other  impediments  to  the 
outflow  of  urine  necessarily  lead  to  bilateral  hydronephrosis. 

It  is  evident  that  only  chronic  or  periodical  abnormal  conditions  of  the 
organs  which  discharge  the  urine  are  capable  of  producing  hydronephrosis,  since 
its  development  requires  a  period  of  several  months.  Total  occlusion  of  both 
ureters  or  of  the  urine-carrying  organs  from  the  openings  of  the  ureters  down 
is  not  followed  by  hydronephrosis  because  the  animal  perishes  of  uremia  or  of 
rupture  of  the  bladder  in  a  comparatively  short  time.  But  even  a  unilateral  total 
occlusion  of  the  ureter  does  not  produce  hydronephrosis  if  it  is  permanent,  beeaus-e 
then  the  pressure  in  the  urinary  passages  rapidly  increases,  and  therefore  the 
secretion  of  urine  in  the  corresponding  kidney  diminishes  just  as  rapidly  and  to 
complete  cessation   (Senator). 

As  to  the  individual  causes,  this  much  is  certain  that  the 
following  affections  are,  although  comparatively  rarely,  of 
fairly  equal  importance  in  all  animal  species;  inflammation  of 
the  bladder  or  of  the  ureters,  obstruction  of  the  ureters  by 
stones,  secretions,  coagulated  blood  (for  instance  in  bacterial 
pyelonephritis),  the  obliteration  of  the  ureter-opening  into  the 
bladder  (evidently  congenital  [Kitt]),  congenital  valvular  for- 
mations, constriction  of  the  ureter  by  muscular  fibers  of  the 
wall  of  the  bladder  (Lucks),  stenosis  of  the  urethra  in  enlarge- 
ment of  the  prostate,  compression  through  tumors,  etc. 

The  most  frequent  causes  are,  however,  of  different 
character.  In  hogs.  Lucks  proved  by  the  results  of  careful 
examinations  in  30  cases  that  the  cause  of  hydronephrosis 
usually  lies  in  the  fact  that  the  openings  of  the  ureters  are 
congenitally  placed  too  low  in  the  neck  of  the  bladder  (on  one 
or  both  sides)  and  that  in  the  hog  the  attachment  of  the  bladder 
is  very  loose.  This  makes  it  possible  that  the  partially  filled 
bladder,  which  then  falls  lower  down,  presses  its  neck,  together 
with  the  caudal  portion  of  the  ureter  against  the  anterior  border 
of  the  pubis  and  thus  periodically  prevents  the  voiding  of  the 
urine.  In  cattle  other  causes  are  probably  active,  for  instance, 
the  occasional  bending  of  the  left  ureter  by  the  filled  rumen, 
in  which  case  the  left  kidney  is  pushed  out  of  place  (Breuer), 
also  the  compression  of  the  ureter  by  the  filled  stomach. 

In  chronic  inflammatory  processes  in  the  kidneys  some  urinary  tubuli  are 
at  times  constricted  in  portions  by  the  contraction  of  the  connective  tissue  which 
is  undergoing  atrophy,  or  are  filled  with  small  stones  or  cell  masses,  so  that  the 
canals  which  are  attached  to  the  Malpighian  bodies  are  dilated,  the  urine  con- 
tinuing to  be  secreted,  and  are  thus  transformed  into  retention  cysts.  Such  small 
cysts  are  sometimes  found  in  large  numbers,  the  contiguous  ones  become  confluent 
and  the  entire  kidney  is  transformed  into  a  collection  of  cysts  of  variable  si7es 
(cystic  kidney,  hydrops  cysticus).  In  this  form  the  trouble  is  found  especially 
in  cattle,  and  occasionally  as  a  congenital  condition. 

Anatomical  Changes.  The  dropsical  alteration  of  the 
kidney  may  be  met  with  in  various  stages.  If  the  process  is 
far  advanced,  the  kidney  is  changed  into  a  large  undulating 


Analtiiiiical    ("lianges,    Syniptoiiis.  1027' 

bladder  (in  cattle  it  may  be  Vii  m.  long  and  as  wide  [KittJ, 
in  pigs  it  may  attain  a  weight  of  42  kg.  [Ricliter]).  The  wall 
of  this  bladder  is  formed  by  the  thickened  capsule  of  the  kidney 
and  only  here  and  there  isolated  portions  of  the  cortical  kidney 
substance  may  be  seen.  The  lobulated  kidneys  now  are  divided 
into  several  compartments  and,  if  the  impediment  is  in  the 
region  of  the  bladder,  these  compartments  form  the  direct  con- 
tinuation of  the  ureter  which  occasionally  may  also  be  dilated 
excessively.  In  less  severe  cases  the  cross  section  shows  a 
variable  layer  of  the  renal  substance,  which  looks  firm  and 
anemic;  in  disease  of  slight  degree,  only  the  calyces  and  the 
pelvis  of  the  kidney  are  dilated  noticeably. 

In  the  cystic  kidney  it  is  usual  to  find  partial  or  total  sclerosis  of  the  renal 
tissue  and  in  addition  watery  cysts  of  from  ]ioppy-  to  hemp-seed  size,  or,  if  they 
have  become  confluent,  vesicles  as  lar<ie  as  hazelnuts  or  larjjer,  up  to  the  size  of 
a  fist  and  even  of  a  man's  head;  thev  have  a  white-bluish  luster  and  are  wabbly. 
In  cattle  the  separate  renal  lobes  may  thus  l)e   transformed  into  cysts. 

Symptoms.  One  kidney  may  be  altered  very  greatly,  as 
above  described,  without  causing  any  particular  disturbances 
in  regard  to  the  discharge  of  urine,  because  the  other  organ, 
which  has  become  enlarged  by  compensation,  is  capable  of  at- 
tending to  the  elimination  of  the  urine.  In  bilateral  disease 
symptoms  may  become  manifest  much  earlier,  especially  a 
permanent  or  intermittent  diminution  in  the  quantity  of  urine, 
which  may  even  amount  to  complete,  although  transitory 
anuria,  dependent  upon  whether  the  discharge  of  the  urine 
is  impeded  continuously  by  the  underlying  cause  or  only  from 
time  to  time.  If  the  anuria  persists  for  a  long  time,  or  in 
the  case  of  a  severe  bilateral  hydronephrosis,  uremic  symptoms 
are  not  long  in  making  their  appearance.  On  rectal  explora- 
tion or  on  external  palpation  of  the  abdomen  one  or  both  kidneys 
are  more  or  less  enlarged  and  fluctuating  but  not  painful. 
The  dilated  ureter  may  sometimes  be  palpated  from  the  rectum. 
In  smaller  animals  the  enlargement  of  the  kidney  may  lead 
to  a  considerable  increase  in  the  size  of  the  abdomen  and  in 
such  cases  exploratory  puncture  of  the  swelling  yields  a  urine- 
like fluid. 

Eichter    observed,  in    a    two-year-old    pig,    an    enormous    enlargement    of    the 

abdomen    which    almost  touched    the    floor    and    showed    distinct    fluctuations;    the 

motions  of  the  animal  were  clumsy  and  staggering;  it  often  assumed  a  sitting 
position  like  a   dog. 

In  the  majority  of  cases  hydronephrosis  does  not  seem  to 
cause  any  particular  disturbance  of  health,  and  none  was  ever 
observed  in  cystic  kidney,  which  usually  atfects  only  portions 
of  the  kidneys. 

Treatment.    If  the  impediment  to  the  flow  of  urine  canno 
be  removed    only  extirpation  of  the  affected  kidney  (nephrec- 


1028  Renal    Tumors. 

tomy)  can,  in  case  of  unilateral  disease,  be  considered,  if  the 
enlarged  kidney  interferes  with  the  health  of  the  animal  by 
compressing  the  abdominal  organs.  This  procedure  can  only 
then  be  successful  when  the  other  organ  is  still  capable  of 
functioning. 

Literature.  Barrier,  Bull.,  1906.  683.  —  Basset,  Eev.  gen.,  1903.  I.  263.  — 
Horn,  Beitr.  z.  Kenntn.  d.  chron.  Nierenerkrank.  d.  Schafes.  Diss.  Leipzig,  1908. 
—  Kowalewski,  A.  f.  Vet.-Wiss.,  1904.  1004.  —  Kuknljevic,  A.  L.,  1905.  539.  — 
Lucks,  Monh.,  1905.  XVL  254.  —  Eichter,  Z.  f.  Flhvg.,  1907.  XVII.  429.  —  Suffran 
&  Daille,  Kev.  vet.,  1905.  612. 


14.    Renal  Tumors. 

Among  new-formations  in  the  kidneys  there  are  found  especially 
adenomas  and  carcinomas;  primary  sarcoma  is  very  rare,  but  second- 
arily it  occurs  occasionally.  In  dogs  villous  proliferations  sometimes 
develop  in  the  renal  pelvis  and  in  the  ureter,  and  impede  the  outflow  of 
the  urine,  thus  causing  dilatation  of  the  renal  pelvis  and  atrophy  of  the 
substance  of  the  kidney. 

Tuberculosis  of  the  kidneys  is  frequent  in  cattle  and  is  also  met  with 
in  dogs  and  pigs.  Small  tubercles  or  larger  cheesy  foci  are  disseminated 
mainly  in  the  cortical  portion  where  they  originated  through  embolisms. 
As  the  cheesy  foci  enlarge  they  may  finally  perforate  the  walls  of  the 
renal  pelvis  and  then  the  tuberculous  process  passes  over  into  the 
mucous  membrane  of  the  latter.  Tuberculosis  may  in  this  location  some- 
times also  arise  from  urogenic  infection. 

New-formations  in  the  kidneys  are  recognized  only  with  difficulty 
and  their  recognition  is  only  possible  if  one  or  both  kidneys  are  con- 
siderably enlarged.  The  actual  nature  of  the  new-formation  is  some- 
times indicated  by  external  conditions,  such  as  their  presence  in  other 
organs  or  as  the  enlargement  of  inguinal  glands  (in  carcinoma).  If  an 
enlargement  of  the  kidneys  exists  or  if  the  urine-carrying  organs  are 
not  affected  the  diagnosis  of  renal  tuberculosis  depends  upon  the  demon- 
stration of  tubercle  bacilli  in  the  urine. 

The  treatment  can  at  best  be  symptomatic. 


15.    Animal  Parasites  in  the  Kidneys, 
(a)    Eustrongylus  gigas. 

Etiology.  The  eustrongylus  gigas,  which  sometimes  occurs 
as  a  parasite  in  the  renal  pelvis  of  dogs,  horses,  cattle;  also 
in  many  wild  living  animals  and  in  man,  is  a  blood-red  thread- 
worm about  the  size  of  a  lead  pencil;  the  male  is  13-40  cm. 
long,  the  female  20  cm.-l  m.  The  eggs  (Fig.  177)  are  oval  in 
shape,  brownish  in  color;  their  covering  is  thick  and  shows 
numerous  round  depressions.  The  eggs  are  68-80  ^  long  and 
30-44  /*  wide. 

It  is  not  known  how  the  worm  enters  the  renal  pelvis. 
^Vhile  it  grows  here  it  produces  a  severe  purulent  and  hemor- 
rhagic inflammation  Avhich  in  its  turn  causes  a  secondary  in- 


Etiology,    Symptoms.  1029 

flammation  and  destruction  of  the  renal  tissue.     The  kidney 

is    eventually   transformed   into   a    thick-walled   sac  in   which 

the   worm   is   coiled   up,   imbedded   in   a 

l)uruIent-bloody  mass.    In  rare  cases  two 

worms  are  found  together  in  one  renal 

l)elvis;    Verney    has    even    found    four 

specimens  in  the  kidney  of  a  dog. 

Symptoms.  The  sjniiptoms  which 
are  caused  by  the  worms  vary  from  case  fio-.  177.  E.r.r^  of  EustroH- 
to  case,  and  it  may  even  occur  that  in  gyius  gigas'!'^ { aucv  Rail- 
spite  of  their  presence  no  disturbances  ^^^'^•^ 

in    health    are    observed;    especially    in 

horses  and  cattle  hardly  any  disease  symptoms  have  been 
reported.  On  the  other  hand,  dogs  suffer  severe  jjain,  are 
restless  and  may  even  show  mania  and  an  inclination  to 
1)ite,  simulating  rabies.  Sometimes  the  vertebral  column  is 
curved  laterally,  the  concavity  corresponding  to  the  affected 
side.  In  other  cases  only  general  indisposition  and  emaciation 
are  noted  and  may  increase  to  complete  exhaustion.  The  void- 
ing of  the  urine  may  require  an  effort,  it  contains  pus  and 
blood  and  indicates  the  existence  of  pyelitis. 

Diagnosis.  The  disease  can  be  diagnosed  only  by  the 
demonstration  of  the  characteristic  worm-eggs  (Fig.  177)  in 
the  urine. 

Course.  In  the  presence  of  severe  functional  disturbances 
the  disease  usually  ends  in  death.  Lacoste  saw  in  one  case 
the  worm  pass  out  through  the  urethra  after  which  the  dog 
recovered  completely.  In  exceptional  cases  the  worm  leaves 
the  renal  pelvis  and  is  arrested  in  the  bladder  where  it  causes 
intense  inflammation,  or  it  passes  on  to  the  penal  bone,  causing 
a  swelling  in  the  region  of  the  perineum  which  may  become 
as  large  as  a  fist  and  in  which  the  worm  is  coiled  up  (Leblanc, 
Mc%nin).     I^remic  symptoms  may  also  occur. 

Treatment.  The  removal  of  the  worm  from  the  renal 
pelvis  may  be  attempted  by  oil  of  turpentine  (for  dogs  table- 
or  coffee-spoonful).  If  the  worm  is  arrested  in  the  urethra 
it  can  be  removed  by  incising  the  swelling. 

Literature.  Leblane,  Bull,  de  Taead.  nied.,  1850.  640.  —  Mathis,  Lvon  ined., 
1884.  499.  —  Megnin,  Rec,  1S79.  223.  —  Neumann,  Mai.  parasitaires,  1892.  740 
(Lit.).  —  Pease  &  Smith,  Vet.  Jouin.,  1905.  200.  —  Railliet,  Zool.  med.,  1895. 
419.  —  Rivolta,  Med.  vet.,  1867.   1. 


(b)     Other  Parasites  in  the  Kidneys. 

Of  threadworms  the  larvae  of  the  Selerostommn  are  found  in  the 
kidneys  of  liorsos  where  they  localize  in  the  renal  artery  or  its  branches 
and  may  give  rise  to  hemorrhage  in  the  kidney  (see  page  .  ..).     Petit, 


1 030  Parasites  in  the  Kidneys. 

Henry  &  Germain  (Rec.  1909,  493)  found  in  a  horse,  that  had  been 
killed  on  account  of  repeated  attacks  of  delirium,  numerous  tubercle-like 
foci,  almost  always  in  the  cortical  substance,  which  contained  worm 
larvae  similar  to  rhabditis.  The  Stephanurus  dentatus  occurs  in  pigs 
(frequently  in  the  perirenal  connective  tissue  in  American  pigs).  Rost 
found  in  75%  of  60  experiment  animals  nodules  in  the  kidneys,  which 
contained  larvae  of  nematodes  (D.  m.  W.  1906,  446). 

Of  tapeworms  are  found:  Cysticercus  cellulosae  (in  pigs;  found 
also  once  in  a  dog  [Railliet  &  Trasbot] )  ;  Enchinococcus  polymorphus 
(in  ruminants,  especially  sheep;  very  rarely  in  other  animals");  E. 
multilocularis  (found  once  by  Ostertag)  ;  Taenia  serrata  (found  by 
Wolpert  in  both  renal  pelves  of  a  dog).  Finally  Railliet  &  Lucet  have 
found  small  nodules  containing  coccidia  in  the  kidneys  of  geese  which 
had  died  with  cachectic  symptoms ;  Paechinger  mentions  a  similar  find- 
ing in  horses  and  dogs  (Coccidiosis  renalis). 

Renal  coccidiosis  of  geese  is  caused  by  the  Coccidium  truncatuin 
(Eimeria  truneata)  and  is  manifested  in  progressive  emaciation  with 
extreme  debility,  owing  to  which  the  animals  are  found  sitting  almost 
uninterruptedly.  Many  animals  lie  on  their  backs  and  spread  their 
feet;  if  they  are  stood  on  their  feet  they  take  a  few  steps  and  again 
assume  the  sitting  position.  After  a  prolonged  disease  they  usually  lose 
the  desire  to  eat  and  die. 


Section  II. 

DISEASES  OF  THE  BLADDER. 

1.    Catarrh  of  the  Bladder.    Catarrhus  Vesicae  Urinariae. 
{Cystitis  catarrhalis,  Urocystitis.) 

Etiology.  Catarrh  or  inflammation  of  the  mucosa  of  the 
bladder  is  usually  based  upon  an  infection.  Bacteria  which 
get  into  the  bladder  find  favorable  conditions  for  multiplica- 
tion especially  in  urinary  stasis,  for  instance  in  stricture,  com- 
pression or  obturation  of  the  urethra,  or  in  paralysis  of  the 
bladder,  sometimes  in  the  voluntary  retention  of  urine  in  house 
dogs.  In  such  cases  the  bacteria  enter  the  bladder  from  the 
urethra,  especially  in  female  animals  in  which  the  vaginal 
secretion  may  enter  directly  o^^dng  to  the  shortness  and  com- 
parative width  of  the  urethra. 

An  artificial  infection  may  be  produced  by  catheterization. 
Injuries  of  urethra  and  bladder,  for  instance  during  parturi- 
tion, enable  the  bacteria  to  enter,  and  inflammatory  processes 
in  the  neighborhood  of  the  bladder  may  be  continued  to  its 
w^alls  or  mucous  lining.  In  this  respect  inflammatory  diseases 
of  the  urethra,  the  prostate,  the  internal  female  genital  organs, 
the  kidneys,  the  renal  pelvis  and  the  ureters  are  to  be  men- 
tioned. 

Sometimes  a  bladder  catarrh  develops  m  general  acute 
infectious  diseases  because  bacteria  have  been  carried  to  the 
mucosa  of  the  bladder  with  the  circulating  blood.  Bacteria 
may  also  reach  the  bladder  from  the  diseased  kidnevs,  or 
through  the  intermediation  of  healthy  kidneys  from  distant 
organs  (especially  from  the  intestines  [see  Pyelonephritis]). 
Of  first  importance  as  pathogenic  agents  are  the  pyogenic 
bacteria  but,  especially  in  cystitis  of  intestinal  origin,  the  colon 
bacteria  and  their  related  bacteria  are  important  factors. 

In  manv  cases  the  occurrence  of  the  disease  is  probably 
to  be  referred  to  taking  cold,  which  reduces  the  resistance 
to  the  bacteria  of  the  walls  of  the  bladder. 

Among  irritating  chemicals  cantharides  especially  give 
rise  to  catarrh  of  the  bladder  which  may,  however,  also  appear 
after  the  internal  administration  of  balsamics  and  of  resinous 
remedies  (oil  of  turpentine,  etc.).  It  is  not  certain  whether 
the  inflammatory  process  is  aroused  immediately  by  the  sub- 

1031 


1032  Catarrh    of   the   Bladder. 

stance  circulating  in  the  blood  or  only  after  it  has,  with  the 
urine,  entered  the  bladder  and  thus  has  come  in  contact  with 
the  mucous  membrane  (Hentrich  observed  catarrh  of.  the 
bladder  in  horses  after  feeding  mth  beer  slops  which  had 
become  sour). 

Vesical  calculi  can  also  give  rise  to  inflammation  in  the 
mucosa  of  the  bladder  by  mechanical  irritation. 

Anatomical  Changes.  In  acute  cystitis  the  mucous  mem- 
brane is  vividly  reddened,  swollen,  perhaps  studded  with  small 
hemorrhages,  and  covered  with  viscid  mucus  or  with  a  purulent 
deposit ;  the  submucous  layers  are  soggy  with  serum.  In  more 
intense  inflammation  yellowish,  croupous  fibrin  membranes  are 
found,  or  dirty-gray  diphtheritic  deposits,  or  localized  ulcerous 
destruction;  it  is  also  possible  to  find  small  or  large  abscesses 
in  the  walls  of  the  bladder. 

In  chronic  cystitis  the  mucosa  is  thickened,  corrugated  and 
not  infrequently  covered  with  branched-out  villous  prolifera- 
tions. Salts  are  eliminated  from  the  urine  and  form  a  coarse 
crusty  deposit  on  the  mucous  membrane.  The  muscular  layer 
usually  hypertrophies  when  the  disease  exists  for  a  considerable 
time. 

Often  inflammatory  conditions  are  found  also  in  the 
urethra,  in  the  ureters  and  in  the  renal  pelvis;  in  the  chronic 
forms  dilatation  of  the  renal  pelvis  is  not  infrequent  and  is 
associated  with  inflammation  or  atrophy  of  the  kidneys. 

Emphysema  of  the  bladder  of  cattle  was  observed  in  one  case  each  by  Bunge 
and  Malm  and  in  two  cases  by  Trolldenier.  Outside  of  hemorrhages,  thickening 
of  the  bladder  wall  was  found  with  numerous  air  bubbles  of  various  sizes  in 
the  latter.  In  Bunge 's  case  such  air  bubbles  had  also  developed  in  the  renal 
pelvis  of  the  cow  which  was  ill  with  pyelonephritis. 

Symptoms.  One  of  the  most  striking  phenomena  in  acute 
catarrh  of  the  bladder  is  the  frequent  and  painful  micturition 
(Tenesmus  vesicae.  Stranguria,  Dysuria).  The  animals  make 
frequent  attempts  to  urinate,  during  which  they  either  void 
no  urine  or  only  a  small  quantity  with  manifestations  of  severe 
pain.  The  pressure  to  urinate  and  therefore  the  contraction 
of  the  bladder  muscles  may  be  repeated  at  such  brief  intervals 
that  the  urine  is  discharged  almost  uninterruptedly  and  in 
driblets,  similarly  as  in  paralysis  of  the  sphincter. 

In  male  animals  there  occur  also  frequent  erections  of 
the  penis,  the  testicles  are  drawn  up,  and  in  horses  signs  of 
colic  occur  at  times.  Pressure  upon  the  bladder  causes  severe 
pain  and  at  the  same  time  the  organ  will  be  found  to  be  empty. 
Exceptionally  there  is  retention  of  urine  (ischuria),  perhaps 
because  the  sphincter  is  contracted  convulsively  or  because  the 
mucosa  at  the  neck  of  the  bladder  is  much  swollen,  or  the 
opening  of  the  urethra  is  obstructed  by  exudation. 

The  urine  is  usually  cloudy  and  dark  in  color;  it  contains 
variable,    but    comparatively    small    quantities    of    albumen 


Symptoms. 


1033 


(albuminuria  spuria),  occasionally  white  mucus-  and  pus- 
floccules,  also  gray  pseudomembranes  or  tissue  shreds.  The 
reaction  is  alkaline  in  herbivora,  but  in  carnivora  either  acid 
(in  catarrh  due  to  B.  coli)  or  more  frequently  also  alkaline. 
Ammoniacal  fermentation  takes  place  already  within  the 
l)ladder  and  is  recognized  by  the  characteristic  pungent  odor 
and  also  by  the  fact  that  a  moistened  strip  of  red  litmus  paper 
turns  l)lue  when  it  is  laid  over  the  opening  of  a  vessel  which 
pontains  fresh  urine.  The  sediment  is  always  copious  and  con- 
sists of  pus  cells,  red  blood  corpuscles,  large  pavement  epithelia, 


Fig.  178.     Vrinary  sediment  of  a  Tiorse  with  catarrh  of  the  bladder,     a  p-avement 

epithelia    (suiK>rficial   layer),     b  pavoinent  epithelia    (deeper  layer,  tailed  cell«).     c 

pus  cells,     d  triple  phosphate  crystals,     e  streptococci. 

a]!so  elongated,  slender  or  molar-shaped  epithelia  (Figs.  178, 
179,  180).  Together  with  ammoniacal  fermentation  numerous 
coffin-shaped  crystals  of  ammonia-magnesia  phosphate  are 
found,  and  thorn-apple-shaped  crystals  of  acid  ammonia  urate. 
Finally  the  freshly  voided  urine  usually  contains  very  many 
bacteria. 

Simple  acute  catarrh  is  very  rarely  accompanied  by  high 
fever  and  lassitude,  which  is,  however,  frequent  in  inflammation 


1034 


Catarrh    of    the   Bladder. 


of  the  bladder.     In  this  case  the  appetite  is  suppressed  and 
defecation  retarded. 

The  clinical  picture  of  chronic  catarrh  of  the  bladder  is 
similar,  although  the  sjonptoms,  especially  pain  and  pressure 
of  urine  are  less  severe  and  often  absent  (Gmeiner).  The 
urine  is  also  similar  in  character,  but  red  blood  cells  are  less 
numerous  while  on  the  other  hand  ammoniacal  fermentation 
is  more  frequent.  (Sivieri  observed,  in  a  mare  with  chronic 
bladder  catarrh,  rupture  of  the  bladder  after  partial  necrosis 
of  its  thickened  wall.) 

Course.  Simple  acute  catarrh  of  the  bladder  is  not  rarely 
relieved  by  appropriate  treatment,  but  in  certain  cases  it  passes 
over  into  the  chronic  form  which  is  much  more  obstinate.  In- 
flammation which  is   accompanied  by  copious  pus-formation, 


Fig.   179.     Pavement    epithelia     (superficial      Fig.  180.   Pavement  epithelium  ( deeper 
layer)    from    the    bladder   of   a   horse    with      layer)    from   the   bladder   of   a   horse 
catari-h  of  the  bladder.  with  catarrh   of  the  bladder. 


hemorrhage,  ulceration  or  necrosis  takes  usually  an  unfavorable 
course,  because  in  such  cases  general  infection  is  apt  to  occur, 
chemical  changes  in  the  urine  give  rise  to  stone  formation; 
the  inflammation  may  be  transmitted  to  the  pelvis  of  the  kidneys 
and  finally  to  the  kidneys. 

Treatment.  Absolute  rest,  non-stimulating  food  and  the 
drinking  of  as  much  water  as  possible  are  indicated  in  all 
cases. 

In  simple  acute  catarrh  of  the  bladder  healing  is  not  in- 
frequently produced  by  internal  treatment  only.     For  this  the 


Treatment.  1 O35 

disinfectants  are  adapted  first  of  all,  for  instance,  according 
to  Gnieiner  and  Schmidt,  urotropin  (5-8  gin.  for  large  animals, 
0.23-0.5  gm.  for  dogs,  2  to  3  times  daily  in  much  water)  wliicli 
exerts  a  disinfecting  action  after  its  absorption  and  elimination 
through  the  kidneys,  owing  to  its  ability  to  split  off  formalde- 
hyde in  the  acid  gastric  juice.  The  remedy  may  be  prescribed 
under  the  name  of  Hexaniethylentetramin  and  is  then  much 
less  expensive.  In  ammoniacal  fermentation  of  the  urine  it 
is  preferable,  according  to  Uebele,  to  administer  Hehnitol 
(10-15  gm.  for  large  animals,  twice  daily;  1-2  gm.  for  dogs, 
3  times  daily  in  powder  or  10%  solution),  because  it  can  split 
off  formaldehyde  in  alkaline  solution  also  and  may  therefore 
bo  given  subcutaneously.  Both  remedies  diminish  ammoniacal 
fermentation  and  change  the  alkaline  into  the  acid  reaction. 
Salicylic  acid  and  its  salts  are  further  to  be  considered,  also 
salol,  salipvrin,  resorcin,  benzoic  acid,  folia  uvae  ursi,  etc. 
(seep.  1020). 

In  chronic  catarrh  of  the  bladder  the  same  remedies  are 
employed,  and  also  balsamics,  especially  copaiba,  and  oil  of 
turpentine.  Here  local  treatment  ])y  means  of  irrigations  with 
disinfecting  and  astringent  solutions  seems  more  useful 
(Gmeiner).  According  to  Gmeiner  oxycyanate  of  mercury  in 
a  solution  of  1 :1000-5000  is  most  appropriate,  a  small  amount 
of  NaCl  may  be  added.  Uebele  advises  irrigating  the  bladder 
"s^itli  2%  solutions  of  helmitol.  Other  remedies  are  nitrate  of 
silver  (0.1%),  boric  acid,  tannin,  alum,  lead  acetate  (1-3%), 
resorcin  (3-5%),  ichthyol  solution  (y2-2%),  etc. 

The  bladder  is  irrigated  as  follows:  After  emptying  the  urine  artificially, 
lukewarm  water  (35°  C.)  or  better,  a  %%  solution  of  XaCl  is  allowed  to  run 
into  the  bladder  through  a  funnel  which  is  connected  with  the  catheter  by  means 
of  a  rubber  tube;  in  large  animals  the  ainount  injected  is  about  300  cc. ;  in  small 
animals  as  much  as  50  cc.  The  water  is  allowed  to  flow  out  by  lowering  the  funnel. 
Then  the  disinfecting  solution  is  injected  also  lukewarm  and  likewise  removed 
after  a  few  minutes. 

In  certain  cases  of  catarrh  of  the  bladder  operation  may 
be  considered. 

Literature.  Bunge,  Z.  f.  Flhvg.,  1898.  VTII.  168.  —  Gmeiner,  Monh..  1907. 
XVIII.  (51.  —  Hentrich.  Z.  f.  Yk.,  1905.  .59.  —  Malm,  Monh.,  1905.  XVJ.  254.  — 
Xencioni,  X.  Ere,  1903.  447.  —  Schmidt,  Die  Cvstitis  und  Xephritis  usw  Diss. 
Giessen.  1909  (Lit.).  —  Sivieri,  X.  Ere.  1908.  '18.  —  Suffran,  Rev.  vet..  1909. 
405.  —  Taylor,   Vet.  Eec,  1905.' 75.  —  Troll. lenier.   :Mnii]i.   1904     XV.  5. 


Twisting  of  the  Bladder.  This  was  observod  l)y  Stroud  and  hy 
Griveaux,  each  in  one  dog.  and  was  manifested  by  pressiire  of  urine, 
retention,  enhirgenient  of  the  abdomen ;  the  dilated  bladder  could  l)e 
felt  through  the  abdominal  walls  and  on  rectal  examination,  which  was 
painful.  In  Stroud's  case  there  existed  a  paralytic  weakness  of  the 
hindquarter  and  strong  swelling  of  the  perineal  region;  Griveaux  met 
an  impediment  in  front  of  the  neck  of  the  bladder  on  attempting  cathe- 
terization. The  trouble  caused  death  in  a  short  time. —  (Griveaux, 
J.  vet..  1906.  393.— Stroud.  O.  M.  1906.  219). 


1036  Paralysis  of  the  Bladder. 

2.    Paralysis  of  the  Bladder. 

By  paralysis  of  the  bladder  is  meant  the  inability  to  void 
the  urine  voluntarily  or  to  retain  it. 

According  to  this  definition  those  cases  may  not  be  included  in 
paralysis  of  the  bladder  in  which  purely  mechanical  factors  have  inter- 
fered with  the  voiding  of  the  urine  or  in  which  the  psychic  functioning 
of  the  brain  has  ceased  to  be  active. 

Etiology.  A  myopathic  origin  may  be  assumed  for  tran- 
sitory paralysis  of  the  Detrusor  urinae,  which  is  observed 
occasionally  in  otherwise  healthy  animals  when  they  were 
obliged  to  retain  the  urine  for  a  long  time  on  account  of  pro- 
tracted labor  or  because  they  were  confined  in  a  room.  In 
such  cases  the  muscles  of  the  bladder  are  stretched  excessively 
by  the  urine  which  has  collected  in  the  bladder  in  consideral)le 
amount  and  thereby  the  power  of  contraction  is  reduced  for 
a  time.  A  myopathic  paresis  of  the  bladder  is  also  accountable 
for  the  retention  of  urine  which  arises  in  exceptional  cases 
in  inflammatory  conditions  of  the  walls  of  the  bladder  or  in 
deep-seated  inflammations  of  the  contiguous  organs,  especially 
the  peritoneum.  By  passing  to  the  muscularis  of  the  bladder, 
the  inflammatory  process  may  diminish  the  contractility  of 
the  muscles.  In  such  cases  it  is,  however,  probably  more  often 
an  occlusion  of  the  first  urethral  portion  or  a  spasm  of  the 
sphincter  that  causes  the  retention. 

A  persistent  paralysis  of  the  bladder  develops  only  in 
certain  diseases  of  the  nervous  system,  especially  in  injuries 
affecting  the  sacral  and  the  posterior  lumbar  portion  of  the 
cord  and  their  nerve  roots  and  nerves.  Such  affections  are: 
inflammation,  contusion,  hemorrhage  in  the  conns  medullaris, 
compression  of  the  latter  and  of  the  related  nerve  roots  in 
the  anterior  portion  of  the  sacral  canal,  during  intervertel)ral 
enchondrosis  or  pachjTneningitis  ossificans;  exceptionally  the 
trouble  may  occur  in  consequence  of  a  new-formation  or  of 
an  abscess.  In  horses  it  occurs  rather  often  in  inflammation 
of  the  Cauda  equina  (combined  paralysis  of  tail  and  sphincters). 
A  lesion  outside  of  the  vertebral  canal  of  the  nerves  which 
pass  to  the  bladder  has  not  been  observed  in  animals,  nor 
disease  of  the  centers  for  the  bladder  muscles  in  the  sympathetic 
nerves  of  the  pelvic  cavity.  In  diseases  of  the  spinal  cord 
above  the  posterior  lumbar  section,  paralysis  of  the  bladder 
is  found  only  in  such  cases  in  wdiich  the  conductivity  of  the 
centripetal  and  centrifugal  tracts  has  been  diminished  or  de- 
stroyed. This  may  take  place  in  contusion,  inflammation  and 
compression  of  the  cord. 

Pathogenesis.  In  addition  to  the  ganglion  cells  vdthin  the 
bladder  wall  itself  the  motility  of  the  bladder  is  influenced 
by  sympathetic,  spinal  and  cerebral  centers.  As  an  intimate 
functional   reciprocity  develops  between  these  centers   in  the 


Pathogenesis,    Symptoms.  1037 

course  of  development,  the  disease  of  one  of  them  or  of  the 
rchited  tracts  eliminates  the  function  also  of  the  other  centers 
which  may  have  remained  healthy.  As  the  spinal  centers 
are  connected  particularly  intimately  with  the  sympathetic 
centers  wliich  immediately  influence  the  motility  of  tJie  bladder, 
distnrbances  in  the  bladder  become  striking  and  persistent' 
especially  in  lesions  of  the  spinal  centers  wliich  lie  in  the 
posterior  lnml)ar  and  anterior  sacral  section  of  the  spinal  cord, 
the  more  so  as  in  these  cases  the  activity  of  the  striped  nmscles 
of  the  urinary  organs  and  the  reflex  action  of  the  sensory  nerves 
upon  the  urethra  and  the  neighboring  organs  is  necessarily 
eliminated.  In  all  diseases  of  the  nervous  system  above  the 
sympathetic  bladder  centers  there  occurs  more  or  less  improve- 
ment in  the  distur])ance,  probably  owing  to  the  increased  ac- 
tivity of  the  sympathetic  centers. 

In  unconsciousness  retention  of  the  urine  takes  place  in  such  a  manner 
that  the  pressure  of  the  urine  is  not  felt  or  that  the  inhibitory  action  of  the  brain 
upon  the  .si)hiiicter  is  not  exerted.  The  same  mechanism  may  probably  be  assumed 
for  the  occurrence  of  that  form  of  retention  which  is  sometimes  produced  under 
the  infiueuce  of  certain  intense  psychic  stimulations  (excitement)  ;  and  a  similar 
origin  IS  probably  responsible  for  the  retention  which  is  frequently  noted  in  the 
course  of  paralytic  hemoglobinemia. 

Symptoms.  In  paralysis  of  the  Detrusor  urinae  the  urine 
fails  of  being  voided  for  a  considerable  time  (Ischuria,  Retentio 
urinae) ;  owing  to  the  constantly  increasing  tension  of  the 
bladder  the  animals  become  restless  and  attempt  to  urinate, 
provided  tlie  sensory  conductivity  is  not  interrupted  as  well. 
In  spite  of  all  efforts  and  of  the  cooperation  of  abdominal 
pressure  they  void  only  small  quantities  of  urine  in  a  thin 
and  feeble  stream.  Soon,  however,  the  sphincter  is  relaxed  by 
the  increasing  tension,  and  dribbling  of  urine  occurs.  The 
bladder  is  found  to  be  greatly  dilated  on  rectal  exploration, 
or  m  smaller  animals  by  palpation  through  the  abdominal  walls 
and  by  percussion;  pressure  upon  the  bladder  causes  large 
amounts  of  urine  to  be  discharged  which  ceases  suddenlv  when 
the  pressure  is  removed  (Ischuria  paradoxa).  If  a  catheter 
IS  introduced  into  the  bladder,  the  urine  flows  out  without  force 

In  complete  paralysis  of  the  sphincter  the  animals  cannot 
retam  the  urine  at  all  or  only  for  a  short  time,  and  in  con- 
sequence this  is  discharged  at  very  short  intervals,  in  fact, 
drop  by  drop  at  the  commencement  of  total  paralysis,  wetting 
the  vicinity  of  the  urethral  opening  or  the  pudenda  (Inconti''- 
nentia  urinae) ;  in  incomplete  paralysis  small  quantities  of 
urine  are  voided  at  frequent  intervals  and  without  pain. 

Usually  the  paralysis  occurs  in  both  muscles  simultaneously 
and  involuntary  discharge  is  observed,  or  dribbling  of  the 
urme  at  first  when  the  bladder  is  verv  full,  later  when  it  is 
only  moderately  filled. 

_  In  the  further  course  of  the  disease  disintegration  of  the 
urme  commences  already  in  the  bladder,  because  bacteria  easily 
enter  it  through  the  incompletelv  closed  neck;  thev  multiplv 


1038  Paralysis  of  the  Bladder. 

readily  in  the  dammed-up  urine,  and  in  a  short  time  catarrh 
of  the  bladder  develops. 

Diagnosis.  In  paralysis  of  the  bladder  due  to  transverse 
lesions  of  the  spinal  cord  above  the  posterior  lumbar  segment, 
also  in  retention  of  the  urine  during  loss  of  consciousness  or 
after  violent  psychic  influences,  the  urine  is  voided  in  a  strong 
stream,  at  long  intervals  or  after  external  mechanical  influences 
upon  the  region  of  the  bladder;  the  discharge  of  the  urine 
does  not  cease  immediately  with  the  cessation  of  the  pressure 
upon  the  bladder,  and  if  a  catheter  is  introduced  into  the 
bladder,  the  urine  flows  out  in  a  vigorous  stream.  Inflammatory 
processes  and  mechanical  impediments  in  the  lower  urinary 
passages  can  easily  be  excluded  by  local  examination.  Polyuria 
and  frequent  micturition  might  be  mistaken  for  paralysis  of 
the  sphincter,  but  are  readily  differentiated  by  considering 
the  other  symptoms  of  the  basic  affection. 

Treatment.  In  order  to  prevent  the  consequences  of  re- 
tention of  urine  as  much  as  possible,  the  urine  should  be  re- 
moved several  times  daily  with  a  clean  catheter,  or  the  bladder 
should  be  made  to  empty  itself  by  gradually  increased  pressure. 
It  is  well  to  apply  a  drying  or  disinfecting  salve  to  the  skin 
in  order  to  keep  the  region  of  the  urethra  clean.  In  cases  where 
no  severe  organic  disease  exists,  the  relief  of  the  paralysis 
may  be  attempted  by  cold  applications  to  the  region  of  the 
sacrum,  irrigation  of  the  bladder  with  cold  water,  or  friction 
on  the  region  of  the  bladder.  Faradic  electricity  (the  positive 
pole  on  the  sacrum,  the  negative  on  the  pudenda  in  retention, 
on  the  perineum  in  dribbling)  is  powerless. — Parascandolo  be- 
lieves that  certain  cases  of  paralysis  of  the  bladder  may  be 
relieved  by  operative  treatment. 

Literature.  Luciani,  Physiologie,  1906.  II.  433  (Lit.).  —  Miiller,  Deutsche 
Zeitschr.  f.  Nervenheilk.,  1902.  XXV.  86  (Lit.  on  animal  experim.).  —  Parascandolo, 
D.  t.  W.,  1901.  477. 


Spasm  of  the  Bladder.  This  is  said  to  originate  without  local 
disease  of  the  urinary  tract,  when  the  animals  are  obliged  to  retain 
urine  for  a  long  time  on  account  of  protracted  work  (Roll).  But 
psychic  influences,  colicky  pains  and  tetanus  may  also  produce  the 
trouble.  In  spite  of  repeated  attempts  the  animals  are  not  able  to  void 
the  urine  (Ischuria  spastica),  or  at  most  a  few  drops  are  discharged  at 
one  time  (Dysuria  spastica).  The  bladder  is  greatly  dilated  and  sensi- 
tive to  pressure.  The  history  as  well  as  the  absence  of  local  pathologic 
changes  (calculus,  swelling,  etc.)  afford  sufficient  diagnostic  indications. 

In  horses  the  spasm  usually  disappears  spontaneously  if  they  are 
allowed  to  rest  on  clean  straw  or  in  a  sheep  barn.  In  horses  and  also 
in  other  animals  sponging  of  the  region  of  the  bladder  is  indicated,  also 
a  gradually  increasing  pressure  upon  the  bladder.  Lukewarm  enemas, 
chloral  hydrate  (25-50.0  or  1-2.0  gm.)  per  rectum  hasten  recovery;  also 
morphine  injections.  If  in  spite  of  these  measures  no  urine  is  voided, 
a  catheter  covered  with,  morphine  ointment  may  be  used,  or  punctare 
of  the  bladder  may  be  required. 


Diseases  of  the  Circulatory  Organs 


Section  I. 

DISEASES  OF  THE  PERICARDIUM. 

1.    Pericarditis. 

Occurrence.  Pericarditis  is  not  a  very  prevalent  disease. 
It  occurs  most  frequently  in  cattle  in  the  form  of  traumatic 
pericarditis,  inflammations  of  the  pericardium  from  other 
causes  being  much  more  rare,  and  in  all  probability  usually 
tuberculous  in  origin.  Still  more  rarely  the  disease  is  observed 
in  horses,  in  which  it  usually  occurs  as  a  sequel  of  croupous 
pneumonia.  It  occurs  a  little  more  often  in  dogs,  usually  on 
a  tuberculous  basis,  less  often  in  distemper  or  other  diseases. 
In  hogs  pericarditis  is  not  very  rare,  appearing  most  often  in 
s^\dne  plague,  less  often  in  erysipelas.  In  fowls  the  disease 
is  also  observed  occasionally,  usually  as  a  complication  of 
cholera  and  chicken  plague,  less  often  in  tuberculosis. 

Etiology.  The  occurrence  of  pericardial  inflammation  is 
due,  almost  without  exception,  to  the  immediate  influence  of 
infectious  substances,  although  these  often  become  effective 
only  if  certain  predisposing  conditions  are  also  present. 
Searching  bacteriological  examinations  have  not  been  made 
very  often  with  respect  to  pericarditis  in  animals,  but  those 
that  have  been  reported,  and  also  the  mode  of  onset  of  the 
disease,  permit  the  assumption  that  the  infectious  substances 
mentioned  below  are  particularly  concerned  in  the  production 
of  pericarditis.  The  Bac.  bipolaris  may  be  active  in  this 
manner,  not  only  alone  but  also  in  association  with  other 
bacteria ;  in  fact,  there  is  hardly  one  of  the  diseases  for  which 
this  bacterium  is  responsible  that  is  not  occasionally  associated 
with  pericarditis.  Further,  the  pyogenic  bacteria,  the  tubercle 
bacillus,  the  virus  of  swine  erysipelas,  chicken  plague,  con- 
tagious pleuro-pneumonia  of  cattle  and  of  variola  may  also 
take  part  in  the  production  of  pericarditis. 

1039 


1040  Pericarditis. 

Jowett  observed  a  pneumo-pericarditis  which  occurred  in  turkeys  in  epizootic 
extension  and  was  characterized  by  a  copious  fibrinous  exudation ;  a  bacillus  bipolaris 
was  found,  both  in  the  pericardial  exudate  and  in  the  blood;  chickens  and  pigeons 
which  were  kept  in  the  same  place  remained  healthy,  but  it  was  possible  to  infect 
them  artificially.  In  Jowett 's  opinion  the  disease  is  a  different  affection  from 
chicken  cholera. 

Tlie  point  of  entrance  of  the  microorganisms  may  either 
be  in  an  injnry  of  the  thorax,  or  more  frequently  the  virus 
reaches  the  pericardium  by  way  of  the  blood  and  lymph  streams. 
The  infection  is  most  easily  explained  when  traumatic  influences 
affect  the  pericardium,  and  when  pyogenic  or  putrefactive 
bacteria  enter  simultaneously  with  the  injuring  object  or  pass 
in  subsequently  through  the  opening.  Penetrating  injuries  of 
the  heart  region  are  rather  rare  as  a  whole,  and  likewise  rarely 
an  effect  of  contusions  of  the  praecordia  is  exerted  without 
penetration  of  the  wall  of  the  thorax,  so  that  bacteria  which 
have  entered  the  blood  in  another  manner  are  carried  to  the 
pericardium  and  then  proliferate  in  the  contused  tissue. 

Those  injuries  of  the  pericardium  are  of  greater  frequency 
and  of  the  highest  importance  in  which  foreign  bodies  have 
entered  the  pericardium  from  neighboring  organs  (Pericarditis 
traumatica).  Pericarditis  of  such  an  origin  occurs  frequently 
in  cattle,  less  often  in  goats  and  sheep  and  only  exceptionally 
in  the  other  animals.  In  a  case  observed  by  Henniges  in  a 
horse  a  needle,  probably  from  the  esophagus,  entered  the 
pericardium;  in  "a  case  of  Lewin's,  from  the  stomach  or 
duodenum;  in  a  hog  a  needle  came  from  an  unknown  part  of 
the  body  (Teetz),  or  from  the  stomach  (Nietschke),  while  in 
a  dog  seen  by  Petit  the  foreign  body  (needle)  had  probably 
passed  with  the  blood  of  the  posterior  vena  cava  into  the 
heart  and  had  partially  advanced  into  the  pericardium  after 
perforating  the  w^all  of  the  heart.  In  ruminants  foreign  bodies 
which  have  been  swallowed  usually  pass  from  the  second 
stomach  toward  the  pericardium  (Vol.  II).  The  anterior 
surface  of  the  reticulum  is  separated  from  the  pericardium  only 
by  the  thin  diaphragm  which  is  easily  perforated  even  by  com- 
paratively short  foreign  bodies.  In  this  respect  needles  are 
most  dangerous  because,  after  having  perforated  the  mucosa 
of  the  reticulum  they  are  constantly  pushed  farther  by  the 
repeated  contractions  of  the  muscles  of  the  reticulum  until  the 
points  reach  the  diaphragm ;  then  the  contractions  of  the  latter 
aid  in  pushing  the  needles  against  the  pericardium  and  in 
finally  entering  it.  Of  similar  importance  are  other  rigid 
bodies  which  are  more  or  less  pointed  at  both  ends,  especially 
thin  wire  (according  to  Collas  parts  of  the  wire  w^hich  has 
latterly  been  used  for  packing  pressed  hay  are  responsible 
relatively  often),  nails,  knife  blades,  etc.  Together  with  the 
foreign  bodies  bacteria  usually  enter  the  pericardium  as  a 
matter  of  course. 

The  intermediation  of  infection  by  the  blood-  and  lymph- 
streams  must  be  assumed  in  those  cases  in  which  the  aifection 


Etiology,  Anatomical  Changes.  1041 

develops  In  association  with  diseases  of  neighboring  organs  or 
in  the  coiirso  of  a  generalized  acute  infections  disease.  Aside 
from  inflannnations  of  the  heart  muscle  or  the  endocardium 
wliieli  easily  pass  over  into  the  pericardium  which  is  connected 
with  the  intramuscular  connective  tissue,  pericarditis  occurs 
preferahly  as  a  sequel  to  pleurisy,  pneumonia,  pulmonary  or 
pleural  tuberculosis  and  is  produced  in  these  cases  l)y  the  virus 
of  the  related  diseases.  Pericarditis  may  also  develop  directly, 
by  continuity,  after  perforation  of  the  gullet  and  in  consequence 
of  tlie  mediastinitis  due  to  it,  also  after  suppuration  of  the 
peril )r()nc'hial  lymph  glands,  etc.  Of  the  acute  infectious  dis- 
eases it  is  especially  hemorrhagic  septicemia,  pyosepticemia 
neonatorum,  less  often  strangles,  variola,  articular  rheumatism, 
etc.,  which  lead  to  pericarditis. 

The  bacillus  bipolaris,  the  pyogenic  bacteria  and  the  tuber- 
cle bacillus  do  not  necessarily  exert  their  inflammatory  action 
only  after  a  previous  affection  of  other  organs  or  after  a 
i>eneralized  infection  (secondary  or  consecutive  pericarditis) 
but  may  in  many  cases  do  so  independently  (primary  peri- 
carditis). 

The  perieartlitis  observed  in  epizootic  extension  in  sheep  by  Trasbot,  Anacker 
and  Kowalewsky  was  evidently  not  primary,  but  a  partial  manifestation  of 
hemorrhagic  septicemia,  and  as  a  matter  of  fact  Kowalewsky  found,  on  autopsy, 
endocarditis  and   pneumonia  in  addition   to   pericarditis. 

It  is  only  exceptionally  that  chemical  substances  or  me- 
chanical irritants  give  rise  to  chronic  pericarditis,  the  fornier 
in  bacterial  diseases  of  other  organs,  in  nephritis,  etc.,  the  latter 
by  new-growths,  parasites,  sterile  foreign  bodies.  (Borchardt 
saw  serous-hemorrhagic  pericarditis  with  nephritis  and  hepa- 
titis in  two  horses  which  suffered  from  lysol  poisoning.) 

In  infectious  non-traumatic  pericarditis  certain  predispos- 
ing causes  like  cold,  over-exertion,  railroad  transportation,  etc., 
are  of  importance  although  they  are  not  capable,  of  them- 
selves, of  giving  rise  to  an  inflammation. 

Anatomical  Changes.  In  acute  pericarditis  delicate  or  thick 
fibrinous  membranes  are  deposited  on  one  or  both  layers  of 
the  pericardium  which  may,  in  larger  animals,  attain  a  tliiek- 
ness  of  2-3  cm.,  and  a  fluid  exudate  accumulates  in  varying 
amounts  in  the  pericardial  cavity,  which  may  be  clear  or  very 
cloudy;  it  may  contain  floccules  of  fibrin  and  in  traumatic 
pericarditis  it  has  usually  a  foul  odor.  If  fibrin  is  secreted 
copiously,  the  surface  of  the  heart  becomes  uneven,  villous 
(villous  heart,  cor  villosum),  and  the  fibrin  masses  may  divide 
the  pericardial  cavity  into  irregular  compartments  (which  are 
especially  well  marked  in  cattle).  In  many  cases  the  exudation 
assumes  a  purulent  character  and  if  the  inflammation  is  pro- 
longed a  proliferation  of  connective  tissue  is  more  manifest. 
The  latter  form  of  inflammation,  and  also  pericarditis  in  its 

Vol.    1— G6 


1042  Pericarditis. 

initial  stag^e,  is  sometimes  limited  to  portions  of  the  pericardium 
(pericarditis  circumscripta)  in  which  the  vicinity  of  the  large 
vessels  is  affected  preferably,  less  often  that  of  the  apex.  In 
the  majority  of  cases,  however,  the  inflammation  involves  the 
entire  pericardium  almost  uniformly  (P.  diffusa),  although 
also  in  these  cases  the  visceral  layer  usually  shows  more  intense 
changes.  In  proportion  to  the  amount  of  exudate  the  peri- 
cardium is  more  or  less  distended  and  sometimes  occupies  a 
very  considerable  portion  of  the  thoracic  cavity.  The  quantity 
of  exudate  varies  within  wdde  limits  and  may  amount  to  36 
(Friedberger)  and  even  40  liters  in  horses,  I814  liters  (Trasbot) 
in  cattle,  and  y^  liter  in  dogs.  The  connective  tissue  septa  of 
the  heart  muscle  are  also  infiltrated  with  sero-cellular  exudate ; 
if  the  amount  of  exudate  is  very  great,  compression  and  atrophy 
of  the  heart  may  result. 

Finally  there  are  evidences  of  stasis,  such  as  marked  full- 
ness of  the  veins,  passive  hyperemia  of  the  lungs  and  of  the 
liver,  edematous  infiltration,  etc. 

In  traumatic  pericarditis  of  cattle  the  foreign  bodies  are 
not  infrequently  found  in  the  exudate,  either  free  or  with  one 
end  penetrating  the  wall  of  the  heart.  It  may  also  occur  that 
the  foreign  body  is  not  found  because  it  has  been  pushed  back 
into  the  reticulum,  or  because  it  had  rusted  and  crumbled; 
in  many  cases  it  is  entirely  in  the  heart  muscle,  or  exceptionally, 
in  a  ventricle.  (It  is  possible  for  an  abscess  to  form  in  the 
heart  muscle  and  break  into  the  pericardial  cavity  or  into 
one  of  the  ventricles  [Cadeac].)  A  traumatic  origin  of  the 
inflammation  is  suggested  by  the  presence  of  a  firm  connective 
tissue  cord  between  pericardium  and  diaphragm,  and  also  be- 
tween the  latter  and  the  reticulum.  This  cord  is  either  solid, 
or  it  contains  several  cavities,  either  side  by  side  or  com- 
municating w^ith  each  other,  and  filled  with  purulent  or  ichorous 
fluid;  in  rare  cases  a  long  canal  is  found  in  the  center  of  the 
connective  tissue  cord,  Avhich  connects  the  lumen  of  the 
reticulum  with  the  pericardial  cavity. 

Chronic  pericarditis  is  characterized  by  connective  tissue 
proliferation  leading  either  to  simple  thickening  of  the  peri- 
cardial layers  (tendinous  spots.  Maculae  albidae  s.  lacteae)  or 
to  adhesions  between  them  (P.  fibrosa  adhaesiva) ;  sometimes, 
indeed,  a  complete  union  of  the  pericardial  layers  results 
(Concretio  pericardii).  In  tuberculous  pericarditis  cheesy  foci 
may  be  found  in  varying  numbers  in  the  new  connective  tissue 
which  may  be  very  copious,  but  this  form  of  pericarditis  occurs, 
especially  in  dogs,  also  as  a  serous  or  hemorrhagic  inflam- 
mation. 

Symptoms.  The  clinical  picture  of  traumatic  pericarditis 
is  usually  preceded  by  prolonged  digestive  disturbances,  which, 


Symptoms.  1043 

accordinf>:  to  Bongartz,  last  from  1  to  6  wooks;  Rometimos  tliey 
become  very  severe  and  may  be  associated  on  motion  with 
sensitiveness  to  pressure  in  the  region  of  the  reticidnm,  with 
superficial  resjnration  and  evidences  of  pain.  Later,  when  the 
foreign  body  has  reached  tlie  pericardium,  the  symptom  complex 
of  pericarditis  follows  immediately;  although  exceptions  may 
be  noted  in  so  far  as  the  signs  of  traumatic  gastritis  may  dis- 
appear for  a  time  the  pericarditis  becoming  manifest  only  after 
their  reappearance,  or  the  trouble  may  develop  without  previous 
digestive  disturbances.  In  similar  manner  a  non-traumatic 
pericarditis  of  secondary  origin  is  introduced  by  the  s>^nptoms 
of  the  basic  affection. 

The  j(orio(l  between  the  ingestion  of  the  foreign  body  ami  the  appearance 
of  tlie  ])eric*ar(lial  symptoms  depends  u))on  the  nature  of  the  foreign  body,  the 
manner  in  which  the  animals  are  kept  and  fed,  and  upon  accidental  factors 
(parturition,  etc.)- 

In  the  initial  stage  of  pericarditis  the  animals  manifest 
severe  pain,  they  avoid  all  motion,  stand  with  head  stretched 
forward,  the  elbows  spread  out,  the  hind  feet  drawn  under 
the  l)elly,  the  back  arched,  they  frequently  look  back  toward 
the  abdomen  and  at  times  lie  down  carefully,  only  to  get  up 
again  immediately.  Pressure  on  the  region  of  the  heart,  on 
the  chest  or  on  the  back;  also  percussion  of  the  precordia 
increases  the  pain  considerably;  the  animals  groan,  attempt 
to  evade  the  pressure  or  depress  the  back  deeply.  They  dis- 
like to  move,  are  surprisingly  fatigued  after  brief  motion,  and 
then  show  shallow  breathing,  respiration  becoming  abdominal 
in  type.  The  pain  increases  markedly,  especially  on  going- 
down  hill.  These  symptoms  are  sometimes  so  mild  as  to  fail 
to  arouse  attention,  and  the  first  expert  examination,  especially 
in  cows  which  are  not  worked,  often  shows  already  a  fairly 
advanced  stage  of  the  disease. 

The  heart  beat  is  hastened  from  the  first  by  i/.,  2  or  3 
times  the  normal  rate  and  may  be  arhythmical.  The  increase 
is  sometimes  aggravated  further  without  any  cause  whatever, 
or  through  quite  insignificant  influences.  Especially  during 
motion  the  heart  beat  shakes  the  entire  region  of  the  heart, 
and  the  heart  sounds  are  sometimes  heard  at  a  distance  of 
3  to  4  steps,  being  unusually  clear  and  loud.  (Lecouturier 
describes  them  with  the  word  "claque-claque").  Sonnenberg 
observed  bradycardia  in  a  cow  (26  heart  beats  to  the  minute), 
together  with  epileptoid  convulsions  and  loss  of  consciousness, 
which  ceased  during  periodical  occurrences  of  increased  heart's 
action  (over  100  heart  beats). 

Friction  sounds  in  the  heart  regions  afford  the  most  val- 
uable s^iiiptom.  These  sounds  are  synchronous  with  the  motions 
of  the  heart,  but  they  do  not  follow  as  regularly  as  the  endo- 
cardial sounds ;  they  may  l)e  heard  together  with  the  systole  or 


1 044  Pericarditis. 

with  tlie  diastole,  or  tlion  immediately  before  or  after.  Tliey  may 
be  soft  or  rough,  creaking,  and  always  give  the  impression  of 
friction,  or  if  they  are  very  short  and  intense  they  sound  as 
though  two  liquid  or  solid  bodies  were  beating  against  each 
other.  These  sounds  are  often  felt  with  the  hand  placed  on  the 
cardiac  region,  and  may  be  increased  on  pressure  upon  the  inter- 
costal spaces.  They  are  limited  to  the  region  of  the  heart, 
audible  on  both  sides  and  are  influenced  by  the  respiratory  move- 
ments at  most  by  becoming  less  intense  during  inspiration, 
because  then  the  lung  has  moved  between  heart  and  thorax. 

In  the  presence  of  a  fluid  exudate,  the  friction  sounds 
usually  disappear  entirely  if  delicate  or  few  pseudo-membranes 
are  formed  separating  the  rough  surfaces  of  the  pericardium ; 
in  the  presence  of  only  small  amounts  of  fluid  the  friction  sounds 
may  persist.  If  there  are  very  copious  masses  of  fibrin,  some 
portions  of  the  fibrin  covered  surfaces  touch  even  in  the  pres- 
ence of  much  fluid  and  produce  friction  sounds  to  the  end. 

In  traumatic  pericarditis  gases  and  fluid  are  not  infre- 
(luently  present  together,  and  then  splashing,  gurgling  and  sim- 
ilar sounds  are  heard  in  addition  to  the  friction  sounds,  also  the 
sound  of  falling  drops,  etc.,  etc. 

The  heart  beat,  which  is  at  first  increased  in  intensity,  grad- 
ually becomes  weaker  and  may  at  times  be  unnoticealile,  but  if 
much  exudate  is  present,  wave-like  movements  may  be  felt  in  the 
cardiac  region.  With  the  weakening  of  the  heart  beats  the 
intensity  of  the  heart  sounds  diminishes  and  sometimes  they 
disappear  entirely. 

An  increased  cardiac  dullness  may  be  ascertained  only  in 
the  presence  of  much  fluid,  of  very  much  fibrinous  exudate  or 
of  tuberculous  new-formations.  The  increase  then  gradually 
occurs  upwards,  forwards  and  backwards ;  upward  it  may  reach 
as  high  as  the  shoulder  line  and  may,  in  small  animals,  reach 
forward  to  the  second  intercostal  space,  backwards  in  all  animals 
to  tlie  6th  or  7tli  intercostal  spaces  (Fig.  181).  In  the  lateral 
position  the  upper  border  moves  slightly  down,  because  then  the 
heart  lies  somewhat  further  away  from  the  thorax.  In  rumi- 
nants an  absolute  cardiac  dullness  is  at  first  noticeal)le,  which 
later  enlarges  in  the  manner  indicated.  Any  dullness  on  the 
right  side  is  always  less  marked  than  on  the  left  side.  In  some 
cases  of  traumatic  pericarditis  in  which  the  gases  of  putrefac- 
tion form  or  in  which  gases  from  the  reticulum  have  reached  the 
pericardial  cavity,  a  tympanitic  and  even  a  metallic  percussion 
sound  of  varying  extent  may  be  elicited  on  the  upper  border  of 
the  dullness. 

The  pulse  is  accelerated  from  the  beginning;  at  first  fairly 
full  and  tense,  often  arhythmical,  later  it  becomes  very  small, 
thread-like,  owing  to  compression  and  possibly  to  involvement 
of  the  heart,  and  the  arhythmia  usually  increases. 

With  the  increase  of  the  exudate  the  veins  are  constantly 
filled  more  strongly,  and  this  is  particularly  noticeable  in  the 


Symptoms. 


1045 


jngTilar  veins.  Tlio  Jiii-iilai'  voins,  wliicli  are  dilated  like  thick 
cords  and  stand  out  strongly,  sometimes  show  iiiidiilations  wliicli 
are  synchi'onous  witli  the  auricular  systole  and  slightly  pre- 
cede the  heart  heat  (presystoUc  venous  pulse).  (In  cattle,  and 
often  also  in  horses,  even  under  normal  conditions,  nndulation 
and  perhaps  a 
slii>ht  presystolic 
pulsation  of  the 
iuii'ular  veins  mav 
1e  noted.)  At  tli'c 
same  time  an  edem- 
atous s  w  e  1 1  i  n  .i;' 
develops  on  the 
up]ier  and  lower 
chest  and  also  in 
the  anterior  por- 
tion of  the  lower 
al)domen,  further 
in  the  region  he- 
hind  the  elhow,  on 
the  dewlap  and  in 
the  trachea,  where 
it  may  appear 
first,  if  the  head  is 
held  low,  and  may 
he  associated  Avith 
edema  of  the 
'  larynx. 


Distnrhances  in 
respiration  exist  in 
all  cases,  the 
hreathing  h  e  i  n  g 
more  or  less  has- 
tened and  superfi- 
cial, and  lahored 
on  the  slightest 
motion.  From  time 
to  time  a  feehle 
and  very  painful 
c  o  u  g  h  is  heard. 
With  the  increase 
of  the  edema  fluid 
accumnlates  also 
in    the    hodv    cav- 


Vig.  181.  Increased  cardiac  dullness  in  Pericarditis 
icith  fluid  exudate.  The  dotted  curved  line  shows  the 
margin  of  tlie  nornml,  tlie  solid  curved  line  the 
marjjin  of  the  increased  dullness.  The  straijrht  dotted 
line  indicates  tlie  middle  line  of  the  steiiium,  the 
liiruros  "ive  the  ribs. 


ities     a  n  d     inter- 
feres still  more  with  respiration,  which  is  now  labored  even 
when  the  animals  are  resting,  the  more  so  as  the  sjTiiptoms  of 
stasis  constantly  increase  and  may  even  give  rise  to  pnemnonia. 
The  temperature  is  either  raised  from  the  heginning-  or 


]  046  Pericarditis. 

arise  occurs  in  tlie  later  course  of  the  disease ;  it  is  not  usually 
high,  unless  the  underlying  disease  causes  a  considerable  degree 
of  fever.  When  the  temperature  rises  within  the  body,  chills 
and  trembling  are  frequently  observed  and  the  temperature 
is  unequally  distributed  over  the  surface  of  the  body.  In  cattle 
traumatic  pericarditis  may  in  exceptional  cases  run  an  afebrile 
course. 

With  the  development  of  the  symptoms  the  general  condi- 
tion of  the  animals  becomes  constantly  worse.  Large  animals 
avoid  every  movement  as  much  as  possible,  and  stand  with  neck 
stretched  out  straight,  they  lie  down  only  rarely,  very  carefully 
and  only  for  short  periods ;  their  eyes  have  a  plaintive  expres- 
sion ;  smaller  animals  usually  lie  constantly  on  the  ground.  The 
desire  to  eat  diminishes  more  and  more,  so  tliat  the  patients 
become  emaciated.  Defecation  is  retarded,  although  in  some 
cases,  especially  in  traumatic  pericarditis,  diarrhea  occurs. 

Chronic  pericarditis  usually  arises  out  of  the  acute  form, 
the  condition  of  the  animals  improving  after  a  certain  time,  but 
without  complete  recovery.  It  is  more  rare  for  the  disease  to 
develop  insidiously  from  the  commencement  (mostly  in  the 
presence  of  tumors,  tuberculous  swellings,  etc.),  and  in  such 
cases  the  symptoms  of  the  initial  stage,  like  irregular  heart 
action,  rapid  fatigue  during  work,  may  remain  unnoticed  for 
weeks. 

The  most  striking  s^^llptoms  are  dyspnea  and  rapid 
fatigue  on  moving  about  and  still  more  when  working,  then  a 
decided  increase  and  arhythmic  character  of  the  heart  function. 
Enlargement  of  the  cardiac  dullness  is  either  al)sent  or  examina- 
tion gives  the  same  result  as  in  acute  pericarditis  with  effusion. 
In  the  latter  case  the  heart  beat  and  heart  sounds  are  weak. 
Friction  sounds  are  usually  absent.  Another  s^miptom  is  found 
in  the  fullness  of  the  jugular  veins.  In  the  later  stages  of  the 
disease  edema  may  develop  on  the  lower  chest  and  in  the 
vicinity. 

Course  and  Prog-nosis.  Acute  pericarditis  usually  ends 
fatally,  within  the  tirst  week,  in  those  cases  in  which  puruleiit  or 
ichorous  exudate  has  collected  in  large  quantities  or  in  which 
the  affection  has  occurred  in  connection  with  an  infectious  dis- 
ease, especially  pneumonia,  pleurisy  or  hemorrhagic  septicemia. 
In  the  majority  of  cases,  however,  the  disease  takes  a  longer 
course,  2  to  3  weeks  and  more,  and  shows  at  times  transitory 
improvement.  Ultimately,  however,  the  permanent  disturbance 
of  the  heart  function  or  the  degeneration  of  the  heart  muscle 
lead  to  death  even  in  these  cases,  the  end  being  preceded  by 
symptoms  of  stasis,  such  as  venous  hyperemia  and  edema,  some- 
times hemorrhagic  infarcts  in  the  lungs,  chronic  catarrh  of  the 
respiratory  passages  and  of  the  intestinal  tract,  cutaneous 
edema,  thoracic  dropsy,  ascites,  etc.  The  animals  become  much 
emaciated  and  exhausted  and  usually  perish  in  this  stage  with 


Symi)touis,    Diagnosis.  1047 

sjnnptoms  of  pulmonary  edema.  Sometimes  deatli  occurs  sud- 
denly at  a  time  when  the  general  condition  of  the  animal  is 
still  fairly  satisfactory.  Recoveries  are  rare  in  cases  which 
are  clinically  well  marked  and  usually  follow  upon  a  period  of 
convalescence  lasting  several  weeks.  However,  even  in  those 
cases  which  take  a  comparatively  favoral)le  course,  chronic 
changes  remain  which  influence  the  heart  action  unfavorably. 
In  extensive  adhesions  the  heart  beat  is  weak  and  the  thorax 
is  depressed  in  the  region  of  the  heart  (Roll). 

The  course  of  traumatic  pericarditis  varies  in  the  several 
cases,  but  is  usually  insidious,  extending  over  weeks  and  months, 
and  even  longer,  during  which  time  the  symptoms  usually 
increase  gradually  or  with  transitory  remissions.  Eventually 
digestive  disturbances  become  more  and  more  evident  and  finally 
a  soporose  condition  develops,  accompanied  by  paralysis-like 
debility,  probably  due  to  the  absorption  of  putrefactive  poisons 
from  the  exudate  (de  Bruin).  In  many  cases  metastatic,  puru- 
lent inflammatory  foci  form  in  various  organs,  for  instance  in 
the  joints  and  tendon  sheaths,  and  in  such  cases  the  disease  may 
terminate  with  the  clinical  picture  of  pyemia.  Other  complica- 
tions are  pneumonia  and  pleurisy,  gastric  and  duodenal  catarrh, 
etc.  Sudden  death  is  not  a  very  rare  occurrence  in  any  stage  of 
'  he  disease  and  follows  either  upon  injury  or  perforation  l)y  the 
foreign  body  of  the  heart  muscle  or  of  the  larger  blood  vessels 
of  the  heart,  or  through  the  influence  of  sapremia.  On  the  other 
hand,  protracted  cases  are  observed  occasionally,  in  which  the 
well-marked  s^Tiiptoms  gradually  diminish  in  intensity,  the 
nutrition  improves  and  the  animals  may  even  be  put  to  work 
(Mathis,  Jensen).  Sometimes  spontaneous  recovery  occurs,  the 
foreign  body  either  breaking  through  to  the  outside  or  returning 
into  the  reticulum. 

Diagnosis.  During  the  initial  stage  the  s^miptoms  are  not 
suftieiently  characteristic  to  make  a  positive  recognition  of  peri- 
carditis possible,  although  the  development  of  an  acute  peri- 
carditis is  suggested  by  the  very  great  sensitiveness  of  the  pre- 
eordia,  and  by  the  pounding,  often  arhythmic  heart  beat  which  is 
altered  decidedly  by  even  comparatively  slight  external  influ- 
ences. Later  the  friction  sounds  or  the  various  splashing 
sounds,  together  with  the  decided  enlargement  and  peculiar  form 
of  the  cardiac  dullness  unite  to  make  up  a  characteristic  clinical 
picture,  which  is  developed  further  by  s^nuptoms  of  blood  stasis 
and  l)y  edema,  and  which  it  is  almost  impossible  to  mistake.  It 
is,  however,  not  to  be  forgotten  that  none  of  these  phenomena 
are  pathognomic  in  themselves  and  that  some  of  them  may  be 
absent,  not  only  in  traumatic  pericarditis  but  also  in  other 
inflammations  of  the  pericardium. 

For  the  diagnosis  of  a  commencing  traumatic  pericarditis  tlie  high 
pulse  rate  (100-110  a  minute)  with  a  normal  or  at  most  maximal  normal 


1048  Pericarditis. 

temperature  (Meyer,  Eber)  is  suggestive.  According  to  Eber  the  ques- 
tion may  be  decided  even  in  those  rare  cases  in  which  the  temperature 
rises  more  or  less  during  the  initial  stage,  the  increased  pulse  rate 
remaining  unchanged  in  spite  of  the  lowering  of  the  temperature  by  the 
action  of  antifebrin  in  doses  of  50-100  Gm.  per  day.  According  to  Otto 
a  peculiar  muscular  trembling  in  the  vicinity  of  the  elbows  is  of  impor- 
tance in  this  respect,  which  occurs  especially  after  the  animal  has  been 
standing  for  some  time. 

Fibrinous  pericarditis  might  be  mistaken  for  fibrinous 
pleurisy  when  this  has  given  rise  to  the  so-called  pleuro-peri- 
cardial  sounds.  These  friction  sounds  are  purely  pleuritic  and 
are  characterized  by  being  heard,  together  with  the  heart  sounds, 
only  during  either  inspiration  or  expiration ;  moreover,  they  are 
heard  synchronously  with  the  respiratory  movements  during  the 
heart-pause.  Moreover,  pleurisy  is  rarely  limited  to  so  small 
a  space  and  therefore  friction  sounds,  synchronous  with  the 
respiratory  movements,  are  also  heard  more  posteriorly.  Still, 
it  must  not  be  forgotten  that  pleurisy  and  pericarditis  may  occa- 
sionally be  present  at  the  same  time. — In  rheumatism  of  the 
intercostal  muscles  the  intercostal  spaces  are  painful,  but  fric- 
tion sounds  are  absent  or  at  most  dull  muscular  sounds  are 
audible.  If  a  fibrinous  pleurisy  should  also  be  present,  as  is 
the  case  occasionally  in  the  so-called  pleurodynia  of  horses,  the 
nature  of  the  disease  will  be  sufficiently  cleared  up  by  the  his- 
tory of  the  case  (Vol.  II.).— From  the  endocardial  sounds  in 
valvular  disease  the  pericardial  friction  sounds  are  differen- 
tiated especially  by  the  fact  that  they  seem  to  develop  immedi- 
ately under  the  ear,  are  sometimes  increased  by  pressure  and 
become  weaker  on  inspiration ;  finally  by  the  fact  that  they  are 
not  quite  synchronous  with  the  heart  movements. — At  the  very 
beginning  general  acute  infectious  diseases  may  have  to  be  con- 
sidered, in  ruminants  especially  anthrax,  but  in  such  cases  the 
temperature  is  usually  decisive,  since  in  pericarditis  the  tem- 
perature rises  are  usually  slight  unless  the  disease  has  developed 
upon  a  septicemic  basis. 

Pericarditis  with  effusion  might  give  rise  to  confusion  with 
pneumonia  in  those  cases  in  which  only  the  lower  sections  of  tlie 
lungs,  in  the  neighborhood  of  the  heart,  have  become  condensed 
and  may  therefore  simulate  an  increased  cardiac  dullness.  In 
such  cases  the  character  of  the  heart  beat  and  of  the  heart 
sounds  affords  information  because  in  pneumonia  they  are  not 
weakened  at  all  or  only  slightly  so,  in  contrast  to  pericarditis 
with  effusion. — In  cattle,  lung  plagaie  may  cause  a  clinical  pic- 
ture which  is  somewhat  like  that  of  traumatic  pericarditis,  but 
in  most  cases  sufficient  points  of  difference  are  present,  for  in- 
stance, the  preceding  digestive  disturbances,  the  comparatively 
small  dullness,  the  striking  weakness  of  the  heart-beat,  the  com- 
plete absence  of  bronchial  respiratory  sounds,  the  characteristic 
pericardial  sounds  and  slight  fever  or  its  absence.— In  peri- 


Diagnosis,   Treatment.  1049 

tonitis  with  efTusion  an  enlarged  area  of  cardiac  dullness  may 
1)0  sinuilated  l)y  an  encapsulated  exudation  in  the  vicinity  of  the 
heart  and,  in  "larger  animals,  especially  in  cattle,  by  free  fluid 
exudation.  If  free  exudation  is  present  in  the  thoracic  cavity, 
the  heart  beat  and  the  heart  sounds  are  not  weakened  or  only 
slightly,  especially  in  smaller  animals  and  in  the  sitting  position ; 
moreover,  the  dulhiess  is  limited  horizontally. — An  encapsulated 
pleural  exudate  or  a  swelling  in  the  vicinity  of  the  lieart  nuiy  ])e 
eliminated  in  such  cases  in  which  the  heart  has  been  displaced 
(see  compression  of  the  heart).  A  dullness  due  to  enlargement 
of  the  heart  (hypertrophy,  dilatation)  may  have  a  similar  shape, 
but  hardly  ever  extends  so  far  forward,  the  heart  sounds  are 
heard  distinctly,  friction  sounds  and  sensitiveness  of  the  pre- 
cordia  are  absent. 

About  the  nature  of  the  exudate  external  conditions  may 
offer  infonnation  in  so  far  as  pericarditis  occurring  after  cold, 
in  consequence  of  croupous  pneumonia,  or  of  primary  pleurisy 
leads  to  the  formation  of  a  fibrinous  or  sero-fibrinous  exudate, 
while  metastatic  pericarditis  is  usually  purulent  and  accom- 
panied by  high  fever.  In  traumatic  pericarditis  of  cattle  the 
exudate  may  be  sero-fibrinous,  purulent  or  ichorous.  The 
assumption  of  an  ichorous  pericarditis  is  justified  by  the  greater 
severity  of  the  general  sjanptoms,  by  the  tympanitic  and  possibly 
metallic  nature  of  the  percussion  sound  and  by  the  presence  of 
splashing  sounds.  Traumatic  pericarditis  is  usually  manifested 
by  local  and  venous  symptoms  similar  to  those  of  the  rather 
infrequent  tuberculous  pericarditis  of  cattle  (Klaber,  Lienaux, 
Wyssmann  and  others). 

In  doubtful  cases  Gnieiner  recommends  a  test  puncture  of  the  pericardium, 
on  the  left  side  within  the  area  of  dullness,  if  necessary  also  on  the  right  side. 

Chronic  pericarditis  is  very  difficult  of  recognition  without 
an  exact  knowledge  of  the  history,  because  most  of  the  s^^^lp- 
toms  are  observed  also  in  chronic  pleurisy  and  in  chronic  inter- 
stitial pneumonia.  Only  an  absolutely  exact  determination  of 
the  shape  of  the  dull  area,  the  nature  of  the  heart  beat  and  the 
characteristic  sjTiiptoms  of  stasis  may  be  of  assistance.  Chronic 
myocarditis  cannot  be  differentiated  with  certainty  from  chronic 
fibrinous  pericarditis. 

Treatment.  If  treatment  is  justified  by  the  fact  that  the 
prognosis  is  not  absolutely  unfavorable,  complete  rest  must 
above  all  be  assured.  Any  disturbance  in  defecation  is  to  be 
relieved  by  small  doses  of  mild  laxatives,  and  the  diet  must  be 
regulated  appropriately.  Herbivora  should  receive  good  hay, 
if  possible  mixed  with  fresh  green  feed,  also  flour-  or  bran-slop ; 
carnivora  are  fed  with  gruel  or  broths,  also  milk.  In  persistent 
inappetence  artificial  feeding  (Vol.  II.)  may  become  desirable. 

The  inflammatory  process  may  be  alleviated  by  cold  com- 
presses.   A  sac  filled  with  snow  or  ice  and  fastened  with  a  wide 


2050  Pericarditis. 

belt,  or  a  compress  made  of  tow  or  cotton,  is  applied  to  the 
region  of  the  heart  and  cold  water  poured  over  it  from  time 
to  time;  large  animals  may  be  put  under  the  shower.  In 
primary  pericarditis  preparations  of  salicylic  acid  may  be  tried 
in  similar  doses  as  in  pneumonia  (Vol.  II.)  or  in  somewhat 
smaller  ones,  because  their  harmful  action  upon  the  heart  is 
here  more  easily  exerted.  Lactophenin,  salicylic  acid,  antifebrin, 
antipyrin  and  salipyrin  may  be  administered  in  very  high  fever. 

For  weakness  of  the  heart,  cardiac  remedies  are  indicated, 
digitalis  (in  large  animals  2-4  gm.  daily,  in  small  animals,  of  a 
2 :150.0  infusion  to  which  5  gm.  of  potassium  nitrate  have  been 
added,  one  tablespoonful  every  two  hours).  Caffeine  is  also  of 
service  (2-5.0  gm.  or  0.2-1.0  gm.  subcutaneously),  camphor  (cam- 
phorated oil  20-30  gm.  or  2-3  gm.  subcutaneously),  possibly  wine, 
alcohol,  or  ether. 

To  promote  absorption  diuretic  remedies  and  mild  laxatives 
may  be  tried.  In  excessive  accumulation  of  fluid,  with  conse- 
quent compression  of  the  heart,  puncture  of  the  pericardium 
should  be  considered.  But  in  these  cases  puncture  is  not  as 
harmless  a  proceeding  as  in  pleurisy  because  a  portion  of  the 
exudate  may  flow  into  the  pleural  cavity  through  the  opening  in 
the  pericardium,  after  the  trocar  has  been  removed  (Moussu, 
Gmeiner,  author's  case). 

Puncture  of  the  perioardium  is  done  with  a  simple  trocar  inunediately  above 
the  parasternal  line,  in  the  5th  or  6th  intercostal  space,  but  always  within  the 
area  of  dullness ;  after  removal  of  the  exudate  the  pericardial  cavity  may  be  irrigated 
with  lukewarm  sterilized  water  or  with  a  mild  disinfecting  solution.  If  the  exudate 
is  purulent  it  seems  more  advisable  to  open  the  pericardium  by  an  incision  and 
to  wash  out  the  cavity  thoroughly.  During  this  operation  it  may  be  possible  to 
find  and  remove  the  foreign  body    (Bastin). 

In  traumatic  pericarditis  Meyer's  operation  may  also  be 
tried  (Vol.  II.).  If  this  is  not  followed  by  improvement  or  if 
the  disease  is  already  far  progressed  slaughtering  of  the  patients 
should  not  be  delayed,  because  later  on  the  flesh  will  become 
useless  for  human  consumption  on  account  of  emaciation  or 
sapremia  or  of  general  pyemic  infection.  In  order  to  remove 
edematous  infiltration  and  thus  make  the  flesh  fit  for  consump- 
tion Moussu  recommends  the  removal  of  the  exudate  through 
a  puncture  from  the  direction  of  the  xiphoid  cartilage  (Fig.  182). 
This  procedure  merits  consideration  also  in  non-traumatic  peri- 
carditis of  cattle. 

With  the  animal  standing,  the  positions  of  the  xiphoid  cartilage,  the  linea 
alba  and  the  left  costal  arch  are  ascertained.  In  the  middle  of  the  angle  outlined 
by  these  landmarks,  above  20  em.  in  front  of  the  place  where  the  milk  vein  runs 
toward  the  V.  epigastrica  cranialis,  the  abdominal  wall  is  pierced,  an  incision  is 
made  through  the  skin  about  20  cm.  long,  parallel  to  the  costal  arch,  through 
which  a  portion  of  the  serous  fluid  which  has  accumulated  in  the  subcutaneous 
connective  tissue  will  escape  promptly.  The  muscles  in  the  bottom  of  the  wound 
are  then  separated  with  the  scalpel  as  far  as  the  neck  of  the  xiphoid  cartilage, 
the  subpericardial  fatty  connective  tissue  is  forced  apart  with  one  or  two  fingjers 
of  the  right  hand  until  the  pericardium  is  reached,  as  is  shown  by  feeling  the 
heait   beats.      The   left   index   finger   is   now   pushed   up    to    the    pericardium,   and 


Trcatnicul. 


1051 


upon  it  a  trocar,  at  lea.>-t  2o  cm.  loug  and  o  nini.  thick  is  carrioil  forward  with 
the  right  hand  until  the  heart  beat  is  coinniunicate<l  to  it.  The  trocar  is  now 
pointed  inward  and  forwanl  and  is  forced  with  a  sharp  thrust  about  3--1  cm. 
into  the  pericardium,  the  fluid  being  allowed  to  escape  by  removing  the  stylet. 
A  strip  of  iodoform  gauze  is  jilaced  into  the  wound,  a  compressing  dressing  is 
applied  to  tiie  chest  and  renewal  from  time  to  time.  The  edenui  disapjiears,  in 
tlio  course  of  a  low  days,  for  a  time,  when  the  animal  may  bo  slaughtered. 

VMa 


Fig.   182.     Field  of  operation  for  pmieture  of  the  pericardium  from  the  xi 
laiie.     Lli  linea   alba;    II   costal   arch:    VMa  niilkvein ;   P  point  of  incis 

;Mor.ssu.) 


phoi 
ion 


d  eiirti- 
(After 


Lienaux  calls  attention  to  the  fact  that  in  the  presence  of  adhesions  the 
operation  fails  just  at  this  point  of  punction,  or  that  the  trocar  may  enter  the 
ventricle,  in  which  ca^  e  a  stream  of  blood  will  escape  through  the  trocar.  This 
accident  appears  however  to  be  of  no  importance. 

In  order  to  prevent  possible  complications  (phlegmons,  malignant  edema), 
Lienaux  drains  the  pericardium,  after  punction,  by  introducing  a  rubber  drain 
with  lateral  openings  through  the  eanula  into  the  pericardial  sac  and  securing 
it  -with  sutures  after  removal  of  the  eanula.  In  a  case  treated  in  this  manner 
the   exudate   ilisappeared   permanently   so   that  the   animal   could  be   fattened. 

Cliroiiic  pericarditis  can  hardly  be  treated  successfully.  At 
best  the  animals  must  be  saved  from  exertion  and  receive  car- 
diac remedies.  Animals  which  are  intended  for  slau.^hter  should 
be  killed  as  early  as  possible. 

Literature.  Albrecht,  W.  f.  Tk.,  1893.  259.  —  Aubry,  J.  vet.,  190.3.  3-35.  — 
Bratradin  T.  Z.,  1904.  42U.  —  de  Bruin,  Monh.,  1900.  XI.  1  (Lit.  on  traumat. 
Pericarditis).  —  Dottl,  W.  f.  Tk.,  190S.  227.  —  Eber,  Z.  f.  Tm.,  1906.  X.  321.  — 
Eisenmann,  Monh.,  1906.  XVII.  17.  —  Gmeiner,  B.  t.  W.,  1906.  4()9.  —  Henniges, 
M&^r  1S4S.  514,  —  Jensen,  Maanedsskr.,  1905.  XVTII.  35.  —  Jowett,  J.  of  comp. 
Path.,  1908.  XXI.  324.  —  Klaber,  B.  t.  W.,  1901.  731.  —  Koppit^,  T.  Z.,  1906. 
537.  —  Leblanc,  J.  vet.,  1905.  78.  ~  Lewin,  Z.  f.  \k.,  1894.  18.  —  Lienaux, 
Ann.,  1905.  314;  1908.  311.  —  Mathis,  J.  vet.,  1904.  277.  —  Moussu,  Rec,  1901. 
465;  Bull.,  1905.  296.  —  Noack,  S.  B.,  1889.  74;  1890.  81.  —  Otto,  ibid.,  1899. 
91  _  Petit,  Bull.,  1901.  264;  1905.  281.  —  Schmidt,  P.  Mt.,  1871-72.  162.  — 
Sonnenberg,  B.  t.  W.,  1909.  171.  —  Teetz,  Z.  f.  Flhyg.,  1904.  XIV.  61.  —  Wyssmann, 
B.  t.  W..  1905.  387  (Lit.  on  tuberk  Pericarditis  of  cattle). 


Compression  of  the  heart  fso-ealled  pseudopericarditis).  Aside 
from  IIh'  coinprcssioii  of  Ihc  licart  which  is  produced  by  a  copious  peri- 
cardial exudate,  the  organ  may  he  crowded  or  displaced  hy  formations 
outside  of  the  pericardium;  this  occurs  especially  in  cattle,  hut  some- 


1052  Dropsy  of  the  Pericardium. 

times  also  in  other  domestic  animals.  Abscesses  (mostly  traumatic  in 
origin)  develop  with  preference  subpleurally  or  subpericardially,  and 
new-formations  or  the  somewhat  more  frequent  tuberculous  swellings  are 
found  at  the  base  of  the  heart  or  in  the  anterior  mediastinum.  Only 
rarely  abdominal  organs  (especially  the  reticulum)  compress  the  heart 
by  prolapsing  into  the  thoracic  cavity;  in  other  cases,  which  are  also 
very  rare,  a  pulmonary  abscess  or  a  very  large  echinococcus  of  the  lung 
exerts  pressure  upon  the  near-by  heart.  If  such  formations  are  present, 
the  diastolic  dilation  of  the  heart  is  more  or  less  interfered  with  and  at 
the  same  time  the  heart  muscle  is  made  to  atrophy  (Atrophia  cordis). 
The  large  vascular  trunks  are  often  compressed  at  the  same  time,  or 
they  may  be  affected  exclusively. 

The  clinical  picture  shows  great  similarity  with  that  of  pericarditis; 
especially  similar  symptoms  of  stasis  are  to  be  noted.  On  the  other 
hand,  the  pulse  rate'is  only  slightly  increased,  intermissions  are  fref(uent 
and  a  displacement  of  the  heart  to  the  right,  forward,  backward  or 
upward  may  be  demonstrated  by  the  character  of  the  heart  beat  or  of 
the  heart  sounds;  pericardial  sounds  are  absent.  In  certain  cases  the 
dullness  is  much  larger  than  is  usual  in  pericarditis.  Sometimes  an 
exploratory  puncture  affords  valuable  indications  for  diagnosis. 

Treatment  need  be  considered  only  in  the  case  of  subpleural  or  sub- 
perieardial  abscesses  or  of  cystic  new-formations,  in  order  to  remove  the 
fluid  contents. 

Literature.  Bretaguier,  Eec,  1909.  156.  —  Hnyiien,  Aim.,  1907.  144.  — 
Joest,  Dresd.  B.,  1906.  —  Lieiiaiix,  Ann.,  1905.  1,  121,  473.  —  Matins  &  Ball, 
J.  vet.,  1905.  653.  —  Monssu,  Eec,  1903.  757.  —  Petit  &  Delacroix,  Bull.,  1905. 
133.   —  Seegert,  Z.   f.   Vk.,   1901.   126. 


Dropsy  of  the  Pericardium.     Hydrops  Pericardii. 

{Hyd  roper  icardium.) 

Etiology.  AVitli  the  exception  of  inflammatory  processes, 
wdiich  do  not  belong  here,  an  accumulation  of  serous  fluid  occurs 
in  the  pericardium  either  from  stasis  of  the  blood  in  chronic 
diseases  of  the  heart  muscle  or  of  the  valves,  or  in  chronic 
pulmonary  affections,  and  also  in  connection  Avith  liydremia. 
On  a  similar  foundation  dropsy  of  the  pericardium  develops 
in  chronic  inflammations  of  the  kidneys,  in  chronic  glanders, 
chronic  anemia,  in  liver-fluke  disease,  lung^vorm  disease,  etc. 
The  diseases  which  have  been  enumerated  usually  exert  their 
effects  also  upon  the  veins  of  other  parts  of  the  body,  and 
therefore  symptoms  of  liydrops  are  in  these  cases  observed 
elsewhere  also. 

Anatomical  Changes.  The  pericardium  of  healthy  animals 
contains  at  most  a  few^  cubic  centimeters  of  a  serous  fluid,  but 
in  dropsy  of  the  pericardium  the  quantity  may  amount  to  100-200 
times  the  normal.  The  liquid  is  clear  or  slightly  turbid  (because 
of  the  admixture  of  desquamated  and  degenerated  epithelial 
cells),  it  is  thin  fluid,  sometimes  bloody;  the  specific  gravity  is 


Symptoms,    Diagnosis,    Treatment.  1053 

less  than  1010,  the  content  of  albumen  less  than  3%.     Other 
changes  are  present  "which  point  to  the  underlying  condition. 

Symptoms.  Dropsy  of  tlie  pericardium  is  always  observed 
in  animals  which  have  ]jresented  s^niiptoms  of  the  basic  disease 
for  some  time.  Aside  from  tliese  the  most  important  sjnnptoms 
are  an  enlarged  area  of  cardiac  dullness  of  similar  shape  and 
extension  as  in  pericarditis  with  effusion,  feeble  and  dull  heart 
sounds.  If  dropsy  is  present  also  in  the  thorax,  the  enlarged 
area  of  cardiac  dullness  is  in  small  animals  easily  determined 
while  they  are  sitting  or  lying  on  the  back,  because  then  only 
the  dullness  due  to  the  fluid  accumulated  in  the  pericar<lial 
cavity  renuiins. 

Symijtoms  of  stasis,  respiratory  disturbances,  albuminuria, 
feeble  and  small  pulse  beats  also  become  evident,  but  these 
s^nnptoms  are  largely  due  to  the  l)asic  condition  itself  which 
indeed  is  of  deciding  influence  upon  the  course  and  prognosis. 

Diagnosis.  Dropsy  of  the  pericardium  differs  from  peri- 
carditis with  fluid  exudate  by  the  absence  of  acute  s^miptoms 
(pain,  fever)  and  of  friction  sounds,  and  by  the  presence  of 
manifestations  of  hydrops  elsewhere. 

Treatment.  As  hydrops  of  the  pericardium  only  represents 
a  lohenomenon  of  other  affections,  the  treatment  must  be  adapted 
to  the  nature  of  the  underlying  condition.  It  is  sometimes 
possible  to  diminish  the  pericardial  fluid  by  the  systematic 
administration  of  diuretic  and  diaphoretic  remedies  and  of 
laxatives.  If  the  accumulation  of  fluid  is  excessive  punction 
of  the  pericardium  may  be   attempted. 


Accumulation  of  Blood  in  the  Pericardium  (Haemopericardium). 
Hemorrhage  into  the  pericardial  cavity  may  occur  from  the  cavities  of 
the  heart,  from  the  blood  vessels  of  the  heart  muscle  or  from  the  larger 
vessel  trunks.  As  immediate  causes  of  bleeding  may  be  mentioned 
trauma  or  spontaneous  rupture  of  the  heart,  rupture  of  the  dilated 
coronary  artery  or  of  a  large  vessel  trunk,  especially  of  the  aorta,  if  this 
is  dilated  above  the  valves.  Finally  bleeding  may  occur  exceptionally 
in  diseases  with  hemorrhagic  diathesis. 

Hemopericardium  can  only  be  recognized  with  a  certain  degree  of 
probability  in  cases  in  which  the  bleeding  is  slow,  because  in  rapid 
hemorrhage  death  occurs  as  soon  as  in  y^-l  hour.  The  diagnosis  is 
based  upon  the  demonstration  of  fluid  in  the  pericardium  (p.  1042), 
the  symptoms  Of  internal  hemorrhage  and  the  discovery  of  some  disease 
which  is  known  to  be  able  to  lead  to  hemorrhage  in  the  pericardium. 

3.     Gas  in  the  Pericardium.    Pneumopericardium. 

Etiology.  An  accumulation  of  gas  in  the  pericardium 
occurs  usually  only  in  cattle,  when  a  foreign  body  penetrating 
into  the  pericardium  from  the  reticulum  has  formed  a  canal 


1054  Piifnimopericanlium. 

tlirougli  which  gases  ma^'  pass  from  the  reticuhim  into  the 
pericardial  cavity  (see  p.  1.042) ;  the  same  occurs  in  ichorous 
pericarditis  in  which  putrefactive  gases  are  formed.  Atmos- 
pheric air  enters  the  pericardium  only  in  very  exceptional 
cases,  for  instance  after  penetrating  wounds  of  the  pericardium 
by  external  agencies,  by  fractured  ribs,  by  l^reaking  down  of 
a  lung  cavity  which  had  been  adherent  to  the  pericardium. 

Symptoms.  An  intense  tympanitic  percussion  sound  is 
noticeable  in  the  region  of  the  heart,  over  an  area  which  is 
sharply  limited  at  the  periphery  and  corresponds  to  the  cardiac 
area;  this  sound  is  sometimes  metallic  in  character.  In  pure 
pneumopericardium  the  heart  sounds  are  high  and  metallic, 
owing  to  the  resonance  of  the  pericardium.  In  most  cases, 
however,  the  pericardium  contains  fluid  exudate  as  well  as  gases, 
and  this  gives  rise  to  loud  splashing,  clacking  noises  which 
are  sometimes  audible  from  a  distance  of  several  steps,  and 
which  are  often  compared  with  the  noise  made  by  a  millwheel 
(bruit  de  moulin). 

The  clinical  picture  is  supplemented  by  the  more  or  less 
marked  symptoms  of  pericarditis  (p.  1043)  which  is  usually 
present,  or  the  signs  of  gas  accumulation  appear  only  in  a 
certain  stage,  for  instance,  at  the  beginning  or  toward  the 
end  of  pericarditis.  In  making  a  diagnosis  it  should  be  re- 
membered that  a  tympanitic  sound  in  the  region  of  the  heart 
may  also  be  produced  by  infiltration  of  the  lung  portions  in 
the  vicinity  of  the  heart  or  by  diaphragTuatic  hernia  (portions 
of  intestine  in  the  pericardium  [Pettit]). 

Prognosis.  Pneumocardium  is  always  of  very  unfavorable 
significance  and  a  chance  for  recovery  exists  only  in  those 
rare  cases  of  injury  to  the  pericardium  in  which  infection 
failed  to  occur. 

Treatment.  The  same  treatment  is  here  indicated  as  in 
acute  pericarditis,  but  the  necessity  for  operation  is  greater. 

Literature.     Petit,  Kec,   1902.   679    (see  also  Lit.   on  pericarditis). 


Section  II. 

DISEASES  OF  THE  HEART. 

1.     Palpitatio  Cordis. 

{Tachycardia,  Ilypcrkinesis  cordis.) 

A  purely  nervous  palpitation  which  is  independent  of 
organic  heart  diseases  appears  in  domestic  animals  onh'  very 
rarely,  hut  it  has  been  observed  preferably  in  higiiljred  and 
very  vivacious  horses  and  dogs,  also  once,  by  Bredo,  in  a  four- 
year-old  cow. 

The  greater  portion  of  cases  reported  under  this  name  in  veterinary 
literature  must  undoubtedly  be  classed  with  spasm  of  the  diaphragm 
or  with  organic  heart  diseases.  Older  authors  commonly  considered 
spasm  of  the  diaphragm  as  palpitation,  and  more  recently  organic  heart 
diseases  which,  especially  after  external  influences,  also  may  give  rise 
to  similar  spasmodic  attacks,  have  not  been  duly  considered  in  the  inter- 
pretation of  symptoms. 

Etiology.  An  abnormally  increased  action  of  the  normal 
heart  muscle  may  be  caused  either  by  an  excessive  irritation 
or  by  an  increased  irritability  of  the  N.  s}^npathicus  or  by 
paralysis  of  the  X.  vagus.  The  first  mode  enters  into  con- 
sideration in  those  cases  in  which  palpitation  occurs  after 
violent  psychic  irritation,  after  fright,  in  case  of  fire,  on  falling, 
after  railroad  trans])ortation,  or  from  over-exertion ;  similar 
conditions  may  however  also  lead  to  acute  cardiac  dilatation 
or  to  acute  heart  weakness.  A  congenital  morbid  irritability 
of  the  nervous  system  in  nutritive  disturbances,  in  hemorrhages, 
in  Basedow's  disease,  must  in  certain  cases  also  l)e  brought 
into  causal  relation  with  palpitation.  Then  inflammation  or 
degeneration  of  the  N.  vagus  (in  chronic  lead  poisoning) 
usually  leads  to  tachycardia.  Finally  palpitation  sometimes 
persists  after  influenza    (Pr.  Mil.  Vb.). 

]\Iartius  considers  palpitation  as  a  purely  secondary  phenomenon 
which  is  always  based  upon  a  paroxysmal  acute  heart  dilatation,  i.  e., 
an  organic  heart  disease. 

1055 


1056  Tachycardia. 

Symptoms.  The  entire  behavior  of  the  animals,  especially 
their  distressed  expression,  reveals  great  anxiety,  the  animals 
tremble,  horses  and  cattle  perspire.  In  the  heart  region  thrills 
are  seen  which  are  synchronous  with  the  heart  beat  and  which 
are  sometimes  transmitted  to  the  entire  tnmk  and  to  the 
vertebral  column.  The  heart  beat  is  stronger,  as  a  rule  much 
accelerated  and  arhythmical  in  so  far  as  a  number  of  rapid 
heart  beats  alternate  with  several  which  are  less  rapid,  or 
as  brief  intermissions  occur.  The  heart  sounds  are  very  strong 
and  are  sometimes  audible  from  a  distance  of  several  steps. 
At  the  same  time  the  pulse  is  usually  feeble.  These  symptoms 
permit  the  assumption  that  a  heart  weakness  was  present  in 
the  cases  in  question,  and  this  assumption  is  strengthened  by 
other  signs  mentioned  by  several  authors,  such  as  intermittent 
pulse,  systolic  murmurs,  greater  fullness  and  pulsation  of  the 
jugular  vein. 

Diagnosis.  The  assumption  of  nervous  palpitation  pre- 
supposes the  absence  of  any  organic  disease  of  heart  or  blood 
vessels  which  could  produce  similar  disturbances  in  the  heart 
function.  Severe  acute  general  diseases  must  also  be  eliminated. 

Course.  Palpitation  always  lasts  only  a  short  time,  a  few 
hours,  or  at  most  one-half  to  one  day,  after  which  the  attack 
disappears  either  rapidly  or  quite  gradually.  In  horses  that 
are  otherwise  healthy,  further  attacks  usually  occur  only  ^  if 
the  external  influences  are  repeated,  but  anemic  and  otherwise 
predisposed  animals  may  have  attacks  in  rapid  succession. 
The  tachycardia  which  is  due  to  paralysis  of  the  vagus  is 
usually  permanent,  but  as  a  rule  it  is  followed  in  a  few  days 
by  a   foreign-body-pneumonia    (vagais  pneumonia). 

Treatment.  An  attack  of  true  tachycardia  usually  passes 
over  without  any  treatment  after  complete  rest  is  secured  and 
the  diet  regulated.  In  nervous  excitement  the  following  drugs 
may  be  administered:  morphine  (for  horses  0.30-0.50  gm.,  for 
dogs  0.02-0.05  gm.  subcutaneously),  chloral  hydrate  (20-40.0 
or  1-2.0  gm.  dissolved  in  lukewarm  water,  per  os  or  per  anum), 
possibly  potassium  bromide  (10-15.0  gm.  or  1-2.0  gm.  in  the 
drinking  water).  Other  narcotics  may  be  given  successfully. 
Cardiotonic  remedies  should  be  administered  if  cardiac  weak- 
ness is  present. 

Literature.  Bietlo,  Ann.,  1897.  31.  —  Kroon,  Holl.  Z.,  18f)9.  388.  —  Martins, 
Tachy-Kardie,  1895;  Ergeln.  d.  Path.,  1894.  1.  2.  Abt.,  59  (Lit.  on  tachycardia 
in  general).  —  Nordheim,  Z.  f.  Vk.,  1890.  275.  —  Pr.  Mil.  VI.,  1900.  147.  — 
Schniitt,  B.  t.  W.,  1897.  590. 

2.    Slow  Heart  Action.    Bradycardia. 

Slowing  of  the  heart  action  depends  upon  a  functional 
disturbance  in  the  heart  muscle  without  any  demonstrable 
organic  changes. 


Bradyeaidia.  1057 

Etiology.  The  cause  of  a  decided  slowing  of  the  lieart 
beat  lies  either  in  an  excessive  stimulation  of  the  vagus  or 
in  certain  affections  of  the  heart  muscle. 

An  excessive  stinnilation  of  the  N.  vag-us  may  follow  upon 
a  bilateral  comi)ression  of  this  nerve  (in  the  thorax  cavity, 
in  the  medulla  oblongata),  it  may  be  due  to  slight  inflannnation, 
to  compression  of  the  vagus  center  in  certain  brain  affections, 
and  finally,  it  may  be  a  reflex  effect  from  the  stomach  or  in- 
testine, from  the  peritoneum  or  from  the  skin  (Albrecht).  Cer- 
tain chemical  substances  (e.  g.,  tannates)  are  also  capable  of 
irritating  the  vagus.  Certain  diseases  of  the  heart  muscle 
frequently  cause  bradycardia,  for  instance,  degeneration  of  the 
muscle  in  acute  infectious  diseases,  chronic  myocarditis, 
atrophy  of  the  heart,  affections  of  the  coronary  arteries,  finally 
insufficient  nutrition  of  the  heart  muscle  in  inanition. 

From  what  has  been  said  it  is  readily  seen  that  bradycardia  indeed  occurs 
as  an  acoompaninient  of  various  diseases,  but  that  it  niust,  nevertheless,  be 
considered   separately  because  in  many  cases  a  cause   cannot  be  ascertained. 

Symptoms.  In  horses  a  reduction  in  the  number  of  heart 
beats  has  been  observed  to  as  few  as  9  (Zimmermann),  in  most 
cases  only  to  12-20  (Dieckerhoff,  Nordheim,  Vogel,  Zschokke), 
in  dogs  to  20-18  (Frohner,  Albrecht).  The  heart  l)eat  remains 
vigorous  and  the  heart  sounds  are  clear.  The  animals  are 
apparently  quite  well;  only  in  severe  cases  they  show,  aside 
from  the  symptoms  of  the  underlying  disease,  languor,  somno- 
lence, lassitude,  attacks  of  heart  spasms  or  of  heart  weakness. 

Diagnosis.  Bradycardia  is  easily  recognized  and  the  cause 
may  often  be  ascertained.  It  is  possible  to  determine  by  sub- 
cutaneous injections  of  atropine  (for  large  animals  0.02-0.05; 
for  dogs  0.005-0.008  gm.)  whether  the  cause  lies  in  the  vagus 
or  in  the  heart,  because  bradycardia  which  is  due  to  an  excessive 
stimulation  of  the  vagus  disappears  for  a  time  after  the  ad- 
ministration of  atropine.  Sjnnptoms  of  heart  weakness,  which 
may  become  manifest  only  on  motion,  point  to  an  organic  dis- 
ease of  the  lieart. 

Treatment.  Nerve  stimulants  are  indicated  in  all  cases, 
such  as  injections  of  atropine,  alcohol,  ether,  also  sponging, 
and  the  relief  of  any  digestive  disturbances  that  may  be  present. 

Literature.  Albrecht,  W.  f.  Tk.,  1895.  225  (Lit.).  —  Frohner,  Monh.,  1R91. 
IL  548.  —  Gutbrod,  W.  f.  Tk.,  1901.  493.  —  Nordheini,  Z.  f.  Vk..  189(1.  275.  — 
Sonnenberg,  B.  t.  W.,  1909.  171.  —  Vogel,  Kep.,  1888.  1.  —  Zimmermann,  O.  M., 
1900.    289. 

3.    Intermittent  Heart    Action.   Actio  Cordis  Intermittens. 

( A rhythynia  co rclis. ) 

Intermittent  heart  action  is  a  disturbance  of  the  heart  beats 
which  may  be  produced  by  the  total  omission  of  one  or  several 
ventricular  contractions  or  by  additional  systolic  contractions. 

Vol.  1—67 


;lQ5g  lutermitteut    Heart   Action. 

Etiology.  The  omission  of  ventricular  contractions  occurs 
frequently  in  horses  as  a  sequel  of  acute  infectious  diseases 
especially  in  the  course,  or  during  the  convalescence,  of  in- 
fluenza; in  other  animals  it  is  hardly  ever  observed.  As  the 
actual  cause  a  reflex  or  immediate  excessive  stimulation  of  the 
N.  vagus  may  be  assumed,  since  in  the  cases  observed  by  the 
author  the  omissions  could  always  be  relieved  by  atropine, 
which  is  known  to  paralyze  the  vagus  endings.  The  stimula- 
tion of  the  vagus  becomes  manifest  by  the.  intermediation  of 
the  central  nervous  system  when  the  omissions  occur  in  brain 
affections,  for  instance,  in  case  of  increased  intracranial  pres- 
sure (chronic  Hydrocephalus  internus,  brain  tumors,  inflam- 
mation of  the  brain  coverings,  etc.).  Digestive  disturbances 
(enteric  catarrh,  obstipation)  also  sometimes  give  rise  to 
transitorv  intermissions  which  are  prol)ably  produced  by 
chemical  "substances  that  have  been  absorbed  from  the  intestine, 
in  such  a  manner  that  the  poisons  irritate  the  N.  vagus  or  its 
center  either  directly  or  reflexly.  The  ventricular  systole  may 
finally  be  omitted  iii  certain  cases  in  connection  with  diseases 
of  the  heart  muscle  or  of  its  nervous  apparatus,  for  instance, 
in  acute  inflammatory  processes  in  the  heart  muscle,  in  the 
pericardium  or  in  the  endocardium. 

Intermissions  of  the  heart  beat  which  are  produced  by 
additional  systolic  contractions  occur  in  all  animal  species  and 
always  depend  upon  an  abnormal  stimulation  of  the  heart. 
The  abnormal  stimulation  consists  either  in  an  increased 
diastolic  pressure  in  any  one  portion  of  the  heart  (in  heart 
weakness),  or  it  develops  in  acute  inflammatory  processes  in 
the  heart  muscle,  in  the  pericardium  or  endocardium.  Some- 
times poisons  which  have  been  absorbed  in  the  intestines  exert 
an  abnormal  stimulation  upon  the  heart. 

Pathogenesis.  The  physiological  irritability  or  conductivity 
of  the  heart  is  reduced  by  excessive  stimulation  of  the  N.  vagus, 
and  this  occurs  first  on  the  points  of  transition  between  the 
auricles  and  the  ventricles,  where  the  compartments  of  the 
heart  are  connected  only  by  small  muscular  bundles.  In  con- 
sequence single  contractions  of  the  heart  muscle  omit,  according 
to  the  degree  of  disturbance  either  only  in  the  ventricles  or 
also  in  the  auricles.    The  same  occurs  in  diseases  of  the  heart. 

Under  the  influence  of  an  abnormal  stimulation  at  the  time 
when  the  respective  heart  segments  are  usually  in  diastole, 
an  unusual  contraction,  an  additional  systole  occurs  following 
immediately  upon  a  normal  systole  but  preventing  the  occtir- 
rence  of  the  next  normal  systole  by  reducing  the  irritability 
of  the  heart  for  a  time.  The  sooner  the  additional  systole 
follows  upon  the  immediately  preceding  normal  contraction,  the 
less  complete  are  the  filling  and  contraction  of  the  heart,  the 
aortic  pressure  being  as  yet  lowered  but  slightly,  and  in  con- 


Pathogenesis,     Synii)toni.«;, 


1059 


sequence  the  arterial  pulse  omits   in   spite   of  the  additional 
contraction  of  the  heart. 

Symptoms.  In  omission  of  the  ventricular  systole  a  pause 
corresponding  to  one  heart  beat  can  often  be  observed  after 
every  2  to  5  lioart  beats.    The  intermissions  are,  liowover,  often 


Fig.   183.     Inicrmittcnt  heart  action  in  the  hortie.     Sphygmograph  of  tlie  abdominal 
aorta.     Inteiiuission  of  two  successive  pulse  beats    (Time  indicated  in  0.2"). 

iiiucli^  less  frequent,  only  after  every  10  to  15  heart  beats,  and 
occasionally  no  regularity  can  be  observed.  Usually  only  one 
heart  beat  is  omitted,  but  there  are  cases  in  which  2  to  I  suc- 
cessive heart  beats  are  missing  (Fig.  183).  In  many  cases 
a  very  feeble,  dull,  short  heart  sound  is  heard  in  the  anterior 


Fig.  184.  JnicrniilUiit  heart  avlioti  and  contraction.'^  of  the  rcntrirlrs.  occiirrin;!  at 
different  times,  in  a  hijrsc.  A  ( 'anlio^napli,  llie  small  apioos  a  correspond  to  tlie 
auricular  contractions,  the  larger  hi'  to  the  ventricular  contractions.  The  auricular 
apex  persists  during  omission  of  ventricular  systole.  It  corresponds  with  a  of  tlie 
Phlebigraph  li  of  the  jugular  vein  (negative  venous  pulse).  After  each  omission  of 
the  ventricular  contraction  the  pressure  in  the  vein  rose,  because  the  vein  was  not 
emptied.      (Z  time  in  0.2".) 

portions  of  the  heart,  which  corresponds  to  the  persisting 
auricular  contractions,  while  the  vigorous  systolic  heart  sound 
which  depends  upon  a  contraction  of  the  ventricles  is  omitted. 
The  occurrence  of  the  auricular  contraction  may  be  assumed 
positively  because  the  negative  venous  pulse  at  the  entrance 


1060 


Intermittent  Heart  Action. 


of  the  chest  can  be  felt  even  during  the  pause  (Fig.  184).  The 
heart  beat  following  upon  the  pause  is  usually  stronger,  while 
the  subsequent  beats  are  either  normal  in  force,  or  evenly 
weakened,  or  then  gradually  diminish  in  intensity.  The  pulse 
behaves  similarly  to  the  heart  beat  (true  arhythmia  of  Caroni 
and  Cadiot).  During  motion  the  number  of  heart  beats  is  in- 
creased, the  abnormal  rhythm  being  usually  preserved,  although 
sometimes  it  changes  in  the  same  animal  from  time  to  time, 
so  that  the  pauses  occur  at  shorter,  and  again  at  longer 
intervals. 

Extrasystolic  arh5rthmia  is  recognized  by  the  rapid  suc- 
cession of  two  or  several  heart  beats,  which  are  separated  from 
the  other,  normal,  heart  beats  by  a  pause,  so  that  bigeminous, 
trigeminous,  etc.,  heart  beats  are  noted.  The  pulse  beat  cor- 
responding with  the  additional  systole  is  usually  absent;  only 
when  this  systole  is  separated  from  the  preceding  one  by  a 
longer  interval,  or  if  it  occurs  frequently  a  rather  feeble  pulse 
may  be  felt  (Fig.  185).    During  motion  the  arhythmia  becomes 


Z 
A.f. 

C 


JjUJjLiJULillJUUlJLijLjlJLjLJLlJJ^^ 


Fig.  185.  Arhythmia  of  the  heart  due  to  additional  systole,  in  a  dog  with  cardiac 
dilatation  and  inability  to  close  the  bicuspid  valve,  c  Curve  of  heart  beats.  A.f. 
Sphygmograph  of  the  Art.  femoralis,  Z  time  in  1/.5  seconds ;  s  normal  ventricular 
systole,  the  pulse  is  distinctly  felt;  (s)  in  the  sphygmograph;  s'  additional  systole, 
to  which  at  +  in  the*  sphygmograph  not  a  beat  corresponds,  bvit  at  s'  a  minimal 
rise;  s'-s"  crowded  additional  systoles,  to  which  in  sphygmograph  elevations  cor- 
respond which  are  in  part  minimal,  are  hardly  or  not  at  all  to  be  felt. 


still  more  striking,  or  if  it  had  not  been  observed  at  rest  it 
then  becomes  manifest.  It  may  often  be  relieved  temporarily 
by  cardiotonics. 

Course.  If  the  intermission  of  the  heart  action  occurs 
in  the  course  of  an  acute  disease,  it  disappears  together  with 
its  removal;  but  if  in  the  meanwhile  lasting  changes  have 
developed  in  the  heart,  the  arh^^'ihmia  persists  mthout  inter- 
fering, as  a  rule,  with  the  health  of  the  animal.  In  chronic 
heart  affections,  however,  the  arhythmia  disappears  at  most 
for  a  certain  time  and  the  animals  show  signs  of  being  broken- 
winded. 

Treatment.  Aside  from  the  treatment  of  the  basic  disease, 
animals  which  show  a  considerable  degree  of  arhythmia  should 


Treatment.  1061 

1)0  worked  oiilv  with  great  care.  If  the  arhythmia  depends  upon 
organic  diseases  of  the  heart  muscle,  cardiac  remedies  are  some- 
times of  vahie. 

Literature.  Ca.liot,  Bull.,  1894.  188.  —  Caroni,  Rec,  1894.  607.  —  Hering, 
J).  111.  W.,  1  !»()(•).  929.  —  Siedamgrotzky,  S.  B.,  1886.  20.  —  Wenckebach,  Die 
ArliYthniic  d.   Ilerzcus,   1903. 

4.     Hypertrophy  of  the  Heart.     Hypertrophia  Cordis. 

Hypertrophy  of  the  heart  consists  in  an  increase  in  the 
heart  innsck'  which  arises  from  thickening  and  possibly  from 
multiplication  of  the  muscular  fibers  under  the  influence  of 
an  increase  in  function  persisting  for  at  least  four  weeks. 

Etiology.  During  severe  work  the  normal,  or  usually  in- 
creased blood  is  forced  against  the  normal  or  increased  re- 
sistance at  greatly  shortened  intervals,  and  if  this  is  repeated 
time  and  again  it  is  followed  by  hypertrophy  of  the  heart 
muscle.  In  horses  used  for  rapid  motion,  in  hunting  dogs,  and 
exceptionally  in  pack-horses  and  draught-oxen,  the  relatively 
great  size  of  the  heart  stands  in  relation  to  the  increased 
muscular  exertion.  A  comparatively  large  heart  may  be  said 
to  be  a  constant  finding  in  some  species  of  these  animals,  and 
it  is  not  improbable  that  heredity  may  be  of  influence  upon 
the  dimensions  of  the  heart.  This  physiological  hypertrophy 
is  alwavs  in  proportion  to  the  development  of  the  muscles  of 
the  bodv  and  does  not  require  any  treatment. 

On  the  other  hand  a  pathological  hypertrophy  of  the  heart 
does  not  stand  in  direct  relation  to  the  development  of  the 
skeletal  muscles  or  is  limited  to  some  portions  of  the  heart. 
In  persistent  disturbances  of  the  circulation  the  part  of  the 
heart  which  is  connected  Avith  the  place  of  the  disturbance  is 
forced  to  continuouslv  increased  exertion  and  this  is  eventually 
followed  bv  hAT>ertrophy  of  this  portion  of  the  heart ;  m  dis- 
eases of  the  left  venous  ostium,  however,  the  right  ventricle 
also  hypertrophies  owing  to  increased  work  done.  Pathological 
processes  in  the  heart  muscle  itself,  such  as  chronic  myocarditis, 
tumors,  echinococcic  cysts,  etc.,  also  lead  to  an  increase  m 
the  muscular  tissue  in  those  parts  of  the  heart  which  are  not 
immediatelv  affected.  A  similar  result  is  produced  by  ad- 
hesions of  the  layers  of  the  pericardium  because  it  necessitates 
an  increased  amount  of  work  on  the  part  of  the  heart.  Acute 
cardiac  dilatation  mav  also  form  a  basis  for  the  development 
of  hvpertrophv  if  the  heart  muscle  is  comparatively  unimpaired. 
(In  chronic  mvocarditis  the  hypertrophy  may  at  tunes  be  only 
apparent  being  simulated  bv  the  fact  that  the  wall  of  some 
portion  of  the  heart  has  become  thicker  owing  to  cellular  m- 
mtration  or  to  simultaneous  new-formation  of  connective  tissue 
[E     \lbrecht]).     Finallv  hvpertrophv  of  the  heart  often  de- 


1062  Hypertrophy  of  the  Heart. 

velops  in  older  dogs  in  consequence  of  a  chronic,  especially 
interstitial,  inflammation  of  the  kidneys. 

Senator  sees  the  cause  of  nephritic  hypertrophy,  which  usually  occurs  in 
the  left  heart,  less  often  in  both  halves  of  the  heart,  in  a  narrowing  of  the  vessels 
which  is  produced  by  irritating  substances  retained  in  the  blood,  and  also  in  an 
irritation  of  the  heart  muscle  by  these  same  substances.  In  certain  cases,  which 
may  be  not  a  few,  the  enlargement  of  the  heart  probably  occurs  through  the 
influence  of  the  causes  which  are  responsible  for  the  inflammation  in  the  kidneys. 

The  secondary  hypertrophy  of  the  heart  which  occurs  in 
connection  with  chronic  diseases  of  the  heart,  lungs,  arteries 
or  kidneys  is  a  phenomenon  of  these  diseases  and  will  there- 
fore be  considered  in  connection  with  them.  Here  onlj^  the 
so  called  idiopathic  h;)T3ertrophy  of  the  heart  is  to  be  discussed 
which  arises  from  an  acute  cardiac  dilatation  or  is  possibly 
produced  by  irritating  substances  that  are  not  known  exactly. 

Many  contributions  on  idiopathic  hypertrophy  of  the  lieart  may  be  found  in 
veterinary  literature ;  on  the  basis  of  their  clinical  symptoms,  however,  most  of 
them  must  be  classed  rather  with  chronic  myocarditis  or  with  cardiac  dilatation. 

Anatomical  Changes.  The  determination  of  cardiac  hyper- 
troph}"  requires  an  exact  knowledge  of  the  physiological  dimen- 
sions, the  relations  between  heart  and  body  weight  and  a  con- 
sideration of  the  size  of  the  respective  heart  cavities. 

The  relation  of  the  weight  of  the  heart  to  the  weight  of  the  living  body 
in  the  horse  is,  according  to  Franck  &  Martin,  1%  on  an  average;  according  to 
Frey,  1.28%;  according  to  Schubert,  0.84%;  in  cattle,  according  to  Schmalz, 
0.3.3-0.42%;  according  to  Schneider,  in  the  steer  0.4427r,  in  the  ox  0.414%,  in 
the  cow  0.492%  ;  according  to  Schubert,  in  the  steer  0.436%,  in  the  ox  0.42%, 
in  the  cow  0.52%,  and  in  calves  0.708%;  in  the  dog,  according  to  Schubert,  1% 
of  tjje  body  weight. 

During  moderate  contractions  the  hypertrophy  of  the 
muscle  may  be  noticeable  even  on  external  inspection,  especially 
if  it  is  only  partial.  The  form  of  the  lieart  is  changed  thus 
that  with  an  increased  thickness  of  the  left  ventricular  wall 
the  heart  as  a  whole  is  slender,  elongated,  like  a  pointed  cone, 
while  in  hypertrophy  of  the  right  ventricular  wall  the  heart 
as  a  whole  becomes  broader  and  more  flat,  the  right  heart  being 
involved  in  the  formation  of  the  apex;  indeed,  if  the  hyper- 
trophy is  very  great,  the  right  ventricle  reaches  beyond  the 
apex  of  the  left  ventricle.  The  thickened  muscle  is  usually 
firm  and  like  rul)ber.  The  weight  of  the  heart  is  also  increased 
and  may  in  well  marked  cases  amount  to  twice  the  normal 
weight. 

The  customary  classification  of  simple  hypertrophy  (walls  thickened,  cavity 
of  normal  width),  concentric  hj'pertrophy  (walls  thickened,  cavity  smaller)  and 
eccentric  hypertrophy  (walls  thickened,  cavity  dilated)  is  well  adapted  for  a 
concise  description  of  the  findings,  but  it  has  no  particular  significance,  except 
that  the  last  form  indicates  a  considerable  insufficiency  of  the  previously  hyper- 
trophied  heart  muscle. 


Symptoms.     Treatment.  1063 

Symptoms.  Pliysiological  hypertrophy  of  tlie  heart  does 
not  u'ive  rise  to  any  morbid  symptoms.  The  s^^llpt()nls  of 
hypertrophy  M'hieh  develop  in  connection  with  organic  heart 
diseases  or  arterial  affections  will  be  considered  in  connection 
with  these  diseases. 

Tn  the  remaining  cases  the  hypertrophy  is  characterized 
by  an  enlarged  cardiac  dullness,  increased  force  of  the  heart 
beat,  accentuated  diastolic  heart  sonnd  and  by  a  strong  and 
tense  pnlse. 

If  the  energy  of  the  heart  conti'actions  is  diminished  later 
on,  the  symptoms  of  cardiac  insnlliciency  appear  which  cor- 
res])()n(l  with  those  of  dilatation  (p.  1064).  At  first  they  usually 
occur  oidy  on  motion,  but  may  later  be  observed  also  at  rest. 
There  are  then  noticeaUle  languor,  feeble  pulse,  increased  full- 
ness of  the  veins,  grathuilly  increasing  emaciation,  dropsical 
signs,  sometimes  vertigo  and  attacks  similar  to  i)alpitation. 

Treatment.  The  treatment  will  have  to  be  limited  to  pre- 
venting, if  possible,  the  exhaustion  of  the  heart  muscle;  this 
is  done  by  careful  use  and  proper  feeding  of  the  patients. 
The  animals  may,  even  for  considerable  periods,  be  used  for 
uniform  and  quiet  work,  but  exertion  usually  decidedly  aggra- 
vates their  condition,  the  circulatory  disturbances  are  increased 
and  sudden  death  may  follow.  In  cardiac  weakness  the  remedies 
mentioned  for  cardiac  dilatation  are  applicable   (p.  1067). 

Literature.  Kiihiie.  Mag.,  1870.  8S.  —  Lienaux,  Ann..  1904.  157.  —  ]\rauri, 
Rev.  vet..  1894.  121.  —  Sclirader.  D.  t.  W.,  1902.  156.  —  Serlingr,  ^V.  f.  Tk.,  1SS8. 
205.  —  SiedanigrotJkv,  8.  B.,  1887.  20.  —  Schubert,  Beitr.  r.  Anatoiiiie  <1.  Ilerzens 
d.  Haussjiiigetiere.     Diss.  Leipzig.   1909    (Lit.).  —  Vogel,  Eep.,  1888.  1. 


5.    Dilatation  of  the  Heart.    Dilatatio  Cordis. 

The  term  "Cardiac  Dilatation"  is  used  to  designate  a 
deficient  emptying  of  the  heart  cavities  during  systole,  a  con- 
<lition  which  is  based  upon  a  muscular  force  of  the  heart  muscle 
which  is  relatively  small  in  proportion  to  the  resistance. 

Tn  accordance  with  it.s  considerable  power  of  adaptation,  tlie  lieart 
is  capable  of  taking  up  an  amount  of  l)lood  which  is  far  in  excess  of  the 
average  amount,  and  to  expel  it  during  the  next  systole,  if  its  uuiscles 
are  unimpaired.  This  is  a  compensatory  dilatation,  purely  diastolic, 
which  develops  in  some  forms  of  valvular  lesions  and  leads,  after  a 
certain  time,  to  hypertrophy.  It  will  not  be  further  discussed  in  this 
place. 

Etiology.  Dilatation  of  the  heart  develops  acutely  from 
an  excessive  increase  of  the  blood  pressuiv  and  usually  apjiears 
quite  early  upon  excessive  and  especially  upon  unaccustomed 
muscular  exertion.  Under  such  circumstances  the  heart  muscle 
becomes  inea])able  of  responding  to  the  excessive  increase  of  the 


106-4  Cardiac  Dilatation. 

demands  put  upon  it,  and  the  less  so  as,  owing  to  rapidly 
succeeding  contractions,  some  muscular  fibers  may  tear.  A 
dilatation  which  has  occurred  in  this  manner  either  disappears 
after  a  time,  usually  after  a  hypertrophy  has  developed  in 
the  meantime,  or  it  persists  and  leads  to  death,  rarely  within 
a  short  time,  although  this  has  happened  within  a  few  minutes. 
The  trouble  usually  occurs  most  frequently  in  army  and  race 
horses,  and  is  designated  by  German  authors  as  ' '  Over-exertion 
of  the  Heart,"  or  ''Acute  Cardiac  Insufficiency;"  by  French 
authors,  "Coeur  force,"  "Coeur  fatigue,"  "Surmenage."  In 
cattle  and  hogs  the  disease  is  not  infrequent  if  these  animals 
are  forced  to  do  unusually  severe  muscular  work  (for  instance, 
while  being  driven  to  market)  after  long  continued  confine- 
ment in  the  stable  or  after  they  are  fattened.  It  is,  however, 
to  be  noted  that  in  a  number  of  such  cases  the  heart  muscle 
possibly  had  previously  not  been  quite  sound.  (According  to 
de  la  Camp  severe  muscular  work  causes  a  dilatation  only  in 
a  heart  which  is  already  diseased.) 

In  the  majority  of  cases  the  basis  for  dilatation  is  pro- 
vided by  a  disease  of  the  heart  muscle  or  of  the  arteries,  also 
by  valvular  anomalies,  in  which  case  the  dilatation  may  develop 
either  acutely  or  chronically.  Extensive  degeneration  of  the 
heart  muscle  may  reduce  the  muscular  force  of  the  heart  so 
much  that  this  organ  cannot  even  overcome  the  normal  blood 
pressure.  Of  similar  significance  is  myocarditis,  which  evi- 
dently enters  as  a  factor  even  more  frequently  than  degenera- 
tion of  the  heart  muscle.  Disease  of  the  coronary  arteries  is, 
in  domestic  animals,  probably  only  rarely  a  basis  for  dilatation. 
The  same  is  true  of  tumors  and  parasites  which  may  be  found 
in  the  heart. 

In  the  stage  of  insufficient  compensation  in  valvular  lesions, 
the  section  of  the  heart  which  lies  in  front  of  the  diseased 
portion  is  dilated,  while  in  diseases  of  the  left  venous  ostium 
the  right  ventricle  is  also  dilated.  The  cause  of  this  dilatation 
will  be  discussed  at  greater  detail  under  organic  heart  diseases. 

It  is  also  as  a  consequence  of  cardiac  weakness  that  dilata- 
tion may  occur  as  a  sequel  of  cardiac  hypertrophy  associated 
with  chronic  nephritis. 

Anatomical  Changes.  The  affected  cavities  of  the  heart 
are  larger  than  normal.  The  walls  are  flabby,  so  that  the 
opening  is  not  patent  when  an  incision  is  made  on  autopsy. 
If  the  size  of  the  heart  was  normal  before  the  development 
of  the  dilatation,  the  walls  are  thinner  in  proportion  to  the 
degree  of  dilatation.  If  the  disease  has  lasted  for  some  time, 
there  occurs  an  atrophy  of  the  muscles,  which  may  be  so  ex- 
treme that  the  visceral  layer  of  the  pericardium  comes  into 
opposition  to  the  endocardium  (Dilatatio  passiva).  If,  on 
the  other  hand,  the  dilatation  has  developed  in  a  heart  that 
had  previously  become  hypertrophied,  the  wall  of  the  dilated 


Aiialoiiiical   Cliana'cs, 


1065 


cavity  eitlior  remains  of  normal  thickness,  or  appears  to  l)e 
even  thicker  (Dilatatio  activa).     In  this  case  the  presence  of 


Fig.  186.     Cardiac  Dilatation.     The   (lotted   line   gives   the   normal   heart    dullness, 

the  solid  line   indicates  the  enlarged  heart  dullness    (4th  to  (ith  intercostal  space), 

the  dullness  passes  backward  into  the  anterior  border  of  the  liver  dullness,  which  is 

also  enlarged.      (Same  dog  as  in   Fig.   1S7.) 


Fig,    187.     Cardiac  Dilalatioii.     Enormously   increased  cardiac  dullness  on   the  right 

side.     The  dotted  line  gives  the   borders  of  ihe   dullness,  which  occurs  normally   in 

huffe  dogs.      (The  same  dog  as  in  Fig.  ISO.) 


'l()(](j  Cardiac  Dilatation. 

dilatation  may  be  surmised,  aside  from  the  diameter  of  the 
respective  cavities,  by  the  fact  that  the  trabeculae  on  the  inner 
surfaces  of  the  ventricular  wall  are  narrow  and  separated 
one  from  the  other  by  wide  spaces.  At  the  same  time  the 
chordae  tendineae  are  usually  thin  and  elongated.  The  muscles 
almost  always  show  signs  of  parenchymatous  or  fatty  degenera- 
tion and  also  of  atrophy.  A  dilatation  of  the  auricles  is  as 
a  rule  observable  at  first  glance  and  may  be  recognized  by 
the  fact  that  the  walls  have  become  as  thin  as  paper  and  that 
the  septum  has  acquired  larger  dimensions. 

In  other  organs,  especially  in  the  lungs,  in  the  liver,  spleen, 
kidneys,  etc.,  there  are  sjTiiptoms  of  venous  stasis  and  dropsical 
effusions  due  to  the  same. 

Symptoms.  In  severe  cases,  enlargement  of  the  cardiac 
dullness  may  be  shown,  which  is  sometimes  very  considerable, 
while  in  animals  in  which  normally  an  absolute  heart  dullness 
is  not  found,  above  all  the  occurrence  of  such  an  absolute 
heart  dullness  is  noticeable.  In  carnivora  the  dilatation  of 
the  left  ventricle  causes  an  enlargement  of  the  cardiac  dullness 
upward  beyond  the  mammary  line  (Fig.  186) ;  in  other  animals, 
both  upward  and  even  more  backward  (Fig.  188).  On  the 
other  hand,  the  dilatation  of  the  right  ventricle  is  characterized 
by  the  occurrence  of  an  absolute  dullness  on  the  right  side,  or 
by  an  enlargement  of  the  dullness  which  is  normally  very  slight 
in  small-chested  animals.  (Fig.  187  and  189.)  Considerable 
dilatation  of  the  right  ventricle,  however,  causes  an  increase 
of  the  dullness  even  on  the  left  side.  It  is  possible,  as  shown 
by  a  case  of  the  author's  in  a  dog  six  weeks  old,  for  the  cardiac 
dullness  in  dilatation  of  the  right  half  of  the  heart  to  extend 
forward  as  far  as  the  second  intercostal  space.  It  is  not  certain 
whether  this  is  to  be  observed  only  in  very  young  animals. 
The  force  of  the  heart  beat  is  usually  increased  because  a 
greater  portion  of  the  heart  is  in  apposition  to  the  chest  wall. 
Sometimes  the  trunk  receives  a  thrill  synchronously  with  the 
heart  beat.  The  beat  appears  weaker  only  when  the  heart 
weakness  has  become  considerable.  The  systolic  heart  sound 
is  increased  in  force  like  the  heart  beat,  while  the  second  sound 
is  usually  small  or  not  at  all  jjerceptible.  The  action  of  the 
heart  is  not  infrequently  arhythmical,  and  the  first,  less  often 
also  the  second  heart  sounds  are  dicrotic.  Endocardial  sounds 
are  caused  by  the  relative  insufficiency  of  the  valves  which 
develops  after  a  while  in  some  cases. 

In  contrast  to  the  increased  heart  beat,  the  pulse  is  always 
feeble.  It  may  also  be  arhythmical  and  intermittent,  corres- 
ponding to  the  heart  beat. 

In  the  case  of  a  prolonged  acute,  and  in  chronic  dilatation, 
sometimes  a  venous  stasis  is  observed,  especially  fullness  and 
pulsation  of  the  jugular  veins.     In  a  marked  dilatation  of  the 


Syiiijitoin^ 


lor,: 


right  heart  a  positive  (systolic)  pulse  of  the  jugular  veins 
may  even  be  noticeable  (relative  insufficiency  of  tlie  tricus])i(l). 
Further,  cyanotic  discoloration  of  the  mucous  membranes  is 
observed;  also  attacks  of  vertigo;  in  more  advanced  cases, 
considerable  dyspnea,  sometimes  "imlmonary  hemorrha.iics 
edema,  liydrops  of  the  l)ody  cavities,  dimiiiulion  of  tlie  amount 
of  urine,  etc.  Some  of  tliese  phenomena  are  at  first  hardly 
noticeable  "when  the  animals  are  at  rest,  but  they  increase 
decidedly  even  on  brief  motion  and  sometimes  to  such  a  degree 
that  tlie  nniinnl  may  die  suddcidy  with  swnptoms  of  asphyxia. 


Tig.  188.  Ctnilim:  Dihiluliun.  Tlif  duttrd  liuc  gives  the  borders  of  llie  nornuil  heart 
dullness,  Mliich  ajipears  in  the  illustration  to  lie  too  liigli,  on  account  of  the 
swelling  of  the  lower  chest.  The  solid  line  indicates  the  upper  and  posterior  borders 
of  the  greatly  enlarged  heart  dullness.  Owing  to  the  dilatation,  the  punctuni  niaxi- 
nnim  of  the  systolic  sounds  arising  in  the  left  venous  ostium  (large  circle)  and  of 
the  second  pulmonary  soinid   (small  circle)   is  displaced  upward.   (Compare  Fig.  ISO.) 


Course.  If  the  animals  are  cai'ed  for,  the  symptoms  may, 
if  they  are  not  yet  severe,  diminish  considerably,  and  in  such 
cases  the  cardiac  dullness  will  become  much  smaller.  In  acute 
dilatation  a  complete  retrogression  may  be  observed,  whicli, 
however,  usually  leaves  a  hypertrophy  behind. 

Diagnosis.  The  characteristic  symptoms  of  cardiac  dilata- 
tion are:  enlargement  of  the  heart  dullness,  increase  in  the 
force  of  the  first  heart  sound,  arhythmia  of  the  heart  action, 
feeble  pulse,  symptoms  of  stasis.  The  feel)leness  of  the  pulse 
differentiates   the   disease   from   primary   hypertrophy   of  the 


1068 


Cardiac   Dilatation. 


heart.     The  absence  of  friction  sounds  distinguishes  it  from 
pericarditis  or  from  hydropericardium. 

Treatment.  Permanent  recovery  may  be  hoped  for  only 
if  a  previously  healthy  heart  has  become  dilated  owing  to  very 
severe  muscular  exertion.  In  such  cases  the  circulatory  dis- 
turbances retrogress  considerably  or  entirely  under  absolute 
rest  and  through  the  influence  of  repeated  administration  of 
cardio-tonic  remedies,  first  of  all  cligitahs.  This  improvement 
may  occur  in  a  short  time.     (For  details  see  the  chapter  on 


Fig.  189.  Cardiac  Dilatation.  Heart  dullness  of  the  horse  pu-iured  in  Fig.  ISH, 
on  the  right  side,  in  the  4th  to  5th  intercostal  space;   in   front  the  ujiper   border 

reaches  the  scapular  line. 

valvular  diseases.)  Even  dilatation  which  commences  in  the 
course  of  acute  infectious  diseases  may  sometimes  be  reduced 
by  similar  treatment;  but  if  the  heart  had  been  diseased  pre- 
viously or  if  there  are  permanent  impediments  to  the  circula- 
tion of  the  blood,  if,  moreover,  signs  of  degenerative  processes 
exist,  it  may  be  possible  to  ob)tain  an  improTement  that  is  nt 
times  quite  considerable,  but  this  will  soon  yield  to  an  aggrava- 
tion of  the  condition.  Such  patients  can  be  tised  for  work  only 
to  a  very  limited  degree.  It  is  always  necessary  to  insure 
nutritious  feeding  and  to  save  the  animals  from  work. 

Literature.  De  la  Camp,  Z.  f.  kl,  Med.,  1904.  LI.  1.  —  Goedeeke,  T>.  t.  W., 
1910.  205.  —  Pr.  Mil.  Vb.,  1899-1908.  —  Trasbot,  A.  d'Alf.,  1878.  204;  Bull, 
1899.  206.  —  Zschokke,  Sch.  A.,  1900.  XLII.  211,'  (See  also  Lit.  on  hyi^ertrophy  of 
the  heart.) 


Myocarditis.  1069 

6.    Inflammation  of  the  Heart  Muscle.    Myocarditis. 

(a)     Acute  Myocarditis.     Myocarditis  Acuta. 

There  are  two  principal  types  of  acute  inflammatory 
processes  in  the  heart  muscle,  namely,  the  parenchymatous 
myocarditis,  which  is  characterized  by  a  pathological  effusion 
that  may  be  very  slight,  and  by  a  more  emphatic  degeneration 
of  tlie  muscular  fibers,  and  secondly,  purulent  myocarditis,  in 
which  purulent  softened  foci  are  developed  in  the  heart  muscle. 

In  contrast  to  purulent  myocarditis,  the  acute  parenchymatous 
myocarditis  cannot  be  sharply  distinguished  from  parenchymatous  or 
fatty  degeneration.  The  essential  ])oint  of  ditt'erentiation  is  really  only 
in  the  pathological  effusion  which  is  a])sent  in  purulent  myocarditis 
(Kitt),  but  which,  in  parenchymatous  disease,  may  be  so  inconsiderable 
that  it  is  only  possible  by  means  of  microscopical  examination  to  decide 
Avhether  the  process  is  to  be  called  an  inflammation  or  a  degeneration. 
If  the  gross  anatomical  appearance  of  the  heart  muscle  does  not  always 
offer  diagnostic  information,  the  clinician  is  even  less  in  a  position  to 
decide  whether  and  for  how  long  a  time  the  process  in  the  heart  muscle 
is  inflammatory  or  simply  degenerative  in  nature,  because  both  processes 
usually  develop  under  similar  conditions  and  are  manifested  by  the  same 
symptoms.  It  is  therefore  justified  from  a  clinical  point  of  view  to 
consider  the  parenchymatous  degeneration,  together  with  acute  paren- 
chymatous myocarditis. 

Nor  does  the  consideration  of  acute  parenchymatous  and  of  purulent 
inflammation  in  separate  chapters  appear  justified,  because  clinically 
they  cannot  be  differentiated,  and,  moreover,  the  treatment  of  both 
diseases  is  similar. 

Etiology.  Aside  from  the  inflammation,  which,  according 
to  some  authors  (Friedberger  &  Frohner,  Zschokke)  develops 
primarily  in  exceptional  cases  in  horses  and  hunting  dogs 
owing  to  excessive  exercise,  and  which  probably  belongs  more 
properly  to  acute  cardiac  dilatation,  acute  parenchymatous 
myocarditis  is  a  secondary  affection,  which  occurs  especially 
in  acute  infectious  diseases  and  very  rarely  in  certain  intoxica- 
tions. The  toxins  which,  in  the  course  of  acute  infectious 
diseases,  circulate  in  the  blood,  produce  sometimes  only  a 
parenchymatous  degeneration  or  at  the  same  time  a  fatty 
degeneration  of  the  muscular  fibers,  sometimes  also  a  serous 
or  cellular  infiltration  of  the  interstitial  tissue,  and  frequently 
hemorrhages.  This  occurs  especially  in  the  septicemic  diseases, 
for  instance,  in  hemorrhagic  septicemia,  in  swine  erysipelas, 
anthrax,  and  acute  glanders,  while  foot  and  mouth  disease  and 
especially  variola,  seem  to  be  complicated  by  myocarditis  only 
in  their  malignant  forms.  An  inflammation  which  was  observed 
by  Dieckerhoff  in  connection  with  the  so  called  Skalma  and 
Avhich  was  called  by  him  '' Myocarditis  septica,"  undoubtedly 


1070  Myocarditis. 

develops  upon  the  basis  of  an  infiuenzal  infection.  Since  in 
infections  diseases  the  heart  mnscle  behaves  like  a  parenchyma- 
tous organ,  the  frequency  of  myocarditis  in  infectious  diseases 
may  best  be  indicated  by 'the  comparatively  frequent  occurrence 
of  renal  albuminuria,  whioli  points  to  a  parencliymatous  disease 
of  the  kidney. 

Of  poisons,  especially  the  heavy  metals  (mercury,  copper, 
antimony),  also  phosphorus  and  arsenic  are  capable  of  causing 
a  degeneration  of  the  heart  muscle. 

Myocarditis,  usually  purulent  in  character,  develops  if 
infected  emboli  have  been  carried  into  the  blood  vessels  of 
the  heart  (myocarditis  embolica),  which  occurs  most  frequently 
in  cattle.  The  emboli  may  be  derived  from  any  part  of  the 
body  where  suppuration  or  gangrenous  disintegration  of  tissues 
is  present,  but  most  frequently  a  purulent  or  gangrenous  in- 
flammation of  the  lungs  or  of  the  intestinal  tract,  a  disintegrat- 
ing thrombus  of  the  umbilical  vessels,  purulent  inflammation 
of  the  hoof,  puerperal  endometritis,  strangles,  glanders  or 
decubital  gangrene  are  responsible  for  the  affection.  In  cattle 
the  necrosis  bacillus  sometimes  gives  rise  to  the  formation 
of  dry  necrotic  foci  in  the  heart  muscle  (Kitt). 

There  is  also  a  possibility  in  the  case  of  ulcerating  valvular 
inflammation  that  portions  of  the  blood  clots  deposited  upon 
the  valves  together  with  pathogenic  bacteria  are  arrested  in 
the  smaller  branches  of  the  coronary  arteries.  The  transpor- 
tation of  bacteria  into  the  blood  vessels  of  the  valves  and  into 
those  of  the  heart  muscle  are  probal)ly  simultaneous  (see 
endocarditis),  but  the  inflannnation  may  be  continued  directly 
from  the  diseased  valves  to  the  heart  muscle.  The  same  is 
sometimes  the  case  in  purulent  or  ichorous  pericarditis. 

Injuries  of  the  heart  muscle  produce  a  purulent  or  ichorous 
myocarditis  most  frequently  in  cattle  and  in  the  same  manner 
as  the  inflammation  of  the  pericardium  which  has  usually 
developed  earlier  from  the  same  cause  (see  p.  10-40).  It  is 
much  less  frequent  that  foreign  bodies  which  have  penetrated 
the  wall  of  the  thorax  and  have  entered  the  heart  produce 
myocarditis,  because  such  injuries  usually  cause  death  even 
before  an  inflammatory  process  could  possibly  be  developed. 

Anatomical  Changes.  A  very  variable  number  of  muscular 
fibers  is  finely  granular,  swollen,  and  they  sometimes  contain 
fat  globules.  If  the  disease  is  extensive  the  muscular  fibers 
disintegrate  into  larger  or  smaller  clumps  (Zschokke).  The 
interstitial  tissue  frequently  shows  serous-cellular  infiltration 
and  sometimes  contains  red  blood  cells  (Myocarditis  parenchym-, 
atosa).  The  heart  muscle  is  of  a  lighter  brown-red  than  normal, 
or  grayish-red.  It  is  flabby  and  friable.  The  cut  surface  con- 
tains light  gray  or  even  butter-yellow  dots  and  stripes  (which 
are  especially  noticeable  in  animals  dead  of  foot  and  mouth 
disease),  sometimes  also  dark  red  dots.     In  the  case  of  more 


Analouikal   Clianges,     Symptoms.  1071 

extensive  degeneration  the  muscle  assumes  an  almost  uniform 
grav-vellow  color.  These  changes  are  not  alike  in  all  sections 
of  the  heart.  Besides  healthy  or  comparatively  slightly  clianged 
portions  there  arc  ])arts  of  *the  heart,  of  various  extent,  which 
show  verv  considerable  disease. 

Metastasis  or  immediate  continuation  of  a  purulent  in- 
flannnation  from  the  vicinity  leads  to  the  fonnation  of  sinaller 
pus  foci  which  form  abscesses  by  gradual  increase  in  size  or 
])v  confluence  (]\Iyocarditis  purulenta).  Injuries  of  the  heart 
niuscle  will  also  cause  the  formation  of  abscesses.  The  con- 
tents of  an  abscess  may  eventually  be  inspissated  into  a  cheesy 
mass  and  even  become  calcified.  It  may  also  break  into  the 
pericardial  cavitv  or  into  a  heart  cavity.  Occasionally  ichorous 
pus  is  found  in  the  abscesses.  (In  the  heart  muscle  of  calves 
which  Avere  apparently  healthy  Kitt  found  repeatedly  a  diffuse 
necrosis  which  was  similar  to  the  necrosis  ol)served  in  hogs 
in  the  skeleton  muscles.) 

Symptoms.  The  functioning  ability  of  the  heart  muscle 
is  diminislied  not  only  by  the  degeneration  but  also  by  the 
inflammation  in  direct  proportion  to  their  intensity  and  ex- 
tension. Consequently,  the  symptoms  correspond  with  the 
clinical  picture  of  cardiac  debility  only  if  the  affection  is  con- 
siderable. The  clinical  picture  of  myocarditis  occurring  m 
connection  with  acute  infectious  diseases  develops  as  a  rule 
graduallv.  The  number  of  heart  beats  increases  three-  or  four- 
fold. The  heart  beat  is  at  first,  and  sometimes  permanently, 
increased  and  can  be  felt  over  a  larger  territory  than  usual 
on  account  of  the  rapid  contractions  of  the  heart  muscle  which 
is  otherwise  weakened.  In  contrast  the  pulse  is  feeble,  some- 
times thready  and  often  arrhythmical.  To  these  sjmiptoms  are 
added  signs  of  stasis,  at  first  only  in  the  form  of  a  dark  red 
coloration  or  cyanosis  of  the  visible  mucous  membranes  while 
at  tlie  same  time  the  veins  are  filled  more  strongly.  Later, 
however,  the  larger  veins  are  more  prominent.  All  these  s^^np- 
toms  may  eventually  retrogress  slowly,  the  number  of  heart 
beats  becoming  more  and  more  nomial,  the  pulse  fuller  and 
its  tension  greater,  while  the  blood  stasis  disappears,  and  with 
the  cure  of  the  basic  disease  the  cavity  of  the  heart  returns 
to  the  normal. 

In  severe  cases,  however,  the  disturbances  increase,  the 
heart  beat  becomes  more  and  more  rapid,  the  pulse  more 
thread-like,  irregular  and  intermittent,  venous  pulsation  is 
noticeable,  the  respiration  is  hastened  and  more  or  less  labored. 
Vertigo,  trembling  and  debility  become  manifest,  and  finally 
paralysis  of  the  heart  terminates  the  disease.  In  exceptional 
cases' the  cardiac  weakness  develops  so  rapidly  that  the  sick 
animals  fall  down  as  though  of  an  apoplectic  stroke,  and  die 
after  a  short  time,  for  instance,  in  the  malignant  form  of 
foot  and  mouth  disease,  and  sometimes   also  in  influenza  of 


1072  Myocarditis. 

horses.  Finallj^  sudden  death  may  occur  in  animals  that  are 
apparently  healthy  and  in  which  autopsy  shows  that  somewhere 
in  the  heart  muscle  an  abscess  had  existed  for  some  time  and 
which  had  caused  death  by  perforating-  into  the  pericardial 
cavity  or  into  one  of  the  heart  cavities.  Such  cases  occur 
preferably  in  animals  that  are  continuously  saved  from  all 
exercise  (cows). 

Diagnosis.  Acute  myocarditis  may  be  mistaken  especially 
for  acute  peri-  or  endocarditis,  since  in  both  these  diseases 
the  heart  beat  is  usually  much  stronger  and  bounding.  In 
the  initial  stage  the  differentiation,  on  the  ground  of  clinical 
symptoms  alone,  is  hardly  possible.  Later  on,  however,  these 
diseases  may  be  eliminated  by  the  absence  of  abnormal  sounds. 
— The  general  vascular  paralysis  which  is  frequent  in  acute 
infectious  diseases  is  characterized  by  the  fact  that  the  veins 
are  not  filled  very  strongly  and  by  the  pale  blue  discoloration 
of  the  mucous  membranes.  This  affection  is  frequently  asso- 
ciated wdtli  acute  myocarditis. 

The  nature  of  the  inflammation  of  the  heart  muscle  can 
be  ascertained  only  approximately  by  considering  the  basic 
disease  or  the  morbid  cause;  especially  a  purulent  inflammation 
can  be  assumed  only  then  when  other  factors  admit  the  possi- 
bility of  metastasis.  Aside  from  parenchymatous  degeneration 
or  inflammation  of  the  heart  muscle,  the  kidneys  also  become 
often  similarly  affected  in  acute  infectious  diseases,  and  the 
albuminuria  which  is  due  to  such  an  occurrence  may  be  made 
use  of  in  making  a  diagnosis. 

Prognosis.  The  significance  of  parenchymatous  degenera- 
tion or  inflammation  depends  primarily  upon  whether  the  basic 
disease  permits  a  removal  of  its  cause.  If,  however,  the 
degeneration  or  the  functional  disturbances  produced  by  it 
have  passed  a  certain  degree,  healing  becomes  impossible.  Of 
deciding  importance  in  these  cases  is  the  tone  of  the  vascular 
walls  and  also  the  degree  of  impediment  to  the  blood  stream; 
in  general  vascular  paralysis,  or  in  extensive  infiltration  of 
the  lungs  the  circulatory  disturbances  assume  a  threatening 
character  earlier,  the  heart  changes  being  of  like  degree. 

The  pulse  rate  is  of  importance  in  so  far  as,  with  an  in- 
crease to  more  than  twice  the  normal,  an  equalization  of  the 
disturbances  can  hardl}^  be  hoped  for.  If  the  disturbances  of 
the  cardiac  activity  are  less  severe,  the  irregularity  and  weak- 
ness of  the  pulse  are  again  of  unfavorable  import. — In  purulent 
inflammation  the  prognosis  is  always  unfavorable. 

Treatment.  The  cardiac  weakness  may  be  counteracted 
by  excitants  or  cardio-tonics.  According  to  the  intensity  of 
the  functional  disturbances,  the  following  remedies  may  be 
considered:     Alcohol    (in    the    drinking   water);    for    smaller 


Trc'aluR'ut. 


1073 


animals  wiiio  or  I)raiuly,  digitalis  (in  powder  form,  as  infnsion, 
maceration  or  dialyzation),  stropliantliin  subcutaneously^ 
camphor  internally,  or  camphorated  oil  subcntaneously,  ether 
snbcutaneously,  etc.  Gmeiner  always  observed  good  eitects  in 
myocarditis  I'ol lowing  npon  acnte  infections  diseases  from 
caffeine  (large  animals  G  to  8  gms.,  smaller  animals  0.5  to  1.0 
gms.)  snbcutaneously  every  6  to  8  hours.  In  very  severe  cases 
the  pre])arations  of  camphor  are  particularly  indicated,  and 
occasionally  even  in  apparently  hopeless  cases  the  occurrence 
of  heart  jiaralysis  may  be  prevented  by  subcutaneous  injec- 
tions, Avliich  are  repeated  every  hour  or  every  two  hours. 

Aside  from  this  treatment  good  effects  "may  be  obtained 
from  spongings  and  the  removal  of  retained  feces.  It  goes 
without  saying  that  absolute  rest  and  good  nutrition  of  the 
patient  must  be  secured. 

Literature.    Berton,  Rec,  1898.  289.  —  Cadiot,  Bull.,  1893.  374.  —  Friedberger 
:\[uiic-li.   Jill...   1877-78.  oS.  —  Gmeiner,  B.   t.   W.,   lOOf).  409.  —  Johne    S    B     1878* 

i'T'xi^'oT    '^^'■^^^"^''■'    -'^-    ^-^    1^04.   489   —   Zschokkc,   Schw   A.,   1900.'  XLIL    193' 
ALIX.  320.  ' 


(b)  Chronic  Myocarditis.    Myocarditis  Chronica. 

Chroiuc  inflammatory  processes  in  the  heart  muscle  occur 

m  domestic  animals  much  more  frequently  than  used  to   be 

assumed.     A  part  of  the  cases  described  as  idiopathic  hvper- 

trophy  or  as  dilatation  of  the  heart  was  evidently  due  to  chronic 

.  myocarditis. 

Etiology.  Chronic  myocarditis  not  infrequently  develops 
from  the  acute  form.  Further,  abscesses  developing  in  the 
heart  muscle  incite  an  increase  in  connective  tissue,  either  in 
their  immediate  vicinity  or  in  more  distant  portions.  Occa- 
sionally chronic  muscular  rheumatism,  chronic  nephritis,  chronic 
endoarteritis,  may  act  as  exciting  causes.  Tuberculous  foci 
or  abscesses  with  circumscribed  myocarditis  are  sometimes 
seen  m  cattle  and  dogs,  exceptionally  also  in  hogs,  not  infre- 
quently m  chickens  (Folger).  Chronic  peri-  and  endocarditis 
IS  sometimes  also  followed  by  chronic  myocarditis,  either  from 
a  direct  continuation  of  the  inflammatory  process  or  from  the 
same  cause  as  the  peri-  or  endocarditis,  and  in  fact  the  in- 
flammatory process  may  occur  simultaneously  in  the  heart 
muscle.  In  a  portion  of  the  cases  the  disease  undoubtedly  de- 
velops idiopathically  for  reasons  that  are  not  known.  Occa- 
sionally, perhaps,  certain  chemical  substances  or  mechanical 
influences  and  agencies  leading  to  increased  arterial  pressure 
may  be  of  importance.  Fleischer  &  Lode  have  produced  necrotic 
foci  m  the  heart  muscle  in  59%  of  their  experiment  raljbits 
atter  combined  injections  of  adrenalin  and  caffeine,  and  the 
necrotic  foci  were  much  smaller  if  adrenalin  alone  was  injected 
intravenously. 

Vol.  1— ns 


1074  Clirniiic   Myocarditis. 

A  disease  described  by  some  Hungarian  veterinarians  (Sehleiffer, 
Viasz,  Horvath,  Laszlo)  as  a  sequel  of  foot  and  mouth  disease  is  prob- 
ably also  based  upon  a  chronic  myocarditis  which  has  developed  out  of 
the  acute  inflammation.  The  most  striking  morbid  symptoms  are 
dyspnea,  attacks  of  asphyxia  during  motion,  delayed  change  of  the  hair 
coat,  bad  nutrition  and  diminished  milk  secretion. 

Anatomical  Changes.  The  heart  muscle  is  more  solid, 
either  throughout  or,  more  frequently,  in  portions  of  various 
extension,  and  contains  grayisli-wliite  spots  or  streaks  (scars). 
(In  extensive  degeneration  of  the  cardiac  muscular  fibers,  the 
heart  muscle  may,  however,  become  softer,  even  before  the 
occurrence  of  an  active  tissue  atrophy.)  More  extensive  scars 
are  bulged  outward  through  the  action  of  the  blood  pressure 
(aneurysma  cordis  chronicum  fibrosum).  The  heart  is  en- 
larged in  the  case  of  extensive  disease,  both  owing  to  a  thick- 
ening of  its  walls  and  because  of  a  dilatation  of  the  cavities. 

Symptoms.  Smaller  scars  in  the  heart  muscle  sometimes 
do  not  cause  any  morbid  symptoms.  Since,  however,  larger 
portions  of  the  heart  are  usually  affected,  manifestations  of 
heart  weakness  nevertheless  appear  sooner  or  later.  A  partial 
atrophy  of  the  muscular  fibers  may,  in  certain  cases,  be  com- 
pensated by  the  increased  functioning  of  the  unaffected  fibers, 
but  this  compensation  lasts  only  for  a  time  and  finally  the 
symptoms  of  heart  weakness  appear  in  such  cases  also. 

In  the  initial  stage  of  the  disease,  which  occasionally  lasts 
a  long  time,  the  cardiac  insufficiency  becomes  evident  only  after 
severe  exertion  or  excitement.  The  pulse  is  much  increased, 
usually  arhythmical  and  feeble.  The  heart  beat  is  irregular 
and  bounding;  the  systolic  heart  sound  loud  and  high.  The 
veins  are  filled  strongly.  There  is  vertigo,  staggering  gait, 
rapid  fatigue,  severe  dyspnea,  occasionally  collapse.  In  the 
further  course  these  symptoms  become  manifest  even  at  rest, 
after  a  dilatation  of  the  heart  has  been  added  in  the  meanwhile, 
owing  to  which  endocardial  sounds  may  be  manifest.  After 
variable  periods  of  time  serous  fluid  accumulates  in  the  serous 
cavities  and  cutaneous  edemata  develop. 

Course.  The  condition  of  the  animals  often  varies  con- 
siderably, especially  under  the  influence  of  external  conditions. 
In  some  cases,  especially  after  over-exertion,  death  may  occur 
suddenly  even  before  the  condition  has  become  very  serious. 
On  the  other  hand,  the  disease  may  be  recognized  in  animals 
which  are  saved  from  excessive  exercise  only  on  the  occurrence 
of  symptoms  of  stasis  (chronic  bronchial  catarrh,  dropsy, 
gastro-enteric  catarrh,  etc.). 

Diagnosis.  Chronic  myocarditis  may  be  recognized  only 
then  when  the  development  of  the  morbid  condition  out  of  an 
acute  disease  of  the  heart   or  of  its  lining's  can  be   followed 


Diagnosis.    Treat  lueiil.  1075 

exactly  by  contiimed  observation  of  the  animals,.  In  niakintj 
a  diagnosis,  chronic  endocarditis,  chronic  pericarditis  an<l 
chronic  ])nhn(>nary  affections  must  especially  enter  into  con- 
sideration. 

Treatment,  in  very  ill  animals  which  have  become  useless 
for  work,  no  opportunity  is  offered  for  treatment,  because  such 
animals  are  usually  disposed  of  otherwise.  In  other  casco  a 
similar  thera])eutic  ])roceeding  is  indicated  as  in  dilatation  of 
the  heart  (see  p.  1068). 

Literature.  Ball,  J.  vet.,  1906.  .344.  —  Folger,  ^ronh.,  1909.  XX.  .348.  — 
Horvath,  A.  L..  UKili.  1S2.  —  Las?.l<'),  ibid.,  1906.  219.  —  Pr.  Mil.  Vb.,  1900.  147.  — 
Zschokke,  Sohw.  A..   lOdO.  XLII.  19:!. 


Ossification  of  the  Heart  Muscle.  Tliis  is  au  extremely  rare  dis- 
ease, which  so  far  has  usually  ])een  observed  only  in  older  animals, 
exceptionally  in  younger  animals  (by  C'adiot  in  a  five-year-old  pony) 
and  in  cattle  (Marty,  Joest).  The  cause  of  the  condition  is  unknown. 
►Stoss  speaks  of  an  extensive  irritation  produced  by  great  variations  in 
the  blood  pressure.  The  ossification  begins  ahiiost  without  exception  in 
the  wall  of  the  right  auricle.  At  first  connective  tissue  proliferation 
occurs,  then  calcification  and  finally  islands  or  platelets  consisting  of 
spongy  bone  substances.  By  union  of  these  bone  plates,  which  occurs 
later  on,  the  wall  of  the  auricle  may  eventually  be  transformed  into 
a  large  connected  bony  plate.  The  process  of  ossification  does  not  pro- 
gress beyond  the  place  where  the  veins  open  into  the  heart.  The  ossified 
auricle  is  usually  considerably  enlarged,  full  and  tense. 

In  lighter  cases  the  ossification  of  the  auricle  does  not  interfere 
noticeably  with  the  heart  action.  If,  however,  the  process  is  more 
extensive,  signs  of  heart  weakness  become  manifest  during  work,  and 
later  on  also  at  rest.  The  cause  of  these  signs  cannot  be  determined 
during  the  life  of  the  animal. 

Literature.  Joest,  Dresdn.  B.,  1908.  17-5.  —  Kriiger,  B.  t.  W.,  1892.  509.  — 
Xocard,  Bull.,  18S4.  236.  —  Stoss,  D.  Z.  f.  Tm.,  18SS.  XIII.  301   (Lit). 

7.    Fatty  Heart.    Cor  Adiposum. 

Etiology.  In  a  general  increase  of  fat  deposits  the  thin 
fat  layer,  which  is  normally  present  underneath  the  serous 
covering  of  the  heart,  increases  considerably,  so  that  it  covers 
the  surface  of  the  heart  as  a  connected  layer  up  to  several 
millimeters  in  thickness,  and  may,  moreover,  form  in  places 
considerable  fat  deposits  and  polypoid  nodes.  This  condition 
is  observed  preferably  in  obese  animals,  especially  in  fat  house 
dogs;  exceptionally  a  fatty  degeneration  of  the  heart  muscles 
develops  smiultaneously  with  the  degeneration  of  the  proto- 
plasm in  intoxications  and  in  infectious  diseases. 

The  excessive  deposit  of  fat  becomes  of  importance  because  the 
fat  accumulates  not  only  on  the  outer  surfaces  of  the  muscles,  but  also 
Ijetween  the  nuiscular  fibers  which  are  then  forced  apart,  at  the  same 


1076  Fatty  Heart. 

time  compressed,  and  are  finally  caused  to  atrophy.  Even  the  spread- 
ing apart  of  the  muscular  fibers  alone  renders  the  contractions  of  the 
heart  muscle  more  difficult  to  a  certain  degree,  and  any  occurring  degen- 
eration or  atrophy  reduces  the  strength  of  the  heart  muscle  still  more. 

Symptoms.  In  an  excessive  degree  of  fatty  heart,  symp- 
toms of  heart  weakness  present,  sncli  as  feeble  heart  beat, 
perhaps  an  increased  cardiac  dullness  which,  however,  is 
difficult  of  demonstration  in  obese  animals;  also  feeble  heart 
sounds,  possibly  anorganic  murmurs,  feeble,  small  pulse;  in 
severe  cases  vertigo,  and  finally  cutaneous  edema.  The  pro- 
duction of  dyspnea  and  of  vertigo  is  to  a  certain  degree  to  be 
credited  to  the  deposit  of  fat  in  the  respiratory  muscles.  These 
symptoms  become  marked  after  severe  exercise,  or  even  during 
simple  motion.  Death  occurs  finally  through  paralysis  of  the 
heart,  pulmonary  edema  or  rupture  of  the  heart. 

Treatment.  The  treatment  for  obesity  (p.  915)  is  indicated 
in  this  condition.  If  signs  of  cardiac  weakness  are  already 
present,  cardio-tonic  remedies  must  be  considered. 


8.    Rupture  of  the  Heart.    Ruptura  Cordis. 

Etiology.  The  healthy  heart  muscles  tear  at  most  under 
the  immediate  influence  of  an  injury  (external  injuries,  falling 
down  in  cattle,  from  wounds  caused  by  a  foreign  body  entering 
from  the  reticulum).  Dull  pressure  exerted  upon  the  heart 
can  hardly  produce  a  rupture.  Usually  rupture  of  the  heart 
forms  a  secondary  occurrence  which  is  observed  when  the 
resistance  of  the  heart  muscle  has  been  reduced  by  degenera- 
tion or  atrophy.  This  is  most  frequently  the  case  in  animals 
with  valvular  troubles,  where,  however,  the  permanent  increase 
of  the  blood  pressure  in  certain  portions  of  the  heart  is  also 
of  importance.  Rupture  of  the  heart  can,  far  less  frequently, 
be  brought  into  causal  relation  with  occlusion  of  the  coronary 
arteries  or  with  abscess  in  the  heart  wall.  In  these  conditions 
there  usually  exists  already  a  circumscribed  bulging  of  the 
diseased  heart  wall  (aneurysma  chronicum  cordis)  and  this 
persists  under  special  conditions.  A  bulging  of  the  wall  of 
the  heart  may  occur  exceptionally  in  acute  myocarditis 
(aneurysma  acutum  cordis).  As  further  causes  for  heart 
rupture  may  be  mentioned  tumors  or  parasites  (especially 
echinococcus),  in  horses  also  aneurysm  of  the  coronary  arteries, 
which,  however,  is  very  rare  (Walter,  Gurlt,  Bogmann,  Cadiot, 
Piot-Bey). 

In  literature  reports  may  be  found  of  rupture  of  a  sound  heart  muscle  from 
nervous  causes,  but  this  possibility  has  not  been  proved  irrefutably  in  a  single  case. 

The  bursting  of  a  heart  which  is  already  diseased  occurs 
sometimes  without  any  special  cause,  particularly  under  the 


Rupture  of  the  Heart.  1077 

influence  of  a  normal  blood  pressure,  but  in  most  cases  exciting 
causes  may  be  demonstrated,  such  as  severe  exertion,  straining 
on  defecation,  bloating,  excitement  during  mating,  during  an 
operation,  etc.  As  these  exciting  causes  become  active  much 
more  frequently  in  horses,  heart  rupture  is  observed  more 
frequently  in  tlie  horse  than  in  other  animals,  with  the  excep- 
tion of  traumatic  rupture  of  the  heart  in  cattle. 

Anatomical  Changes.  Tlie  pericardium  contains  more  or 
less  fresh  l)lood  (hemopericardium).  A  solution  of  continuity 
in  the  fibers  of  the  heart  muscle  is  often  found  in  the  walls 
of  the  ventricles,  less  often  in  the  walls  of  the  auricles.  The 
tear  is  almost  always  small,  its  borders  ragged  and  its  path 
through  the  ventricular  wall  usually  corresponds  to  a  zigzag 
line,  so  that  it  is  only  vrith  difficulty  possible  to  introduce  a 
probe  into  the  ventricle.  Sometimes  the  tear  takes  place  in 
the  interventricular  septum  (Dieckerhoff),  and  in  such  cases 
hemorrhage  does  not  take  place  into  the  pericardium. 

Symptoms.  In  general  only  symptoms  of  cardiac  paralysis 
or  of  internal  hemorrhage  are  evident,  and  these  cause  death 
rapidly  because  the  heart  is  compressed  by  the  blood  or  hindered 
in  its  diastolic  dilatation,  or  then  the  action  of  shock  upon  tha 
heart  becomes  manifest.  The  occurrence  of  a  rupture  is  usually 
announced  by  sudden  signs  of  indisposition.  In  a  part  of  the 
cases  death  occurs  suddenly,  at  night,  or  so  rapidly  that  hardly 
any  s^^miptoms  are  ascertained  aside  from  collapse  and  con- 
-s^ilsions. 

Treatment.  A  rupture  of  the  heart  which  has  actually 
occurred  cannot  be  treated.  Its  appearance,  however,  may 
sometimes  l)e  prevented  by  removing  the  exciting  causes. 

Literature.  Bern.lt.  A.  f.  Tk..  1S93.  XIX.  314.  —  Graux.  .1.  vet..  190.5. 
231.  —  Maleval,  Eec.  1904.  508.  —  Petit,  Bull.,  190-5.  I(i6.  —  Piot-Bev,  Bull., 
1906.  42.5.  430.  —  Vogel,  B.  t.  W.,  1906.  682. 


9.     New-Formation  in  the  Heart.     Neoplasmata  Cordis. 

Xew-formations  which  occur  in  the  wall  of  the  heart  are  of  only 
slight  interest,  not  only  on  account  of  their  rarity,  but  also  because  their 
presence  in  the  heart  of  living  animals  can  rarely  ever  be  ascertained 
with  even  a  small  degree  of  probability.  According  to  the  communica- 
tions to  literature,  fibroma,  fibromyxoma,  myxoma,  lipoma,  sarcoma  (in 
horses  melanosarcoma)  and  fibrosarcoma,  metastatic  adenoma,  carci- 
noma, exceptionally  also  lymphosarcoma,  angioma,  lympliangioma  occur 
preferably  in  the  ventricular  wall  and  may.  with  the  exception  of 
carcinoma  or  sarcoma,  be  primary.  The  mo.st  frequent  growths  are  fibro- 
sarcoma, and  in  horses  melanosarcoma.  The  new-formations  which  pro- 
ject towards  the  heart  cavities  or  towards  the  pericardial  cavity  are 
not  infrerpiently  pediculated. 


;l^078  Xe\v-Forniati<»ii.     Animal  Parasites. 

The  muscular  tissue  atrophies  in  the  immediate  vicinity  of  the  swell- 
ings, hut  the  defect  in  muscular  force  is  replaced  by  the  uninjured  parts, 
which  later  on  become  atrophied.  A  hypertrophy  is  more  apt  to  develop 
as  the  swellings  which  bulge  out  into  the  cavities  or  against  the  openings 
of  the  heart,  impede  the  free  circulation  of  the  blood.  The  size  and  loca- 
tion of  the  swellings  is  of  influence  upon  the  degree  of  compensation  and 
therefore  only  unimportant  disturbances  or  none  at  all  are  observed  in 
some  cases,  while  in  others  a  severe  clinical  picture  develops. 

The  mor])id  symptoms  are  very  uncertain  in  character.  In  most 
cases  sudden  death  was  observed,  or  the  swellings  were  found  on  autopsy 
of  such  animals  which  had  not  presented  any  symptoms  of  cardiac 
disease  during  life.  Only  rarely  disturbances  of  the  heart  function  were 
noticed ;  in  horses  dyspnea  was  often  diagnosed,  the  basis  of  which  had, 
however,  remained  obscure  during  the  life  of  the  animal.  It  is  probably 
only  in  exceptional  cases  possible  to  refer  disturbances  in  the  cardiac 
function  to  the  presence  of  a  swelling  in  the  heart  wall  with  any  degree 
of  certainty,  especially  when  the  occurrence  of  a  primar.y  new-formation 
in  the  organs  that  are  susceptible  to  immediate  investigation  permit  the 
assumption  of  a  metastatic  swelling  in  the  heart. 

10.     Animal  Parasites  in  the  Heart. 

Of  animal  parasites  cysticerci  and  echinococci  occur  most  fre- 
quently in  the  heart  muscle  or  under  the  epicardium  (Neumann,  Rev. 
Yet.,  1905,  729,  with  literature).  The  cysticerci  do  not  appear  to  pro- 
duce any  noticeable  disturbances  in  the  heart  function,  and  echinococci 
are  found,  not  at  all  rarely,  in  the  heart  muscle  of  apparently  healthy 
cattle,  as  is  proved  by  the  findings  in  abattoirs.  (In  exceptional  cases 
the  echinococci  occur  also  in  horses,  especially  in  the  heart  muscle  or  in 
the  wall  of  the  aorta.)  If  the  echinococcus  bladder  is  comparatively 
large,  or  if  several  of  them  are  present  at  the  same  time  (Morot  found 
20  in  one  case)  they  naturally  interfere  with  the  heart  action,  but  the 
cause  of  the  disturbance  cannot  be  determined  even  approximately.  In 
a  number  of  cases  death  occurs  suddenly  from  paralysis  or  rupture  of 
the  heart,  or  from  rupture  of  the  echinococcus  bladder  into  the  heart 
cavity  and  the  transportation  of  its  contents  into  the  pulmonary  artery 
(Eggeling).  The  predisposing  cause  for  the  occurrence  of  sudden  death 
may  also  lie  in  the  presence  of  an  infectious  disease.  In  a  case  observed 
by  Sequens,  for  instance,  the  rupture  had  developed  in  the  febrile  stage 
of  foot  and  mouth  disease. 

Of  other  parasites  the  Sarcosporidia  occur  in  the  heart  muscle  of 
sheep  without  leading  to  any  particular  cardiac  disturbances ;  also 
mature  specimens  of  Filaria  immitis  in  the  right  auricle  and  the 
Strongylus  vasorum  in  the  heart  of  dogs  (see  pages  902  and  907).  Cocu 
found  a  living  specimen  of  distoma  hepaticum  in  the  coagulum  attached 
to  the  chordae  tendineae  of  the  right  ventricle  of  a  cow  dead  with  symp- 
toms of  severe  cachexia  and  dyspnea. 

11.    Acute  Endocarditis.    Endocarditis  Acuta. 

Occurrence.  Acute  endocarditis  belongs  to  the  less  frequent 
diseases  and  occurs  in  horses  usually  in  consequence  of  in- 
fluenza or  of  pyemic  affections ;  in  cattle  it  develops  most  fre- 
quently in  the  course  of  pyemia,  of  articular  rheimiatism,  rarely 


Occurrence,     Etiology.  1079 

of  tuberculosis.  Hogs  are  usually  affected  by  an  erysipelatous 
endocarditis;  less  often  the  affection  accompanies  swine  plague, 
and  has  only  in  exceptional  cases  another  origin  (Liipke,  Bang, 
author's  ease).  In  dogs  the  disease  usually  follows  upon 
pyemia,  septicemia,  distem]ier,  exceptionally  also  upon  tul)er- 
(udosis  (Jensen  observed  13  cases  of  ulcerating  endocarditis 
among  3,240  sick  dogs).  In  cats  and  birds  acute  endocarditis 
ai3pears  to  occur  only  very  rarely. 

Etiology.  Acute  endocarditis  develops  as  a  rule  through 
an  infection,  but  the  various  infectious  substances  concerned 
are  at  present  only  partially  known.  Comparatively  often  the 
pyogenic  ))acteria  (cocci,  streptococci,  staphylococci,  liacillus 
pyogenes)  appear  to  be  concerned  in  the  production  of  the 
affection  (Trasliot,  Cadeac,  Albrecht,  Csokor,  Xocard,  Kitt, 
Bang,  Liijike,  Frohner,  Joest,  author's  case).  In  hogs  the 
eiysipelas  bacilli  are  usually  of  importance  as  etiological  fac- 
tors. In  ulcerous  endocarditis  Jensen  and  Thomassen  have 
found  the  bacilkis  coli  connnunis  in  association  with  other  bac- 
teria; Kitt  several  times  the  botryomyces  in  horses;  lAigin.ner 
a  streptothrix  in  cattle.  The  tubercle  bacillus  was  found  by 
Cadeac,  Cadiot  and  Bergeon  in  cattle ;  the  corynebacillus  renalis 
by  Cadeac  and  Scherzer  in  the  deposits  upon  the  affected  heart 
valves;  the  bacillus  l)ipolaris  also  is  prol)ably  frequently  a 
factor.  For  instance,  Jensen  found  ovoid  bacteria  among  other 
microorganisms  in  endocarditis  of  dogs,  and  Bang  as  well  as 
de  Jong  observed  endocarditis  iu  swine  plague  (among  16,000 
hogs  dead  of  swine  plague,  676  cases  of  endocarditis  verrucosa 
were  found  in  England).  Acute  endocarditis  has  also  been 
noted  in  swine  pest  (de  Jong). 

In  some  cases  an  infectious  endocarditis  develops  without 
an  affection  of  the  other  organs  and  must  then  be  considered 
as  a  primary  disease.  In  the  majority  of  cases,  however,  the 
trouble  is  secondary  in  nature  and  the  bacteria  reach  the 
endocardium  from  inflamed  organs  (heart  muscle,  pericardium, 
niediastimmi)  by  direct  continuity  or,  nuicli  more  frequently, 
from  distant  ])athoiogical  foci  with  the  blood  stream.  First 
in  this  respect  are  pyemic  and  septicemic  diseases.  Wherever 
in  the  body  suppurating  inflammations  occur,  like  suppurating 
wounds,  inflanmuition  of  the  umbilical  cord,  variola  (innne- 
diately  before  the  suppurating  stage  or  at  its  beginning), 
puerperal  fever,  strangles,  fibrinous-purulent  inflanunation  of 
the  serous  membranes,  the  malignant  form  of  foot-and-mouth 
disease,  etc.,  the  opportunity  for  localization  of  pyogenic  bac- 
teria on  the  heart  valves  may  be  given.  Sometimes  seemingly 
quite  inconsiderable  losses  in  substance  (ulcers  at  the  tip  of 
the  tail  or  elsewhere  on  the  skin  of  dogs,  bites,  pressure  wounds 
in  horses,  etc.)  or  inflammatory  foci  in  other  organs  (in  the 
case  of  Blanc's,  inflanunation  of  the  bile  ducts)  aft'ord  a  ]ioint 
of  entrance  to   the  pyogenic  bacteria.      The   transmission   of 


]080  Acute  Endocarditis. 

bacteria  from  the  blood  of  the  mother  to  the  fetus  is  also 
possible,  and  this  explanation  must  probably  be  accepted  for 
cases  that  occur  successively  in  several  young  of  the  same 
mother  animal  (Burke,  Stephenson).  Jensen  and  Frohner  even 
believe  the  transmissibility  of  the  disease  from  animal  to 
animal  to  be  not  impossible. 

In  contrast  to  man,  articular  rheumatism  is  not  often  com- 
plicated with  endocarditis  in  animals ;  most  frequently  perhaps 
in  cattle,  and  evidently  also  under  the  influence  of  pathogenic 
bacteria  (streptococci  or  perhaps  also  staphylococci)  which  in 
all  probability  produced  the  articular  rheumatism  itself. 
Probably  the  endocarditis  which  sometimes  follows  upon  rheu- 
matic founders  of  horses  must  also  be  explained  in  this  sense. 
Inflammation  of  the  endocardium  must,  especially  in  horses, 
undoubtedly  be  referred  to  the  action  of  streptococci  when  it 
develops  in  connection  with  grippal  or  catarrhal  pneumonia. 

The  bacilli  of  swine  plague  are  deposited  in  the  tissue  of 
the  heart  valves  after  a  slight  acute  general  infection,  or  as 
Jensen,  Lohnsee  and  Eisenmann  have  shown,  after  the  erysip- 
elatous urticaria  has  run  its  course,  and  cause  there  an  inflam- 
mation through  which  the  apparently  recovered  animals  perish 
in  the  course  of  a  few  weeks  (see  p.  68).  Marek  saw  an  acute 
endocarditis  being  produced  by  the  erysipelas  bacillus  in  two 
horses  which  had  been  employed  for  the  production  of  erysipelas 
serum. 

In  many  cases  no  bacteria  are  found  in  the  territory  of 
the  inflammation,  a  fact  that  must  be  explained  thus,  that 
either  the  inflammatory  virus  had  disappeared  in  the  mean- 
wiiile,  or  that  bacterial  toxins  absorbed  from  other  organs 
had  produced  the  disease. 

Predisposing  factors  may  be  of  import  to  such  a  degree 
that  formerly  many  cases  of  endocarditis  were  referred  to 
the  immediate  action  of  such  factors.  Among  them  are :  cold 
(frequent  in  horses,  according  to  Trasbot),  over-exertion, 
traumatic  influences  upon  the  heart  region,  fracture  of  ribs, 
etc.  The  chronic  form  of  endocarditis  also  predisposes  to 
renewed  acute  inflammation  (Fuchs). 

Pathogenesis.  The  bacteria  which  circulate  in  the  blood 
stream,  probably  rarely  localize  directly  on  the  surfaces  of  the 
valves  which  are  contiguous  to  the  blood  stream  while  this 
passes  by  them,  less  frequently  on  the  parietal  layer  of  the 
endocardium.  Usually  they  are  arrested  in  the  capillaries  of 
the  valves,  and  also  at  the  same  time  in  the  blood  vessels  of 
the  heart  muscle.  The  reason  why  the  localization  of  the 
bacteria  mentioned  as  the  second  contingency  takes  place  also 
on  that  surface  of  the  valves  which  is  turned  toward  the  lumen 
of  the  heart,  lies,  according  to  Eisenmann,  in  the  peculiar  ar- 
rangement of  the  blood  vessels  in  the  heart  valves.  The  micro- 
organisms, which  have  localized,  and  their  toxins  cause  an  in- 


Pathojfenesis,    Auatumical  Changes.  1081 

flammatory  condition  in  the  tissue  of  the  valves  and  in  tlic 
^vall  of  the  heart.  The  surface  of  the  valves  becomes  roui^li 
and  masses  of  thrombi  are  deposited.  These  interfere  mechan- 
ically with  the  circulation  and  at  the  same  time  the  circulatory 
disturbances  are  much  increased  by  the  simultaneous  myocar- 
ditis. 

Anatomical  Changes.  In  most  cases  the  valves  of  the  left 
half  heart  are  affected,  less  often  those  of  the  right  half  as  well, 
or  even  exclusively  (Endocarditis  valvularis) ;  the  pulmonary 
valves  are  involved  in  exceptional  cases  only.  In  this  respect 
cattle  make  an  exception  in  so  far  as  in  them  disease  of  the 
tricuspid  valves  is  more  frequent.  An  inflammation  of  the 
endocardial  lining  of  the  muscular  wall  (Endocarditis 
parietalis)  is  rare. 

Endocarditis  occurs  in  two  forms,  one  being  designated 
as  verrucous  (Endocarditis  valvularis  verrucosa),  the  other  as 
ulcerous  (E.  valv.  ulcerosa) ;  either  one  of  them  may  pass  into 
the  other.  In  the  verrucous  variety  nodules  are  found  on  those 
surfaces  of  the  valves  which  face  the  blood  stream,  or  at  their 
margins;  these  are  as  large  as  poppy  seeds  or  larger,  they 
may  later  become  confluent,  fonning  larger  nodes,  and  on  the 
surfaces  of  the  valves  coagulated  blood  is  deposited.  It  may 
happen  that  the  inflammation  does  not  progress  further,  the 
verrucous  elevations  gradually  becoming  smaller  and  leaving 
only  a  thickening  of  the  valves.  But  in  other  cases  ulcers 
with  red,  uneven  borders  develop,  their  bases  covered  with 
a  grayish-red  or  yellowish  deposit,  or  the  inflammatory  process 
is  ulcerous  from  the  beginning.  Fibrin  is  deposited  upon  the 
ulcerating  surface  of  the  valves  in  thick,  uneven  masses  which 
make  the  opening  smaller. 

In  consequence  of  the  ulcerous  destruction  the  valve  be- 
comes thinner,  in  some  cases  it  is  bulged  out  by  the  blood 
pressure  (Aneurysma  valvulare  acutum)  and  is  eventually 
ruptured  (A.  valv.  acut.  ruptum).  If  the  destructive  process 
is  rapid,  irregular  cleft-like  openings  form  with  swelled,  gnawed 
borders  (Valvula  fenestrata)  without  aneurysmal  changes. 
When  the  inflammation  is  continued  to  the  endocardial  lining 
of  the  heart,  a  purulent  inflammation  may  arise  in  the  heart 
muscle,  giving  rise  to  bulging  and  to  rupture  of  the  thinned 
muscular  wall  (Aneurysma  cordis  acutum).  Occasionally  the 
valve  is  even  torn  from  the  chordae  tendineae  or  from  its 
attachment. 

Loose  blood  clots  or  loosened  portions  of  the  valvular  tissue 
lead  to  embolism  in  various  organs,  which  may  be  followed  by 
purulent  inflammation. 

Symptoms.  The  clinical  picture  of  acute  endocarditis  is 
characterized  by  its  great  variability.  The  varying  nature  of 
the    inflammatory   process    and    of   the    infectious    vims,    the 


2082  Acute  Endocarditis. 

variable  degree  in  which  the  heart  muscle  is  involved,  the 
different  localization  of  the  inflammation  and  finally  the  pres- 
ence or  absence  of  a  general  infection  which  in  itself  may  be 
very  variable  in  nature,  produce  symptoms  which  differ  in 
different  cases.  With  respect  to  the  last  mentioned  factor  it 
must  be  emphasized  that  in  many  cases  the  blood  remains  free 
from  microorganisms  after  the  bacteria  have  been  deposited 
upon  the  valves,  while  more  frequently  bacteremia  exists  from 
the  beginning  or  develops  later,  in  addition  to  the  valvular 
inflammation. 

The  disease  commences  with  more  or  less  marked  signs 
of  indisposition.  In  this  respect  particularly  deviations  are 
possible  according  to  nature  and  origin  of  the  disease,  only 
languor,  lassitude,  slight  fever  and  fatigue  becoming  manifest 
in  some  animals,  while  in  others  extreme  debility,  complete 
inappetence  and  high  fever  are  observed,  as  they  always  occur 
in  septicemic  diseases.  Between  these  extremes  there  are  many 
transitions. 

The  heart  beat  is  usually  increased  or  bounding  and  may 
produce  a  tremor  of  the  chest  w^all  which  can  he  noticed  from 


Fig.  ino.  Sphpginofjraph  of  the  Art.  femoralis  in  a  dog  with  vlcerati^if/  endomrditis 
of  the  aortic  valves.     Pulse  bounding  and  much  accelerated.   (Time  indicated  in  0.2".) 

a  distance.  The  rate  of  the  heart  beats  varies;  while  it  is 
increased  by  about  one-half  of  the  normal  in  light  cases,  it 
rises  in  severe  attacks  in  large  animals  to  4  to  5  times,  in  small 
animals  to  2  to  3  times  the  usual  rate,  and  is  frequently 
arhythmic.  The  cardiac  dullness  is  not  altered  at  first,  nor 
in  rapidly  progressive  cases  through  their  entire  course,  but 
in  more  prolonged  cases,  in  which  the  heart  is  dilated,  the  area 
of  dullness  is  enlarged.  The  heart  sounds  may  remain  clear 
for  a  long  time,  indeed,  to  the  end,  except  that  they  may  become 
somewhat  feeble  and  dulled,  but  in  most  cases  they  eventually 
become  changed.  Usually  the  two  sounds  run  together  into  a 
single  humming  or  roaring  noise ;  at  other  times  an  endocardial 
murmur  is  heard  instead  of  the  first  or  second  heart  sound  or 
in  place  of  both,  which  is  usually,  soft,  blowing  or  even  has 
a  certain  resonance  to  it  and  is  heard  in  varying  intensity 
over  different  portions  of  the  heart,  just  as  in  chronic  endo- 


Symptoms. 


1083 


carditis.  If  tlio  inflammation  occurs  in  several  portions  of 
the  heart,  several  sounds  may  be  perceptible  whioli  vary  in 
pitch,  intensity  and  volume. 

The  ])ulse  is  always  accelerated,  although  its  frcMjUciicy  is 
extremely  variable  in  dilTerent  cases;  it  is  frequently  arhythmi- 
cal,  irregular  and  intermittent;  the  intermissions  are  sometimes 
so  fre(iuent  that  the  number  of  heart  beats  is  as  much  as  twice 
that  of  the  i)uls(^  beats.  At  the  connnencement  of  light  cases, 
the  jjulse  is  strong  and  even  vigorous  in  relation  to  the  rate, 
but  later,  and  in  severe  cases  from  the  first,  it  is  weakci-  a  in  I 
soft.  The  character  of 
the  pulse  depends  in 
part  upon  tlie  localiza- 
tion of  the  disease  (see 
valvular  diseases) ;  for 
instance  in  inflianuna- 
tion  of  the  aortic  valves 
it  is  bounding  (see  Fig. 
190). 

In  correspondence 
with  the  intensity  of 
the  disease  circulatory 
disturbances  develop 
which  are  manifested 
by  cyanosis,  fullness  of 
the  veins,  negative 
.venous  pulse,  and  by 
frequent  or  difficult  res- 
piration, and  which  may 
be  aggravated  into  as- 
phyctic attacks  on  tlic 
slightest  motion  or 
through  external  in- 
fluences, or  they  oidy 
become  manifest  in  sucli 
attacks,  while  they  are 
not     present     at     rest. 

Another  consequence  of  ^^"-  ^^^-     Temperature  curve  in  acute  endocarditis. 

ilin   /^ii-r>    1 -ifr>  •        T    f       1  '^^^^  disease  liad  appeared  in  a  Great  Dane,  brought 

inc  C11CUU1101>  CllSTUrO-  to  the  hospital  with  an  nker  on  tlie  tail,  and  ended 
anceS,     especially     of     a  fatally  in  four  days. 

severe  pulmonary  hy- 
peremia is  in  many  cases  a  bloody  discharge  from  the  nose 
which  may  be  accompanied  by  symptoms  of  j)ulin()nary  edema. 
Moreover,  edemas  sometimes  develop  quite  early  in  various 
parts  of  the  ))ody,  for  instance,  on  the  limbs  and  on  the  lower 
portions  of  the  trunk.  Occasionally,  and  particularly  in  hogs, 
a  decided  weakness  of  the  hindquarter,  or  even  of  one  posterior 
extremity,  is  observed,  which  is  due  either  to  a  stenosis  of 
the  aortic  opening,  or  to  a  general  embolic  obstruction  of  the 
arteries,  or  to  the  del)ility  Avhich  follows  upon  tlie  severe  general 
disease. 


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Acute  Endocarditis. 


The  temperature  is  raised  in  all  cases  (Figs.  191  and  192), 
but  in  slight  attacks  it  is  moderate,  while  severe  cases  are 
accompanied  by  high  fever.  There  are,  however,  exceptions, 
and  the  great  variability  of  the  disease-causes  makes  it  evident 
that  the  type  of  fever  may  be  subject  to  numerous  variations. 

Disturbances  in  the  general  condition,  w^hich  are  always 
observed,  may  be  so  insignificant  in  cases  running  a  slow 
course  that  they  are  not  observed  at  all  for  a  time,  especially 
in  swine  wdiich*^are  more  indolent  and  live  in  herds.  In  other 
cases  the  attack  commences  with  considerable  indisposition 
or  debility;  in  horses  symptoms  of  colic  are  now  and  then 
apparent. 

With  the  gradual  increase  of  circulatory  disturbances 
death  occurs  in  some  of  the  cases,  while  in  others,  especially 

in  those  affected  with 
the  ulcerous  form, 
symptoms  of  metasta- 
tic inflammation  in  va- 
rious organs  become 
evident.  Such  meta- 
stases may  give  rise  to 
purulent  pneumonia, 
or  purulent  nephritis 
sometimes  accompanied 
by  hematuria ;  to  acute 
meningitis,  purulent  in- 
flammation of  the 
joints,  etc.  Similar 
causes  must  be  at- 
tributed to  the  local 
hemorrhages  which  de- 
velop here  and  there, 
for  instance,  under- 
neath the  cornea. 

In    a    very    small 

percentage   of   cases   a 

possibility  of  recovery 

may  exist ;  but  in  animals   which  do  not  die  the  clinical  picture 

of  chronic  endocarditis  usually  develops. 

Diagnosis.  The  disease  can  only  then  be  recognized  posi- 
tively when  repeated  examinations  have  demonstrated  that 
valvular  insufficiency  or  stenosis  have  developed  in  a  previously 
healthy  heart  in  a  comparatively  short  time.  A  careful 
supervision  of  the  heart  action  and  repeated  examinations  of 
the  heart  are  necessary  the  more,  as  the  elimination  of  acute 
febrile  diseases  (anthrax,  severe  forms  of  influenza,  septicemia, 
etc.),  perhaps  also  of  severe  pulmonary  diseases,  is  possible 
only  in  this  manner.  Of  foremost  importance  is  the  character 
of  the  heart  sounds  and  their  transformation  into  murmurs, 
but  even  such  findings  do  not  afford  absolute  proof  because 


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Fig.   192.     Temperature    curve   in    endocarditis    of 

erysipelas  in  a  horse.     Two  days  before  death  the 

number    of    heart    beats    was    twice    that    of    the 

pulse  beats. 


Diagnosis,     Prognosis.     Treatment.  1085 

similar  plionomona  may  be  observed  in  acute  myocarditis  and 
in  cardiac  dilatation.  If  the  murmnrs  persist  permanently, 
if  to  them  are  added  circulatory  disturbances  and  perhaps 
emboli,  the  nature  of  the  disease  may  be  assumed  with  sufficient 
certainty.  Still  it  nnist  not  be  forgotten  that  an  animal  ill 
with  clironic  endocarditis  may  become  affected  with  another 
septicemic  disease. 

The  dilferentiation  of  verrucous  endocarditis  from  the 
ulcerous  form  is  usually  very  difficult.  In  general  it  may  be 
said  that  the  more  severe  the  symptoms,  the  higher  the  fever, 
and  the  more  turbulent  the  circulatory  disturbances,  the  greater 
is  the  probability  of  ulcerous  endocarditis.  Collateral  factors 
may  atford  information  in  so  far  as  the  verrucous  form  usually 
develops  in  connection  witli  swine  erysipelas  or  with  articular 
rheumatism,  while  endocarditis  ulcerosa  occurs  in  purulent  or 
ichorous  processes  anj^vhere  in  the  body. 

Prognosis.  Acute  endocarditis  is  always  a  severe  disease, 
especially  in  the  ulcerous  form.  Even  in  the  lightest  cases 
there  is  little  hope  for  complete  recovery,  because  usually 
chronic  changes  remain  which  afford  a  basis  for  permanent 
valvular  lesions  and  thus  reduce  both  the  ability  to  work  and 
the  nutrition  of  the  animals. 

Treatment.  Absolute  rest  should  be  procured  first  of  all. 
For  the  alleviation  of  the  excitement,  which  is  noticeable  at 
least  occasionally,  cold  or  ice  compresses  upon  the  heart  or 
-cold  sprays  are  appropriate.  If  the  heart  action  is  very  rapid 
and  irregular  the  cautious  administration  of  digitalis  or  of 
its  preparations  or  of  other  cardiac  remedies  is  indicated  (see 
valvular  diseases).  In  heart  weakness  the  danger  of  cardiac 
paralysis  must  be  counteracted  with  stimulants,  for  instance, 
with  alcohol,  wines,  black  coifee,  tea,  caffeine,  tlieine,  camphor, 
Liq.  Ammon.  Anisatus  internally;  ether,  camphorated  oil,  tinc- 
ture of  musk  subcutaneously.  In  excessively  high  temperature 
the  fever  requires  laetophenin,  antipyrin,  aspirin,  antifebrin, 
etc.  In  endocarditis  of  rheumatic  origin  salicylic  acid  and 
its  preparations  may  be  tried. 

Literature.  Albreeht,  W.  f.  Tk.,  1893.  164.  —  Bang,  D.  Z.  f.  Tm.,  1S02. 
XVIIT.  '27.  —  Bergeoii,  Kev.  vet.,  1905.  820.  —  Coppel,  Die  chron.  Klappeiierkraiik. 
beiin  Huiule,  Diss.  Leipzig,  1908.  —  Dasfh,  T.  Z.,  1907.  518.  —  Eiseumaiin,  Monh., 
1906.  XVII.  97.  —  Frohner,  Monh.,  1894.  V.  171.  —  Hartl,  Z.  f.  Tni.,  1902.  VI. 
450.  —  Jensen,  Maanedsskr.,  1898.  X.  65.  —  Joest,  S.  B.,  1905.  300.  —  Joest  & 
Roder,  Monh.,  1908.  XIX.  158.  —  Liiginger,  ibid.,  1904.  XV.  289  (Lit.).  —  Mever, 
B.  t.  W.,  1905.  740.  —  Trasbot,  A.  d'AIf.,  1877.  921. 

12.    Valvular  Diseases.    Vitia  Cordis.    Heart  Troubles. 

The  designation  of  valvular  lesions  includes  the  chronic 
organic  diseases  which  cause  functional  disturbances  of  the 
heart  valves  and  the  cardiac  ostia.  They  differ  in  their  deriva- 
tion. 


1086  Valvular  Diseases. 

Occurrence.  Since  valvular  lesions  occur  most  frequently 
in  consequence  of  chronic  endocarditis  which  is  most  common 
in  dogs,  the  valvular  troubles  are  found  most  often  in  these 
animals.  (According  to  Cadiot  5%  of  dogs  over  one  year  old 
suffer  from  valvular  disease;  among  793  dogs  autopsied  by 
Johne,  chronic  endocarditis  was  found  in  4.3%,  and  among 
1,831  dogs  which  were  examined  in  the  pathologic-anatomical 
institute  in  Budapest  3.9%  were  found  wdth  evidences  of 
endocarditis).  Next  in  frequency  are  horses,  and  then,  very 
much  less  often,  the  other  mammalians,  if  the  cases  of  acute 
endocarditis  are  not  included.  The  observations  of  Larcher 
and  Hartl  show  that  valvular  diseases  are  not  infrequent  in 
fowls,  although  they  give  rise  to  functional  heart  disturbances 
comparatively  rarely. 

Etiology.  Valvular  heart  lesions  may  be  caused  by  the 
following  diseases  of  the  heart : 

1.  Acute  Endocarditis  (see  p.  1078),  which  in  its  less  rapid 
cases  takes  a  course  presenting  the  clinical  picture  of  valvular 
disease. 

2.  Chronic  Endocarditis  (Endocarditis  valvularis  chron- 
ica). This  disease  is  the  basis  for  most  cases  of  valvular 
troubles  and  develops,  probably  principally,  out  of  the  acute 
inflammation;  it  either  occurs  thus  that,  after  the  acute  endo- 
carditis has  run  its  course,  a  proliferation  with  subsequent 
atrophy  of  the  connective  tissue  takes  place,  or  thus  that  an 
acute  inflammation,  which  is  not  very  intense  of  itself,  recurs 
periodically  and  produces  proliferation  and  atrophy  of  con- 
nective tissue  after  each  recurrence.  Accordingly  all  causes 
and  conditions  which  stand  in  etiological  relation  to  acute 
endocarditis  may  occasionally  also  lead  to  a  chronic  inflamma- 
tion. In  this  respect  those  factors  especially  enter  into  con- 
sideration which  usually,  or  at  least  occasionally  produce  a 
mild  acute  inflammation.  This  is  particularly  the  case  in 
endocarditis  following  upon  articular  rheumatism  and  upon 
croupous  pneumonia,  also  in  inflammation  due  to  tuberculosis 
and  to  erj^sipelas.  In  other  case*  the  inflammation  is  chronic 
from  the  beginning  and  is  usually  not  noticed;  and  in  such 
cases  an  infection  may  be  a  causative  factor,  although  it  does 
not  give  rise  to  acute  symptoms.  Further,  chronic  endocarditis 
develops  in  connection  with  chronic  endoarteritis  and  arterio- 
sclerosis, and  in  dogs  frequently  in  association  with  chronic 
interstitial  nephritis.  Sonnenberg  found  the  mitral  valve  of 
a  cachectic  tuberculous  cow  thickened  and  covered  with  a 
yellowish-gray  deposit,  while  the  endocardium  of  the  left  heart 
showed  diffuse  grayish-yellow  discoloration.  Hartl  found  in 
chickens  repeatedly  a  chronic  endocarditis  the  origin  of  which 
could  not  be  determined.  Lastly,  severe  exertion  or  the 
mechanical  irritation  of  the  valves  which  is  necessarily  exerted 
by  it  upon  them,  and  also  cold  are  said  to  produce  the  disease. 


Etiology-,    Aiialoiiiical  Changes.  1087 

3.  Injuries  to  the  valves  are  also  capable  of  injuring  their 
tunetion.  This  occurs  when  a  valve  is  perforated  or  when 
(luring-  severe  exertion,  a  semilunar  valve  is  torn  from  its 
base  or  one  of  the  bicuspid  or  tricuspid  valves  has  been  torn 
from  the  chordae  tendineae  by  the  force  of  the  pressure  which 
IS  periodically  exerted  upon  the  valves.  (In  a  case  of  Lusti£,-'s 
the  valve  was  torn  otf  during-  severe  work,  in  a  case  of  Cantini's 
will  e  the  horse  was  jumijing;  similar  cases  were  observed  by 
Luthens,  Gerlach  and  Schiitz).  In  exceptional  cases  the  sinipfe 
over-distension  of  the  aortic  valves  causes  an  inabilitv  to  close 
(/schokke). 

4.  Tumors  and  Echinococci  may  cause  both  insufficiencv 
and  stenosis  li  they  grow  from  the  annuli  fibrosi  or  from  the 
wall  of  a  heart  cavity  toward  an  ostium. 

5.  Diseases  of  the  heart  muscle  mav  produce  a  valvular 
insulhciency  even  if  the  valves  are  not  injured  (Insufficientia 
relahva  s.  niuscularis).  Especially  in  the  proper  functioning- 
ot  the  auriculo-ventricular  valves  both  the  relaxation  of  the 
chordae  tendineae  and  the  contractions  of  the  muscles  around 
the  ostium  cooperate  to  a  considerable  degree.  If  the  con- 
tractions are  not  sutficiently  energetic,  the  closure  of  the  valves 
becomes  insufficient.  A  similar  disturbance  results  if  one  of 
the  ostia  has  been  dilated  excessively  in  case  of  cardiac  dilata- 
tion ot  high  degree.  Insufficiencies  from  this  cause  are  bv 
no  means  infrequent  and  are  usually  due  to  chronic  mvocarditis 
sometimes  they  follow  upon  a  cardiac  weakness  from  other 
causes  and  usually  affect  the  right  heart.  Finallv  dilatation 
ot  the  arterial  trunks  close  to  the  heart  mav  result  in  an 
msulhcieney  of  the  semilunar  valves. 

6.  Congenital  heart  lesions  must  also  be  included  here 
Accorc  mg  to  Preisz  they  are  usually  due  to  impeded,  less  often 
lo  taulty^  development  or  to  intrauterine  heart  diseases  1 
comparatively  frequent  anomaly  is  the  persistence  of  an  open- 
iiig-  m  the  upper  anterior  portion  of  the  interventricular  septum 
(l^oramen  mterventriculare  persistens)  and  according-  to  Preisz 
the  cases  described  by  Csokor  and  Johne  under  the  name  of 
Septum  membranaceum  persistens  belong  to  this  lesion  The 
i^  oramen  ovale  between  the  auricles  remains  open  fairlv  often 
and  also  the  Ductus  Botalli.  It  occurs  onlv  verv  rarelv  that 
only  one  auriculo-ventricular  opening  or  a  simple  arterial' trunk 
proceeding  from  the  ventricle  is  found  in  addition  to  the  above 
mentioned  anomalies. 

Anatomical  Changes.  Chronic  endocarditis  leads  to  new- 
tormatioii  loliowed  by  atrophy  of  the  connective  tissue:  owing 
to  these  changes  the  endocardium  is  thickened  in  varvinS 
degrees,  verrucous,  polypoid  or  cauliflower-like  excrescences  are 
formed  on  the  borders  of  the  valve  which  is  in  contact  with  the 
blood  stream  and  the  chordae  tendinae  are  thickened.  The 
thickene<l   valves   become  rigid  and  the  semilunar  valves  are 


1088  Valvular  Diseases. 

transformed  into  thick  flat  pads,  the  separate  portions  of  the 
bicuspid  and  tricuspid  valves  into  thick,  knobby  formations; 
in  exceptional  cases  contiguous  parts  of  valves  become  adherent. 
The  thickened  chordae  tendineae  appear  shortened.  On  the 
parietal  layer  of  the  endocardium  changes  are  frequent  but 
less  striking  and  only  rarely  produce  thickening. 

"  If  the  atrophy  of  the  valves  or  of  the  chordae  tendineae 
has  advanced  to  such  a  degree  that  the  extended  valves  no 
longer  touch,  the  result  is  an  insufficiency,  but  if  polypoid  or 
cauliflower-like  deposits  have  formed  on  the  valves  or  if  the 
latter  are  very  rigid,  and  their  contiguous  portions  perhaps 
adherent,  the  result  is  a  stenosis  of  the  respective  ostium. 
According  to  the  nature  and  localization  of  the  changes  a 
stenosis  is  often  present  together  with  an  insufficiency.  The 
portion  of  the  heart  which  is  proximal  to  the  diseased  part 
(in  the  direction  of  the  blood  stream)  is  then  dilated  and  more 
or  less  hypertrophic.  During  the'  stage  of  incompensation 
there  exist  symptoms  of  blood-stasis. 

As  regards  the  seat  of  the  changes  the  disease  affects  in 
horses  frequently  the  aortic  valves  (according  to  French 
authors  this  is  the  most  frequent  form  of  heart  trouble  in 
horses),  more  rarely  the  bicuspid  valve.  In  cattle  and  goats 
the  valves  of  the  right  heart  are  as  a  rule  affected  most  fre- 
quently, in  swine  those  on  the  left  side  of  the  heart,  especially 
the  bicuspid  valve.  In  dogs  mitral  insufficiency  is  observed 
most  often,  then  the  simultaneous  affection  of  bicuspid  and 
tricuspid  valves  and  about  half  as  often  disease  of  the  tricuspid 
valve  alone.  According  to  Larcher  and  Hartl  the  valves  of  the 
right  ventricle  are  usually  affected  in  birds. 

Symptoms.  According  to  the  localization  of  the  morbid 
process  the  symptoms  are  so  different  that  it  appears  proper 
to  consider  them  separately. 

(a)     Insufficiency  of  the  Aortic  Valves. 

In  insufficiency  of  the  semilunar  valves  of  the  aorta  a 
slit-like  opening  persists  between  the  valves  during  ventricular 
systole,  in  consequence  of  which  a  portion  of  the  blood  which 
had  been  forced  into  the  aorta  during  the  preceding  systole 
flows  back  into  the  left  ventricle,  producing  a  murmur  in  so 
doing.  At  the  same  time  blood  flows  into  the  left  ventricle 
from  the  left  auricle,  and  the  ventricle,  receiving  blood  from 
two  directions,  is  dilated,  owing  to  its  power  of  adaptation, 
but  forces  out  its  entire  blood  content  during  the  next  systole, 
for  which  a  stronger  contraction  is  necessarily  required.  The 
continuous  increase  in  the  activity  of  the  heart  gives  rise  to 
a  hypertrophy  of  the  wall  of  the  dilated  ventricle. 

The  symptoms  of  insufficiency  of  the  aortic  valves  are  as 
follows:     The  stronger  contraction  of  the  hypertrophied  and 


Symptoms. 


1089 


at  the  same  time  dilated  left  ventricle  produces  an  increased 
lifting  heart  beat  on  palpation  of  the  cardiac  region,  especially 


Fig.  193.     Location    of   the  greatest  intensitif   of  endocardial   sounds   in    the   horse, 
a.   b.  shoulder   line;   1    punctum   maximum  of  the  murmur   originating  in  the  left 
auriculo- ventricular  opening;  2  in  the  aortic  opening;  3  in  the  opening  of  the  pul- 
monary artery.     In  the  other  species  similar  conditions  may  be  shown. 


Fie    194      Location  of  the  greatest  intensity  of  the   nntrmur  originating  m  the  right 
auriculo-ventricular  opening   in    the   horse   (1).     The   other   murmurs   the  same   as 

in  Fig.  193. 

after  excitement,  and  a  diastolic  thrill  of  the  wall  of  the  thorax 
is  noted  on  the  left  side.     The  area  of  heart  dullness  on  the 

Vol.  \->^ 


1090 


Valvular  Diseases. 


left  side  is  displaced  in  dogs  about  3-5  cm.  or  more  upward, 
while  in  other  animals  it  is  displaced  upwards  and  backwards 
and  may  reach  as  far  as  the  seventh  rib  and  beyond  the  middle 
of  the  lower  third  of  the  chest.  The  first  heart  sound  is  clear, 
but  the  diastolic  sound  is  accompanied  by  a  murmur  which 
is  usually  loud,  blowing  or  roaring,  perhaps  rough  or  ringing, 
prolonged,  and  which  is  separated  from  the  systole  by  a  rather 
short  pause.  Its  greatest  intensit}^  is,  in  all  mammals,  in  the 
left  fourth  intercostal  space  immediately  below  the  shoulder 
line  (Fig.  193.2),  although  it  may  be  heard,  a  little  less  clearly, 
also  in  the  same  intercostal  space  on  the  right  side.  The 
purely  diastolic  sound  which  originates  in  the  Art.  pulmonalis 
can  be  heard  in  the  region  of  the  left  ventricle  in  association 
with  the  murmurs  just  referred  to,  but  near  the  origin  of  the 


Fig.   195.     Sphygmograph  of  the  ahdominal  aoria  in  the  horse,     a  bounding  pulse  in 
aortic  insufficiency;  b  pulse  of  a  healthy  horse   (Time  in  0.2"). 

pulmonary  artery  (left  third  intercostal  space,  lower  half  of 
the  lower  third  of  the  chest  [Fig.  193.3] )  it  may  be  heard  almost 
alone. 

The  pulse  is  characteristic.  The  hypertrophied  left  ventricle 
forces  an  increased  amount  of  blood  into  the  arota  and  through 
it  into  the  peripheral  arteries  in  which  the  return  flow  of  the 
blood  during  the  preceding  diastole  had  produced  a  very  con- 
siderable lowering  of  the  blood  pressure  in  comparison  with 
the  normal.  The  increased  amount  of  blood  which  is  forced 
out  with  every  ventricular  systole,  and  the  greater  difference 
(compared  with  the  normal)  between  the  systolic  and  the 
diastolic  blood  pressure  in  the  arteries  produce  a  more  vigorous 


Symptoms.  1091 

and  more  rapidlj'  increasing  wave  wliicli  disappears  just  as 
rapidly,  because  after  the  termination  of  the  systole  the  blood 
can  flow  off  rapidly  toward  the  periphery  and  the  lieart. 
Accordingly  the  pulse  is  strong,  large,  rapid  and  l)ounding 
(Fig.  195(/).  A  bounding  pulse  may  be  felt  even  in  the  smaller 
arteries,  and  indeed  in  the  eye  ground  the  pulsation  of  the 
arteries  can  usually  be  seen  clearly.  The  larger,  and  often 
also  the  smaHer  ai'teries  show  systolic  ])ulsation  and  sometimes 
a  systolie  i)ulsation  of  tiie  liver  may  l)e  observed.  At  the  same 
time  a  clapping  vascular  sound  may  often  be  heard  even  over 
smaller  arteries.  Finally  the  mucous  membranes  may  suddenly 
l)ecome  reddened  synehronously  with  each  ventricular  systole; 
this  redness  may  be  emphasized  by  producing  previously  a  cir- 
eumscribed  pallor  by  the  pressure  of  a  finger  tip.  This  capillary 
])ulsation  sometimes  occurs  in  the  severe  cases  of  aortic  in- 
sufficiency. 


(b)    Stenosis  of  the  Aortic  Opening. 

In  stenosis  of  the  aortic  opening  the  left  ventricle  is  obliged 
to  force  the  normal  amount  of  blood  through  an  opening  which 
is  smaller  than  normal,  and  this  leads  to  the  development  of 
a  systolic  murmur  and  also  requires  an  increased  expenditure 
of  energy  which  in  its  turn  causes  an  increase  in  the  thickness 
of  the  left  ventricular  wall. 

,  The  heart  beat  may  therefore  be  heard  over  a  larger  terri- 
tory and  either  more  strongly  or  less  strongly,  because  the  so- 
called  closure  time  of  the  heart  function  is  omitted.  Simulta- 
neously with  the  lieart  beat  a  systolic  thrill  may  usually  be  felt. 
The  cardiac  dullness  is  increased  only  inconsiderably.  The  first 
heart  sound  is  covered  by  a  very  strong,  prolonged  systolic 
murmur,  which  is  separated  from  the  diastolic  sound  by  only 
a  brief  pause;  this  murmur  may  be  so  strong  that  it  can  be 
heard  in  the  neighborhood  of  the  animal.  Its  maximal  point 
is  in  the  fourth  intercostal  space  immediately  below  the  shoulder 
line  (Fig.  193.2).  The  systolic  sound  which  originated  in  the 
right  heart,  as  well  as  the  transmitted  murnmr  are  heard  on 
the  right  side  also.  The  weakened  aortic  sound  may  be  heard 
in  the  left  fourth  intercostal  space,  below  the  shoulder  line, 
while  the  pulmonal  sound  is  heard  in  fairly  normal  intensity 
in  the  third  intercostal  space  in  the  lower  half  of  the  left  lower 
third.  The  pulse  wave  is  sluggish;  its  growth  may  be  followed 
with  the  palpating  finger,  because  owing,  to  the  aortic  stenosis 
the  systolic  pressure  of  the  arteries  increases  much  more  slowly 
than  is  the  case  under  normal  conditions.  At  the  same  time 
the  pulse  is  remarkably  small  and  presents  a  distinct  contrast 
to  the  heart  beat  which  is  usually  increased.  The  systolic 
murnmr  is  transmitted  even  into  the  smaller  arteries,  for  in- 
stance, those  of  the  head  and  of  the  extremities. 


1092  Valvular  Diseases. 


(c)     Insufficiency  of  the  Bicuspid  or  Mitral  Valve. 

If  the  two  flaps  of  the  expanded  bicuspid  valve  do  not 
touch,  a  part  of  the  blood  in  the  left  ventricle  flows  back  into 
the  left  auricle  at  each  ventricular  systole,  and  the  blood  of 
the  pulmonary  veins  is  emptied  into  this  auricle  at  the  same 
time.  This  causes  the  pressure  in  the  auricle  to  be  increased, 
it  becomes  dilated  and  eventually  hypertrophied,  although  the 
hypertrophy  is  usually  not  very  marked.  But  since  the 
auricular  wall  cannot  expend  the  force  sufficient  to  remove  the 
increased  pressure  and  since  at  each  auricular  systole  blood  is 
forced  into  the  pulmonary  veins  which  are  not  provided  with 
valves,  the  stasis  is  continued  upward  into  the  pulmonary  veins 
and  from  these  through  the  comparatively  wide  pulmonary 
capillaries,  to  the  pulmonary  artery  and  the  right  ventricle,  the 
muscular  wall  of  which  is  hypertrophied  in  consequence.  There 
occurs  therefore  an  increase  in  blood  pressure  affecting  the 
entire  lesser  circulation,  which  is  compensated  in  the  right 
ventricle.  The  persistent  passive  hyperemia  of  the  lungs 
gradually  leads  to  the  development  of  the  socalled  brown 
induration  of  the  lung  tissue.  The  muscle  of  the  left  ventricle 
also  is  usually  thickened,  although  not  greatly,  because  at  each 
systole  it  is  obliged  to  force  out  a  larger  amount  of  blood. 

The  heart  beat  is  usually  normal  on  the  left  side,  but  in- 
creased on  the  right  side;  in  horses  a  contraction  is  observed 
commencing  immediately  after  the  beginning  of  the  ventricular 
systole,  instead  of  the  normal  well-marked  systolic  rise  in  the 
region  of  the  heart  during  systole.  Simultaneously  with  the 
heart  beat  a  systolic  thrill  may  often  be  felt.  The  cardiac  dull- 
ness is  not  infrequently  unchanged,  but  at  times  it  is  somewhat 
enlarged  on  the  right  side,  which  may  be  seen  by  the  fact  that 
in  the  fourth  and  also  in  the  fifth  intercostal  space  on  the  right 
side  a  distinct  cardiac  dullness  is  manifest.  On  the  left  side 
the  cardiac  dullness  is  only  rarelj^  noticeably  increased.  Instead 
of  the  first  heart  sound  a  prolonged,  blowing  or  rushing-  systolic 
murmur  is  heard  on  the  left  side,  the  punctum  maximum  of 
which  is  in  the  fifth  intercostal  space,  in  the  middle  of  the  left 
lower  third  of  the  chest  (Fig.  193.1).  In  the  intercostal  spaces 
lying  in  front  of  it  the  systolic  sound  originating  in  the  right 
ventricle  may  also  be  heard  more  clearly,  and  it  is  audible  quite 
distinctly  in  the  right  3d-4th  intercostal  spaces  (Fig.  194.1),  the 
transmitted  and  much  attenuated  murmur  being  also  percep- 
tible. The  diastolic  sound  is  clear,  the  second  aortic  sound 
usually  normal  in  strength,  the  second  pulmonic  sound  (in  the 
left  third  intercostal  space  in  the  lower  half  of  the  lower  third 
of  the  chest  [Fig.  193.3])  much  increased,  clear  and  short,  i.  e., 
accentuated,  because  the  blood  column,  which  within  the  pul- 
monary artery  is  under  an  increased  pressure,  is  thrown  with 
greater  force  against  the  semilunar  valves.    The  pulse  presents 


Symptoms.  1093 

no  particular  cloviatioiis,  becoming  weaker  only  in  severe  eases. 
The  transmitted  systolic  murmur  may  usually  be  heard  also 
over  the  larger  arteries  (carotis,  first  part  of  the  abdominal 
aorta). 

Owing  to  the  continued  increased  blood  pressure  in  the 
lungs  superficial  and  accelerated  breathing  is  noted,  and  also 
bronchial  catarrh.  The  patients  are  inclined  to  pulmonary 
edema. 


(d)     Stenosis  of  the  Left  Auriculo- Ventricular  Opening. 

In  a  narrowing  of  the  left  auriculo-ventricular  opening  tiie 
entrance  of  the  blood  from  the  auricle  into  the  ventricle  during 
the  ventricular  diastole  is  impeded,  so  that  a  dilatation  of  the 
left  ventricle  is  produced  with  su))sequont  hypertrophy.  But 
as  in  spite  of  the  greater  work  accomplished  by  the  thiil-walled 
auricle  it  is  not  capable  of  preventing  the  damming  up  of  the 
blood,  the  stasis  is  continued  to  the  right  ventricle  through  the 
])ulmonary  veins  and  arteries.  This  leads  in  its  turn  to  an 
increase  of  pressure  in  the  pulmonary  circulation  and  to  hyper- 
trophy of  the  right  ventricle,  while  the  left  ventricle  rather 
becomes  smaller. 

The  heart  beat  and  cardiac  dullness  are  the  same  as  in  the 
preceding  lesions.  Of  the  heart  sounds  the  first  one  is  clear 
everywhere,  but  the  second  is  accompanied  by  a  diastolic 
murmur  which  is  most  marked  in  the  left  fifth  intercostal  space, 
in  the  middle  of  the  lower  third  of  the  chest  (Fig.  193.1).  The 
murmur  is  not  usually  loud  and  either  is  heard  through  the 
entire  diastole,  being  separated  from  the  systole  only  by  a  short 
pause,  or  only  at  the  commencement,  eventually  only  near  the 
end  of  the  diastole  (presystolic  murmur).  Aside  from  the 
murmur  the  second  aortic  sound  may  be,  and  tlie  second  pul- 
monic sound  always  is,  heard  distinctly,  the  latter  being  even 
more  accentuated  than  in  mitral  insufficiency.  The  pulse  is 
always  small  and  soft  l)ecause  the  left  ventricle  forces  less  blood 
into  the  aorta.  The  lungs  show  the  same  disturbances  as  in 
mitral  insufficiencv. 


(e)     Insufficiency  of  the  Pulmonary  Valves. 

In  this  condition  the  right  ventricle  receives  blood  from 
two  directions  during  each  ventricular  diastole,  namelv,  the 
blood  which  regurgitates  from  the  pulmonary  artery  and  that 
which  Hows  in  from  tiie  right  auricle;  and  accommodative  dila- 
tation of  the  right  ventricle  occurs  in  consequence  of  the  exces- 
sive blood  supply,  which  is  soon  followed  by  hypertrophv. 

^  The  ventricle  does  more  work  than  normally  and  "forces 
an  increased  amount  of  lilood  to  a  place  where  the  blood  pres- 
sure is  lowered,  the  blood  therefore  flows  more  raindlv  iuto  the 


1094  Valvular  Diseases. 

pulmonary  artery  and  tliis  will  at  times  eventually  dilate.  x\s 
the  expulsive  force  gradually  diminishes,  the  right  ventricle  is 
finally  dilated  to  such  a  degree  that  the  right  auriculo-ventric- 
ular  opening  also  enlarges  so  far  as  to  produce  a  relative  insuffi- 
ciency of  the  tricuspid  valve.  The  insufficiency  of  the  pul- 
monary valves  remains  without  effect  upon  the  lungs  and  the 
left  heart  as  long  as  it  is  compensated  by  the  increased  work 
accomplished  by  the  right  ventricle. 

The  heart  beat  and  the  cardiac  dullness  show  similar  con- 
ditions as  in  diseases  of  the  left  venous  ostium.  The  first  heart 
sound  is  clear  everywhere;  instead  of  the  second  sound  a  pro- 
longed diastolic  murmur  which  gradually  becomes  weaker  in  all 
directions  is  heard  over  the  origin  of  the  pulmonary  artery 
(Fig.  193.  3),  wdiile  the  second  aortic  sound  becomes  constantly 
more  distinct.  No  particular  changes  are  noted  in  the  pulse. 
The  disease  is  always  accompanied  by  respiratory  disturbances. 


(f)    Stenosis  of  the  Opening  of  the  Pulmonary  Artery. 

The  ])lood  which  is  forced  out  of  the  right  ventricle  against 
the  puhnonary  artery  meets,  in  the  diminished  opening  of  the 
pulmonary  artery,  an  impediment  which  increases  the  work  of 
the  right  ventricle  and  leads  to  hypertrophy  of  its  muscle.  The 
blood  pressure  in  the  lungs  is  lowered  permanently,  and  the 
amount  of  blood  in  the  pulmonary  arteries  becomes  less  as  soon 
as  the  energy  of  the  right  ventricle  diminishes. 

The  heart  beat  and  the  cardiac  dullness  show  the  same 
deviations  as  in  the  preceding  form.  Over  the  origin  of  the 
pulmonary  artery  (Fig.  193.3)  a  loud,  prolonged  systolic  mur- 
mur is  heard,  and  more  posteriorly  also  the  first  heart  sound 
which  originates  in  the  left  ventricle ;  the  second  sound  is  clear 
but  weakened  over  the  pulmonary  artery.  The  pulse  is  small 
and  feeble.  Respiratory  disturbances  and  cyanosis  are  noted 
from  the  first. 


(g)     Insufficiency  of  the  Tricuspid  Valve. 

If  the  unfolded  tricuspid  valve  does  not  close  completely, 
a  part  of  the  blood  in  the  right  ventricle  flows,  during  systole, 
back  into  the  right  auricle  through  a  more  or  less  narrow  open- 
ing, the  auricle  is  dilated  and  eventually  slightly  hypertrophied. 

Since  the  auricular  wall  is  capable  of  exerting  only  a 
slight  force,  and  since  the  openings  of  the  venae  cavae  are  not 
closed  by  valves,  the  stasis  of  the  blood  is  continued  into  venae 
cavae  and  into  the  other  veins  of  the  body. 

The  heart  beat  differs  from  the  normal  at  most  in  so  far 
as  a  systolic  thrill  is  often  felt  simultaneously  in  the  3d-4th  inter- 
costal spaces.  The  cardiac  dullness  is  not  altered.  The  first 
heart  sound  is  heard  in  the  left  5th-6th  intercostal  spaces,  either 


Syinptonis. 


1095 


(iiiite  clear  or  to^otlior  with  a  very  faint  transniittca  iiiuniiur; 
the  systolic  nmrniur  reaches  its  greatest  intensity  in  tlie  right 
3d-4th  intercostal  spaces  toward  the  middle  of  the  lower  third  ot 
the  chest  (Fig.  lt)4.1.)  The  diastolic  sound  is  either  ot  normal 
intensit}^  or  f i^ninentlv  becomes  weaker  and  in  such  cases  the 
pulse  becomes  fee])le  and  small.  The  veins  are  filled  strongly ; 
the  iugular  veins  appear  as  thick  cords  and  show  a  systolic 
(positive)  pulsation  following  immediately  upon  the  heart  beat, 
which  mav,  however,  not  be  perceived  owing  to  a  long  hair  coat, 
especiallv  in  dogs.  If  the  auricle  could  not  remove  its  entire 
blood  content,  owing  to  its  rapidly  diminished  functioning 
])ower  a  certain  amount  of  blood  is  forced  at  each  systole  from 


Yi"  100  Cardiu-  ami  I'hhhlqraijh  of  a  horse  irith  hisufficicncij  of  the  Ucuspid  and 
tHcuspid  voices.  A  Cavdio.ua-aph.  Instead  of  the  elevation  ylneh  occurs  normallv 
at  the  beginning  of  ventricuhir  systole,  a  descending  line  is  noted  («— c),  due  to  tne 
omission  of  the  closure  of  the  right  ventricle;  the  line  is  interrupted  by  a  small 
apex  (T)  uhich  corresponds  to  the  systole  of  the  left  ventricle  At  the  beginning 
-of  ventricular  diastole  (c—d)  the  pressure  in  the  ventricles  suddenly  increases  B 
1'iilebi.rniph.  a  negative  venous  pulse;  ^  positive  venous  pulse;  7  carotid  pul>,e , 
5e  rapTd  emptying  of  the  jugular  vein  at  the  beginning  of  the  ventricular  duastole. 

the  right  ventricle  into  the  right  auricle  and  from  this  into  the 
vena  cava.  Bv  the  regurgitation  of  the  blood  into  the  venae 
cavae  a  svstolic  wave  is  produced  and  is  continued  to  the  jugu- 
lar veins.'  The  systolic  venous  pulse  represents  a  pathognomic 
phenomenon  of  tricuspid  insufficiency,  but  it  must  not  be  con- 
founded with  the  presystolic  (negative)  pulsation,  which  also 
occurs  in  this  heart  lesion  and  precedes  the  heart  beat,  or  with 
the  pulsation  of  the  carotis.  Venous  stasis  leads  soon  to 
edemas. 


(h)  Stenosis  of  the  Right  Auriculo- Ventricular  Opening. 
A  narrowing  of  the  right  auriculo-ventricular  opening 
interferes  with  the  flow  of  the  blood  from  the  right  auricle  into 
the  ventricle,  thus  causing  slight  hypertrophy  and  at  the  same 
time  a  considerable  dilatation  of  the  right  auricle.  Owing  to 
the  latter  cause  blood-stasis  occurs  in  the  venae  cavae  from  the 
beginning  and  is  continued  toward  the  periphery.  On  the  other 
hand  the  other  portions  of  the  heart  receive  less  blood  and 


1096  Valvular  Diseases. 

therefore  become  smaller.  In  consequence  of  the  diminished 
pressure  in  the  right  ventricle  and  in  the  pulmonary  artery 
thrombi  easily  form  in  them  which  may  lead  to  embolism  in  the 
blood  vessels  of  the  lungs. 

The  heart  beat  is  weak,  a  cardiac  dullness  can  either  not 
be  demonstrated  at  all  or  it  is  diminished  in  extent.  The  first 
heart  sound  is  clear,  the  second  is  accompanied  by  a  presystolic 
or  diastolic  murmur  (for  similar  reasons  as  in  mitral  stenosis) 
which  is  heard  most  strongly  in  the  right  3d-4th  intercostal 
spaces  in  the  middle  of  the  lower  third  of  the  chest.  The  pulse 
is  feeble  and  small.  The  veins  are  filled  strongly  and  a  pre- 
systolic (negative)  venous  pulsation,  as  well  as  undulation,  may 
be  observed.  The  characteristic  signs  of  severe  blood-stasis, 
especially  marked  dyspnea,  possibly  attacks  of  asphyxia,  occur 
already  early  in  the  disease. 


(i)     Congenital  Heart  Lesions. 

Clinical  manifestations  of  congenital  heart  lesions  have 
been  described  only  rarely.  The  most  decided  sjinj^tom  usually 
consists  in  considerable  weakness.  The  newborn  animals  are 
not  capable  of  looking  for  their  mothers.  They  stand  with 
hardly  a  movement  or  cannot  even  keep  their  feet.  Sometimes 
at  rest,  more  often  on  motion,  severe  dyspnea  and  cyanosis  are 
observed.  Congenital  valvular  lesions  give  rise  to  the  same 
local  symptoms  as  the  acquired  forms,  but  murmurs  are  mostly 
absent  in  cardiac  lesions  which  are  due  to  faulty  development, 
or  they  appear  only  in  those  cases  in  which  there  is  a  difference 
in  the  pressure  in  two  communicating  heart  portions,  provided 
the  abnormal  opening  is  not  too  large.  In  two  cattle  with  per- 
sistent interventricular  openings  Huynen  observed  a  systolic 
murmur  in  the  left  heart  region  and  an  accentuated  diastolic 
heart  sound. 

The  newborn  animals  usually  die  after  a  short  time  or  are 
killed,  as  they  are  not  fit  to  be  raised.  In  rare  cases  they  de- 
velop normally  and  may  even  live  a  fairly  long  time. 


(k)     Combined  Valvular  Lesions. 

The  clinical  pictures  of  valvular  and  ostial  affections  are 
not  always  found  as  well  marked  as  they  have  been  described ; 
in  reality  the  forms  which  have  been  discussed  separately  often 
occur  in  combinations.  The  most  frequent  combinations  are 
those  in  which  a  stenosis  of  the  related  ostium  coexists  with 
insufficiency  of  a  certain  valve.  Since  valvular  insufficiency  is, 
in  a  way,  the  opposite  of  stenosis,  the  individual  components 
of  the  clinical  picture  lessen  each  other ;  an  exception  occurring 
only  in  the  accentuation  of  the  second  pulmonic  sound  in  com- 
bined disease  of  the  left  auriculo-ventricular  opening.    On  this 


Symptoms.  1097 

account  the  diseeriiil)le  deviations  lose  more  or  less  in  distinct- 
ness and  are  often  confused  into  a  clinical  picture  which  is  diffi- 
cult to  analyze.  In  insufficiency  of  the  aortic  valves  and  coexist- 
in.i^  aortic  stenosis,  for  instance,  systolic  as  well  as  diastolic 
munnurs  are  discovered,  while  the  pulse  is  either  not  bounding? 
or  only  slightly  so,  because  the  variations  in  i)ressure  in  the 
arteries  are  not  so  considerable  and  less  abrupt. 

The  clinical  ])icture  is  even  more  complicated  if  two  or  sev- 
eral ostia  and  valves  are  involved  simultaneously.  Frequently 
only  portions  of  one  half  of  the  heart  are  diseased,  for  instance, 
the  aortic  valves  and  at  the  same  time  the  bicuspid  valve,  but 
sometimes  morbid  changes  are  found  in  the  right  as  well  as  in 
the  left  halves  of  the  heart,  as  in  diseases  of  tlie  left  venous  or 
arterial  ostium  simultaneously  with  tricuspid  insufficiency. 

As  it  is  possible  for  two  anomalies  to  occur  in  each  of  four 
places,  i.  e.,  insufficiency  and  stenosis,  and  as  these  eight  indi- 
vidual forces  nuiy  enter  the  most  variable  combinations  with 
each  other  (a  total  of  2-47  combinations  is  possible),  the  vari- 
ability of  valvular  lesions  obsei*\'ed  in  the  different  cases  is  not 
astonishing,  and  at  the  same  time  renders  descriptions  of  the 
clinical  pictures  suitable  for  all  possible  contingencies  an  impos- 
sibility. 

Insufficiency  of  a  valve  or  stenosis  of  an  ostium  disturbs 
the  normal  process  of  the  circulation  of  the  blood  by  producing 
a  permanent  rise  in  the  blood  pressure  in  the  parts  of  the  heart 
wliicli  lie  proximally  to  the  seat  of  the  disease,  and,  in  diseases 
of  the  left  venous  ostium,  also  in  the  pulmonary  vessels.  In 
order  to  maintain  a  normal,  or  at  least  approximately  normal 
velocity  of  the  blood  current  in  the  body  and  a  normal  blood 
pressure,  certain  joarts  of  the  heart  are  forced  to  accomplish, 
continuously  an  increased  amount  of  work.  This  causes  their 
walls  eventually  to  In^oertrophy,  and  the  heart  is  then  enabled 
to  accomplish  the  plus  of  work  without  constantly  drawing  upon 
its  reserve  strength.  As  long  as  the  increased  work  of  certain 
parts  of  the  heart  maintains  the  normal  velocity  of  the  blood 
current,  and  as  long  as  therefore  the  functions  of  the  various 
organs  rest  undisturbed  in  spite  of  the  existing  valvular  lesions, 
with  the  exception  of  certain  local  disturbances  which  are  con- 
stant accompaniments  of  some  heart  lesions:  a  compensation 
of  the  valvular  lesion  is  said  to  exist.  However,  in  this  stage 
the  function  of  the  organs  is  usually  undisturbed  only  in  a  con- 
dition of  rest,  in  greater  muscular  exertions  and  still  more  in 
over-exertion  transitory  signs  of  incompensation  may  appear. 
Sometimes,  especially  in  insufficiency  of  the  aortic  valves,  the 
heart  may  l3e  equal  even  to  these  excessively  increased  demands. 
On  the  other  hand,  in  certain  forms  of  valvular  troubles  the  func- 
tion of  the  organs  is  impaired  to  a  certain  degree,  even  while 
at  rest,  in  spite  of  existing  compensation ;  for  instance,  in  dis- 
eases of  the  left  auriculo-ventricular  opening,  the  increased 
pressure  in  the  lungs  causes  superficial  and  hastened  respira- 


1098  Valvular  Diseases. 

tion,  while  in  aortic  stenosis  symptoms  of  cerebral  anemia  may 
exist. 

The  anatomical  changes  afford  a  satisfactory  explanation 
why  in  diseases  of  the  aortic  ostium  the  symptoms  of  stasis 
generally  become  manifest  later  than  in  other  valvular  diseases. 
Not  only  is  the  most  vigorous  portion  of  the  heart  back  of  the 
affected  portion  in  this  case,  but  the  weakening  of  the  left  ven- 
tricle causes  a  notable  stasis  only  in  the  lesser  circulation,  which 
can  moreover  be  compensated  by  the  right  ventricle.  If,  on  the 
other  hand,  the  right  ventricle  is  obliged  to  compensate  a  heart 
lesion,  the  stasis  continues,  immediately  to  the  right  auricle 
and  to  the  whole  venous  system,  when  the  right  ventricle  be- 
comes fatigued.  Most  unfavorable  are  conditions  in  diseases 
of  the  right  venous  ostium  because  the  thin-walled  right  auricle 
is  hardly  capable  of  producing  a  compensation  worth  mention- 
ing; in  valvular  diseases  of  the  last  variety  a  stage  of  com- 
pensation can  therefore  hardly  be  considered. 

The  cause  of  the  permanent  incompensation  or  decompensa- 
tion which  develops  after  a  certain  time  can  at  present  not  be 
explained  satisfactorily  for  all  cases.  In  a  number  of  cases  the 
fact  that  the  heart  muscle  is  finally  incapable  of  overcoming  the 
constantly  increasing  difficulties  must  probably  be  attributed  to 
the  gradually  increasing  obstacles  to  the  blood  current.  A 
similar  effect  results  from  frequently  repeated  severe  muscular 
exertion,  and  from  pulmonary  edema  which  is  not  rare,  espe- 
cially in  horses.  In  other  cases  the  heart  muscle  is  weakened 
by  myocardial  inflammation  which  developed  simultaneously 
with  or  in  consequence  of  the  endocarditis.  The  strength  of  the 
heart  muscle  is  also  reduced  by  an  extensive  degeneration,  while 
a  slight  degree  of  degeneration  is  not  important  in  this  respect. 
Finally,  a  functional  disturbance  of  the  heart  muscle  must  be 
assumed,  in  a  considerable  number  of  cases,  to  form  the  basis  of 
incompensation,  wliich  cannot  at  present  be  demonstrated  his- 
tologically. 

The  incompensation  is  manifested  by  evidences  of  heart 
weakness,  that  is,  by  lowered  arterial  pressure  and  by  venous 
stasis.  The  slowing  of  the  blood  current  and  the  increased 
fullness  of  the  veins  become  manifest  in  the  appearance  of 
cyanosis,  especially  a  bluish-red  discoloration  of  the  mucous 
membranes  and  even  of  the  unpigmented  skin  (especially  in 
hogs) ;  sometimes  dilatation  and  perhaps  an  undulating  course 
of  the  veins  are  also  observed.  The  fullness  of  the  jugular 
veins  is  particularly  striking  and  is  not  infrequentlj!"  associated 
with  venous  pulsations.  Dropsical  effusions  into  the  body  cav- 
ities and  edemas  are  further  occurrences.  Edematous  swellings 
appear  first  on  the  front  and  lower  chest,  on  the  lower  abdomen 
and  in  the  lower  portions  of  the  extremities,  although  in  the  last 
location  they  usually  do  not  attain  a  considerable  degree,  owing 
to  the  tightness  of  the  skin,  especially  in  large  animals.    In  the 


Symptoms,    Course.  1099 

body  cavities  the  effusion  usually  occurs  rather  early,  first  of  all 
in  the  abdominal  cavity. 

The  stasis  in  the  brain  and  its  membranes  causes  more  or 
less  strikini>'  disturbances  in  consciousness  and  attacks  of  ver- 
ti^"0,  especially  while  at  work,  which  are  sometimes  rei)oated 
very  frequently,  even  as  often  as  10-20  times  a  day.  During 
such  attacks  horses  frequently  fall  on  their  knees  while  in 
motion  (Katzke  is  inclined  to  consider  this  as  a  phenomenon 
which  is  characteristic  of  heart  lesions). 

The  stasis  of  blood  in  the  lesser  circulation  produces  respir- 
atory disturbances;  foundering  is  in  some  of  the  cases  due 
to  a  valvular  lesion.  Chronic  bronchial  catarrh  is  a  frequent 
sequel  of  stasis  in  the  pulmonary  circulation  Rarely  a  l)loody 
or  saffron  yellow  nasal  discharge  occurs  in  consequence  of  pul- 
monary hemorrhage  which,  however,  in  exceptional  cases  causes 
death  by  asphyxia.  Epistaxis  occurs,  though  rarely.  Toward 
the  end  of  the  disease  puhnonary  edema  develops  almost  always 
as  a  terminal  ]:)henomenon. 

The  passive  hyperemia  in  the  digestive  organs  produces 
symptoms  of  chronic  gastro-intestinal  catarrh,  and  nutritional 
disturbances  develop  at  the  same  time.  The  stasis  in  the  renal 
veins  leads  to  a  diminution  in  the  amount  of  urine,  while  the 
specific  gravity  is  increased  and  the  urine  frequently  contains 
albumen,  and  occasionally  hyaline  casts. 

A  constant  S3^nptom  of  incompensation  is  presented  by  the 
disturbed  cardiac  action,  which  finds  expression  in  arhj^thmia 
and  feeble  pulse  while  at  rest,  and  still  more  on  motion. 

Loosened  portions  of  thrombi  finally  may  give  rise  to 
embolism  in  various  organs.  In  this  manner  emboli  may  get 
into  the  lungs  from  the  right  heart  and  into  the  other  organs 
from  the  left  lung.  Cerebral  emboli  and  also  cerebral  hemor- 
rhages may  be  followed  immediately  by  sudden  death. 

Course.  Valvular  disease  is  characterized  by  a  very 
changeable  course.  Aside  from  the  fact  that  its  influence  upon 
the  circulation  varies  according  to  localization  and  intensity,  the 
course  is  modified  by  external  conditions  and  by  work.  While 
dogs  which  often  pass  their  lives  in  quiet  comfort  not  rarely  live 
for  years  with  valvular  disease  in  animals  which  are  employed 
for  work,  especially  in  horses,  this  becomes  aggravated,  rela- 
tively early,  to  such  a  degree  that  they  become  useless  for  exer- 
tion. For  the  same  reason  symptoms  of  stasis,  the  development 
of  Avhich  requires  considerable  time,  are  observed  in  horses 
more  rarely;  they  show  instead  signs  of  rapidly  increasing- 
dyspnea  and  usually  die  suddenly  of  puhnonary  edema,  cardiac 
paralysis  or  rupture  of  the  heart,  during  work  or  while  in 
motion.  In  dogs  the  gradual  development  of  the  sequelae  of 
cardiac  anomalies,  up  to  severe  edematous  infiltrations,  can  be 
observed  far  better;  in  cattle  and  in  hogs  there  is  far  less  oppor- 


1100  Valvular  Diseases. 

tunity  because  these  animals  are  usually  slaughtered  before  the 
occurrence  of  these  symptoms. 

The  disease  takes  a  more  rapid  course  in  very  young  and 
in  very  old  animals,  because  both  lack  the  strength  which  is 
required  for  a  sufficient  compensation.  Congenital  heart  lesions 
lead  to  death,  with  symptoms  of  severe  blood  stasis,  usually 
during  the  first  few  weeks  or  months  of  life,  although  occa- 
sionally the  animals  become  older.  Such  cases  have  been 
observed  by  Thomas,  Walley,  Johne,  Hutyra,  Lienaux. 

Diagnosis.  The  recognition  of  valvular  disease  is  only  pos- 
sible on  the  basis  of  an  exact  examination,  which  also  considers 
the  clinical  pictures  described  above.  In  the  interpretation  of 
the  results  the  following  points  should  be  considered,  in  addition 
to  the  conditions  which  have  already  been  related. 

Sometimes  so-called  anorganic  murmurs  are  heard  without 
valvular  lesions  and  without  any  impediments  to  the  circulation 
in  the  heart;  these  murmurs  are  heard  more  frequently  during 
systole,  only  very  rarely  during  diastole.  These  murmurs  may 
be  eliminated  if  in  addition  enlargement  of  a  portion  of  tlie 
heart  or  accentuation  of  the  second  sound  can  be  demonstrated, 
or  if  a  thrill  can  be  felt  ("frfmissement  cataire"). 

The  absence  of  murmurs  does  not  exclude  the  presence  of 
a  valvular  lesion,  because  in  case  of  slight  insufficiency  or 
stenosis,  especially  at  rest,  murmurs  are  not  produced  which  are 
transmitted  to  the  chest  wall  with  sufficient  intensity,  and 
because  in  severe  insufficiency  the  formation  of  murmurs  may 
not  occur,  as  in  such  a  case  the  regurgitation  of  the  blood  does 
not  take  place  through  a  narrow  slit;  finally,  in  the  stage  of 
incompensation  too  feeble  contractions  of  the  heart  may  cause 
the  murmurs  to  disappear.  In  all  these  cases  cardiac  remedies 
and  muscular  exertion  which  have  the  effect  of  strengthening 
the  contractions  of  the  heart  usually  cause  the  murmurs  to 
reappear.  It  appears  therefore  advisable  in  all  cases  in  which 
a  suspicion  of  heart  disease  exists,  which  includes  all  cases  of 
dyspnea  the  nature  of  which  is  not  quite  evident,  to  examine  the 
animals  immediately  after  work  and  particularly  to  auscultate 
the  heart  region.  Nor  should  it  be  forgotten  *  that  in  aortic 
aneiirysm  murmurs  are  heard  which  correspond  to  the  endo- 
cardial murmurs. 

In  domestic  animals  the  recognition  of  the  several  valvular 
anomalies  is  always  successful  in  the  stage  of  compensation, 
sometimes  also  in  compensated  cases,  if  the  character  of  heart 
beat,  heart  sounds  and  cardiac  dullness  is  observed  and  the 
punctum  maximum  of  the  murmurs  is  ascertained;  a  task  which 
is  not  particularly  difficult  in  horses.  A  murmur  which  has 
originated  in  any  section  of  the  heart  is  naturally  heard  most 
strongly  at  that  place  where  the  related  part  of  the  heart  is 
nearest  to  the  chest  wall ;  but  a  decided  dilatation  of  the  heart 
with  displacement  of  the  heart  sections  produces  also  a  dis- 


Diagnosis.     Prognosis.  1101 

placement  of  tlic  piiiicta  iiiaxiina.  (Figs.  188,  189.)  The 
nature  of  the  pulse  is  of  great  importance  for  diagnosis ;  in  fact, 
its  signilicance  is  often  decisive,  and  tlie  same  is  true  for  the 
cliaractor  of  the  arteries  and  veins.  Finally  tlie  frequency  of 
the  several  valvular  anomalies  must  be  considered  on  making 
a  diagnosis. 

AVith  the  determination  of  a  valvular  lesion  tlie  proof  has 
not  yet  l)e(Mi  alTordod  that  this  lesion  is  hased  upon  a  chronic 
endocarditis,  although  valvular  disease  depends  upon  this  in  a 
great  majority  of  cases.  The  actual  cause  of  a  heart  lesion  can 
only  then  be  ascertained  "with  absolute  certainty  in  living 
animals  if  the  develoi)ment  of  the  disease  could  be  traced  from 
an  acute  endocarditis,  in  connection  with  an  infectious  disease 
or  with  chronic  arthritis.  On  the  other  hand,  the  absolute  dis- 
appearance of  endocardial  murmurs  and  of  the  s^anptoms  of 
insufficiency,  after  the  systematic  administration  of  cardiotonic 
remedies  and  during  i)hysical  rest  admits  the  assumption  of  a 
muscular  insufficiency. 

Prognosis.  ^Vlthough  the  prognosis  of  chronic  valvular 
lesions  is  always  unfavorable  in  regard  to  the  possibility  of 
healing,  the  various  forms  of  valvular  anomaly  require  different 
interpretation  with  respect  to  their  effect  upon  life  and  the  use- 
fulness of  the  animals.  Stenosis  of  the  ostia  is  in  general  a 
more  severe  disease  than  is  insufficiency  of  the  related  valves, 
and  disease  of  both  valves  of  the  heart  is  always  more  dan- 
gerous. Of  comparatively  the  least  dangerous  significance  are 
diseases  of  the  aortic  opening,  because  the  strong-walled  left 
ventricle  maintains  its  functioning  power  for  a  fairly  long  time. 
Disease  of  the  left  auriculo-ventricular  opening  must  l)e  judged 
less  favorably  because  the  right  ventricle  is  capable  of  less 
exertion  and  because  in  addition  oxidation  is  interfered  with 
by  the  persistently  increased  pressure  in  the  lungs.  The  val- 
vular lesions  which  are  localized  in  the  right  heart  are  always 
of  very  unfavorable  significance ;  that  of  the  pidmonary  opening 
because  the  lungs  receive  less  blood,  that  of  the  right  auriculo- 
ventricular  opening  because  the  auricle  which  is  to  produce 
the  compensation  is  incapable  of  doing  so. 

The  s^inptoms  of  incompensation  are  always  serious,  and 
the  more  so  the  less  they  are  to  be  referred  to  external  con- 
ditions. Of  course,  the  prognosis  is  the  less  favorable 
the  less  the  animal  can  be  protected  against  exciting  and 
exhausting  influences.  If  the  disease  has  existed  only  a  short 
time,  the  age  and  general  condition  of  the  patient  must  be  con- 
sidered. 

Treatment.  Since  healing  of  valvular  lesions  is  impossible 
of  accomplishment,  the  treatment  nuist  attempt  to  postpone  an 
aggravation  of  the  fairly  good  condition  by  a  proper  regulation 
of  the  diet,  as  long  as  symptoms  of  incompensation  have  not 


2102  '  Valvular  Diseases. 

made  tlieir  appearance.  The  patients  must  therefore  be  pro- 
tected from  all  injfluences  which  impose  an  increased  amount  of 
work  on  the  heart,  which  suddenly  change  the  blood  pressure  or 
irritate  the  heart  in  any  way.  It  is  therefore  necessary  to  regu- 
late the  diet  thus,  that  the  animals  receive  no  irritating  sub- 
stances with  their  food  (which  must  be  insisted  upon  especially 
in  carnivora),  that  not  too  much  food  is  taken  in  at  one  time,  but 
that  the  usual  daily  ration  is  eaten  in  several  small  portions.  They 
must  be  supplied  with  pure  air  or  led  around  in  the  open.  The 
work  done  by  the  patients  must  be  supervised  very  carefully. 
The  animals  are  capable  of  accomplishing  light,  quiet  and  uni- 
form work  in  proportion  to  the  mildness  of  their  heart  trouble. 
Experience  has  shown  that,  if  these  precautions  are  observed, 
animals  with  heart  disease  may  do  satisfactory  work  even  for 
years,  especially  in  agricultural  emplo^anent.  Finally  the  diges- 
tion must  be  watched  because  fecal  retention  increases  the 
abdominal  pressure,  and  therefore  the  activity  of  the  heart.  In 
such  cases  the  administration  of  mild  laxatives,  especially  of 
mineral  salts,  castor  oil,  rhubarb  or  aloes  is  indicated. 

In  the  stages  of  incompensation  (and  veterinary  aid  is 
usually  requested  only  at  this  time)  absolute  rest  must  be 
insured  and  the  action  of  the  heart  regulated.  Above  all  digi- 
talis does  good  service  because  the  heart  contracts  more  vigor- 
ously and  less  frequently  under  its  influence,  so  that  the  muscles 
obtain  more  rest  during  the  longer  pauses.  Larger  animals 
should  receive,  if  possilDle,  powxlered  fresh  leaves  (horses  2-4 
g-m.,  cattle  4-6.0  gm.  daily),  dogs  an  infusion  (1-2.0  gm.;  200.0 
gm.  of  water;  2-3  tablespoonfuls  daily),  and  the  nitrate  or 
acetate  of  potassium  may  be  added  to  increase  the  diuresis. 
According  to  the  investigations  of  Kunz-Krause  &  Eoder  it 
appears  better  to  employ  Folia  Digitalis  dialysata  (for  larger 
animals  5-15  cc.  per  os)  or  the  Digitalysatum  Burger  (20-30 
drops  subcutaneously  for  smaller  animals).  Maceration  of 
digitalis  leaves  (maceration  in  pure  water  for  12-24  hours)  may 
also  be  given  to  advantage.  Digalen  has  an  excellent  action 
and  is  to  be  recommended,  especially  if  dangerous  cardiac  weak- 
ness is  present  (horses  5-15  cc,  cattle  20  cc,  subcutaneously; 
or  15-30  cc.  intravenously;  dogs  5-15  cc  or  0.857  cc  per  kg. 
of  body  weight),  but  if  required  for  prolonged  treatment  it  will 
be  employed  only  in  valuable  or  valued  animals.  Digitalis 
being  rendered  inactive  in  the  stomach  of  the  ruminants  (Sal- 
visberg),  those  preparations  should  be  selected  for  these 
animals  which  are  adapted  for  subcutaneous  administration. 
Diehl  observed  abortion  in  pregnant  cows  after  the  use  of  dig- 
italis. The  tincture  of  strophanthus  (10-25.0  g-m.  for  large 
animals,  the  same  number  of  drops  in  smaller  animals,  daily) 
has  been  found  unreliable  in  contrast  to  Strophanthinum 
depuratum,  Merck,  the  good  action  of  which  is  constant.  It  is 
given  subcutaneously  in  aqueous  solution  (soluble  in  40  part8 
of  water)  (0.002-0.003  gm.  for  horses,  0.00025-0.001  for  dogs). 


Treatment.  1103 

At  the  point  of  injection  painful  swellings  occur  and  sometimes 
]U'crosis  of  the  skin  (Frohner,  Author's  case).  Caffeine  also 
has  an  excellent  effect  (caffeine  sodium-benzoate  or  sodium- 
salicylate  6-8.0  gm.  for  large  animals;  0.5-1.0  for  small  animals 
subcutaneonsly). 

In  pulmonary  stasis,  and  also  in  general,  moderate  vene- 
section may  prove  advantageous. 

In  case  of  distressing  palpitation  cold  compresses  upon  tlie 
region  of  the  heart  Mill  be  found  beneficial,  also  subcutaneous 
injections  of  morphine  (0.20-0.50  gm.  or  0.01-0.03  gm.).  Lienaux 
treats  the  annoying  cough  of  coexisting  bronchial  catarrh  suc- 
cessfully with  apomorphine  (0.005-0.05  for  large,  0.003-0.005 
gm.  for  smaller  dogs,  subcutaneously). 

In  edema  of  the  subcutaneous  connective  tissue  calomel  may 
be  tried,  since  in  human  medicine  a  remarkable  increase  in  urine 
and  a  rajiid  diminution  of  the  edemas  has  repeatedly  been 
observed  after  its  administration  (for  dogs  0.05-0.10  gm.  3-4 
times  daily  alone  or  with  an  equal  amount  of  jalap.  The  other 
diuretic  remedies  (acetate  of  potassium,  squills,  etc.)  may  also 
be  employed  and  at  the  same  time  the  daily  amount  of  drinking 
water  must  be  reduced.  Very  effective  is  further  agurin  (for 
dogs  daily  1-3  gm.  dissolved  in  water),  theocin  (in  like  doses), 
theophyllin  (in  like  doses).  Together  with  the  diminution  of 
the  subcutaneous  edemas  the  transudations  in  the  body  cavities 
frequently  also  become  less,  and  these  may,  moreover,  be 
removed  temporarily  by  repeated  punction.  If  this  is,  however, 
followed  immediately  by  a  reaccumulation  of  serum,  it  should 
not  be  repeated. 

Finally  an  existing  anemia  is  treated  by  the  systematic 
administration  of  iron  and  by  appropriate  feeding. 

Literature.  Balint,  Kozl.,  1897.  II.  239.  —  Brunninger,  A.  f.  Tk.,  1895. 
XXI.  39  (Lit.  on  supposed  heart  lesions).  —  Cadiot,  Bee,  1892.  568.  —  Coppel, 
Chron.  Klappenerkrank.  beim  Hunde,  Diss.  Leipzig,  1909  (Lit.)-  —  Fiebiger, 
Z.  f.  Tm.,  1902.  VI.  54.  —  Hartl,  Z.  f.  Tm.,  1902.  VI.  450  —  Huynen,  Ann.,  1908. 
391.  —  Kor^nyi,  Orv.  H.,  1906.  1019.  —  Kunz-Krauge  &  Roder,  Monh.,  1906.  XVII. 
344.  —  Lienaux,  Ann.,  1908.  325.  ~  Lnstig,  Hann.  Jhb.,  1884-85.  53.  —  Malkmus, 
D.  t.  W.,  1902.  389.  —  Marek,  Z.  f.  Tm,,  1908.  X.  448.  —  Martins,  Erg.  d.  Path., 
1894.  I.  2.  Abt.  38.  —  Oppermann,  D.  t.  W.,  1905.  307.  —  Piehz,  D.  Z.  f.  Tm., 
1898.  XXIV.  169.  (Lit,).  —  Eegenbogen,  Monh.,  1904.  XV.  418.  —  Salvisberg, 
rber  die  Wirkung  d.  Digitalis  new.,  Diss.  Bern.,  1907.  —  Schtitz,  A.  f.  Tk.,  1882, 
VIII.  139.  —  Sonnenberg,  B.  t.  W.,  1908.  213.  —  Trasbot,  A.  d 'Alf.,  1878.  210.  — 
"Wilhelm,  S.  B.,  1881.  77.  —  Zschokke,  Schw.  A.,  1907.  XLIX.  323. 


Section  III. 
DISEASES    OF   THE    BLOOD   VESSELS. 

1.     Chronic  Inflammation  of  the  Arterial  Wall.    Endoarteritis 

Chronica. 

{Endoarteritis  chronica  deformans.     Atheromatosis,  Arterio- 
sclerosis,  Atherosclerosis.) 

Occurrence.  Chronic  inflammation  of  the  arterial  wall  as 
an  independent  disease  is  apt  to  develop  at  a  more  advanced 
age;  it  is  only  rarely  observed  in  animals,  and  then  limited  in 
contrast  to  man  to  the  large  arterial  trunks.  Only  Liipke  saw 
four  cases  of  periarteritis  nodosa  in  axis-deer,  which  affects 
almost  all  arteries  of  the  general  circulation,  not  excepting  the 
smallest  blood  vessels. 

According  to  an  inquiry  of  M.  Schmidt  an  endoarteritis  of  the  aorta  could 
be  shown  macroscopically  in  0.5%  out  of  2,069  horses  autopsied  in  the  pathologic- 
anatomical  institute  in  Budapest,  according  to  Kitt  a  chronic  inflammation  is 
frequently  met  with  at  the  origin  of  the  aorta  of  older  horses.  Lyding  found 
endoarteritic  changes  in  the  aortae  of  35  out  of  100  cattle,  and  out  of  10  each 
of  horses  or  dogs  these  changes  could  be  ascertained  in  two  each.  These  observations, 
and  also  those  made  by  Sequens  and  Caparini,  permit  the  assumption  that  on  careful 
examination  the  disease  may  be  found  more  often  in  domestic  animals  than  has 
hitherto  been  assumed. 

Etiology.  Concerning  the  causes  of  the  disease  nothing 
positive  is  known.  In  a  part  of  the  cases  the  degenerative 
process  probably  arises  from  an  insufficient  nutrition  of  the  tis- 
sues in  advanced  age.  Whether  severe  exertion  may  be  a  factor, 
by  raising  the  blood  pressure  repeatedly,  is  not  certain. 

In  rabbits  intravenous  injections  of  adrenalin,  continued  for  several  weeks, 
give  rise  to  a  condition  similar  to  arteriosclerosis,  which  however  is  limited  exclusively 
to  the  aorta.  Opinions  are  not  yet  in  accord,  as  to  whether  the  disease  proceeds 
from  the  toxic  action  of  the  adrenalin  upon  the  tissue  elements  of  the  media, 
or  from  the  increased  pressure  in  the  arterial  system  which  results  from  the 
administration  of  adrenalin  (Erb  jun.,  Kiilbs,  B.  Fischer,  Scheidemandel,  Koranyi, 
K.  Ziegler).  Most  authors  take  these  changes  to  be  arterionecrosis  in  contrast 
to  arteriosclerosis.  In  this  connection  the  experiments  of  Eeinecke  with  barium 
chloride  merit  consideration,  because  the  same  changes  were  produced  as  by 
adrenalin,  and  even  more  the  experiments  of  Philisophow,  who  succeeded  in  effecting 
the  same  process  with  salts  of  mercury,  lead  and  zinc,  that  is,  with  substances 
which  do  not  raise  the  blood  pressure.  A  particular  importance  must  finally  be 
attributed  to  the  experiments  of  Saltykow  with  saprophytic  and  killed  virulent 
staphylococci,  in  which  the  changes  in  the  aortic  wall  are  claimed  to  correspond 
with  those  of  arteriosclerosis. 

1104 


Etiology,     Aiiatoiiiical   f'hanges.  1105 

These  experiments  render  it  not  impossible  that  the  inflam- 
mation of  tlio  arterial  Avail  nsnally  develops  under  the  influence 
(•f  certain  cliemieal  substances  or  bacterial  toxins.  In  human 
medicine  the  excessive  use  of  alcohol  and  tobacco,  ^out,  Bright 's 
disease,  syphilis  and  metallic  poisonini>-  are  believed  to  stand  in 
relation  in  this  respect. 

Circumscribed  ejidoarteritis  very  frequently  arises  in 
horses  under  the  influence  of  the  Sclerostomum  vul)[>-are,  prefer- 
ably in  the  Arteria  mesenterica  anterior,  not  rarely  in  tlie  aoi'ta 
or  in  the  arteries  of  the  extremities,  exceptionally  also  in  the 
arteries  of  the  other  org-ans,  inchidin.i'-  those  of  the  heart 
(Cadiot,  Piot-Bey,  ;^^al>•nin).  A  similar  iiifluence  is  exerted  by 
the  much  less  frequent  Spiroptei'a  san.^-uinolenta  upon  the  aorta 
of  the  dog,  the  Filaria  Poelsi  (Vryburg)  or  the  Filaria  Blini 
(('arougeau  &  ^farotel)  upon  the  aorta  of  buffalo  in  Sumatra, 
sometimes  also  upo7i  that  of  cattle,  without,  however,  causing 
disturbances  in  the  health  of  the  animals.  In  cattle  the  inflam- 
matory process  is  sonu^times  produced  1)v  foreign  bodies  (Sei- 
berth)". 

The  virus  of  peiiaiteritis  nodosa  in  axis-deer  could  not  be  determined  by 
Lupke  (the  eocei  -which  were  repeatedly  demonstrated  in  the  Idood  and  in  the 
diseased  organs   failed  to  produce   the   disease   in  small  experiment  animals). 

Anatomical  Changes.  In  the  incipient  stage  of  the  process 
small,  elongated  or  round,  white  or  pale  j^ellow,  shallow  eleva- 
tions are  found  on  the  intima  of  the  artery,  which  are  most 
numerous  at  those  places  at  which  the  blood  is  thrown  most 
strongly  against  the  wall,  for  instance  at  the  turns  of  main 
arteries,  at  places  where  branches  are  given  off,  etc.  Corre- 
sponding to  these  spots  there  exists,  in  horses  and  cattle,  a  pro- 
liferation of  the  connective  tissue,  Avitli  a  slight  fatty  degenera- 
tion and  calcification,  in  dogs  the  media  and  intima  are  atro- 
phied and  there  is  fatty  and  calcareous  degeneration.  Cavity 
formation  is  rare,  ulcerous  destruction  (atheromatous  ulcer) 
is  completely  missing  (Lyding).  Eventually  the  arterial  wall 
bulges  and  becomes  rigid  in  consequence  of  diminished  elas- 
ticity. 

Calcification  of  the  aortic  wall  occurs  frequently  in  old 
birds,  less  so  in  horses  and  cattle;  in  the  latter  it  is  found, 
according  to  Lignieres,  as  a  sequel  of  the  Argentinian  disease 
known  under  the  name  of  ''Enteque,"  not  only  in  the  Avails  of 
the  aorta  but  also  in  those  of  the  smaller  arteries.  In  pigeons 
the  Hypodectes  columbarum  Avhich  exists  as  a  parasite  in  the 
vicinity  of  large  vessels  may  give  rise  to  similar  changes. 

In  periarteritis  nodosa  the  arterial  wall  is  thickened,  consequently  the  vascular 
lumen  is  smaller  or  entirely  obliterated.  A  nodose  thickening  of  the  arterial  wall 
is  observed  in  varying  degree.  The  lumen  is  narrowed  or  obliterated  or  it  is  bulged 
out  and  often  contains  thrombi. 

Symptoms.  A  generalized  arteriosclerosis  can,  in  a  fairly 
advanced  stage  be  recognized  only  if  the  vessels  which  are  imme- 

Vol.  1-70 


1106  Arteriosclerosis. 

diately  accessible  to  examination  are  involved.  The  walls  of 
the  subcutaneous  arteriosclerotic  vessels  give  to  the  touch  a 
peculiar  rigid  and  sometimes  uneven  firmness,  the  pulse  is  slug- 
gish but  at  the  same  time  fairly  strong  because  the  left  ventricle 
is  usually  hypertrophied.  The  aortic  sound  is  sometimes 
accentuated  in  consequence. 

The  changes  in  the  vascular  walls  may  occasionally  be  rec- 
ognized in  the  abdominal  aorta  and  in  its  pelvic  branches.  In 
other  cases  the  presence  of  the  disease  can  only  be  assumed 
when  the  left  ventricle  becomes  hypertrophic  without  manifest 
cause  or  when  symptoms  of  thrombosis  or  embolism  make  their 
appearance. 

Periarteritis  of  axis-deer  is,  according  to  Liipke,  manifested  in  gradually 
increasing  digestive  disturbances  which  show  much  similarity  with  the  clinical 
picture  of  chronic  intestinal  catarrh.  In  t^pite  of  fairly  good  appetite  a  gradually 
progressive  emaciation  becomes  noticeable  which  passes  into  a  sickly  condition 
lasting  for  weeks  and  months. 

For  the  symptoms  of  circumscribed  arteriosclerosis  the 
following  chapters  should  be  consulted. 

Treatment.  The  further  development  of  an  established 
inflammation  of  the  arteries  cannot  be  arrested  in  any  way  and 
can  not  even  be  retarded.  In  human  medicine  iodide  of  potas- 
sium is  administered  internally  in  arteriosclerosis.  Koranyi 
succeeded  in  obtaining  a  favorable  influence  upon  the  process, 
which  had  been  produced  in  rabbits  by  injections  of  adrenalin, 
or  with  subcutaneous  injections  of  iodipin,  but  Fleischer  &  Loeb 
could  not  confirm  his  results. 

Literature.  Carougeau  &  Marotel,  Eev.  gen.,  1903.  I.  447.  —  Erb,  A.  f. 
exp.  Path.  u.  Phmk.,  1905.  LIII.  140.  —  Gulyas,  A.  L.,  1906.  73.  —  Josue,  Presse 
med.,  1904.  281.  —  Koranyi,  D.  m.  W.,  1906.  679.  —  Liipke,  Verh.  d.  Deutsehen 
Path.  Gesellsch.,  1906.  149.  —  Lyding,  Z.  f.  Tm.,  1907.  XI.  359.  —  Philisophow, 
V.  A.,  1910.  CXC.  238.  —  Scheidemandel,  V.  A.,  1905.  CLXXXI.  363.  —  iSaltykow, 
Beitr.  z.  path^  An.,  1908.  XLIII.  147.  —  Bequens,  Vet.,  1892.  352. 


2.    Dilatation  of  the  Aorta.  Aneurysma  Aortae. 

Occurrence.  The  disease  occurs  relatively  most  often  in 
horses,  much  less  often  in  dogs  and  cattle;  in  other  animals  it 
is  hardly  ever  seen. 

Etiology.  The  walls  of  the  aorta  and  those  of  the  arteries 
in  general,  with  very  few  exceptions,  become  dilated  only  when 
their  power  of  resistance  has  been  reduced,  for  instance  in  the 
presence  of  chronic  endoarteritis,  especially  when  the  blood 
pressure  is  lastingly  raised.  This  evidently  accounts  for  the 
fact  that  aortic  aneurysm  is  observed  most  frequently  in  horses 
because  these  animals  are  often  employed  for  hard  labor. 

It  might  be  interesting  to  ascertain  in  how  far  the  relation  between  the 
frequency  of  aneurysm  to  kind,  species  and  employment  of  the  animals  is  mani- 
fested.    According  to  Tombari  the  severe  exertions  which  hunters  are  obliged  to 


Etiology,    Anatomical  Changes,    Syiuptonis.  1107 

undergo  may  be  consideiod  to  stand  in  causal  relation  to  tlie  I'loqueni'V  of  aneurysm, 
and   according;-  to   Paiat  the  same  holds  true  lor    "bus  horses. 

In  exceptional  cases  the  commencement  oi'  the  development 
of  an  aneurysm  corresponds,  as  to  time,  with  external  influences, 
such  as  moving  a  heavy  load,  jumping,  being  thrown,  or  struck 
on  the  trunk,  etc.,  or  it  may  be  referreil  to  such  an  accident  with 
a  degree  of  probability.  In  such  cases  the  traumatic  factor  of 
a  sudden  excessive  rise  in  blood  pressure  might  cause  a  par- 
tial tear  in  the  aortic  wall,  in  consequence  of  which  the  ^veak- 
ened  arterial  wall  eventually  bulges  out.  On  the  other  hand  it 
is  not  impossible  that  even  in  such  cases  the  wall  of  the  vessel 
was  not  quite  healthy  before  the  accident. 

Anatomical  Changes.  A  portion  of  the  aorta  is  either 
evenly  dilated  (Aneurysma  cylindricum)  or  the  healthy  portion 
gradually  passes  into  a  dilated  segment,  which  again  gradually 
passes  into  the  healthy  part  of  the  vessel  (A.  fusiforme),  or 
only  a  short  segment  of  the  vessel  is  sacculated  (A.  sacciforme). 
In  the  latter  case  the  sacculation  either  alfects  the  entire  cir- 
cumference of  the  vessel  (A.  sacciforme  periphericum  s.  axiale) 
or  only  a  part  of  it  (A.  sacciforme  semiperiphericum).  The 
sacculated  bulging  may  reach  in  horses  the  size  of  a  man's  head 
(Labat  &  Cadeac),  in  dogs  the  size  of  a  turkey's  egg  (Barrier). 
The  wall  of  the  aneurysm  is  usually  thickened,  although  in 
places  it  may  be  thinned  out,  owing  to  compression  by  neigh- 
boring organs  or  from  other  causes.  The  thiekening  of  the  wall 
may  be  aided  by  layers  of  fibrin,  which  are  sometimes  deposited 
on  its  inner  surface,  and  these  may  entirely  obliterate  the  lumen 
of  smaller  vessels. 

The  adjoining  organs  are  crowded  aside  by  the  constantly 
increasing  aneurysm  or  they  are  compressed.  Usually  the 
trachea  or  a  bronchus  are  found  compressed,  one  or  more  ver- 
tebral bodies  atrophic,  the  Vagus  or  the  N.  Recurrens  com- 
pressed. Loosened  portions  of  fibrin  are  carried  away  mth  the 
blood  and  are  usually  arrested  in  the  vessels  of  the  posterior 
half  of  the  body. 

The  bursting  of  an  aneurysm  almost  always  leads  to  fatal 
internal  hemorrhage.  The  break  may  occur  into  the  cavity 
of  the  thorax  or  into  the  abdominal  cavity,  or  the  blood  may 
be  poured  into  a  contiguous  organ  to  which  the  aneurysm  had 
become  adherent.  In  this  manner  hemorrhages  may  take  place 
into  the  bronchi,  the  lungs,  the  stomach,  the  intestine  or  between 
the  layers  of  the  mesentery. 

Symptoms.  The  symptoms  of  aortic  aneurysm  in  animals 
have  in  the  past  not  been  observed  with  sufificient  exactness.  In 
the  majority  of  cases  the  reports  mention  only  increasing 
emaciation  and  weakness  or  sudden  fatal  internal  hemorrhage. 

Owing  to  the  anatomical  conditions  only  aneurysms  which 


1108  Dilatation  uf  the  Aorta. 

have  formed  on  the  abdominal  aorta  can  be  palpated,  in  larger 
animals  from  the  rectum,  in  smaller  animals  through  the  abdom- 
inal wall.  Below  the  vertebral  column,  slightly  to  the  left,  a 
IJulsating  swelling  is  felt,  of  variable  size,  elongated  or  spherical, 
lirm  or  slightly  elastic,  which  is  continued  into  the  normal  seg- 
ment of  the  aorta  or  into  the  two  pelvic  arteries.  Sometimes 
the  character  of  the  swelling  cannot  be  determined  exactly ;  that 
is  in  cases  in  which  edematous  swellings  or  tough  connective 
tissue  have  formed  around  it. 

The  pulsation  of  the  swelling  does  not,  of  itself,  prove  the  presence  of  an 
aneurysm,  because  tumors  or  abscesses  connected  with  the  aorta  may  show  a  similar 
pulsation,  although  it  is  then  only  by  continuation.  If  it  can  however  be  determined 
by  grasping  the  swelling,  that  it  becomes  harder  and  larger  with  each  pulsation, 
an  aneurysm  is  undoubtedly  present. 

An  important  sjmiptom  is  presented  by  the  retardation  and 
sluggishness  of  the  pulse,  which  may,  however,  be  observed  only 
in  case  of  a  considerable  thrombosis.  The  pulse  is  felt  dis- 
tinctly after  the  heart  beat,  distally  to  the  dilatation,  because 
the  copious  deposit  of  fibrin  has  usually  made  the  lumen 
of  the  vessel  narrower  and  has  thereby  impeded  the  flow  of  blood 
toward  the  periphery;  in  consequence  the  increase  in  the  sys- 
tolic ])lood  pressure,  which  is  recognized  as  a  pulse  beat,  reaches 
its  climax,  in  which  it  can  be  felt,  later.  The  vessels  in  which 
this  retardation  can  be  felt  depend,  of  course,  upon  the  situa- 
tion of  the  aneurysm.  If  this  is  at  the  origin  of  the  aorta,  the 
retardation  is  noticed  in  all  arteries  of  the  body,  an  aneurysm 
in  the  posterior  aorta  causes  a  retardation  of  the  pulse  only  in 
the  arteries  of  the  posterior  half  of  the  body  It  may  also  occur 
that  the  pulse  is  not  synchronous  in  the  two  corresponding  lat- 
eral halves  of  the  body,  viz.,  if  an  artery  branching  out  from 
the  aneurysm  has  become  narrower. 

Over  aneurysms  which  lie  superficially  or  which  form  on 
the  aorta,  vascular  murmurs  are  usually  heard,  wliich  may  be 
perceived  as  either  one  or  two  murmurs  or  as  a  continued  roar- 
ing. Over  a  pulsating  swelling  in  the  sacral  region  Tombari 
lieard  a  blowing  murmur,  which  had  more  the  character  of  rub- 
l)ing,  while  over  a  dilatation  of  the  first  segment  of  the  pos- 
terior aorta  Schmidt  perceived  a  humming  sound  which  was 
synchronous  with  the  heart  beat.  In  aneurysms  at  the  origin 
of  the  aorta  the  murmurs  are  heard  over  the  base  of  the  heart 
and  even  lower  down. 

The  left  half  of  the  heart  is  hypertrophied  only  in  those 
cases  in  which  extensive  arteriosclerosis  is  present  at  the  same 
time  as  the  aneurysm  or  in  which  the  lumen  of  the  dilated  aorta 
has  become  much  narrower  on  account  of  thrombi.  A  dilata- 
tion at  the  origin  of  the  aorta  may  lead  to  insufficiency  of  the 
semilunar  aortic  valves. 

In  case  of  considerable  stenosis  of  the  vascular  lumen  the 
nutrition  of  the  parts  of  the  body  which  are  distal  to  the  dilata- 


Symptoms,     Course,     Treatment.  110!) 

lion  Is  impaired.  In  almost  all  cases  wliicli  have  been  observed 
for  some  time,  weakness  of  the  hind  quarter  could  be  deter- 
mined, which  was  mostly  noted  only  durino-  motion  in  excep- 
tional cases  also  at  rest  (Barrier).  Finally  there  are  syini)toins 
of  cardiac  weakness  (rai)id  fatii-ue,  stron.i;-  lillino-  of  veins, 
vertigo,  sometimes  epileptoid  convulsions    [Lustig]). 

Nervous  spnptoms  are  observed  only  in  exceptional  cases, 
when  a  nerve  trunk  has  been  compressed  by  the  aneurysm.  In 
Vagus  compression,  foi'  instance,  the  heart  beat  nuiy  be  accel- 
erated; com])ression  of  the  N.  Recurrens  may  cause  laryngeal 
whistling.  In  a  case  observed  by  Schmidt  the  horse  gave  evi- 
dences of  severe  pain  on  lowering  the  head. 

Course.  A  fairly  long  time  is  probably  required  for  the 
develo])ment  of  aneurysms  to  that  degree  in  which  they  give 
rise  to  decided  morbid  changes,  probably  several  years  (in  Toin- 
bari's  case  the  disease  had  existed  at  least  three  years).  Death 
is  due  either  to  the  compression  of  neighlioring  organs  or  to  cir- 
culatory disturbances,  unless  the  bursting  of  the  aneurysm  ter- 
minates life  suddenly,  possibly  Avitli  symptoms  of  internal  hem- 
orrhage or  with  s^^nptoms  of  pulmonary  or  intestinal  hemor- 
rhage. 

Treatment.  A  succes£.ful  treatment  of  aortic  aneurysm  is 
not  possible.  The  stimulation  of  blood  clots  within  the  aneu- 
rysm by  electro-puncture,  injections  of  chloride  of  iron,  the 
introduction  of  foreign  bodies  does  not  enter  into  consideration 
in  animals.  Nor  do  subcutaneous  injections  of  gelatin  promise 
results  (in  man  50-130  gm.,  injected  in  one  dose,  of  a  2-3% 
solution).  It  may  be  mentioned,  by  the  way,  that  tetanus  infec- 
tion should  be  prevented  by  employing  Gelatina  sterilisata  pro 
injectione  (Merck).  The  treatment  is  therefore  limited  to  sav- 
ing the  animals  from  exertion  and  regulating  any  existing  car- 
diac disturbances.  The  administration  of  iodide  of  potassium 
also  seems  to  be  useless. 

Literature.      Barrier,   Bull.,    1894.   327.   —   Gerlach,    Z.    f.    Flhvg-.,  1905.    XV. 

ll.l.    —    Lai  at   &    Ca.leae,    Rev.   vet.,    1884.    105.    —   Petit,    Rec,    1905.  273,    299; 

Bull.,  1906.  ]04.  —  Piot-Bev,  Bull..  1905.  170.  —  Sr-biuidt.  A.  f.  Tk.,  1SS9.  XA'. 
295.  —  Tonibari,  Vet.  .Thb.,"l882.   74. 

Aneurisms  of  other  blood  vessels.  Even  more  frequently  than  in 
the  aorta,  a  dilatation  of  the  anterior  mesenteric  artery  and  of  its  main 
branches  occurs  in  liorses  under  tiie  intlnenee  of  the  Sclerostomum  vnl- 
^are  (Vol.  II.),  exceptionally  and  also  from  other  causes  in  swine  (Koch. 
Leibinger).  In  the  other  arteries  of  the  alnlominal  cavity  aneurisms 
are  formed  nuich  more  rarely,  hut  they  occur  for  instance  in  the  Arteria 
coeliaca.  the  Arteria  mesenteriea  ])osterior  or  in  Arteria  hepatica.  In 
other  branches  of  tlie  aorta  dilatations  are  also  very  rare.  In  Cadiot's 
case  in  an  ass,  and  in  three  cases  reported  1)y  Piot-Bey  in  cattle  a  dilata- 
tion of  the  coronary  arteries  had  caused  sudden  death.  Steinmeier  saw 
a  dilatation  of  the  carotis  cause  sudden  death  by  bursting  and  Reimers 
ol)served  i?i  tlio  sacral  region  in  a  cow  a  tense,  faintly  pulsating  bulging 


1110         General  Dimiuution  in  the  Tonus  of  the  Small  Arteries. 

which  corresponded  to  a  dilated  Arteria  ischiadica.  Querippel  described 
a  dilatation  of  the  crural  artery,  Straube  one  of  the  Arteria  digitorum 
communis  volaris,  Blase  one  of  the  Arteria  pharyngea  in  a  horse  15 
years  old ;  in  the  last  case  the  symptoms  consisted  in  edema  and  ulcera- 
tions on  the  head  and  neck,  swelling  of  the  tongue  and  gums,  salivation, 
and  the  usual  signs  of  pharyngitis ;  the  aneurism  eventually  burst  into 
the  pharyngeal  cavity.  Vogel  observed  a  dilatation  of  the  facial  artery 
in  a  cow,  Mouquet  one  in  the  cervical  artery  in  a  horse,  Ravenel  one 
in  the  brachial  arter}^  in  a  hen.  Nocard  found  in  a  young  dog  an 
aneurism  of  the  aorta  and  at  the  same  time  one  of  the  pulmonary  artery. 
Mouquet  found  in  a  horse  a  dilatation  of  the  pulmonary  artery; 
Chardin  in  a  horse  a  dilatation  of  the  hepatic  artery,  which  weighed 
14  kg.  (the  horse  had  frequently  stood  still  on  trotting  and  disliked  to 
gallop),  Dupas  found  varicose  dilatations  in  the  territory  of  the  mesen- 
teric veins,  and  Frohner  in  a  horse  a  dilatation  of  the  external  thoracic 
vein. 

General  diminution  in  the  tonus  of  the  small  arteries.  ( General  vas- 
cular paralysis).  A  reduction  in  the  tonus  of  all  small  arteries  may  be 
produced  by  certain  chemical  substances,  like  amyl  nitrite,  alcohol, 
chloral  hydrate,  chloroform,  if  they  have  been  introduced  into  the  organ- 
ism in  considerable  amounts.  Romberg,  Bruhns,  Passler  and  Roily  dem- 
onstrated in  their  experiments  a  similar  action  on  the  part  of  the  toxins 
of  various  infectious  substances.  From  a  general  relaxation  of  the 
arteries  it  necessarily  results  that  the  abdominal  vessels,  the  innervation 
of  which  is  derived  from  the  N.  splanchnicus,  and  which  especially  in 
herbivora  form  a  very  wide  system  of  blood  vessels,  receive  a  very  con- 
siderable portion  of  the  total  blood  quantity,  so  that  the  amount  of  blood 
in  the  other  organs  is  diminished.  The  diminution  in  blood  pressure 
and  the  slowing  of  the  blood  circulation  cause  an  acceleration  of  the 
contractions  of  the  heart,  the  pulse  becoming  feeble  and  empty,  because 
the  retarded  circulation  and  the  overdistension  with  blood  of  the  abdom- 
inal organs  have  produced  a  deficient  filling  of  the  heart.  Cyanosis 
develops  in  addition,  although  the  vessels  of  the  mucous  membranes  and 
the  other  veins  are  not  filled  unduly,  because  the  liackflow  of  the  venous 
blood  toward  the  heart  is  not  interfered  with ;  in  severe  cases  the  bluish 
discolored  mucous  membranes  are  pale  or  livid.  The  anemia  of  the  brain 
gives  rise  to  disturbances  in  consciousness  and  in  respiration,  and  at 
times  the  inner  temperature  falls  below  normal.  Finally  the  slow  cur- 
rent in  the  blood  vessels  reduces  the  functioning  power  of  the  heart, 
and  heart  weakness  is  added  to  the  original  circulatory  disturbances. 
Severe  general  atony  of  the  arteries  causes  death  in  a  short  time. 

In  fatal  cases  of  colicky  diseases  in  horses  (especially  after  rupture 
of  stomach  or  intestine),  also  in  the  course  of  general  infectious  diseases 
the  authors  have  observed  this  clinical  picture  repeatedly.  It  probably 
occurs  not  quite  rarely,  either  alone  or  associated  with  the  symptoms 
of  acute  myocarditis. 

The  trouble  is  differentiated  from  cardiac  weakness  only  by  the  fact 
that  the  veins  are  never  filled  strongly. 

If  atony  is  not  yet  complete  its  removal  may  be  attempted  by  vaso- 
contracting  remedies  (camphor,  caffeine,  barium  chloride,  eserine,  adren- 
alin, suprarin  or  by  intravenous  infusions  of  a  physiological  salt  solu- 
tion with  adrenalin  or  suprarenin,  while  vaso-dilating  remedies  (alco- 
hol, ether)  must  be  avoided. —  (Passler  &  Roily,  Miinch.  Med.  "Woch. 
1902,  1737). 


Obstruction  of  tho  Larpor  Artorios.  1111 

3.    Obstruction  of  the  larger  arteries.     Thrombosis  et  embolia 

arteriarum. 

Etiology.  In  exceptional  cases  the  aorta  and  its  larger 
liranelies  may  be  obstructed  by  enil)oli  which  are  derived  from 
the  heart  or  from  an  aneurysm  of  the  thoracic  aorta.  Usually, 
however,  the  obstruction  of  a  relatively  wider  vascular  lumen 
occurs  through  a  thrombus  originating  at  a  spot  in  the  wall 
of  the  vessel  which  has  become  roughened  or  after  an  embolus 
has  become  wedged  in,  the  throml)us  becoming  gradually  larger 
by  deposits  of  new  layers  of  fibrin.  For  this  reason  all  causes 
which  are  capable  of  producing  an  endoarteritis  chronica 
deformans  may  also  constitute  the  basis  of  thrombosis  of 
larger  vessels. '  This  occurs  most  frequently  in  horses  and  is 
usually  brought  about  by  the  larvae  of  the  Sclerostomum  vul- 
gare  (Scl.  bidentatum) ;  in  dogs  the  Filaria  immitis  sometimes 
leads  to  extensive  thrombosis.  Exceptionally  the  vascular 
lumen  may  be  obstructed  when  arteries  are  compressed  ])y  a 
tumor  (Mack,  Frohner),  by  exostoses  (Gassner,  Pirl),  which 
may  also  produce  chronic  inflammation,  even  to  complete  occlu- 
sion of  the  aorta.  An  acute  inflanmiation,  finally  ( Vennerhohn) 
or  contusion  of  the  vessel  wall  (H.  Bouley)  may  be  the  causes 
of  occlusion  of  arteries. 

Anatomical  Changes.  The  thrombosis  in  horses  which  is 
usually  produced  by  larvae  of  sclerostoma  is  found  mostly  in  the 
"anterior  mesenteric  artery,  fairly  frequently  at  the  posterior 
end  of  the  abdominal  artery  and  in  its  pelvic  branches  (artt. 
iliacae,  femorales,  hypogastricae),  from  where  the  thrombus 
may  become  continued  downward  into  the  tibial  arteries;  in 
exceptional  cases  the  vessels  of  an  anterior  extremity  (art.  axil- 
laris, art.  brachialis)  or  the  first  portion  of  the  aorta  (Berg- 
strand)  is  found  obstructed.  In  a  case  of  Filariosis  haematica 
in  a  dog  Hutyra  found  a  large  portion  of  the  thoracic  and  abdom- 
inal aorta  filled  up. 

The  thrombus  is  usually  attached  to  the  roughened  wall  of 
the  vessel ;  it  is  dry,  tough,  and  usually  arranged  in  layers.  It 
may  cover  only  a  part  of  the  vessel  wall  and  thus  make  the 
lumen  smaller  (thrombosis  parietalis),  or  it  occupies  the  entire 
periphery  of  the  vessel  wall,  in  which  case  there  remains  a 
patent  canal  in  the  direction  of  its  longitudinal  axis  (Thr. 
canalisatus),  or  finally  it  obstructs  the  vessel  entirely  (Thr, 
obturans).  The  end  or  the  outer  surface  of  a  throml)us  which 
does  not  occlude  the  blood  vessel  completely  is  usually  formed 
by  layers  of  fresh  fibrin,  which  reach  into  the  circulating  blood 
and  perhaps  into  a  lateral  branch  in  the  form  of  plug's,  and  are 
in  all  probability  usually  the  result  of  post-mortem  coa,«'ulation. 

An  obturating  thrombus  may  in  time  disintegrate  and  l)e 
absorbed,  but  in  the  meanwhile  a  proliferation  of  connective 


1112 


Obstructiou  of  the  Larser  Arteries. 


tissue  from  the  vessel  wall  takes  place  which  may  eventually  fill 
out  the  vessel,  the  lumen  of  which  is  already  narrowed,  com- 
pletely and  transform  it  into  a  firm  connective  tissue  cord 
(organization  of  thrombus).  Such  a  change  occurs,  however, 
more  often  at  the  places  where  emboli  have  become  wedged  in, 
which  is  a  fairly  frequent  occurrence  in  the  smaller  peripheral 
arteries. 


Fig.  197.     TJiiomhosis    of    the   posterior    end    of    the    abdominal    aorta   and    of    its 

branches,  in  a  horse,  a  Abdominal  aorta;  6  b'  Art.  circiiniflexa  ilium  prof.;   c  c '  Art. 

iliaca  externa;  d  d'  Art.   hypogastrica  ;  [  f  e' Art.   obturatoria  ;  //'Art.   iliolumbalis; 

[I  o'  Art.  giutaea  sup. ;  h  h'  Art.  sacralis  lateralis. 


Pathogenesis.  The  obstruction  of  large  arterial  trunks  pro- 
duces a  peculiar  disturbance  in  the  function  of  the  muscles.  In 
the  majority  of  cases  the  vessel  is  not  completely  obstructed  by 
the  thrombus,  and  even  if  this  occurs,  a  collateral  blood  circula- 
tion is  established  in  a  short  time  by  the  intermediation  of 
branches  which  pass  off  proximally  to  the  thrombus.  The  part 
of  the  body  which  is  to  be  nourished  by  the  obstructed  vessel 
receives  also  in  future  a  certain  amount  of  blood,  sufficient  to 


Pathogenesis,     Symptoms.  lllS 

supply  all  tissues  of  the  body  part  in  ciuestion  with  the  nutri- 
tional substances  necessary  for  life,  and  which  sometimes  even 
eiial.lcs  m  muscles  to  accomplish  a  certain  degree  of  work.  If 
however,  the  animal  accomplishes  prolonged  and  severe  mus- 
cular labor,  the  deficiency  in  oxygen  causes  an  insufficient  oxida- 
tion and  therefore  the  development  of  insufficient  force,  and  also 
a  tT-ansitory  accumulation  of  products  of  metabolism  in  the 
muscle,  especuilly  lactic  acid  and  carbonic  acid,  which  lead  to  a 
more  rapid  fatignie  of  the  muscle.  When  the  exercise  is  inter- 
rupted, the  products  of  fatigue  are  gradually  eliminated  from 
the  muscle,  the  feeling  of  fatigue  and  the  disturbance  in  func- 
tion are  abated,  but  reappear  on  renewed  prolonged  muscular 
exertion. 

Symptoms.  The  form  and  the  intensity  of  motor  disturb- 
ances depend  upon  the  arteries  which  are  obstructed  and  upon 
the  degree  of  occlusion.  In  the  rather  rare  thrombosis  of  the 
posterior  portion  of  the  aorta  the  trotting  or  galloping  horse 
begins,  after  a  variable  time,  to  become  uncertain  in  the  hind- 
quarter,  it  staggers,  the  feet  are  raised  less  high,  and  soon  it  can 
no  longer  move  at  all,  remaining  standing,  bathed  in  perspira- 
tion and  trembling.  If  urged  further,  it  finally  collapses  and 
tails  to  the  ground.  While  lying  on  the  ground  the  animal  grad- 
ually becomes  calmed;  it  arises,  after  a  time,  of  its  own  accord 
and  may  move  at  a  walk. 

In  thrombosis  of  aortic  branches,  especially  the  pelvic  or 
temoral  arteries,  the  motor  disturbance  commences  in  a  similar 
manner,  but  is  limited  to  one  of  the  posterior  extremities.  After 
a  certain  time,  which  may  be  only  a  few  minutes,  the  horse  raises 
the  toot  less  high,  it  cannot  move  it  very  certainly,  may  interfere 
occiisionally  against  the  other  foot;  it  hangs  its  head  and  if  pos- 
sible bears  the  weight  of  the  body  upon  the  front  feet;  soon  the 
joints  are  bent  less  and  less,  the  hoof  scraping  the  ground  at 
each  step,  and  finally  the  affected  foot  gives  out,  the  animal  fall- 
ing upon  the  diseased  side  of  the  body  on  being  urged  further 
In  bilateral  thrombosis  of  the  femoral  ai-terv  the  motor  disturb- 
ances correspond  as  a  whole  with  those  of  thrombosis  of  the 
abdominal  artery,  although  the  uncertainty  in  the  sacral  region 
is  less  striking.  '  ^ 

_  Thrombosis  of  the  axillary  and  brachial  arteries  leads  to 
similar  disturbances  in  motion  in  the  one  fore  foot.  Here  also 
a  gradually  increasing  muscular  weakness  becomes  perceptible 
the  horse  stumbling  on  the  fore  foot,  knocking  it  against  impedi- 
ments and  scraping  the  ground  with  the  hoof,  until  the  foot 
commences  to  tremble  violently  and  is  finally  paralyzed 

Complete  occlusion  of  the  pelvic  arteri'es  causes  paralysis 
ot  the  sacrum,  the  tail,  the  bladder,  and  of  the  rectum;  a  partial 
thrombosis  gives  rise  to  motor  disturbances,  which  occur  only 
on  motion  and  is  similar  to  sacral,  paralysis. 

The  paralysis  disappears  after  a  certain  period  of  rest  but 


2114  Obstruction  of  the  Larger  Arteries. 

reappears  on  the  next  occasion,  unless  accidentally  paralytic 
hemoglobinemia  has  been  added,  to  which  horses  with  throm- 
bosis of  the  arteries  of  the  extremities  appear  to  be  predisposed. 

General  symptoms  are  also  present  as  a  rule.  The  animal 
shows  great  anxiety,  the  heart  action  is  remarkably  excited  and 
accelerated,  the  respiration  is  also  accelerated  and  difficult,  the 
mucous  membranes  show  intense  injection.  Although  a  general 
perspiration  takes  place,  the  affected  extremity  remains  dry 
(Humbert,  Gal),  it  feels  very  cool  to  the  touch  (Palat).  Fried- 
berger  &  Frohner  have  observed  no  general  symptoms  in  throm- 
bosis of  the  axillary  artery,  in  spite  of  existing  motor  disturl)- 
ances. 

Thrombosis  may  be  recognized  with  absolute  certainty,  if 
it  is  possible  on  palpation  to  find  firm  blood  clots  or  a  compress- 
ing swelling  in  the  related  blood  vessels.  In  many  cases  tlic 
hand,  which  has  been  introduced  into  the  rectum,  may  ascertain 
the  presence  of  the  thrombus  on  palpating  the  aorta  or  the 
larger  vessels  on  the  sides  of  the  pelvis ;  its  presence  may  also 
be  assumed,  owing  to  the  weakness  or  complete  absence  of  pulsa- 
tion or  owing  to  a  thrill  which  may  be  felt.  If  the  throml^osis 
cannot  be  found  within  the  pelvis,  a  total  or  partial  obstruction 
of  the  femoral  or  axillary  arteries  may  be  assumed  to  exist  from 
the  fact  that  the  pulse  cannot  be  felt  at  all  or  only  feebly  in  the 
vessels  beyond  the  thrombus,  on  the  metatarsus  or  metacarpus. 

A  partial  thrombosis  sometimes  produces  no  disease  symptoms  -whatever. 
For  iustance  a  horse  with  partial  thrombosis  of  the  posterior  aorta  covered  a 
distance  of   130  km.  two  days  before  autopsy    (Gratia). 

Glockner  has  observed  difficult  deglutition,  whistlinjj  respiration,  and  later  the 
symptoms  of  pulmonary  emphysema  in  thrombosis  of  the  carotid  arteries. — Siegen 
saw  epileptiform  convulsions  in  thrond)osis  of  the  left  carotid  and  the  internal 
carotid ;  the  convulsions  appeared  only  after  the  horse  had  trotted  for  20-30  minutes 
and   lasted   about   20   minutes. 

Course  and  Prognosis.  In  a  portion  of  the  cases  softening 
or  contraction  of  attached  thrombi  occurs,  so  that  the  blood 
paths  become  more  or  less  opened,  or  the  obstruction  persists, 
but  the  circulation  in  the  territory  concerned  is  equalized  by  the 
collateral  circulation  which  has  meanwhile  been  established.  In 
both  cases  the  affected  part  of  a  body  may  after  a  certain  time 
(3-6  months)  again  receive  a  sufficient  supply  of  blood  for  the 
muscles  to  accomplish  even  continued  and  severe  work.  A  com- 
plete recovery  in  this  meaning  of  the  term  is  nevertheless  very 
rare,  since  the  supply  of  blood  through  the  narrowed  paths  or 
through  the  new  collateral  tracks  still  remains  insufficient,  and 
since  the  existing  thrombosis  gives  rise  to  the  further  produc- 
tion of  fibrin  or  to  embolism,  which  are  followed  by  relapses  and 
by  aggravation  of  the  condition.  In  exceptional  cases  throm- 
bosis of  the  posterior  extremities  may  be  complicated  eventually 
by  thrombosis  of  the  brachial  artery  (Schraml). 

In  other  cases,  an  equalization  of  the  circulatory  disturb- 
ances does  not  take  place,  the  function  remains  permanently  im- 


Course  and  Prognosis,     Treatmoiit.  1115 

paired,  and  tlio  impediment  to  the  circulation  is  even  increased 
by  the  deposit  of  new  masses  of  fibrin.  In  such  cases  the 
affected  part  of  the  body,  usually  an  extremity,  atrophies  owin^- 
to  iusullicient  nutrition*,  and  the  animal  finally  becomes  unfit 
even  for  very  liiiht  and  slow  work.  In  rare  cases  the  obstruc- 
tion may  beci)me  so  extreme  that  some  origans  receive  no  Ijlood 
at  all  aiid  die  in  consequence.  Martin  and  Bouley  saw,  each 
iu  one  case,  oan,i;rcne  of  the  muscles  of  the  anterior  extremity 
after  ol)struction  of  the  axillary  artery,  Cadeac  &  Malet  observed' 
the  same  in  a  posterior  extremity  in  thrombosis  of  the  femoral 
arterv. 

If  a  vessel  has  become  obstructed  by  an  embolus  derived 
from  the  first  segment  of  the  anterior  or  posterior  aorta,  the 
fact  must  be  considered  in  giving-  a  prognosis  that  similar 
emboli  might  be  carried  into  vital  organs  (brain,  kidneys,  etc.). 

Treatment.  In  order  to  promote  the  collateral  circulation, 
systematic  exercise  of  the  animals  is  indicated,  the  patients 
lu'ing  led  about  daily  at  a  walk  until  the  first  symptoms  of 
paralysis  appear  (Bayer).  It  is  sometimes  possible  to  realize 
even  complete  improvement  by  continued  and  gradually  increas- 
ing work  (Baver,  Jolme).  It  may  also  be  attempted  to  massage 
a  thrombus  which  is  palpable  in  the  pelvic  cavity,  with  the  hand 
in  the  rectum,  for  5-10  minutes  daily,  which  proceeding  may  also 
perhaps  hasten  the  absorption  of  the  fibrin  coagulations  (Collin, 
Beyer).  Internal  treatment  which  has  repeatedly  been  pro- 
l)osed,  especially  the  administration  of  iodide  of  potassium, 
promises  no  results. 

Literature.  Albreeht,  W.  f.  Tk.,  1901.  325.  —  Cadeac  &  Malet,  Eev.  vet.. 
18S.5.  530  (Lit.).  —  Frohner,  Mouh.,  1903.  XIV.  445;  1905.  553;  1907.  XVI II.  130. 
—  Gratia,  Ann.,  1906.  489.  —  Merkt,  W.  f.  Tk.,  1904.  261.  —  Schimmel  &  Eess-er, 
Ann.,  1905.  543.  —  Biedamgrotzky,  S.  B.,  1896.  18. 


Thrombosis  of  the  Pulmonary  Artery.  The  obstruction  of  the  pul- 
monary artery  is  not  very  rare  and  is  brought  about  by  emboli  from  the 
right  heart.  The  parts  of  thrombi  may  have  originated  in  the  right  heart 
itself,  or  not  infrequently  they  are  carried  there  with  the  venous  blood 
from  distant  parts  of  the  body.  In  exceptional  cases  thrombosis  forms 
in  the  pulmonary  artery  after  the  invasion  of  foreign  bodies  (hair  which 
had  been  introduced  oil  venesection  from  tlte  jugular  vein  [Zschokke] 
or  broken  hypodermic  needles  jPrevot])  or  in  the  presence  of  parasites 
(Filaria  im'mitis,  Strongylus  vasorum  fFerez]).  In  many  cases  the 
cause  could  not  be  determined,  prol)ably  because  distant  organs  had  not 
been  examined  carefully.  Kiippel  succeeded  in  63%  of  the  cases  diag- 
nosed bv  him  to  find  the  source  of  the  embolism  by  careful  and  syste- 
matic examination  of  the  organs  of  horses  which  had  ])een  slaughtered 
(lie  found  thrombosis  of  the  pulmonary  artery  in  9%  of  all  slaughtered 
liorses,  which  were  mostly  old  animals)  ;  the  embolisms^  originated  in 
most  cases  in  thrombotic  veins  in  the  posterior  extremities  and  in  the 

sheath. 

Obstructions  of  smaller  pulmonary    vessels    do   not   give    rise    to 
pathological   disturbances,   but   when   larger   branches  were   obstructed 


1116 


Obstruction  of  the  Large  Venous  Trunks. 


(Kappel  found  this  to  have  been  the  case  in  12  out  of  38  instances), 
ditficult  respiration  occurred,  like  dyspnea  or  sudden  asphyxia  which 
sometimes  caused  rapid  death. —  (Kappel,  Z.  f.  Tm.,  1904.  VIII.  321. — 
Prevot,  Bull.,  1908,  625.). 


4.    Obstruction   of  the   Large   Venous   Trunks.    Thrombosis 

Venarum. 

Obstruction  of  the  large  venous  trunks  is  rare  and  is  usually 
due  to  compression  (by  enlarged  lymph  glands,  tumors, 
abscesses),  less  often  it  occurs  in  connection  with  endophlebitis 
or  slowing  of  the  circulation. 

Cases  of  thrombosis  of  the  venae  cavae  have  been  observed 
especially  in  horses  and  cattle,  once  also  in  a  dog.  In  the  horse 
thrombosis  of  the  portal  vein  has  been  known  to  occur. 


Fig.  198.     Stenosis  of  the  anterior  vena  cava.     Edematous  infiltration  of  the  region 
of  neck  and  shoulder;   the  swelling  is  sharply  arrested  near  the  xiphoid  cartilage. 

The  symptoms  are  easily  interpreted  by  the  anatomical 
arrangement  of  the  venous  trunks,  because  stenosis  or  obstruc- 
tion of  one  vena  cava  produces  venous  stasis  in  that  part  of 
the  body  from  which  the  vein  returns  the  blood  to  the  heart. 
Thus  thrombosis  of  the  anterior  vena  cava  produces  strong- 
filling  of  the  veins  of  head,  neck,  anterior  extremities,  and 
thorax,  also  edematous  infiltration  of  these  regions  or  dropsy 
of  the  chest  (Fig.  198).  If  the  obstruction  is  incomplete  a  neg- 
ative   pulsation    may   become    evident    in    the    jugular    veins. 


Symptoms.  1117 

Tlirombosls  of  tho  posterior  vena  cava  causes  similar  changes 
in  tlie  liindquarter,  witli  which  abdominal  dropsy  is  associated 
if  the  location  of  the  obstruction  is  between  heart  and  liver. 
Thrombosis  of  the  portal  vein  impairs  the  motility  of  stomach 
or  intestine  (Vol.  II.). 

The  circulatory  disturbances  may  occasionally  Ijecome  much 
lessened,  as  was  shown  in  a  case  of  Albrecht's  and  in  one  of  the 
author 's. 

Literature.  Albrecht,  Z.  f.  Tm.,  1902.  VI.  428  (Lit.).  —  Barrier,  Bull., 
1906.  I'.s.i.  —  Basset,  Kec,  1905.  (i09.  —  Bretagnier,  Kec,  1909.  15(3.  —  Chouleur 
&  Lebasque,  Bull.,  1908.  256.  —  Cuny,  J.  vet.,  1906.  224.  —  Douville,  Bull.,  1907. 
(i2.  —  Forgeot,  J.  vet.,  1906.  362.  —  Friedrieh,  B.  t.  W.,  1905.  4.  —  Petit  & 
Delaeroi.x,  Bull.,   1905.    133. 


5.    Rupture  of  the  Large  Blood  Vessels,  Ruptura  Vasorum. 

The  walls  of  the  large  blood  vessels  rupture  at  times,  even 
without  previous  disease.  The  first  seginents  of  the  aorta  and 
of  the  puhnonary  artery  are  very  thin  at  the  level  of  the  semi- 
lunar valves  (the  aorta  of  the  horse  is  in  some  places  only  1  mm. 
thick,  while  lower  down  the  thickness  is  5-7  mm.),  so  that  they 
are  bulged  out  somewhat  by  the  pressure  of  the  blood,  eveii 
under  normal  conditions  (Sinus  Valsalvae)  and  may  rupture 
if  a  sudden  rise  in  blood  pressure  occurs.  Among  causative 
factors,  aside  from  immediate  injuries,  may  be  mentioned  the 
pulling  of  heavy  loads,  severe  exertion  in  galloping,  vomiting, 
labor  pains  (Sigl)  or  other  exertions.  Similar  causes  may  some- 
times lead  to  rupture  Of  the  anterior  or  posterior  vena  cava  or 
of  the  portal  vein. 

Usually,  however,  rupture  is  preceded  by  a  disease  of  the 
vessel  wall,  although  this  may  not  be  visible  to  the  naked  eye, 
as  in  a  case  of  Caparini's.  In  most  cases  there  is  a  sclerosis 
with  subsequent  bulging  of  the  vessel  wall,  which  favors  rupture. 
This  cause  is  responsible  for  the  rupture  of  vessels,  especially 
in  older  animals.  The  same  result  is  observed  if  an  abscess  or 
ulcerating  process  in  the  immediate  vicinity  of  the  vessel  is 
transmitted  to  the  vessel  wall  from  an  ulcerating  valve,  a  cari- 
ous bone,  or  from  a  breaking  down  new  growth,  causing 
erosion  of  the  vessel.  Finally  animal  parasites,  in  the  horse 
the  larvae  of  Sclerostomum  vulgare,  in  the  dog  Spiroptera  san- 
guinolenta  may  weaken  the  vessel  wall  so  much  in  places  that 
it  finally  tears  under  the  influence  of  the  blood  ]3ressure. 

The  following  facts  may  illustrate  the  manifold  etiological  factors:  Palat 
saw  rupture  of  the  aorta  at  the  level  of  the  valves  without  demonstrable  external 
cause,  Lustig  saw  it  occur  on  galloping.  Sequens  found  in  three  cases  the  point 
of  rupture  about  1  cm.  above  the  valves  in  the  vicinity  in  which  the  vessel  wall 
was  diseased,  but  Cadiot  could  not  find  any  pathological  changes  in  two  cases. 
In  one  case  described  by  Vaerst  hemorrhage  occurred  from  a  small  aneurysm 
situated  opposite  the  valves. — In  a  case  reported  by  Prietsch  the  healthy  pulmonary 
artery  was  ruptured  while  drawing  a  heavy  load.  Block  saw  a  four-yonr-old  stallion 
bleed   to   death   after   having  been   thrown ;    the   pulmonary   artery  was   torn   at  the 


1118  Rupture  of  the  Large  Blood  Vessels. 

bifurcation. — Ehlers  observed  rupture  of  the  portal  vein  after  a  blow  on  the  left 
side  of  the  body. — Schrulle  reports  a  case  of  fatal  hemorrhage  from  rupture  of 
the  left  axillary  artery  in  a  horse  which  had  been  thrown.  On  autopsy  of  a 
horse  Biihrmann  found  an  abscess  between  the  pillars  of  the  diaphragm,  which 
had  ruptured  into  the  aorta. — in  Gassner  's  case  an  exostosis  on  the  16th  vertebra 
had  injured  the  aortic  wall,  in  Noack's  case  a  sarcoma  growing  behind  the  kidney 
had  done  the  same.  Parasites  may  also  be  involved.  Morgagni  found  in  one 
dog,  Megnin  in  three  dogs,  the  Spiroptera  sanguinolenta  in  the  wall  of  the  aorta; 
it  was  present  in  the  form  of  small  whitish  nodes  one  of  which  had  caused  rupture 
of  the  aorta.  Durieux  and  Degive  finally  could  demonstrate  in  a  horse  that  fatal 
hemorrhage  had  been  due  to  destruction  of  tissue  by  the  larvae  of  the  Sclerostomum 
vulgare  (in  one  case  the  aorta  was  apparently  sound,  in  the  other  it  presented 
in  its  entire  length  the  picture  of  atheromatosis). 

The  symptoms  of  rupture  of  a  vessel  indicate  in  general 
only  internal  hemorrhage,  the  exact  cause  of  which  can  usually 
only  be  ascertained  on  autopsy. 

Literature.  Bonnet,  J.  vet.,  1905.  147.  —  Caparini,  Arch,  sclent,  d.  E.  Soc. 
ed  Aecad.  Vet.  It.,  1903.  87.  —  Ehlers,  B.  t.  W.,  1889.  4.  —  Gamble,  V.  Journ., 
1908.  345.  —  Lustig,  W.  f.  Tk.,  1877  241  —  Magnin,  Eec,  1903  693.  —  Pecus, 
J.  vet.,  1902,  351.  —  Petit,  Bull.,  1905.  299;  1906  104.  —  Pr.  Mil.  Vb.,  1899-1908. 
—  Prietsch,  S.  B.,  1881.  85.  —  Sequens,  Vet.,  1892.  352.  —  Sigl,  W  f.  Tk.,  1905. 
8.  _  Vaerst,  Monh.,  1893.  IV.  185. 


Lyiu])hynhagia.  1119 

Appendix. 
Lymphorrhagia. 

Etiology.  In  horses  and  cattle,  and  exceptionally  in  other 
animals  8\vellini>s  develop  sometimes  in  a  short  time,  in  variable 
numl)er  andcxtent,  containini;-  a  clear  lynii)h-like  flnid  which  may 
be  mixed  with  dead  tissue  shreds.  According  to  lioll'mann  and 
Dratsehinsky  these  swellings  are  due  to  tears  between  the  skin 
and  fascia  or  between  muscle  and  fascia,  produced  by  some  con- 
siderable injury  which  has  a  pushing  or  pulling  action.  Into 
these  tears  lymph  flows  from  the  torn  hmph  vessels  and  is  mixed 
with  the  torn  tissue  particles.  (Astrachanzew  found  once  in  the 
Iymi)h  a  worm  5  cm.  long,  which  he  believed  to  be  a  kind  of 
Filaria  medinensis.) 

Bayer  has  seen  lymph  effusions  in  a  cat,  in  circular  arrangement 
around  the  nipples ;  the  lymph  vessels  were  dilated. 

Symptoms.  Sometimes  the  swellings  form  successively  in 
the  course  of  several  days  and  produce  marked  changes  in  form 
if  they  become  confluent.  In  the  case  of  a  cow,  reported  by 
Zonda,  which  had  broken  down  beneath  an  ox,  swellings  like  those 
just  described  formed  on  the  lower  alxlomen,  on  the  chest  and 
on  the  internal  aspect  of  the  thighs,  all  in  the  course  of  four 
days.  Although  the  appetite  is  not  impaired  the  animals  rapidly 
become  emaciated,  owing  to  the  loss  of  nutritive  material.  The 
swellings  are  not  painful  or  warm,  but  they  show  fluctuation  if 
situated  superficially.  After  incision  a  clear,  yellow  odorless 
haiipli  flows  out,  or  sometimes  a  dirty  yellow  or  reddish,  ill- 
smelling  fluid  which  is  mixed  with  tissue  shreds.  The  quantity 
may  be  considerable. 

Treatment.  The  swellings  are  usually  treated  l)y  incision, 
removal  of  the  hTnph,  irrigation  of  the  cavities  with  disinfecting 
solutions  or  the  application  of  disinfecting  powders,  finally  the 
application  of  a  compressing  dressing.  Sometimes  continued 
irrigation  of  the  cavity  with  lukewarm  solutions  of  corrosive 
sublimate  is  of  benefit  (on  opening  such  swellings  there  is 
always  danger  of  septic  infection  [Jolme]).  If  the  skin  has 
been  loosened  over  a  large  extent  it  may  have  to  be  sutured  to 
the  underlying  tissue.  Small  swellings  disappear  on  the  appli- 
cation of  warm  compresses  and  massage.  The  patients  must  be 
nourished  generously. 

Literature.  Astraelianyew,  A.  f.  Vet. -Wigs.,  1S93.  204.  —  Dratschinskv,  ibid., 
1904.  7S7.  —  Hoffmann,  Z.  f.  Vk.,  IsiOT.  1.  —  Vennerholin,  Svensk  Vet.-ti.lsskr., 
1904.  TX.  oU7.  —  Wallcv,  J.  of  eomp.  Path.,  1892.  360.  —  Zon<la,  Vet.,  1894.  369, 


Index,  Vol.  I. 


PAGE 

Abortin    ''^47 

Abortion,  enzootic 740 

Abortion,  infectious    740 

Abscess   of   kidney 1008 

Acetone   39 

Aetinobacillosis    666 

Actinobacillus    666 

Actinomycosis    642 

Actinomycosis,  atypical    66/' 

Actinomycosis  of  the  dog 670 

Actinomycosis  of  man 665 

Actinophytosis   645,  667,  670 

Actinomyces  bicolor    671 

Actinomyces  bovis 643 

Actinomyces  canis 671 

Actinomyces  cmiiculi    420 

Actinomyces  necrophorus 420 

Adenitis,  equorum 366 

Adeno-carcinoma  of  the  kidney  1028 

Adenoma  of  the  heart 1077 

Adenoma  of  the  kidney 1028 

Adrenalin,     action     on     blood 

vessels    1104 

Aerogenes  bacillosis    151 

African  glanders   734 

Agglutination  in  glanders.  ....  721 
Agglutination       in       infectious 

abortion     '4^ 

Agglutination  in  tuberculosis.  .  ")S, 

Aggi'essins  in  anthrax 30 

Aggressins     of      the      bipular- 

bacillus   R4.  13() 

AggTessins  in  fowl  cholera ....  ^G 

Aggressins  in  strangles 3S2 

Albuminometer,  Esbach   078 

Albuminuria    ^^^ 

Albuminuria,  physiological    .  .  .  077 

Albuminuria  renalis    078 

Albuminuria,  spurious    0i(^8 

Albuminuria,  true   0<8 

Aleppo  boils ^97 

Allergy  in  abortion ^47 

Allergy  in  glanders |^0S 

Allergy  hi  tuberculosis 574 

Allotriophagia    f>63 

Amblyomma  hebraeum   25/ 

Ameisic  acid  in  urine 027 


PAGE 

Amyloid  kidnej-  987 

Anemia    845 

Anemia,  acute   847 

Anemia,  chronic    847 

Anemia,  infectious  of  chicks. . .  846 

Anemia,  infectious  of  hor.ses.  . .  851 

Anemia,  progressive  pernicious  863 
Anemia,  progressive  pernicious 

of  cattle 868 

Anemia  of  the  young  pig. ....  846 
Anemia  of  siieep  and  goats  in 

Punjab    867 

Anaplasnia  marginale 763 

Anaplasmosis   783 

Anasarca,  essential   216 

Anasarca,  idiopathic   216 

Aneurism  of  the  aorta 1106 

Aneurism  of  the  blood  vessels  1109 
Aneui*ism  of  the  coronary  ar- 
teries   1076,  1109 

Aneurism   of   the   heart,   acute 

1076-1081 

Aneurism  of  the  heart,  chronic  1076 

Aneurism  of  the  heart,  fibrous  1074 

Aneurism,  iiipture 1081 

Aneurism,  valvular   1081 

Angina,  Vol.  II 

Angma  diphth.  vitulorum 419 

Angioma  of  the  heart 1 

Anopheles  mosquitoes    797 

Anthraco-muein   12 

Anthrax    1 

Anthrax,  acute 16 

Anthrax,  apoplectic    16 

Anthrax,  bacterial    24 

Anthrax  in  man 31 

Anthrax,  intermittent   18 

Anthrax,  subacute  16 

Antiphymatol  85 

Antistreptocoecus  senun   .  .231,  386 

Aorta,   aneurism   of 1106 

Aorta,  calcification  of 1105 

Aorta,  rupture  of 1117 

Aphthous  eruption    340 

Aphthous  fever  of  eamivora. .  354 

Aphthous  fever  of  fowls 354 

Ai^hthous  fever  of  the  horse..  .354 


121 


1122 


Index. 


PAGK 

Aphthous  fever  of  man 355 

Apiosoma  higeminiim   765 

Apoplectic  septicemia  of  fowls  101 

Apoplexy   intermeningialis    ...  14 

Argas  miniatus    840 

Argas  perspieus 840 

Argas  reflexus    840 

Arion   subfuseus    8 

Arteriosclerosis    1104 

Arteritis,  acute    1111 

Arteritis,  chronic   1104 

Arteiy,  compression  of 1109 

Artery,  crushing  of 1111 

Artery,  plugging  of 1111 

Arthritis  urica  968 

Arythmatic     action     of     heart, 

systolic    1059 

Arvthmatic     action     of     heart. 

true    1057 

Atrophy  of  heart 1052 

Atrophy  of  kidney,  cyanotic.  .  .  985 

Atrophy  of  kidney,  granular  .  .  1001 

Azoturia    886 

Babesia,  see   Piroplasma 760 

Bacillus  abortus  infectio 740 

Bacillus  aerogenes 148 

Bacillus  anthracis 3,  19 

Bacillus  anthracis  asporogenes.  4 

Bacillus  anthracoides   20 

Bacillus  avicida 88 

Bacillus  avisepticus 88 

Bacillus  bipolaris  sejiticus.  .7!).  80 

Bacillus  bovisepticus 104 

Bacillus  bubalisepticus    114 

Bacillus  canariensis  necro] (horns  100 

Bacillus  canisepticus 199 

Bacillus  chauveaui 39 

Bacillus  cholerae  cohnnbaruin .  .  98 

Bacillus  cholerae  gallinannn  .  . .  88 

Bacillus  cholei'ae  suum 261 

Bacillus  coli  communis.  ..  .146.  159 

Bacillus  cuniculicida 101 

Bacillus  diphtheriae  avium. 424.  427 
Bacillus      diphtheriae      colum- 

barum   424,  427 

Bacillus  diphtheriae  hominis.  . .  437 

Bacillus  diphtheriae  vituloruni.  419 

Bacillus  enteritidis  Gaertnei'.  . .  148 

Bacillus  equisepticus 173 

Bacillus  erysipelas  suis 60,  72 

Bacillus  felisepticus   211 

Bacillus  f iliformis 420 

Bacillus   gallinaiiim    98 

Bacillus  gangi'aenae  emphvsem. 

2(),  39,  49 

Bacillus  gastromycosis  ovis.  .  .  .  57 

Bacillus  mallei  681 

Bacillus  multocida 79 


PAGE 

Bacillus   necrophorus    419 

Bacillus  necrosis   419 

Bacillus  nodulifaciens  bovis...  640 

Bacillus  edematis  aerogenes...  34 

Bacillus  edematis  maligiii.  .  .20,  32 

Bacillus  edematis  sporogenes.  .  34 

Bacillus  edematis  thermophilus  44 

Bacillus  of  Bradsot 57 

Bacillus  of  calf  noma 419 

Bacillus  of  Reindeerpest 60 

Bacillus  ovisepticus 119 

Bacillus  paracoli   151 

Bacillus  phlegmones  emphvsem. 

.'..34,  39 

Bacillus  pneumoniae  felis 210 

Bacillus  pleurisepticus   80 

Bacillus  polyarthritidis 142 

Bacillus  polymorphous  suis.  .  .  .  1007 

Bacillus  Preisz-Nocard 633 

Bacillus  pseudoanthracis    20 

Bacillus    pseudotuberculosis 

courmont   631 

Bacillus    pseudotuberculosis 

murium    632 

Bacillus    pseudotuberculosis 

ovis    633 

Bacillus    pseudotuberculosis 

vituloruni    638 

Bacillus  pyocyaneus   151 

Bacillus  pyelonephritidis  bovum  1011 

Bacillus  pyogenes  bovis...  144,  146 

Bacillus  pyogenes  suis 143,  146 

Bacillus  renalis   1013 

Bacillus  rhusiopathiae  suis.  .()0,  72 

Bacillus   sanguinarum    99 

Bacillus     septicemia      anseium 

exud 100 

Bacillus  septicemia  murium.  ...  64 

Bacillus  suipestifer  262 

Bacillus  suisepticus   ..126.1.39.  262 

Bacillus  tetani   440 

Bacillus  tubei'culosis    504,  569 

Bacillus      tuberculosis.       typus 

bovinus    506 

Bacillus      tuberculosis.      typus 

gallinaceus    510 

Bacillus       tuberculosis.       ty|)ns 

humanus    506 

Bacillus  typhi  canariensis 100 

Bacillus   vitulisepticus    112 

Backsteinblattern     67 

Bacterium  chauveaui 39 

Bacterium  phlei   572 

Baleri 837 

Barbone     113 

Barlow's  disease 949 

Beschalausslag    356 

Beschiilseuche   815 

Big-head    959 

Bilharzia  Bomfordi   906 


IikU'x. 


1123 


PACK 

Billiarzia  cvassa   n()(i 

Billiar/.ia   lieinati)l)ia    !M)ti 

Billiarzia  iiulica    iXKi 

Billiarziosis   WH) 

BiliaiT  fever    7S4 

Blackieo-    3f) 

Blacklesrine   55 

Black  (luarter ."50 

Black  water    7(14 

Bladder,  catarrh   of lOlH 

Bladdei'.  ini<:atioii  of 10:55 

Bladder,  i)aralvsis  of lOHli 

Bladder,   spasiii  of 10:5S 

Bladder,  torsion  of 10.'{5 

Blue  tongue    418 

Blood  anemia   S45 

Blood  cells,  count ini:' H7() 

Blood  coloring'   Sfifi 

Blood  coloring-  matter  in  urine.  7(J2 

Blood  diseases    S45 

Blood    in    })ericardium 1053 

Blood  vessel,  rupture  of 1117 

Blood  vessels,  diseases  of 1104 

Bloody  urine 702,  979,  981,    987 

Boil  disease,  endemic 797 

Bollinger's    Wild    and    Rinder- 

seuche     103 

Boophilus    annulatus    708 

Boophilus   Argent inus  ....702,  708 

Boophilus    Australis    702.  708 

Boophilus    bovis    708 

Boophilus   decoloratus  ....702,  708 

BotiTococcus     07.S 

Botryomyces  ecjui    073 

Botiyomyeosis    ()72 

Bou-f  rid'a    400 

Bovovaccine    597 

Bradsot    57 

Braunschweigej-  l)ii-d  disease.  .  .  290 

Braxy    57 

Bright's  disease   • 989 

Broneho-pneumonia    of    Ameri- 
can cattle   105,  107 

Broncho-pneumonia,  caseous  of 

sheep    ()3(i 

Bniit  de  IMoulin 1054 

Brustseuche    1 70.  182 

Bi-ustseuche  of  rahl)its 102 

Buffalo  disease  113 

Bulbar  paralysis,  infectious...  495 

Bursattee    ..'.... 739.  832 

Butter  bacillus 572 

Cachexia,  aqueous 841.  845 

Cachexia,  o.sseous 950 

Cachexia.  ]n'emic    144.  147 

Cachexia,  tuberculous 498 

Caderas.  Mai   de 8.35 

Calculi,  renal    1021 

Carbuncl."    39 


PAGE 

( 'arceag    789 

Carpinclio   830 

Cataract,  diabetic 927 

Catarrhal  fever,  malarial 418 

Catarrhal  fever,  maligiumt ...  .  408 

Catarrh  of  uiiimry  vessels.  .  .  .  1031 

Catarrh  of  vagina 750 

Cattle  i)lague' 234 

Cement  cough 138 

Cercomonas  gallinae   424 

Chemotlierapy    802 

Chicken  cholera    87 

Chlamy<l<>zoa   in    fowl   pest....  290 

Chlamydo/.oa  in  fowl  di))litheria  425 

Chlamydozoa  in  i)ox 290 

Chlamydozoa  in  labies 466 

Chlamydozoa  in  vaginal  catan-li  751 
Chlorban'um.  efl'ect  u])on  walls 

of  blood  \essels 1104 

Chloi-osis   84() 

Cholera  of  l)irds 87 

Cholera  of  canarv  binls 99 

Cholera  of  ducks." 98 

Cholera  of  fowl 87 

Cliolera  of  swine 257 

Cholei'a  of  water  l)irds 98 

Cholera  vibrion    101 

Cholera-like  gasti'o  entei'itis  of 

birds     .  . .  .' 101 

Chromatotaxis    691 

Cinnii'ro     197 

Cladothrix  can  is 670 

Clavelee     302 

Clostrvdium     saiT'o))livsematous 

..." ' 20.  40 

Coccidiosis,    Vol.    II 

Coccidiosis  I'cnalis   1030 

Coccidium  truncatum    1030 

Cocobacillus    ])seudo    a<-tinomy- 

cosis  polymori)hous 669 

Cocol)acillus  ozoenae  foetidus.  .  199 

Cocobacillosis   146,1,52,  157 

Coma  diabetic 105 

Comi)lemeiit      fixation      in     in- 
fluenza      174 

Complement  tixation  in  glanders  717 
Complement  fixation  in  abortion 

inf 747 

Com]>lement    fixation   in    tuber- 
culosis      587 

Conjunctival   reactif)n   in    glan- 
ders      714 

Conjunctival  reaction  in  tuber- 
culosis      582 

Cornfodder  disease    105 

Corynebacillus  al)ortus  inf..  . .  .  741 

Corynebacillus   icmUis    1013 

Corynethrix    ]iseu(h)t\iberculosis 

nuirium    032 

CoiTza   contagiosa  efiuorum...  366 


124 


1  nd 


I' AUK 

Coi-yza  gang'renosa  bovuiii 408 

Cow  pox  318 

Craniotabes    940 

Croup   of   cattle 417 

Cryptocoecus  farcinimosus  ....  735 

Culex  mosquito    903 

Cystic  kidney 1025 

Cysticerciis    celluh'SMo    of    the 

'kidney    1030 

Cystitis  catarrhal 1031 

Cystitis  verrucous   080 

Cystoscope    1010 

Cytorhyctes  vacccinae    295 

Cytorhyctes  variolae 295 

Debal 838 

Decompensation  in  heart  valve 

defects   1098 

Delhi  boil   797 

Dengue  fever   196 

Dermacentor  reticnlatus    .  .  780,  793 

Dermo  reaction  in  ii hinders.  ...  716 

Denno  reaction  in  tuhei-culosis.  584 

Dextrin  in  urine 922 

Diabetes  azoturicus   918 

Diabetes  hepatoyenic 924 

Diabetes  insipidus   918 

Diabetes  insipidus  verus 918 

Diabetes  mellitus  922 

Diabetes  mellitus  decipiens.  . .  .  926 

Diabetes  mellitus  interinitlent .  .  927 

Diabetes  neurogenic    923 

Diabetes  ])ancreatic 924 

Diamond  skin  di.seaso 67 

Diathesis,  hemorrhagic   973 

Diarrhea  neonatorum   145 

Diazoreaction    423 

Dikkopziekte 287 

Dilatatio  cordis   1063 

Dilatatio  cordis  activa 1065 

Dilatatio  cordis  passivn 1064 

Diphtheria   of  birds 424 

Diphtheria  of  calves 419 

Diphtheria  of  mannnalia 423 

Diphtheria  of  man 437 

Diphtheritic     inlhnnmation     of 

the  eyes  of  ducks 436 

Diplococcus  pneumoniae 172 

Diplococci  in  osteomalacia  ....  952 

Diplococci  in  rachitis 935 

Discomyces  equi 673 

Disinfection  of  stock  car 23 

Disinfection  of  skin 23 

Distemper  in  dogs 197 

Distomum  hematobium   906 

Distomum     hepaticum     in     the 

heart 107S 

Dollar  flecks 825 

Doui'ine   815 


PAGK 

Dung  bacillus 572 

Dunkopziekte   287 

Dwarfism   930.  945 

Dysentery,  Vol.   II 

Dysentery  of  sucklings 145 

Dysentery  of  hens  and  turkevs  99 

Dysuria  ' ". .  1038 

East  coast  fevei- 778 

Echinococcus  in   heart 1078 

Echinococcus  in  kidney 1030 

Echinococcus  in  liver.  Vol.  IF.  . 

Echinococcus  in   spleen 914 

Eimeria  ti'uncata   1030 

El  Debab 838 

Emphysema  gangrenosa   39 

Endoarteritis,  chronic 1104 

Endoarteritis  deformans    1104 

Endocarditis,  acute 1078,  1086 

Endocarditis,  chronic   1086 

Endocarditis    in    erysipelas    of 

swine 66,       70 

Endocarditis,  parietal 1081 

Endocarditis,  ulcerous   ...1079.  1081 

Endocarditis,  valvular   1081 

Endocarditis  verrucous 1081 

Enteque   112 

Enteritis  hypei'trophica  bovum  639 
Enteritis  paratuberculous  ....  639 
Enzootic  dysentery  of  fowls.  . .  98 
Enzootic  pneumonia  of  i)ig's.  . .  138 
Enzootic  pneumo])ercarditis   of 

turkeys     99 

Ephemeral  fever   196 

Epithelioma,  contagious 424 

Epithelioma,  contagious  of  men  428 
Epitheliomyces  croupogenes  .  .  425 
Epizootic     pneumoenteritis     of 

turkeys    99 

Erysipelas  of  swine 60 

Erysipelotrii'heen     65 

Erythroblasts     S4S.     865 

Eustrongylus  gigas  1028 

Exanthema,  coital    356 

Exanthema,  infectious    295 

Exanthema,  vesicular   351 

Exudative  septicemia  of  geese.       99 

Earcin    678 

Farcin  cryptococcique    734 

Farcin  d'Afrique 734 

Farcin  de  riviere 734 

Farcin  du  boeuf 667 

Farcy 678 

Fat,  alimeutarv   915 

Fatty  heart  .  .* 1075 

Feather  eating  antl  imlliug.  .  .  .  6')7 

Fever  a))lithous   328 

Fever  ])ilious 791 

Fever  typhoid    1 70 


hiilex. 


IL'." 


PAliK 

Kihioiua  of  heart H*~~ 

Fihioiuyoma  of  heart 1077 

yihrosarcoina    of   heart 1077 

Filaria   Hliiii    !»0S.  lio.') 

Filaria   Kvansi   !>0S 

Fihiiia  heniatica !•••- 

Filaria  ininiitis S>02 

Filaria  Poelsi   llOo 

Filaria  saiifruinis  equi 90') 

Filaria  saiiiiiiinis  honiiiiis 903 

Fixed  virus  of  rabies   489 

Flesh  of  tuberculous  annuals. .  514 

Foal  ]iaralysis   loS 

Foot-and-mouth  disease   32<S 

Foot   rot    34() 

Forest   disease    764 

Formalin   in   milk   loo 

Formic  acid    i'27 

Fowl  cholera    S7 

Fowl  diphtheria  424 

Fowl  pest  290 

Fowl  pox    424 

Fowl  septicemia 87 

Fowl  tnboiculi'sis 510 

Fowl  typhoid   290 

Furunculin    385 

Gall  disease  inf 7S3 

Galloserin    96 

Gall  sickness 783 

Gambia  fever 837 

Gangrene  in  erysipelas  of  swine  68 

Gangrene,  emphysematous  ....  39 

Gangrene  foudroyante   34 

Gas  in  pericardium   1053 

Gastro  enteritis  choleriea  avium  101 
Gastro    enteritis    hemorrhagica 

canum    211 

Gastromvcosis    57 

Geel  Dikkop   418 

Gigrantoevtes 863 

Giilar  .  .* 868 

Girdle  bactei-inm   79 

Glanders    678 

Glanders,  African   734 

Glanders  bacilli   681 

Glanders    infection   687 

Glanders    nodules    687 

Glanders  ulcers 689 

Glomerular  nephritis    991 

Glossanthrax     17 

Glossina  decorsei   808 

Glossina  fusca   807 

Glossina  longipei;ni> 808 

Glossina  pallidipes   807 

Glossina  pal]ialis  808 

Glossina   morsitans    907 

Glycosuria 922 

Gotta   968 

Gourme 366 


PAf.K 

(Jout   !M)S 

f  Jrapes 49s 

Grass  l)acillus .")72 

(Jregaiiiiosis 424 

(irip   170 

(nips'  l)acillus    142 

(Jrouse  disease   101 

(Juanin  formaticm  96S 

(iuriuiii   387 

Heart,  atrophy 1052 

Heart   defects 10S."» 

Heait   <lcfccts,  oong-enital 10S7 

Heart  dilatation 1063 

Heart    fatty   1075 

Heart    hyi)ertropliy   lOtjl 

Heart    insulliciency   1064 

Heart  nniscle.  calcification  of.  .  1075 

Heai-t  muscle,  itillaiiimatiou  of.  1069 
Heart  muscle,  inflammation  of, 

acute 1069 

Heart  muscle.  inflammatif»n  of, 

chronic 1073 

Heart  nmscle.  inflammation  of. 

]iarenchym I0(i!l 

Heart  muscle,  inflammation  of, 

]nirulent    1071 

Heart  valvular  defects,  conijx-n- 

sating 1097 

Heart  valvular  defects,  noncom- 

pensatincr    1098 

Heart  water   257 

Hemameba  leukaemiae   870 

Hemameba  vivax  870 

Hematopa  fly S07 

Hematozoa    760 

Hematozoon   Lewis    !)07 

Hematozoon    subulatum    90S 

Hematuria     !)7g 

Hematuria  vesicalis 081 

Hemoa])lithin    34f) 

Hemoglobinemia     884 

Hemoglobinemia  of  cattle 000 

Hemog-lobincmia.  enzootic    ....  764 

Hemoglobinemia.  paralytic   . . .  886 

Hemoglobinemia.  rheumatic  .  . .  886 

Hemoglobin ui-'a    760 

Hemoglobinuria,  enzootic 764 

Hemoglobinuria,   paroxysmal    .  886 

Hemoglobinuria,  to.xemic   886 

Hemoi)ericardium   1053 

Hemophilia    900 

Hemophysalis  leachi   762,  793 

Hemorrhagic  septicemia    77 

Hemorrhagic      septicemia,     of 

birds    <;7 

Heiiioi-rhag;.'       septicemia,      of 

buti'aloes   1 1;; 

Hemorrhagic      septicemia,      of 

caftle 103 


1126 


Index. 


PAGE 

Hemorrhagic       ssepticeuiia,      of 

ducks  .  r 9S 

Hemorrhagic      septicemia,      of 

fowls    /; '. 87 

Hemorrhagic      septicemia,      of 

rabbits  \ 101 

Hemorrhagic      septicemia,      of 

sheep    lis 

Hemorrhagic      septicemia,      of 

sucklings    145 

Hemorrhagic      septicemia,      of 

swans  98 

Hemorrliagic      septicemia,      of 

swine    125 

Hide  bound    112 

Hodgkin's  disease    881 

Hog  cholera    257 

Hoof  disease 835 

Horse  pox 324 

Horse  sickness   285 

Hyalomma  ^>]gy])ti('uin    762 

Hydremia    845 

Hydremia  of  cattk'  at  sugar  re- 
fineries         846 

Hydrocephalus,  Vol.  11 

Hydronephrosis    1025 

Hydropericai'dium   1052 

Hydrophobia   463 

Hydrops  ascites,  Vol.  II 

Hydrops  pericardii    1052 

Hydrotetanin    442 

Hyperemia  renum  984 

Hyperglykemia    .  .  . , 925 

Hyperplasia  liensis   913 

Hypertrophy  of  heai't  muscle. .   1061 

Hypertrophy,  idi(i]>athic    1062 

Hypertrophy,  nephritic  ..1006,  1062 

Hypertrophy,  pathologic 1061 

Hypertroi^hy,  physiologic    ....   1 061 

Hypertrophy,  secondary 1062 

Hyphomycosis  destruens 739 

Hypoplasia  cordis  et  arterium . ,     901 

Ictero-hematuria    789 

Icterus,  Vol.  II 

Immunization,     see     Protective 
inoculation. 

Inoculation,  diagnostic,  of  glan- 
ders  ...  .....'. .  .  .     706 

Inoculation,       diagnostic,       in 
rabies  487 

Inoculation,  diagnostic,  in  tuber- 
culosis         573 

Inoculation,  protective,   against 
abortion  inf 749 

Inoculation,  protective,   against 
anthrax 24 

Inoculation,  protective,  against 
bincklrc:-   51 


PAGE 

Inoculation,  protective,  against 

buffalo  disease ... ,.,  118 

Inoculation,  protective,  against 

calf  paralysis 170 

Inoculation,  protective,  against 

coast  fever  781 

Inoculation,  protective,  against 

cholera,  fowl 96 

Inoculation,  jarotective,  against 

cholera,  hog- 280 

Inoculation,  protective,  against 

diphtheria   437 

Inoculation,  protective,  against 

diphtheria,   of  birds    436 

Inoculation,  protective,  against 

distemper  of  dogs   210 

Inoculation,  protective,  against 

dysenteiy  of  calves   156 

Inoculation,  protective,  against 

foot-and-mouth  disease 351 

Inoculation,  protective,  against 

glanders 727 

Inocitlation,  protective,  against 

hem.  septicemia    86 

Inoculation,   protective,  against 

hem.  septicemia  of  sheep  .  .  123 
Inoculation,  protective,  against 

horse  sickness 288 

Inoculation,  protective,  against 

influenza  194 

Inoculation,  protective,  against 

lung  plague  of  cattle 402 

Inoculation,  protective,  against 

malignant  edema   38 

Inoculation,  protective,  against 

piroplasmosis   777,  789,     796 

Inoculation,  protective,  against 

pox ..'..298,     314 

Inoculation,  protective,  against 

rinderpest    "250 

Inoculation,  protective,  against 

sheep  pox  314 

Inoculation,  protective,  against 

spirochetosis   842. 

Inoculation,  protective,  against 

swine  erysij^elas 73. 

Inoculation,  protective,  against 

swine  plagtie  137,     141, 

Inoculation,  protective,  against 

tetanus 461 

Inoculation,  protective,  against 

trypanosomiasis   804 

Tnnculation,  protective,  against 

tuberculosis 597 

Incontinence  of  urine 1037 

Induratio  cyanotica 985 

Infarcts,  hemorrhagic 986 

Infectious  disease  of  canaries.  .  99 
Infectious  enteritis  of  fowls.  .  .        98 


lude.T. 


lli>7 


Infectious  enteritis    of    pheas- 
ants   98 

Infectious  leukemia  of  fowls.  .  09 

Infectious  necrosis  of  canaries.  100 

Influenza    170 

Influenza  catarrhalis    17S.  ISl 

luthieiiza  of  man 19.3 

Influenza  jiectoralis ITS,  1S2 

Infusion  of  salt  solution,  intra- 
venous    850 

Infusion  of  salt  solution,  rectal.  SoO 

Inhalation,  anthrax    14.  'M 

Inhalation,  tuberculosis 524 

Inosite  in  the  urine 927 

Insutliciency.  muscular    10S7 

Tiisuthcieiicy.  relative 1087 

InsutlicieiU'V.  valvular,  bicuspid  10!)2 
InsufMcieiu'V,    valvular,     tricus- 
pid   ". 1(!:)1 

InsufHciency.  valvular,  seniiluii. 

aortae     lOSS 

Insutliciency.  valvular,  semilun. 

art.  pulin 1093 

Interniis.sion  of  heart  beats   .  .  .  10.")7 

Intermittent  jiaia lysis 111;? 

Intoxicatio  diabetica    928 

Ischuria  paradoxa   in;i7 

Ischuria  spastica  lO.W 

Ixidioplasma.  biseniinum. 7(i5 

Ixodes,  hexagonus   709 

Ixodes,  reduvius   708 

Ixodes,  ricinus  769 

Japanese  worm  734 

Jaswa    3 

Jaundice,  protozoan    783 

Jaundice,  mali.jm    791 

Johne's  disease 639 

Joint  evil  158 

Kala  Azar  790 

Kyanolophiaea    290 

Kyphosis 944 

Lactosuria   922 

Lamziekte    109 

Latent  infection  in  anthrax   ...  9 

Latent  infection  in  blackleg-   ...  54 

Lead,  effects  of Ill 

Lead  chlorosis   846 

Leeches  739 

Leishmania  Donovan  i   796 

Leishniania  tropica    797 

Leukemia    869 

Leukemia,  infectious 877 

Leukemia  of  fowls   99.  877 

Leukemia  of  mammals 869 

Leukemia  lienalis 871 

Leukemia,  lymphatic   869 


PAGE 

Ijcukemia,  myelogx-nic 869 

Leukemia,  sublympiiatic    881 

Ijeukanlhiakozidiii     12 

Leucocythemia    869 

Leucocyfozfion  i)iroplasmoi(l(s..  735 

Leucosis,  aleukemic   876 

I.ieucosis,  leukemic   875 

Levulose,  in  the  urine    927 

Licking  di.^ease !)41 

Li]>oma  of  heart In77 

Lockjaw -439 

Loin  distemiH'i- S51 

Lnmbriz    118 

L'irdosis 944 

Lues  venera  cMiii 815 

Lumbago .' 886 

Lungs,  infect,   indannnation   in 

goats   124 

Lungs,  glandei's  in    694 

Lupine  disease.  Vol.   11 

Lymphadenia  8(in 

Lymphadenia.  aleuken:i«' 881 

Lymphadenia,  leukemii- 8(59 

Lymphadenitis  caseosa   o\iiiii..  (533 

Lymphangioilis  epizootica    ....  734 
Lymphangioitis  f  a  r  c  i  m  i  msa 

bovis (567 

Lymphangioitis  malleosa    700 

i^jmphangioitis  pseudof ar- 

cinosa 734 

Lymphangioitis  reticularis  ....  700 

T^yniphangioitis  ulcerosa 731 

Lymphang-ioma  of  heart 1077 

Lymph,  excess  of   1119 

Lymphorrhagia    1119 

Lymphosarcoma  in  heart 1077 

Lymphosarcomatous  swelling  of 

"glands 878 

Lyssa   463 

:Macrocytes    863 

Maculae  albidae 1042 

Maculae  lactae   1042 

Malaria  of  animals 851 

Malaria  of  man 797 

]\Ialaria  ])lasmodia   797 

:\Ialarial  catarrhal   fever  .  .418,  791 

Malarial  fever    851 

Mai  de  caderas   835 

Mai  du  coit 815 

;^^alignant  catarrh    408 

Malignant  edema    32 

Malignant  malarial   fever    ....  418 

]\Lili^iant  protozoan  jaundice.  791 

Mallehi    70S 

Mallein  reaction 70S 

!Mallein  test,  cutaneous    709 

Mallein  test,  organic 709 

Mallein  test,  therniif   709 


1128 


Index . 


PAGE 

Malta  fever  196 

Mancha    44 

Margaropus,  see  boophilus.  .  .  .  762 

Marginal  points 764 

Mbori 812 

Melanosarconia  of  lieaH 1077 

Melanosareonia  of  spleen    914 

Mellituria    922 

Meningitis,   tuberculous   ...543.  559 

Micrococcus,  ascofornians    ....  673 

Micrococcus,  botryogenes    673 

Micrococcus,  caprinus    125 

Micrococcus,  nitrificans   952 

Microcytes 865 

Milk  bacillus,  Moller's 572 

Milk  from  tuberculous  cows   ..  511 

Miliaiy  tuberculosis   .  .544,  561,  565 

Molluscum  contagiosum   424 

Moorhen  infection 101 

Mosquito    836 

Mouse  septicemia 64 

Mycobacterium  lacticola 572 

Mycosis  of  parrots   ]  00 

Mycosis  of  pheasants 98 

Mj'elocytes    875 

Myocarditis,  acute    1069 

Myocarditis,  chronic   1073 

Myocarditis,  embolic 1070 

Myocarditis,  parenchymatous. . 

1069,  1070 

Myocarditis,  purulent    . .  .1069,  1070 

Myocarditis,  septic    1069 

Myxomatous  disease  of  rabbits.  102 

Myxoma  in  the  heart 1077 

Nagana 805 

Navel  ill 158 

Necrosis  bacillus   419 

Necrosis,  infectious  of  canaries  100 

Nephrectomy   1010 

Nephritis,  acute  988 

Nephritis,  alba    1000 

Nephritis  apostematosa    1008 

Nephritis,  chronic,  indui'ativa .  .  1001 

Nephritis,  diffusa    991 

Nephritis  flbroplastica    1000 

Nephritis  fibrosa    1003 

Nephritis  fibi'o-vesiculosa   1003 

Nephritis  granulosa   1003 

Nephritis  interstitialis  chronica.  1001 

Nephritis  maculosa    alba 1000 

Nephritis  mixta   996 

Nephritis  mix.   non-indurativa.  996 
Nephritis  mix.  parenchymatosa.  996 
Nephritis  parenchymatosa  hem- 
orrhagica      986 

Nephritis  pvtrulenta    1007 

Nephrolithiasis  1021 

Nettle  rash    67 


PAGE 

New  bom,  diseases  of  145 

Nocardia   648 

Noduli  arthritiei   970 

Non-compensating  heart  valves.  1098 

Obesity   915 

Oligemia    845 

Oligocythemia 845 

Omphalophlebitis  septica 158 

Ophthalmic  reaction  in  glanders  724 
Ophthalmic  reaction    in    tuber- 
culosis     587 

Opsonins  in  glanders   724 

Opsonins  in  tiypanosomiasis. .  833 

Opsonins  in  tuberculosis 587 

Oriental  boil 734 

Oriental  rinderpest   234 

Osteochondi'odystrophia  fetalis.  936 

Osteomalacia    950 

Osteomalacia,  juvenile    938 

Osteomalacia,  physiologic   953 

.Osteomalacia,  relation  to  osteo- 
porosis    955 

Osteomalacia,  relation  to  rachi- 
tis    954 

Osteoporosis   937,  955 

Osteoporosis  simulating  rachitis.  937 

Osteopsathyrosis  950 

Ouilbek    . .' 418 

Ovinatio    314 

Oxybutyric  acid 925.  927 

Palpatio  cordis   1055 

Panaritium    346 

Paracolon  bacillosis 151 

Paralysis  infectiosa    495 

Paralysis,  vesicae  urinariae    . .  .  1036 

Paratuberculosis  bacilli    ...572,  641 

Paratubereulosis  enteritis   639 

Pasteurella    79 

Pasteurellosis    ,  77 

Pearl  disease  498 

Pectus  carinatum    944 

Pectus  gallinaceum   944 

Periarteritis  nodosa   1105 

Pericarditis   1039 

Pericarditis  circumscripta    ....  1042 

Pericarditis  diffusa   1042 

Pericarditis  fibrosa  adhesiva    .  .  1042 

Pericarditis  ti'aumatica    1042 

Peripheral  coccus-like  bodies.    .  763 

Peripneumonia    389 

Perisplenitis    864 

Perisucht   498.  53S,  549 

Perisucht  bacillus    509.  623 

Perisucht  bacillus.  IMiillrr's   .  .  .  572 

Pestis  avium 290 

Pestis  bovum    orientales 234 

Pestis  equnruni    285 


Ill(l«'.\. 


112!l 


PAGK 

I'estis  gallinanun    290 

Pestis  sunin   257 

Petechial  fever 21G 

Pheasant  ejiideniic   98 

Phlyctenular  eruption   356 

Phosphorus  content  of  milk...  931 

Phosphorus  in  foods  932 

Phthisis  mesaraica   545,  503 

Phthisis  tuberculosa  pulin  .... 

498.  536,  549 

Picotte  302 

Pietin  contaprieux 346 

Pink  eye   170 

Piroplasma  Argcntinuni    768 

Piroplasma  bigeminum    766 

Piroplasma  canis    792 

Pii'oplasma  Donovani 796 

Piroplasma  cqui   7S5 

Piroplasma  liirci    790 

Piroplasma  horse  typhus 218 

Piroplasma  hominis 795 

Piroplasma  of  influenza    174 

Piroplasma  niutans    7()6.  7S2 

Piroplasma  ovis 789 

Piroplasma   parvum    778 

Piroplasmosis   760 

Piroplasmosis,  atypical    768 

Piroplasmosis  of  cattle   764 

Piroplasmosis  of  the  do,i>-   ....  791 

Piroplasmosis  of  the  goat   ....  790 

Piroplasmosis  of  the  horse   . .  .  784 

Piroplasmosis  of  man 796 

Piroplasmosis  of  the   sheep.  .  .  789 

Piroplasmosis,  tropical    782 

Plasmodium  malariae   797 

Pleuro-pneumonia,     contagious, 

of  cattle ". 389 

Pleuro-pneumonia,     contagious. 

of  the  horse   170 

Pleuro-pneumonia.      infectious, 

of  goats 406 

Pleuro-pneumonia,     septic,     of 

calves  Ill 

Pneumo-enteritis  of  turkeys  . .  99 

Pneumonia,  chronic,  of  sheep.  407 

Pneumonia,  enzootic,  of  pigs.  .  138 
Pneumonia,       contagfious.       of 

swine    125 

Pneumonia,    multiple    necrotiz- 
ing   131 

Pneumo-pericarditis,  infectious. 

of  turkeys 98 

Poikilocytosis    858.  865 

Polmonera    389 

Polydipsia 927 

Polyphagia   !IJ7 

Polyneuritis  infectiosa   81S 

Polyuria   918 


PAGE 

Polyvalent  serum  in  calf  dysen- 
tery     156 

Polyvalent  scrum  in  licni.  septi- 
cemia      87 

Polyvalent      scrum      in      swine 

plague    1 .37,     140 

Ptdyvalcnt   cfihui   scrinri 15() 

Pommeliere   498 

Porcher's  sugar  test 927 

Pox 295 

Pox,  abortive    309 

Pox,  cow    318 

Pox  of  fowls 424 

Pox  of  the  hor.se 324 

Pox  of  men    323 

Pox,  pointed    322 

Pox  of  slicc))   302 

Pox,  stone  . 322 

Pox,  swine    325 

Precipitine  reaction  in  glanders.  723 
Precipitine  reaction  in  tubercu- 
losis    587 

Proteus  bacillosis 1.52 

Proteus  in  dog-  typhus    212 

Protozoan  diseases   760 

Protozoan  jaundice  784 

Pseudo  acid-fast   bacilli 572 

Pseudoactinomycosis   667 

Pseudoanthrax  bacilli   20 

Pseudoblackleg  bacilli 44 

Pseudo  coast  fever   782 

Pseudocolon  bacillosis 148 

Pseudoleukemia    881 

Pseudopericarditis   1051 

Pseudorabies 495 

Pseudotubei-culosis,  bacillary  .  .  635 

Pseudotuberculosis,  zoogli(|Uc.  .  631 

Pscudotubercle 633 

Pseudotubercle  bacilli   

572,  6.3.3,  635 

Pseudotuberculosis     6.3.3 

Pseudotuberculosis  of  calves.  .  .  6.38 

Pseudotuberculosis  of  cattle...  639 

Pseudotubei-culosis  of  sheep...  633 

Pseudotubercular    enreritis.  . .  .  641 

Psittacosis    100 

Pulse,  bounding 1091 

Pimcture  of  pericardium    1050 

Purpura  hemorrhagica    216 

Pu.^tula   maligna    31 

Pustular  inflam.  of  ludutlis  uf 

horses    354 

Pyelitis    1019 

Pyelitis  catarrhalis    1020 

Pyelitis  diphtlu'vica    1020 

Pyelitis  hemorrhagic:!    1<*2() 

Pyelitis  membranai'ca    I'lJO 

Pyelitis  ulcerosa     10'2tl 


1130 


ludex. 


PAGE 

Pyelonephritis  bacillosa    1010 

Pyelonephritis  baeteritica  bovum  1010 

Pyelonephritis  cavernosa 1016 

Pyelonephritis  diphtheriea    . . .  1010 

Pyelonephritis  mycotica    1010 

Pyemia  of  rabbits 97 

Pyemic  cachexia   141,  144 

Pyemic   joint   inflam.    of   suck- 
lings      158 

Pyobacillosis 141 

Pyobacillus  bovis    144 

Pyobacillus  capsnlatus  cunieuli.  102 

Pyobacillus  suis 141 

Pvocyaneus  bacillosis   151 

Pyonephrosis .1008,  1017 

Pyosepticemia  of  sucklings.  . .  .  158 

Pyrosoma    760 

Quarter  ill    30 

Quicksilver,  action  on  blood  ves- 
sels     1104 

Rabies    463 

Rachitis 030 

Rachitis,     relation     to     osteo- 
malacia      954 

Rachitis,     relation     to      osteo- 
porosis    937 

Rachitis  congenita 930 

Rachitis  fetalis 936 

Red  fever    60 

Red  water 764 

Reindeer  pest  60 

Retentio  urinae    1037 

Retinitis  leukaemica    875 

Rhinitis  fibrinosa  bovum 415 

Rhmitis  gangrenosa  bovum.  . .  .  408 
Rhipicephalus      appendiculatus 

762,  779 

Rhipicephalus  bursa    762,  779 

Rhipicephalus  capensis   ...762,  779 

Rhipicephalus  Evertsi 762,  779 

Rhipicephalus  nitens 762,  779 

Rhipicephalus  sanguineus,  .762,  779 

Rhipicephalus  simus 762,  779 

Rhodesian  red  Avater 762,  779 

Rhodesian  tick    fever 778 

Rhusiopathiae  suis   61 

Rickets   930 

Rinderpest   234 

Rinderpest  in  sheep    256 

Rinderseuehe 103 

River  bottom  disease   851 

Roseola  variolosa    307 

Roup 427 

Roup  bacillus    427 

Ruptura  cordis 1076 

Ruptura  lienis   912 

Ruptura  vasnrum   1117 


PAGE 

Saccharomyces  farciminosus  . .  735 

Saccharomyeosis  734 

Salmonellosis  of  fowls   100 

Sarcoma  of  the  heart  , 1077 

Sarcoma  of  the  kidney   1028 

Sarcophysema  gangrenosum   .  .  39 

Sarcosporidia  in  heart  muscle.  .  1078 

Scabrot    302 

Schistosomum   Bomfordi    906 

Schistosonnun  bovis   906 

Schistosomum  crassum    906 

Schistosomum  indicum   906 

Schistosomum  japonicum    906 

Sclerosis  renum   1003 

Sclerosis  maculata 1003 

Sclerostomum  larvae  in  kidney.  1029 

Scorbutus    973 

Scrofula   499,   546,  564 

Septicemia,  apoplectic,  of  ducks  98 

Septicemia,  apoplectic,  of  fowls  101 

Septicemia  of  canaries 99 

Septicemia,  eiysipelatous 69 

Septicemia,  gangrenous    32 

Septicemia  of  geese 99 

Septicemia,  hemorrhagic    77 

Septicemia  of  mice 64 

Septic  joint  infl.  of  sucklings.  .  158 
Septic  pleuropneumonia  of 

calves  Ill 

Septizidin    96 

Sheep  pox 302 

Sheep  pox  in  man   323 

Side  chain  theory   448 

Sleeping  sickness  in  fowls.  101,  838 

Sleeping  sickness  in  man 839 

Snuffling  disease 940,  946 

Sore  heels   324 

Souma   837 

Soumaya  837 

Southern  cattle  fever   764 

Spasmotoxin 442 

Spiegler's  test 978 

Spirillosis  of  fowls 839 

Spirillum,  see  spirochete. 

Spirochete,  anserina    840 

Spirochete,  Duttoni   844 

Spirochete,  eqi;ina    843 

Spirochete,  gallinarum   840 

Spirochete,  Obermeieri 840 

Spirochete,  ovina 843 

Spirochete,  pallida    844 

Spirochete,  reeurentis  844 

Spirochete,  suilla  843 

Spirochete,  Theileri 843 

Spirochete,  Tschichir    843 

Spirochete,  vaccinae    296 

Spirochete  in  influenza 174 

Spirochetosis  of  fowls 839 

Spirochetosis  of  geese    839 

Spirochetosis  of  mammals    .  . .  843 


Index. 


1131 


PAGE 

Sjiiroc'hetosis  of  man    844 

Spiroptern  sanuuiiKilenla OOS 

Splenic  lever 1 

Splenitis  ai>os(eiiial(isa 010 

Splenitis  clironiea   iiuluraliva.  .  013 

Sjilenitis  liyperplastiea 010 

Sjilenonieji'alia 700 

Sporotricliosis   670 

Sporotrichum  eriui 670 

Staphylococci    upon     walls    of 

blood  vessels 1 104 

Stellulae  Yerlieyenii    085 

Stenosis  ostii  aortao   1001 

Stenosis  art.  pulm 1004 

Stenosis  art.   ventr.  dextri 1005 

Stenosis  art.  ventr.  sinistri....  1003 

Stenosis  ostii  venosi  dextri.  .  .  .  1005 

Stenosis  ostii  venosi  sinistri...  100;{ 

Ste})lianiirus  dentnta 1030 

StitT  sickness    106 

Stomatitis  aplitliosa  contajiiosa.  328 

Stomatitis  pnstulosa  contagiosa.  360 

Stomoxys,  brava    836 

Stomoxys  caleitrans 812,  810 

Strangles    366 

Stangles  in  cattle .388 

Strangles  in  dogs    388 

Strangles  in  swine 388 

Sti'angles,  wandering    380 

Streptobacillus   pseudotubercul. 

rodentium    631 

Streptococcus    eapsi;latus    gal- 

linannn    101 

Streptococcus      of      contagious 

abortion   742 

Streptococcus  equi   367 

Streptococcus    of    inf.    vaginal 

catarrh    751 

Streptococcus  melanogenes    . .  .  880 

Streptococcus  of  pyoj<enes  e(\m.  174 

Streptotrichosis    .  .\ 667 

Streptotj'ichosis  of  dogs 670 

Streptotrichosis  of  hoi'ses   ....  660 

Streptotrichosis  of  rabbits    .  .  .  102 

Streptotrichosis  of  lanninants..  667 

Streptothrix  actinomycosis    .  . .  643 

Streptothrix  can  is  670 

Streptothrix  cajn-ae    660 

Streptothrix  cuniculi    102.  420 

Streptotlirix  farcinica     668 

Streptothrix  Israeli    645 

Streptothi'ix  necrophma    420 

StreptothrLx  valvulae  destruens.  660 

Strongylus  sublatus 008 

Strongylus  vasorum    007 

Stuttgart  disease  of  dogs    211 

Sucholoalbumin    268 

Sncholotoxin     268 


PAGE 

Suplagoalbuniin   128' 

Suplagotoxin    128 

f^iiptol l.T, 

Surmenagc   ]06-J 

Surra    Sll 

Susotoxin     128 

Susserin    7(5 

Swamp  fever   851 

Swan  disease    98 

Swine  eiysijielas    (iO 

Swine  fever    257 

Swine  plague    125,     2.58 

Swine  pox   325 

Syphilis   ,S4^ 

Tabaiins  bovinus     333 

Tabanus  lineola    812 

Tabanus  troi)ica    812 

Tabes  dorsalis,  A'ol.  11 

Tabes  mesaraica 381 

Tachycardia    1055 

Takosis  of  goats 125 

Tauruman    (501 

Tenesmus  vesicae  1032 

Tetanin    442 

Tetanolysin    448 

Tetanotoxin    442 

Tetanus    43?) 

Tetanus  agnorum 454 

Tetanus  antitoxin    460 

Tetanus  cerebralis    442 

Tetanus  dolorosus   442 

Tetanus  idiopathicus    439 

Tetanus  neonatorum    445,     454 

Tetanus  partialis    453 

Tetanus  psychicus    430 

Tetanus  rheumaticus 430 

Tetanus  traumaticus   430 

Texas  fever 764 

Three  days'  sickness 106 

Thrombosis    of    abdominal    ar- 
teries       1113 

Thrombosis  of  axillary  arteries.  1113 
Thrombosis      of      the      carotid 

arteries    1114 

Thrombosis  of  the  iliac  arteries  1114 
Thrombosis      of      the      portal 

veins     1116 

Thrombosis   of   the    puhnoiiaiy 

arteries   1115 

Thrombosis  of  the  vena  cava.  .   1116 

Thrombosis  of  the  veins   1116 

Tliroml)')sis    with    enibolisin   of 

arteries     1111 

Throml)us  canalisatus 1111 

Thi-ombus  obturans 1111 

Thrombus  parietalis    1111 


1132 


Index. 


PAGE 

Tick  fever 764 

Tolerance  tests  in   diabetes   in- 
sipidus    921 

Tolerance  tests  in  diabetes  mel- 

litus    927 

Tophi  arthritici   970 

Torsio  lienis   912 

Treponema  pallidium 84-1 

Tri-aeid  combinations SGd 

Trismus   450 

Tristezza    764 

Trommer's  test  for  sugar     .  . .  927 

Trypanolysin    801 

Tiypanosoma  americanum   ....  801 

Trypancsoma  Brucei    799.  80(5 

Trypanosoma  Calmetli    838 

Trypanosoma  Cazaiboni   ..811,  837 

Trypanosoma  eong-olense   838 

Tryj^anosoma  f'ruzi   838 

Trypanosoma  dimorphon     .... 

'. 800,  811,  837 

Trypanosoma  Elmassiani    835 

Trypanosoma  equinuni    835 

Trypanosoma  equiperdum   ....  810 

Trypanosoma  Evansi    812 

Tiypanosoma  Frank 838 

Trypanosoma  gambiense    838 

Trypanosoma  giganteum    800 

Trypanosoma  hinialayanum  ...  838 

Trypanosoma  indicum    838 

Trypanosoma  Lewisii    799 

Trypanosoma  muktesari  838 

Trypanosoma  nanum    838 

Trypanosoma  Pecaudi    ....811,  838 

Trypanosoma  Sudanese    837 

Tiypanosoma  Theileri.783,  800,  838 

Trypanosoma  vivax    812 

Trypanosomes   798 

Tiyi>anosomes  of  man    839 

Tsetse  fly    807 

Tubercle 530 

Tubercle  bacillus   504 

Tubercle  bacillus  of  birds   ....  510 
Tubercle  bacillus  of  cattle   ....  506 
Tubercle  bacillus  of  cold-blood- 
ed animals   630 

Tubercle  bacillus,  homogeneous 

cultures    506 

Tubercle    bacillus,     inoculation 

as  evidence   573 

Tubercle  bacillus  of  man    50(i 

Tubercle  bacillus  in  milk   512 

Tubercle  bacillus,     microscopic 

determination    569 


PAGE 

Tubercle    bacillus,     spread     in 

the  animal  body 533 

Tubercle  bacillus  staining  meth- 
ods      505 

Tubercle  bacillus,   virulence  of 

various  types   509 

Tubercle  in  birds Gil,  636 

Tubercle,  fibrous    533 

Tubercle-like  nodules  532 

Tubercle,  solitary   543,  559 

Tuberculin    574 

Tuberculin,  reactions    574 

Tuberculin,  test  575 

Tuberculosis 498 

Tuberculosis,  aerogenic      infec- 
tion     .^ 516 

Tuberculosis  of  birds   617 

Tuberculosis  of  buffaloes   544 

Tuberculosis  of  cats    548,  567 

Tuberculosis  of  cattle 536 

Tuberculosis    of    cold  -  blooded 

animals   630 

Tuberculosis,  congenital   521 

Tuberculosis  of  dogs   547,  565 

Tuberculosis,  eradication    593 

Tuberculosis  of  goats 5(51 

Tuberculosis,  hereditaiy 520 

Tuberculosis  of   hor.ses  ,...545,  5(51 

Tuberculosis,  latent    530 

Tuberculosis,  local  and  general  544 

Tuberculosis    of  mammals  ....  498 

Tuberculosis    of    man    506 

Tuberculosis,  miliary 544,  561 

Tuberculosis,  open  and  closed.  511 

Tuberculosis  pathogenesis     ....  523 
Tuberculosis  primaiy   and    sec- 

ondaiy    544 

Tuberculosis,    protective     im- 
munization      597 

Tuberculosis,  pseudo-bacillary .  635 
Tuberculosis,  respiratory  infec- 
tion    515 

Tuberculosis  of   sheep    56l 

Tuberculosis  of  swine 54(5,  564 

Tubulonephritis     991 

Tumor  of  the  heart   1077 

Tumor  of  the  kidney    1028 

Tumor  of  the  s])leen.  acute    .  .  909 

Tuinor  of  the  spleen,  chronic .  .  913 

Typhoid   fever    170,  257 

Typhus,  bovine,    contagious...  234 

Typhus  of   canaries    100 

Typhus,  contagious     231 

Tvphus  of  dogs    211 

Typhus  of  fowls  290 


ii.i;: 


Typhus  of  horses 
Tvroma    


Vremia    

Uivlhral  catheti'ii/ation 
T'roevstitis     


21  f) 
543 


.  982 
.  1010 
.   1031 


Vaei-mia    "'<><^.  •"'-•^ 

Vaccinia,  human i/t'«I   i?2-l 

Yacchiation    324 

Vao'iiiitis.   inf.   folIicuUir "oO 

Vaginitis,  inf.  •rvauuhiv "-lO 

Vau-initis.  inf.  vt'iruciiu> 7.')0 

Vaivula   fenesti-aia     lOSl 

VariceUa    322 

Variola   20.2 

Variola  abort  iva    300,  317 

Variola  capriiia   327 

Variola  conipressa    300 

Variola  contluens    310 

Variola  equina   324 

Vanola  transi'enosa    311 

Variola  heni')rrha'_M<-a    311 

Variula  human  a    324 


PA(iK 

VarioUi  nij^ra   31 1 

Variola  ovina    302 

Variola  sine  cxanlhematc   300 

Variola  suilla   325 

Variola  vaccina   31S 

Venous  occlusion   1110 

Venous  pulse    lOOG 

Vibrio  Metsfhniko\  i    101 

Vibrion  of   cholera    101 

Vibrion.  septic  32 

Water  fear   323 

"Werlhof's  disease 073 

White  tlianhea  of  chickens  .  . .  100 

White  diarrhea  of  suckl in ys   ..  145 

White  scour    145 

Wild   und    rinderseuflu' "'.03 

Wind  pox   322 

Wooden  tongue 651 

Wool  ehewini;   960 

Wool  sorter's  disease    31 

Xanthhi  formations   968 

Xanthiu  stones    1023 

Zinc,  eti'et-l  upon  vessel  walls  ...  1104 

Zousfana   83* 


c::« 


N 


X. 


-A 


IX- 


